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1.
Ethics Hum Res ; 43(6): 19-27, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1530137

ABSTRACT

Excluding pregnant people from Covid-19 clinical trials may lead to unintended harmful consequences. For this study, an online questionnaire was sent to physicians belonging to Canadian professional medical associations in order to evaluate their perspectives on the participation of pregnant women in Covid-19 clinical trials. The majority of respondents expressed support for including pregnant women in Covid-19 trials (119/165; 72%), especially those investigating therapies with a prior safety record in pregnancy (139/164; 85%). The main perceived barriers to inclusion identified were unwillingness of pregnant patients to participate and of treating teams to offer participation, the burden of regulatory approval, and a general "culture of exclusion" of pregnant women from trials. We describe why some physicians may be reluctant to include pregnant individuals in trials, and we identify barriers to the appropriate participation of pregnant people in clinical research.


Subject(s)
COVID-19 , Physicians , Canada , Female , Humans , Pregnancy , Pregnant Women , SARS-CoV-2
3.
BMC Musculoskelet Disord ; 22(1): 953, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1526624

ABSTRACT

BACKGROUND: Hand osteoarthritis is a common and disabling problem without effective therapies. Accumulating evidence suggests the role of local inflammation in causing pain and structural progression in hand osteoarthritis, and hand osteoarthritis with synovitis is a commonly encountered clinical phenotype. Methotrexate is a well-established, low-cost, and effective treatment for inflammatory arthritis with a well-described safety profile. The aim of this multicentre, randomised, double-blind, placebo-controlled trial is to determine whether methotrexate reduces pain over 6 months in patients with hand osteoarthritis and synovitis. METHODS: Ninety-six participants with hand osteoarthritis and synovitis will be recruited through the Osteoarthritis Clinical Trial Network (Melbourne, Hobart, Adelaide, and Perth), and randomly allocated in a 1:1 ratio to receive either methotrexate 20 mg or identical placebo once weekly for 6 months. The primary outcome is pain reduction (assessed by 100 mm visual analogue scale) at 6 months. The secondary outcomes include changes in physical function and quality of life assessed using Functional Index for Hand Osteoarthritis, Australian Canadian Osteoarthritis Hand Index, Health Assessment Questionnaire, Michigan Hand Outcomes Questionnaire, Short-Form-36, tender and swollen joint count, and grip strength, and structural progression assessed using progression of synovitis and bone marrow lesions from magnetic resonance imaging and radiographic progression at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups. DISCUSSION: This study will provide high-quality evidence to address whether methotrexate has an effect on reducing pain over 6 months in patients with hand osteoarthritis and synovitis, with major clinical and public health importance. While a positive trial will inform international clinical practice guidelines for the management of hand osteoarthritis, a negative trial would be highly topical and change current trends in clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000877381. Registered 15 June 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373124.


Subject(s)
Osteoarthritis , Synovitis , Australia , Canada , Double-Blind Method , Humans , Methotrexate/therapeutic use , Multicenter Studies as Topic , Osteoarthritis/diagnostic imaging , Osteoarthritis/drug therapy , Quality of Life , Randomized Controlled Trials as Topic , Synovitis/diagnostic imaging , Synovitis/drug therapy , Treatment Outcome
4.
Leadersh Health Serv (Bradf Engl) ; ahead-of-print(ahead-of-print)2021 11 23.
Article in English | MEDLINE | ID: covidwho-1526252

ABSTRACT

PURPOSE: Long-term care (LTC) organizations have struggled to protect their vulnerable clients from the ravages of the COVID-19 pandemic. Although various suggestions on containing outbreaks in LTC facilities have gained prominence, ensuring the safety of residents is not just a crisis issue. In that context, the authors must reasses the traditional management practices that were not sufficient for handling unexpected and demanding conditions. The purpose of this paper is to suggest rethinking the underlying attributes of LTC organizations and drawing insight from the parallels they have to high-reliability organizations (HROs). DESIGN/METHODOLOGY/APPROACH: The authors analyzed qualitative data collected from a Canadian LTC facility to shed light on the current state of reliability practices and culture of the LTC industry and to identify the strengths and weaknesses of the traditional management approaches. FINDINGS: To help the LTC industry develop the necessary crisis management capacity to tackle unexpected future challenges, there is an urgent need for adopting a more systemic top-down approach that cultivates mindfulness, learning and resilience. ORIGINALITY/VALUE: This study contributes by applying the HRO theoretical lens in the LTC context. The study provides the LTC leaders with insights into creating a unified effort at the industry level to give rise to a high-reliability-oriented industry.


