Youth recommendations for early intervention responses by governments for future pandemics

Aims: During the pandemic, youth were particularly vulnerable to experiencing financial hardship, education and employment disruption, and mental health impacts. Ensuring governments and services are prepared to support youth during future outbreaks or novel pandemics should be a key priority. This work aimed to explore youth experiences during COVID-19 and gather youth opinions on government responses to inform planning, policy, and decision-making for future pandemics. Method(s): Youth (ages 15-25) from Ireland and two provinces in Canada (British Columbia and Ontario) were interviewed at three time points during the COVID-19 pandemic. A thematic analysis was conducted using an inductive approach. This research was primarily youth-led and developed. Result(s): Across all three time points, youth experienced mental health and service uptake challenges, with mixed views on pandemic response. Opportunities for personal and societal growth were identified, with desire for incorporating youth voices into governmental decision making processes. Youth offered recommendations for effectively communicating accurate information, prevention of misinformation, and expressed needs regarding service accessibility throughout the pandemic and beyond. Conclusion(s): This work provides insights into the opinions of young people on government and information sharing during the progression of the COVID-19 pandemic. Recommendations were developed to ensure youth are consulted and represented in future pandemics.

Impacts of the COVID-19 pandemic on the tourism industry in Quebec. An analysis focused on outdoor organizations

This study was conducted with the aim of empirically analyzing the impacts of the pandemic of the Covid-19 on the Quebec tourism industry, with a particular focus on the outdoor sector, given that the latter seems to have been a form of escape in several countries and for many citizens. Based on a quantitative approach and a self-administered survey in the summer of 2020 (n = 1210), this study made it possible to analyze the organizational situation of this industry, the tourism performance of the organizations surveyed, their human resources concerns, their short- and medium-term development prospects, as well as the structural and organizational elements where the organizations are the most vulnerable. Overall, it can be seen that the outdoor sector, thanks to its 40 intrinsic characteristics, stands out very positively in this industry, in particular in contrast to organizations located in large urban centers that depend on clients from outside Quebec.

A qualitative study exploring how youth use TikTok to learn about mental health and mental health services in British Columbia, Canada

Aims: Youth are increasingly seeking health information through online platforms, such as websites, social media, and online forums. TikTok emerged as a popular platform for disseminating and consuming health information during the COVID-19 pandemic. As such, this study aimed to explore how youth used TikTok to access information about mental health and mental health services during the pandemic. Method(s): Twenty-one interviews were conducted over Zoom with youth (ages 12-24) who lived in British Columbia, Canada and had accessed TikTok for mental health information during the pandemic. Interviews were audio-recorded, transcribed verbatim, and analysed thematically using an inductive approach. Result(s): Youth described TikTok as a safe place to talk about mental health and share personal experiences. This helped youth feel less alone with their struggles and facilitated conversations about mental health with friends, family, and service providers. Participants also described how mental health content on TikTok helped them be more mindful of their own mental health and the different resources and coping strategies available and encouraged them to seek services. For those hesitant or unable to access services, TikTok provided immediate support. Youth appreciated the ease of accessing this information, given the platform's engaging and digestible format (i.e., short videos) and predictive nature of its algorithm. However, participants expressed concerns with the spread of misinformation and the lack of verifiable information on the platform. Conclusion(s): TikTok is as a practical platform to disseminate mental health information to youth. However, efforts to establish strategies for preventing and reporting misinformation are warranted.

The digital divide: An ongoing state of emergency in adult literacy programs

COVID-19 and closures of in-person interactions with support programs, education providers, government services, and consumer offerings have raised concerns that vulnerable populations may not be able to mitigate the effects of the digital divide. Our chapter discusses the digital divide with a focus on programs for adult learners who have not completed high school. These include literacy, high school completion, and vocational programs. We look specifically at Ontario as a case sample that shares similarities with programs across Canada. These programs are operated by community-based non-profits, school boards, and community colleges. They are usually marginalized within the broader education system and have not been considered as part of comprehensive supports and initiatives when schools and post-secondary institutions were closed. The digital inequalities learners experience have parallels in the very programs they attend to mitigate their own digital learning divide. © Springer Nature Switzerland AG 2021. All rights reserved.

