Trends in falls among older adults before and during the COVID-19 pandemic in Ontario, Canada: A retrospective observational study.

BACKGROUND: The public health measures associated with the COVID-19 pandemic may have indirectly impacted other health outcomes, such as falls among older adults. The purpose of this study was to examine trends in fall-related hospitalizations and emergency department visits among older adults before and during the COVID-19 pandemic in Ontario, Canada. METHODS: We obtained fall-related hospitalizations (N = 301,945) and emergency department visit (N = 1,150,829) data from the Canadian Institute for Health Information databases from 2015 to 2022 for adults ages 65 and older in Ontario. Fall-related injuries were obtained using International Classification of Diseases, 10th edition, Canada codes. An interrupted time series analysis was used to model the change in weekly fall-related hospitalizations and emergency department visits before (January 6, 2015-March 16, 2020) and during (March 17, 2020-December 26, 2022) the pandemic. RESULTS: After adjusting for seasonality and population changes, an 8% decrease in fall-related hospitalizations [Relative Rate (RR) = 0.92, 95% Confidence Interval (CI): 0.85, 1.00] and a 23% decrease in fall-related emergency department visits (RR = 0.77, 95%CI: 0.59, 1.00) were observed immediately following the onset of the pandemic, followed by increasing trends during the pandemic for both outcomes. CONCLUSIONS: Following an abrupt decrease in hospitalizations and emergency department visits immediately following the onset of the pandemic, fall-related hospitalizations and emergency department visits have been increasing steadily and are approaching pre-pandemic levels. Further research exploring the factors contributing to these trends may inform future policies for public health emergencies that balance limiting the spread of disease among this population while supporting the physical, psychological, and social needs of this vulnerable group.

Public health emergency preparedness for infectious disease emergencies: a scoping review of recent evidence.

BACKGROUND: The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies. METHODS: Using scoping review methodology, a comprehensive search was conducted for indexed and grey literature with a focus on records published from 2017 to 2020 onward, respectively. Records were included if they: (a) described PHEP, (b) focused on an infectious emergency, and (c) were published in an Organization for Economic Co-operation and Development country. An evidence-based all-hazards Resilience Framework for PHEP consisting of 11 elements was used as a reference point to identify additional areas of preparedness that have emerged in recent publications. The findings were analyzed deductively and summarized thematically. RESULTS: The included publications largely aligned with the 11 elements of the all-hazards Resilience Framework for PHEP. In particular, the elements related to collaborative networks, community engagement, risk analysis and communication were frequently observed across the publications included in this review. Ten emergent themes were identified that expand on the Resilience Framework for PHEP specific to infectious diseases. Planning to mitigate inequities was a key finding of this review, it was the most frequently identified emergent theme. Additional emergent themes were: research and evidence-informed decision making, building vaccination capacity, building laboratory and diagnostic system capacity, building infection prevention and control capacity, financial investment in infrastructure, health system capacity, climate and environmental health, public health legislation and phases of preparedness. CONCLUSION: The themes from this review contribute to the evolving understanding of critical public health emergency preparedness actions. The themes expand on the 11 elements outlined in the Resilience Framework for PHEP, specifically relevant to pandemics and infectious disease emergencies. Further research will be important to validate these findings, and expand understanding of how refinements to PHEP frameworks and indicators can support public health practice.

Does Vaping Increase the Risk of COVID-19 Transmission and Make Individuals Who Vape Susceptible to Infection and Prone to Severe Illness? A Review.

The predominant mode of transmission of SARS-CoV-2 virus and coronavirus disease 2019 (COVID-19) is aerosols, and e-cigarettes/vaping products are a source of aerosols. There is a public health concern that the use of these products may increase the risk of COVID-19 transmission, susceptibility to COVID-19 and severity of the disease. Based on a review of existing literature, we found emerging evidence that suggests that people who vape are at higher risk of COVID-19, and, because of compromised lung function, their susceptibility to the disease and the severity of outcomes is increased. Aerosols generated by vaping products could be involved in the transmission of the virus when people are close to others who have been diagnosed with COVID-19 and are vaping. These findings may be useful to health care professionals, including dental professionals, in providing evidence to support informing patients about vaping and how the use of vaping products impacts the risk of COVID-19 transmission, infection susceptibility and severity of illness.