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , Reproducibility of Results , SARS-CoV-2
5.
Health Rep ; 32(11): 16-27, 2021 11 17.
Article in English | MEDLINE | ID: covidwho-1524859

ABSTRACT

BACKGROUND: There are important information gaps concerning the prevalence and distribution of infection control practices (ICPs) within workplaces continuing to operate during the COVID-19 pandemic. DATA AND METHODS: To address these gaps, this paper examines the prevalence of workplace ICPs among employed respondents to Statistics Canada's Labour Force Survey in the months of July, August and September 2020 (n = 53,316). The article also seeks to identify sociodemographic, occupational and workplace factors associated with the level and type of workplace ICPs. ICPs included the reorganization of the workplace to allow for physical distancing, increased access to hand sanitizer or handwashing facilities, enhanced cleaning protocols and access to personal protective equipment. Multivariable regression models were used to examine the number of ICPs in place and the absence of specific ICPs. RESULTS: Generally high levels of reported protections among workers (15% of the sample had three ICPs and 72% had four or more ICPs) were observed. However, certain subgroups of workers were less likely to have ICPs in place. These included workers who were male; those with lower levels of education, shorter job tenure, or non-permanent work; and those working in the agricultural, construction, transportation and warehousing, and education industries. INTERPRETATION: In a large sample of Canadian employees, generally high levels of workplace ICPs to reduce the transmission of COVID-19 were observed. Groups with lower levels of ICPs included workers at the start of their employment, workers with low levels of education, and certain industry groups.


Subject(s)
COVID-19 , Workplace , Canada/epidemiology , Humans , Infection Control , Male , Pandemics , Prevalence , SARS-CoV-2
6.
Can J Public Health ; 112(5): 831-842, 2021 10.
Article in English | MEDLINE | ID: covidwho-1524702

ABSTRACT

OBJECTIVE: The primary objective was to determine the association between public health preventive measures and children's outdoor time, sleep duration, and screen time during COVID-19. METHODS: A cohort study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) through The Applied Research Group for Kids (TARGet Kids!) COVID-19 Study of Children and Families in Toronto, Canada, between April 14 and July 15, 2020. Parents were asked to complete questionnaires about adherence to public health measures and children's health behaviours. The primary exposure was the average number of days that children practiced public health preventive measures per week. The three outcomes were children's outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed-effects models were fitted using repeated measures of primary exposure and outcomes. RESULTS: This study included 554 observations from 265 children. The mean age of participants was 5.5 years, 47.5% were female and 71.6% had mothers of European ethnicity. Public health preventive measures were associated with shorter outdoor time (-17.2; 95% CI -22.07, -12.40; p < 0.001) and longer total screen time (11.3; 95% CI 3.88, 18.79; p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (<5 years), and the associations with total screen time were stronger in females and in older children (≥5 years). CONCLUSION: Public health preventive measures during COVID-19 were associated with a negative impact on the health behaviours of Canadian children living in a large metropolitan area.


Subject(s)
COVID-19 , Health Behavior , Public Health , COVID-19/epidemiology , COVID-19/prevention & control , Canada/epidemiology , Child , Child, Preschool , Cohort Studies , Female , Humans , Male
7.
Healthc Q ; 24(3): 1-3, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1524629

ABSTRACT

There is no doubt that the events of the past two years will leave an indelible mark on human history. The tragic loss of so many lives during the COVID-19 pandemic, the long-term health and psychological impacts for many more and the economic and societal changes will reverberate for years to come. While the pandemic is not yet over, we are starting to appreciate how different our new future looks and feels. It is within this context that Longwoods Publishing and the Canadian College of Health Leaders (CCHL) have collaborated, for the first time, in a shared reflection on the future of leadership in Canada's healthcare system.