Mild COVID-19 clinical course among paediatric patients with primary immunodeficiency

Background: The clinical course of coronavirus disease-2019 (COVID-19) varies from those who are asymptomatic, experience mild symptoms such as fever, cough, and dyspnea, to more severe outcomes including acute respiratory distress, pneumonia, renal failure, and death. Early reports suggested severe outcomes in patients with primary immunodeficiency (PID), particularly those with type 1 interferon signalling defects. This prompted a rigid approach to social distancing to protect this patient population, particularly children. To date, real-world data describing the course and outcome of COVID-19 in paediatric PID patients remains scarce. Method(s): In this retrospective case series, we describe the clinical course of 36 paediatric patients with underlying primary immunodeficiency (PID) followed by SickKids Hospital (Toronto, Canada) who were symptomatic and tested positive for SARS-CoV-2 infection between October 2020 to November 2022. Result(s): Our cohort consisted of patients with combined immunodeficiency (66.7%), antibody deficiency (22.2%), neutrophil dysfunction (8.3%), and immune dysregulation (2.8%). The median age was 7.5 years (range: 8 months - 17 years), with 21 male and 15 female patients. Three (8.3%) patients were post-hematopoietic stem cell transplant (HSCT) and 12 (33%) patients were on immunoglobulin replacement. Nine (25%) patients had underlying lung problems including bronchiectasis (1), interstitial lung disease on home oxygen therapy (1), and underlying asthma (7). Most patients had mild clinical course and were managed at home. The most common symptoms were fever (80%), cough (75%) and other upper respiratory tract symptoms (72%). Nineteen (52.7%) patients experienced other symptoms which included headache, lethargy, or gastrointestinal upset. At the time of the infection, 13 patients (36.1%) had received 2 doses of a SARS-CoV-2 vaccine, 5 patients (13.9%) had received 1 dose, and 18 (50%) were not vaccinated. None of the patients received antiviral or monoclonal antibody as prophylaxis or treatment. Only 1 patient required hospital admission out of precaution given the close proximity to HSCT. All patients recovered without complications. Conclusion(s): The paediatric patients with PID followed by our centre experienced mild to moderate COVID-19 symptoms and recovered fully without complications. These findings support the return of much needed social interactions among children, which were impacted severely during the COVID-19 pandemic.Copyright © 2023 Elsevier Inc.

Surveillance for SARS-CoV-2 in Norway Rats (Rattus norvegicus) from Southern Ontario

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from wildlife has raised concerns about spillover from humans to animals, the establishment of novel wildlife reservoirs, and the potential for future outbreaks caused by variants of wildlife origin. Norway rats (Rattus norvegicus) are abundant in urban areas and live in close proximity to humans, providing the opportunity for spillover of SARS-CoV-2. Evidence of SARS-CoV-2 infection and exposure has been reported in Norway rats. We investigated SARS-CoV-2 infection and exposure in Norway rats from Southern Ontario, Canada. From October 2019 to June 2021, 224 rats were submitted by collaborating pest control companies. The majority of samples were collected in Windsor (79.9%;n = 179), Hamilton (13.8%;n = 31), and the Greater Toronto Area (5.8%;n = 13). Overall, 50.0% (n = 112) were female and most rats were sexually mature (55.8%;n = 125). Notably, 202 samples were collected prior to the emergence of variants of concern (VOC) and 22 were collected while the Alpha variant (B.1.1.7) was the predominant circulating VOC in humans. Nasal turbinate (n = 164) and small intestinal (n = 213) tissue samples were analyzed for SARS-CoV-2 RNA by RT-PCR. Thoracic cavity fluid samples (n = 213) were tested for neutralizing antibodies using a surrogate virus neutralization test (sVNT) (GenScript cPass);confirmatory plaque reduction neutralization test (PRNT) was conducted on presumptive positive samples. We did not detect SARS-CoV-2 RNA in any samples tested. Two out of eleven samples positive on sVNT had neutralizing antibodies confirmed positive by PRNT (1 : 40 and 1 : 320 PRNT70);both were collected prior to the emergence of VOC. It is imperative that efforts to control and monitor SARS-CoV-2 include surveillance of rats and other relevant wildlife species as novel variants continue to emerge.