'Communities are attempting to tackle the crisis': a scoping review on community plans to prevent and reduce opioid-related harms.

OBJECTIVES: We sought to understand the implementation of multifaceted community plans to address opioid-related harms. DESIGN: Our scoping review examined the extent of the literature on community plans to prevent and reduce opioid-related harms, characterise the key components, and identify gaps. DATA SOURCES: We searched MEDLINE, Embase, PsycINFO, CINHAL, SocINDEX and Academic Search Primer, and three search engines for English language peer-reviewed and grey literature from the past 10 years. ELIGIBILITY CRITERIA: Eligible records addressed opioid-related harms or overdose, used two or more intervention approaches (eg, prevention, treatment, harm reduction, enforcement and justice), involved two or more partners and occurred in an Organisation for Economic Co-operation and Development country. DATA EXTRACTION AND SYNTHESIS: Qualitative thematic and quantitative analysis was conducted on the charted data. Stakeholders were engaged through fourteen interviews, three focus groups and one workshop. RESULTS: We identified 108 records that described 100 community plans in Canada and the USA; four had been evaluated. Most plans were provincially or state funded, led by public health and involved an average of seven partners. Commonly, plans used individual training to implement interventions. Actions focused on treatment and harm reduction, largely to increase access to addiction services and naloxone. Among specific groups, people in conflict with the law were addressed most frequently. Community plans typically engaged the public through in-person forums. Stakeholders identified three key implications to our findings: addressing equity and stigma-related barriers towards people with lived experience of substance use; improving data collection to facilitate evaluation; and enhancing community partnerships by involving people with lived experience of substance use. CONCLUSION: Current understanding of the implementation and context of community opioid-related plans demonstrates a need for evaluation to advance the evidence base. Partnership with people who have lived experience of substance use is underdeveloped and may strengthen responsive public health decision making.

Y TXT N DRIVE? Predictors of texting while driving among a sample of Ontario youth and young adults.

BACKGROUND: Distracted driving is of particular concern among young drivers. According to the 2012 National Highway Traffic Safety Administration (NHTSA) survey, the greatest proportion of distraction prone drivers is within the 16-19 and 20-24 age groups. One relatively new distraction is texting while driving behaviour (TWD). TWD increases the amount of time drivers spend looking away from the road, slows reaction times and increases the risk of collisions by two-fold. To deter this behaviour many distracted driving campaigns focus on highlighting the risks and dangers of distracted driving; however, evidence suggests that youth and young adults continue to engage in TWD despite awareness of the related risks. Previous studies have examined constructs from the theory of planned behaviour as predictors of TWD (e.g., attitudes, intentions). Understanding the full range of factors that may influence this behaviour can inform the development of evidence-based public awareness campaigns and related interventions. PURPOSE: The purpose of this paper was to examine predictors of TWD behaviour among youth and young adults. We examined constructs from the theory of planned behaviour in addition to the role played by perceived TWD driving skills, experience with collisions due to TWD, descriptive norms (i.e., an individual's beliefs about a behaviour that are gained as a result of observing the actions of others) and risk perceptions. METHODS: An online survey was administered to 2001 Ontario youth and young adults examining potential predictors of TWD behaviour. Regression models were used to examine which key variables were associated with TWD (both reading and sending behaviour) among participants. RESULTS: Overall, regression models had good predictability for reading and sending behaviours. Perceived TWD driving skills and 'almost getting in a collision due to TWD' were positively associated with TWD behaviour in the past week (both reading and sending behaviours). Descriptive norms were positively associated with sending text messages while driving in the past week, but were not significant for reading. In contrast, risk perceptions were positively associated with reading text messages in the past week but not sending. DISCUSSION AND CONCLUSION: The results from this study highlight constructs that can be used to design interventions to deter young drivers from engaging in TWD. Interventions targeting perceived TWD driving skills and descriptive norms have the potential to be more effective than interventions emphasizing risk perceptions. Future studies are needed to better understand the relationships between these predictors and TWD behaviour among this population.