Subject(s)
COVID-19 , Leadership , Canada , Delivery of Health Care , Humans , Pandemics , SARS-CoV-2
8.
Healthc Q ; 24(3): 13-15, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1524628

ABSTRACT

The COVID-19 pandemic has disproportionately affected Canada's long-term care (LTC) sector, with residents of LTC and retirement homes accounting for 67% of all COVID-19-related deaths as of February 15, 2021. This study investigated the impact of the COVID-19 pandemic on LTC residents across Canada during the first six months of the pandemic, including how care changed for residents, using data from the Canadian Institute for Health Information's LTC and acute care databases. The results suggest that LTC residents received less medical care, with fewer physician visits and hospital transfers compared with the same period in 2019. They also had less contact with family/friends compared with the same period in 2019, which was associated with higher levels of depression. In provinces where it could be measured, the number of LTC resident deaths from all causes was higher than pre-pandemic years during the peak of the first wave, even in jurisdictions with few COVID-19-related deaths in LTC.


Subject(s)
COVID-19 , Pandemics , Canada/epidemiology , Humans , Long-Term Care , SARS-CoV-2
9.
Healthc Q ; 24(3): 27-30, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1524627

ABSTRACT

While the COVID-19 pandemic has been the major focus for healthcare leaders since early 2020, the opioid crisis has been growing in the background. Confronting this emerging problem will require new thinking. Guest editors Anne Wojtak and Neil Stuart spoke with Scott Elliott, executive director, and Patrick McDougall, director of Knowledge Translation and Evaluation, at the Dr. Peter AIDS Foundation in Vancouver to gain their insights into how leaders can respond effectively.


Subject(s)
COVID-19 , Leadership , Canada , Humans , Opioid Epidemic , Pandemics , SARS-CoV-2
10.
Healthc Q ; 24(3): 42-47, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1524625

ABSTRACT

The COVID-19 outbreak offered a unique opportunity to capture the experiences of front-line practitioners during substantial and rapid changes to their daily work, including workplace policy, protocols, environment and culture, as well as changes to their overall professional role in the healthcare system. Our team of paramedic researchers collected data throughout the first wave of the COVID-19 outbreak, exploring the lived experiences from a paramedic viewpoint. This article will discuss impactful approaches to leadership in paramedicine - differentiating between successful and failed strategies to leading and supporting teams amid rapid change on the front lines of the fight against COVID-19.


Subject(s)
COVID-19 , Pandemics , Allied Health Personnel , Canada , Humans , Leadership , Pandemics/prevention & control , SARS-CoV-2
11.
Healthc Q ; 24(3): 53-57, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1524623

ABSTRACT

The COVID-19 pandemic has impacted healthcare organizations globally, particularly from a supply chain perspective. Leaders with successful responses have drawn upon their toolkit to anticipate threats, recognize crises, respond decisively, visibly engage in problem solving and facilitate communication. By harnessing these skills, leaders have tackled COVID-19-related challenges, including panic buying, organizational goal misalignment, staff anxiety and criticism. By applying crisis management theory and presenting learnings from interviews with American and Canadian healthcare leaders, we present solutions and lessons learned, including implementing communication methods, building staff resiliency, reducing staff anxiety and leading virtually.


Subject(s)
COVID-19 , Canada , Delivery of Health Care , Humans , Pandemics , SARS-CoV-2 , United States
12.
Healthc Q ; 24(3): 72-75, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1524622

ABSTRACT

Much is already written on how the COVID-19 pandemic ravaged Canada's frail, elderly population - the impact of the global pandemic turned the decades-long challenges within our nation's long-term care sector into daily news coverage. While no commission or report can ever begin to relieve the pain and suffering of individuals who lived through the pandemic, healthcare leaders owe it to all to respond to the urgent call for action to re-envision elder care for the future. The time to act is now. Our leaders need to collaborate and connect with our seniors to take quick action on their recommendations. Our leaders need to be nimble and creative; they need to work together across the system to rethink how aging seniors can be supported and change the system, its funding models and, ultimately, how we value and care for our aging population now and into the future.