Coordination Failure, Pandemic Prevention, and Political Polarization in Global Perspective

The aftermath of the February 2022 public order emergency in Canada offers a timely opportunity to modernize the Emergencies Act and revisit the coordination imperative with the complexity of global emergencies squarely in mind. The failure to coordinate globally in the early stages of the Covid-19 outbreak, despite a vast repository of knowledge of how to do so- set against the backdrop of increasingly polarized politics and geopolitics- transformed an avoidable public health emergency into multiple humanitarian, economic, social, and political crises. This short article highlights Commissioner Rouleau's focus on coordination failure throughout his report. It then situates the public order emergency in a global perspective, focusing on pandemic preparedness and the polarized political context that framed it. The essay is to stress the importance of viewing emergency powers holistically, and to advocate reading the Commissioner's recommendations not in isolation, but as a small and partial response to a wicked-or super wicked-problem of global proportions.

Sharing culture in a tech world: Grandparent-grandchild cultural exchanges over video chat

Grandparents who were separated from their infant grandchildren during COVID-19 sought other ways to connect, including video chat. Video chat supports learning, and its features (e.g., contingent responsiveness) may allow for cultural exchange. However, technological problems may disrupt these exchanges. In a seminaturalistic, longitudinal study, 47 families submitted up to three video chats and surveys. Families were predominantly White/Caucasian, highly educated, and lived between 1 and 2,700 miles apart. Multilevel models were used to predict the proportion of the sessions devoted to exchanging culture (e.g., holidays, parenting advice) and managing tech problems. Culture exchange did not change as a function of infant age, video chat experience, or when encountering tech problems. Although only marginally statistically significant, culture exchange increased as distance increased. Tech problems changed as a function of tech talk. Qualitative analysis revealed that cultural transmission occurred via a culture of care and sharing of information across video chat, that families adapted their behaviors to the new technology, and that technology disruptions rarely interfered with the flow of information. These findings demonstrate the ability to share culture when physically separated and in the presence of tech disruptions. Further, this study supports previous work on the emerging culture of video chat. Families adapted to being separated, and grandparents and infants successfully communicated through a new modality. Because video chat supports family relationships, equitable access to high-speed internet should be a priority to enable more families to use it. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This study demonstrates that video chat allowed for familial culture exchanges to be maintained through a separation during COVID-19. Examining what and how cultural exchanges took place suggests that supports for using video chat, including access to high-speed internet, are necessary for families separated by other circumstances. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Meeting the challenge of gender inequality through gender transformative research: lessons from research in Africa, Asia, and Latin America

While the global development agenda has prioritized gender equality, many challenges remain, and the COVID-19 crisis has exacerbated inequalities. Gender transformative approaches to social change have the potential to address the underlying causes of inequality. This paper draws insights from studies funded by Canada's International Development Research Centre to understand how integrating gender transformative approaches to research can support social change. The findings suggest that gender transformative research is most successful in supporting change when it analyzes and addresses the multiple causes of inequality, takes an intersectional and structural approach, embeds the research in local contexts, and engages power holders and perpetrators of inequality.Alternate :RÉSUMÉSi les objectifs de développement mondial ont donné la priorité à l'égalité des genres, il y a encore de nombreux défis à relever dans ce domaine et la crise de la COVID-19 a exacerbé les inégalités. Les approches transformatrices du genre nous permettent de faire face aux causes sous-jacentes de ces inégalités. Cet article base son analyse sur des études financées par le Centre de recherches pour le développement international, au Canada, et vise à mieux comprendre comment l'adoption d'approches transformatrices du genre dans le contexte de la recherche peut appuyer le changement social. Nos résultats suggèrent que la recherche se basant sur une approche transformatrice du genre a de meilleurs chances d'inciter des changements sociaux lorsqu'elle analyse et répond aux différentes causes des inégalités, lorsqu'elle adopte une approche intersectionnelle et structurelle, lorsqu'elle intègre la recherche dans des contextes locaux et lorsqu'elle confronte les détenteurs du pouvoir et les responsables des inégalités.