A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer.

PURPOSE: This study aims to provide recommendations on the optimal strategies and interventions for the prevention, screening, assessment, and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) in adult cancer populations. METHODS: A systematic search of the published health literature was conducted to identify randomized controlled trials, clinical practice guidelines, systematic reviews, and other guidance documents. The Sleep Disturbance Expert Panel [comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers, and guideline methodologists] reviewed, discussed, and approved the final version of the guideline. Health care professionals across Canada were asked to provide feedback through an external review process. RESULTS: Three clinical practice guidelines and 12 randomized controlled trials were identified as the evidence base. Overall, despite the paucity of evidence, the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using standardized screening tools on a routine basis. While prevention of sleep disturbance is the desired objective, cognitive behavioral therapies are effective in improving sleep outcomes. As part of the external review with 16 health care providers, 81 % indicated that they agreed with the recommendations as written. CONCLUSIONS: Sleep difficulty is a prevalent problem in cancer populations that needs greater recognition by health professionals. Prevention, screening, assessment, and treatment strategies supported by the best available evidence are critical. Recommendations and care path algorithms for practice are offered.

Of time and troubles: patient involvement and the production of health care disparities.

Patient involvement in care practice has many and diverse proponents. It is endorsed by health care institutions and promoted by community agencies representing people with illness. A vast literature documents the benefits of patient involvement and describes ways to enable it. This article contributes to a critical literature on patient involvement by documenting the work done by women with cancer in relation to care timelines and in responding to troubles with care. We highlight continuities and disjunctures between this work, and discourses of patient involvement as they manifest in documents circulating at an Ontario cancer centre. In making visible the social and material resources that underpin successful involvement, the study shows how initiatives that endorse and promote 'the involved patient' can function to exacerbate health care and social disparities. As well, the study extends analysis of the individualization and privatization of health by showing how contemporary discourses of involvement enlist patients to monitor and sustain not only their own health, but also the health care they receive.

Health in Hamilton neighbourhoods: exploring the determinants of health at the local level.

The population health perspective recognizes a broad range of characteristics that are thought to be important determinants of health. In Canada, 12 such determinants of health are recognized, which range from lifestyle practices and the use of health care services to social and physical environments. While the list of social determinants is quite exhaustive, few studies have examined the relative importance of these determinants. The intent of this paper is to examine the relative importance of a range of social determinants of health in predicting four health outcomes of interest using data from a neighbourhood-level cross-sectional health survey conducted in Hamilton, Ontario. The results show that key social determinants of health vary by health outcome. The significance of the findings is discussed in terms of policy relevance and future research.

Health, healing and recovery: therapeutic landscapes and the everyday lives of breast cancer survivors.

Drawing on the theory of therapeutic landscapes, this paper examines the importance of place for shaping health and healing among breast cancer survivors. Semi-structured in-depth interviews were conducted with 14 women in the Greater Toronto Area at various stages of breast cancer recovery to examine where and how they access and create landscapes of healing. The interviews revealed the importance of everyday and extraordinary therapeutic landscapes that are created in bodies and homes, as well as the broader community and nature. Those landscapes with which women interact on an everyday basis appear to be most important for physical and psychological healing. In addition, the research suggests a strong interplay between emotions and place such that emotional geographies, which appear to be embedded within places of healing, play an important role in shaping and maintaining therapeutic landscapes. Further research is needed to understand the place of emotions in creating therapeutic landscapes, particularly for those populations most in need of healing.

Breast cancer information dissemination strategies--finding out what works.

This study aimed to identify the best strategies for dissemination of information about breast cancer In November 2004, 28 breast cancer survivors were interviewed. Three themes emerged from these discussions: the shock of diagnosis; the onus being on the patient to search for information; and the different types of information that breast cancer survivors want. To learn multiple viewpoints, 12 focus groups were held with breast cancer survivors (n = 127) and three focus groups were conducted with information providers (n = 25) in the spring of 2005. Participants validated the themes and identified two programs using "best practices" to provide information for women dealing with breast cancer. This article highlights the study findings, including implications for practice, education, and research.