Subject(s)
COVID-19 , Pandemics , Aged , Aging , Canada , Humans , SARS-CoV-2
13.
Healthc Pap ; 20(1): 4-7, 2021 09.
Article in English | MEDLINE | ID: covidwho-1524621

ABSTRACT

Across Canada, the long-term care sector has received increased attention since the devastating impact of the COVID-19 pandemic. The now often-cited statistic - 80% of deaths in the first wave occurred among individuals residing in institutional long-term care - is tragic enough and is only compounded by the fact that the number of deaths in long-term care were still higher in the second wave in all but two provinces. Many have argued that the impact of the pandemic was amplified in the institutional long-term care sector because of a number of long-standing shortfalls in funding, space, staffing and infrastructure. For example, Canadian provinces had lower average direct hours of care (three hours per day) provided to residents in long-term care facilities than even the average of four hours per day provided in the United States (Hsu et al. 2016).


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , SARS-CoV-2 , United States
14.
Healthc Pap ; 20(1): 10-14, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524620

ABSTRACT

Given our diversity, it is risky to talk about "Canadian values," but this examination of care for older people does reveal some prominent values evident in how we provide care for this population. Identifying eight of these values, this paper argues that these values are being challenged in the wake of the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Aged , Canada , Humans , Long-Term Care , Pandemics/prevention & control , SARS-CoV-2
15.
Healthc Pap ; 20(1): 20-25, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524619

ABSTRACT

The experience of the COVID-19 pandemic has fuelled demands for national threshold standards of quality for long-term care in Canada. The federal government, however, lacks jurisdiction for and experience with the provision of long-term care, which rests constitutionally with the provinces. A creative approach to providing new funding and effective regulatory standard setting would seize the potential of an area of jurisdiction shared by federal and provincial governments - old age security - to establish a long-term care insurance program administered by the federal government and jointly governed by federal and provincial governments.


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , SARS-CoV-2
16.
Healthc Pap ; 20(1): 27-33, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524618

ABSTRACT

The COVID-19 pandemic has driven home the serious vulnerabilities plaguing Canada's long-term care system. We argue for significant new federal investments tied to clear, enforceable quality standards (particularly around staffing); new investments in home care so that more people can "age in place"; and additional support for informal care providers, including respite programs and cash benefits. We explore how to achieve these reforms within the framework of Canadian federalism and call for the creation of a national governance framework - overseen by experts independent of federal and provincial governments - tasked with establishing evidence-based standards for the quality, safety and timeliness of long-term care services.


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , SARS-CoV-2
17.
Healthc Pap ; 20(1): 40-50, 2021 09.
Article in English | MEDLINE | ID: covidwho-1524616

ABSTRACT

A coherent workforce strategy and consensus on essential staffing requirements are needed to ensure quality in long-term care (LTC) homes. We have neither in Canada. No Canadian studies, investigator driven or commissioned, exist to guide us. We generally rely on 20-year-old US recommendations, although we have never actually implemented them. During, and in the wake of the COVID-19 pandemic, it is clear that an insufficient workforce was at the root of much of the failure in LTC to manage the pandemic. This commentary frames research on staffing and LTC homes and the impact of COVID-19. It then outlines key ingredients, such as knowledge of residents, the workforce and the care environment, that are needed in order to estimate staffing needs. Recommendations for decision makers are provided.


Subject(s)
COVID-19 , Long-Term Care , Adult , Canada , Humans , Nursing Homes , Pandemics , SARS-CoV-2 , Workforce , Young Adult
18.
CMAJ Open ; 9(4): E998-E1004, 2021.
Article in English | MEDLINE | ID: covidwho-1524570

ABSTRACT

BACKGROUND: Asian Canadians and Asian Americans face COVID-19-related discrimination. The objective of this qualitative study was to explore the experiences of Asian health care workers dealing with discrimination, with a focus on racial micro-agressions, in Canada and the United States during the COVID-19 pandemic. METHODS: We adopted a qualitative descriptive approach. We used convenience and snowball sampling strategies to recruit participants. We conducted individual, in-depth semistructured interviews with Asian health care workers in Canada and the US via videoconferencing between May and September 2020. Eligible participants had to self-identify as Asian and be currently employed as a health care worker with at least 1 year of full-time employment. We used an inductive thematic approach to analyze the data. RESULTS: Thirty participants were recruited. Fifteen (50%) were Canadians and 15 (50%) were Americans; there were 18 women (60%), 11 men (37%) and 1 nonbinary person. Most of the participants were aged 25-29 years (n = 16, 53%). More than half were nurses (n = 16, 53%); the other participants were attending physicians (n = 5), physiotherapists (n = 3), resident physicians (n = 2), a midwife, a paramedic, a pharmacist and a physician assistant. Two themes emerged from the data: a surge of racial microaggressions related to COVID-19 and a lack of institutional and public acknowledgement. Participants noted that they have experienced an increase in racial microaggressions during the COVID-19 pandemic. They have also experienced threats of violence and actual violence. The largely silent organizational response to the challenges being faced by people of Asian descent and the use of disparaging terms such as "China virus" in the early stages of the pandemic were a substantial source of frustration. INTERPRETATION: Asian health care workers have experienced challenges in dealing with racial microaggressions related to COVID-19 in the US and Canada. More research should be done on the experiences of Asian Americans and Asian Canadians, both during and after the pandemic, and supportive measures should be put in place to protect Asian health care workers.