Working through the Unknowns: Canadian Youth's Experience of Employment during the COVID-19 Pandemic

The changes to our daily lives brought about by the COVID-19 pandemic were significant, and by now, well established. Suddenly we were having to deal with lockdowns, stay-at-home orders and social distancing, the closure of schools and daycares for in-person learning, and carrying out our paid work, if possible, at home. Those who couldn't work at home, in the medical profession, emergency services and essential retail like grocery stores and pharmacies, dealt with unprecedented occupational health and safety unknowns, particularly during the early phases of the pandemic, information about which was slowly revealed in unfolding scientific developments. Youth were among those particularly affected. This study conducts a media analysis of the trends and experiences of young workers during this time. Its aim is to explore early assessments of the effect the pandemic will have on their career trajectories over the longer term. This helps to develop needed information on this demographic, whose plight in the face of the pandemic's other social, health, and economic repercussions, has not had the attention it deserves. The article concludes with recommendations for the empirical research needed to support young workers' transition to adulthood in the coming years.

How Can We Keep Our Patients Safe? Managing Cyber-Threats Post-Pandemic

Attacks on the University of Ottawa Heart Institute and the Newfoundland and Labrador health system in 2021, Toronto Sick Kids Hospital in December 2022, and Ross Memorial Hospital in February 2023 are just some examples of recent cyberattacks on healthcare targets (CBC News, 2021;Mosleh, 2023;Solomon, 2022). [...]while LockBit apologized for the attack on Toronto Sick Kids Hospital in December (Mosleh, 2023), the increase in frequency and scope of ransomware attacks on our healthcare system is a national concern. Remote work often involves using personal devices and unsecured networks, which can make it easier for cybercriminals to gain access to hospital networks, especially if staff have poor password hygiene. [...]hospitals need an incident response plan in place to minimize the impact of a ransomware attack and prevent disruption to patient care in the event of a breach. Attacks on the University of Ottawa Heart Institute and the Newfoundland and Labrador health system in 2021, Toronto Sick Kids Hospital in December 2022, and Ross Memorial Hospital in February 2023 are just some examples of recent cyberattacks on healthcare targets (CBC News, 2021;Mosleh, 2023;Solomon, 2022). [...]while LockBit apologized for the attack on Toronto Sick Kids Hospital in December (Mosleh, 2023), the increase in frequency and scope of ransomware attacks on our healthcare system is a national concern. Remote work often involves using personal devices and unsecured networks, which can make it easier for cybercriminals to gain access to hospital networks, especially if staff have poor password hygiene. [...]hospitals need an incident response plan in place to minimize the impact of a ransomware attack and prevent disruption to patient care in the event of a breach.

A Qualitative Investigation of the Impact of the Sars-Cov-2 Pandemic on Goal Attainment Scaling in a Clinical Research Setting

Objectives: Goal Attainment Scaling (GAS) quantifies the effect of interventions on individuals' personal goals. Goals that are meaningful to individual patients are set by GAS interviewers (physicians/academics, experienced in clinical research/trials) in collaboration with patients and/or their caregivers. The SARS-CoV-2 pandemic presented a major challenge to health care worldwide. We investigated how the SARS-CoV-2 pandemic affected the use and implementation of GAS in clinical/research settings. Method(s): Eleven GAS interviewers in Canada, the US, UK and Australia with current/past experience working with patient-caregivers to identify goals and build scales to measure goal attainment as an outcome were interviewed using a semi-structured approach. They described how the pandemic affected GAS use in clinical/research settings. Interviews were recorded and transcribed, then themes were identified and coded in Nvivo 12. Result(s): Most GAS interviews were moved to the virtual environment during the pandemic (9/11). GAS interviewers identified few negative impacts. Some goals required modification (e.g. going to the gym or shops). Pandemic stress impacted both interviewers and interviewees. Even so, most GAS interviewers (8/11) emphasized positive impacts of the pandemic. These were: 1) the virtual environment meant patients were more readily available as they did not need to travel;2) because interviewers did not have to travel, patient recruitment could be expanded into more remote geographical areas;3) researchers could recruit and retain more participants and collect data more quickly;and 4) interviewers commented they became more open to technology because of the pandemic (9/11). Conclusion(s): Despite the challenges of the SARS-CoV-2 pandemic for health care, most GAS interviewers found that the impacts were largely positive for using GAS in clinical/research settings. The ability to deploy GAS through a virtual platform could facilitate the uptake of GAS as a patient-centric outcome measure.Copyright © 2023

Seniors' Long‐Term Care in Canada: A Continuum of Soft to Brutal Privatisation

We situate the contemporary crisis of COVID‐19 deaths in seniors' care facilities within the restructuring and privatisation of this sector. Through an ethnographic comparison in a for‐profit and nonprofit facility, we explore what we identify as brutal and soft modes of privatisation within publicly subsidised long‐term seniors' care in Vancouver, British Columbia, and their influence on the material and relational conditions of work and care. Workers in both places are explicit that they deliver only bare‐bones care to seniors with increasingly complex care needs, and we document the distinct forms and extent to which these precarious workers give gifts of their time, labour and other resources to compensate for the gaps in care that result from state withdrawal and the extraction of profits within the sector. We nonetheless locate more humane and hopeful processes in the nonprofit facility, where a history of cooperative relations between workers, management and families suggest the possibility of re‐valuing the essential work of care. [ FROM AUTHOR] Copyright of Antipode is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Silent superbug killers in a river near you how factory farms contaminate public water courses on three continents

Water downstream from factory farms harbours an invisible threat to people's health which could eclipse the COVID-19 crisis. The threat? Antibiotic Resistance Genes (ARGs) which are driving antimicrobial resistance the world's superbug crisis - projected to kill up to 10 million people annually by 2050. This publication reports the presence of ARGs in animal waste discharged from industrial farms into public waterways or onto soil (or crops) in four countries. Gauge community impact and sentiment regarding the issue was also highlighted. The water and sediment from public water courses connected to effluent discharges from 6-10 pig farms were tested in each of four countries (Canada, Spain, Thailand and the USA).

E-research in early psychosis: Methodological recommendations for ethics and data security

Aims: The COVID-19 pandemic compelled replacement in traditional research practices (paper-pencil questionnaire) to technology-driven practices (online surveys). Such methods may be effective in reaching larger samples, geographically harder-to-reach populations, reduce recruitment costs, increase cost and time efficiency of recruitment. Despite these advantages, concerns about privacy and confidentiality, sample bias, data quality such as inaccurate responses, duplicate survey completion, and fraudster activity or bots prevail. We aim to provide researchers and reviewers with a series of recommendations for effectively executing and evaluating data collection via online platforms. Method(s): A rapid literature review was conducted and best practices and strategies to mitigate problems with e-research data collection were collated in summer 2021. Based on study needs, these strategies were applied in an on-going e-research in early psychosis intervention services with multiple stakeholder groups across Canada. Result(s): The results were categorized and prioritized based on strategy effectiveness (most, moderate, least) and at three implementation stages (before, during, and after recruitment). An 11-step data quality checklist was adapted and implemented in consultation and approval from institutional research ethics board thus ensured ethical acceptability. Key strategies include not sharing the full survey link publicly, collecting and checking paradata, attention check questions, and so forth. Conclusion(s): Given their unique strengths, the challenges of internetbased research and data collection should not deter researchers from using such approaches. Further, our study provides concrete evidence-based practices and insights for advancing ethical and highquality e-research, taking into account specific considerations associated with early psychosis settings.