Subject(s)
Asian Americans/psychology , COVID-19/psychology , Health Personnel/psychology , Racism/psychology , Adult , Canada , Female , Humans , Interviews as Topic , Male , Pandemics , Qualitative Research , SARS-CoV-2 , United States , Workplace Violence/psychology , Xenophobia/psychology
19.
CMAJ Open ; 9(4): E1013-E1020, 2021.
Article in English | MEDLINE | ID: covidwho-1524569

ABSTRACT

BACKGROUND: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions. METHODS: Participants living in Canada aged 13-19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: "What feelings and emotions have you experienced around the pandemic?" and "What coping strategies have you used during the pandemic?" We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively. RESULTS: A total of 1164 open-ended responses from Canadian adolescents (n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities. INTERPRETATION: Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress.


Subject(s)
COVID-19/psychology , Mental Health/statistics & numerical data , Adaptation, Psychological , Adolescent , COVID-19/epidemiology , Canada/epidemiology , Cross-Sectional Studies , Emotions , Exercise , Female , Humans , Male , Pandemics , Psychological Distress , Qualitative Research , SARS-CoV-2 , Social Media , Stress, Psychological/psychology , Surveys and Questionnaires , Young Adult
20.
J Otolaryngol Head Neck Surg ; 50(1): 65, 2021 Nov 16.
Article in English | MEDLINE | ID: covidwho-1523331

ABSTRACT

BACKGROUND: The COVID-19 pandemic has deeply impacted healthcare and education systems, including resident education. The impact of the pandemic on the different types of pedagogical activities, and the displacement of pedagogical activities to online modalities have not yet been quantified. We sought to evaluate the impact of the COVID-19 pandemic on formal pedagogic components of otorhinolaryngology-head and neck surgery (ORL-HNS) residency, the switch to distance learning and program director's perceptions of the future of teaching and learning. METHODS: A nationwide online survey was conducted on Canadian ORL-HNS program directors. The use of standard didactic activities in-person and online, before and during the pandemic was rated with Likert scales. Perceptions of the pandemic were described with open-ended questions. RESULTS: A total of 11 of the 13 program directors contacted responded. The analysis were conducted using nonparametric statistics. There was a significant drop in overall didactic activities during the pandemic, regardless of the teaching format (3.5 ± 0.2 to 3.1 ± 0.3, p < 0.05). The most affected activities were simulation and in-house lectures. Online activities increased dramatically (0.5 ± 0.2 to 5.0 ± 0.5, p < 0.001), including attendance to lectures made by other programs (0.5 ± 0.3 to 4.0 ± 0.8, p < 0.05). Respondents stated their intention to maintain the hybrid online and in-person teaching model. CONCLUSIONS: These findings suggest that hybrid online and in-person teaching is likely to persist in the post-pandemic setting. A balanced residency curriculum requires diversity in academic activities. The pandemic can have positive consequences if higher education institutions work to better support distance teaching and learning.


Subject(s)
COVID-19/epidemiology , Curriculum , Disease Transmission, Infectious/prevention & control , Education, Distance/methods , Education, Medical, Graduate/methods , Internship and Residency/methods , Otolaryngology/education , Adolescent , Adult , COVID-19/transmission , Canada , Child , Cross-Sectional Studies , Female , Humans , Male , Pandemics , Quebec/epidemiology , Retrospective Studies , Surveys and Questionnaires , Young Adult
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