Patrolling portals: the regulation of online genetic data sharing

Background/Objectives: Online portals are being increasingly used to disseminate genetics data. While portal-facilitated sharing might have significant scientific value, it is also likely to raise difficult legal and ethical questions. Many of these questions were highlighted during the Covid-19 pandemic, as the urgency of efficient data sharing became apparent. Responding to these emerging concerns, regulators around the world have implemented regimes for 'software used as a medical device.' It is unclear how these regimes affect online portals for genetic data sharing. This study addresses how online data sharing may be shaped by new forms of regulatory oversight. Method(s): We performed an international comparative analysis of advisory documents applicable to software as medical devices prepared by medical regulators in Canada, the United States, France, and the United Kingdom. We selected 20 documents for review. Result(s): We found that regulatory agencies are likely to regulate online tools as medical devices only when they are intended to perform a medical purpose. Online portals for genetic data sharing will not usually meet this threshold. Nevertheless, regulatory guidance provides significant insight into the kinds of issues to which regulators are likely to be attentive in addressing online data sharing. We identify eight normative and logistical issues: efficiency, equity, transparency, confidentiality, communication, empowerment, training, and safety. Conclusion(s): This review clarifies how the regulation of medical software might apply to portals for genetic data sharing. We offer recommendations to portal developers and researchers.

A descriptive study of older medical cannabis users in medical cannabis clinics

Introduction: There is a dearth of information on older users (65+ years) of medical cannabis, who may face unique challenges due to altered metabolism with aging, concurrent medication use, and risk of adverse effects. This observational study aimed to describe a large cohort of older medical cannabis users in Canada. Method(s): From Oct 2014 to Oct 2020, a commercial medical cannabis provider based in Canada collected anonymized data for research purposes from patient volunteers. Data included demographic, social, and health details (at intake) and cannabis products, self-perceived changes in symptoms and change in medications (at follow-up, variable duration). Cannabis products were categorized as cannabidiol (CBD) only, tetrahydocannabinol (THC) only or mixed CBD/THC. Of the mixed, formulations could be in 1:1 ratios (CBD+/THC+), predominantly CBD (CBD+/THC-) or predominantly THC (CBD-/THC+). Result(s): In total, 9766 subjects in the older cohort (65+ years old) completed the entire questionnaire (mean age (SD) = 73.6 (6.8) y, 60% female). They represented 23.1% of the total dataset (N = 42,267, mean (SD) =51.5 (16.8) y). The proportion of adults in the older cohort tended to increase over time (pre-2018: 17.6%;2018: 26.7%;2019: 31.2%;2020: 22.7%, when the overall intake decreased from 8869 to 5644). Among the older cohort, 15.5% were previous cannabis users and 67.7% were referred for chronic pain (mainly arthritis, chronic pain, lower back pain). Concomitant analgesic use was common (over-the-counter analgesics: 44.5%;opioids: 28.3%;NSAIDs: 24.5%). 7.9% of the sample (compared to 19.9% in the whole sample) were referred for psychiatric disorders, though 21.4% indicated antidepressant use and 12.3% indicated benzodiazepine use. Another 7% were referred for neurological disorders. Follow-up data were captured in visits (11,992) from 4698 older patients, averaging 2.5 visits per patient. The type of medical cannabis used changed over time, with increasing use of cannabis oil compared to herbal cannabis. In 2020, of 2478 visits, 78.9% use was cannabis oil and 6.7% was herbal forms (pre-2018: 57.6% vs 36.2%). The composition of cannabis oil demonstrated a preference for cannabinoid oil (CBD+) over tetrahydrocannabinol (THC+) in 6043 visits: 45.2% were using CBD+ preparations, only 3.2% were using THC+ preparations, and for CBD/THC combinations, CBD predominated (CBD+/THC-: 30.5%;CBD+/THC+: 16.8%;CBD-/THC+: 4.3%). Adverse-effects (7062 visits) included dry mouth (15.8%), drowsiness (8.6%), dizziness (4%) and hallucinations (0.6%). Patients reported improved pain, sleep and mood over time, though 15-20% reported no improvement or worsening. Medication use was mostly unchanged, though 40% of opioid users reported requiring reduced dosages. Conclusion(s): These data were drawn from a large convenience sample. The data suggest an increasing proportion of older users of medical cannabis, though COVID-19 may have affected recent use. Female users comprised a higher proportion, and cannabis oil containing CBD was preferred. Systematic studies of effectiveness and safety in older users of cannabinoids are needed given its increasing use. Funding(s): No funding was received for this work.Copyright © 2021

Meaning in stressful experiences and coping across cultures

We report three studies to examine how culture may influence people's tendency to see meaning in stressful experiences (MISE), as well as their coping responses. Using a newly developed MISE scale with established measurement invariance across both cultures, we found that Chinese participants were more likely than Euro-Canadians to see meaning in stressful experiences (Studies 1 and 2), to adopt acceptance and positive reframing coping styles (Study 1), and to respond more positively to the COVID-19 pandemic (Study 2). To establish a causal link between MISE and coping, we primed MISE in Study 3 with Chinese participants and found an increase in resilient coping. The research highlights the important roles of culture and meaning making in coping. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Impact of Prenatal Maternal Mental Health during the COVID-19 Pandemic on Birth Outcomes: A Study within CONCEPTION Cohort

Background: External natural events, such as hurricanes, floods, and the COVID-19 pandemic can contribute to increased populational stress, especially for pregnant persons. Exposure to crises can produce short- and longterm health effects on pregnant persons and their offspring. There has been much interest in the association between maternal depression, anxiety, and stress during pregnancy and perinatal outcomes such as preterm birth (PTB) and low birth weight (LBW), before and since the COVID-19 pandemic, however results are controversial. Objective(s): Assess the association between prenatal mental health during the COVID-19 pandemic and preterm birth (delivery <37 weeks gestation) and low birthweight (<2,500 grams). Method(s): Pregnant individuals, >18 years, were recruited in Canada and provided data through a web-based questionnaire. We analyzed data on persons recruited between 06/2020-08/2021 who completed questionnaires while pregnant and two months post-partum. Data on maternal sociodemographics, comorbidities, medication use, mental health (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress), pandemic hardship (CONCEPTION - Assessment of Stress from COVID-19), and on gestational age at delivery and birth weight, were selfreported. Crude and adjusted relative risks (aRR) with 95% confidence interval (95%CI) were calculated to quantify the association between PTB/LBW and maternal mental health. Result(s): A total of 1,265 and 1,233 participants were included in the analyses of PTB and LBW, respectively. No associations between PTB and prenatal mental health (depression [aRR 1.01, 95%CI 0.91-1.11], anxiety [aRR 1.04, 95%CI 0.93-1.17], stress [aRR 0.88, 95%CI 0.71-1.10], nor hardship [aRR 1.00, 95%CI 0.96-1.04]) after adjusting for potential confounders. The risk of PTB was increased with nonwhite ethnicity/race (aRR 3.85, 95%CI 1.35-11.00), consistently with the literature. Similar findings were observed for LBW (depression [aRR 1.03, 95%CI 0.96- 1.13], anxiety [aRR 1.05, 95%CI 0.95-1.17], COVID stress [aRR 0.92, 95%CI 0.77-1.09], or overall hardship [aRR 0.97, 95%CI 0.94-1.01]). Conclusion(s): No association was found between prenatal mental health nor hardship during the COVID-19 pandemic and the risk of PTB or LBW. However, it is imperative to continue the follow-up of mothers and their offspring to detect long-term health problems early.

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.