Availability, use, and impact of workplace mental health supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers.

We investigated the availability and use of workplace mental health (MH) supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers (HCW) and measured anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) completed at four contacts 2020-2022. Reports were available for 4400 HCW working with patients. Half the HCWs had a clinically significant HADS score at one or more contacts Access to MH supports increased during the pandemic, with 94% reporting access to some workplace support by 2022: 47% had made use of at least one support. 25% of those with high HADS scores used no support. Older women and men with depressive conditions were less likely to report use. Reported use of an Employee Assistance Program was associated with a reduction in HADS scores in the following months.

Work Characteristics, Workplace Support, and Mental Ill-Health in a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic.

OBJECTIVE: The aim of the study was to identify determinants of mental health in healthcare workers (HCW) during the COVID-19 pandemic. METHODS: A cohort of Canadian HCW completed four questionnaires giving details of work with patients, ratings of workplace supports, a mental health questionnaire, and substance use. Principal components were extracted from 23 rating scales. Risk factors were examined by Poisson regression. RESULTS: A total of 4854 (97.8%) of 4964 participants completed ratings and mental health questionnaires. Healthcare workers working with patients with COVID-19 had high anxiety and depression scores. One of three extracted components, 'poor support,' was related to work with infected patients and to anxiety, depression, and substance use. Availability of online support was associated with feelings of better support and less mental ill-health. CONCLUSIONS: Work with infected patients and perceived poor workplace support were related to anxiety and depression during the pandemic.

Determinants of SARS-CoV-2 IgG response and decay in Canadian healthcare workers: A prospective cohort study.

INTRODUCTION: Healthcare workers (HCWs) from an interprovincial Canadian cohort gave serial blood samples to identify factors associated with anti-receptor binding domain (anti-RBD) IgG response to the SARS-CoV-2 virus. METHODS: Members of the HCW cohort donated blood samples four months after their first SARS-CoV-2 immunization and again at 7, 10 and 13 months. Date and type of immunizations and dates of SARS-CoV-2 infection were collected at each of four contacts, together with information on immunologically-compromising conditions and current therapies. Blood samples were analyzed centrally for anti-RBD IgG and anti-nucleocapsid IgG (Abbott Architect, Abbott Diagnostics). Records of immunization and SARS-CoV-2 testing from public health agencies were used to assess the impact of reporting errors on estimates from the random-effects multivariable model fitted to the data. RESULTS: 2752 of 4567 vaccinated cohort participants agreed to donate at least one blood sample. Modelling of anti-RBD IgG titer from 8903 samples showed an increase in IgG with each vaccine dose and with first infection. A decrease in IgG titer was found with the number of months since vaccination or infection, with the sharpest decline after the third dose. An immunization regime that included mRNA1273 (Moderna) resulted in higher anti-RBD IgG. Participants reporting multiple sclerosis, rheumatoid arthritis or taking selective immunosuppressants, tumor necrosis factor inhibitors, calcineurin inhibitors and antineoplastic agents had lower anti-RBD IgG. Supplementary analyses showed higher anti-RBD IgG in those reporting side-effects of vaccination, no relation of anti-RBD IgG to obesity and lower titers in women immunized in early or mid-pregnancy. Sensitivity analysis results suggested no important bias in the self-report data. CONCLUSION: Creation of a prospective cohort was central to the credibility of results presented here. Serial serology assessments, with longitudinal analysis, provided effect estimates with enhanced accuracy and a clearer understanding of medical and other factors affecting response to vaccination.

Excess risk of COVID-19 infection and mental distress in healthcare workers during successive pandemic waves: Analysis of matched cohorts of healthcare workers and community referents in Alberta, Canada.

OBJECTIVES: To investigate changes in risk of infection and mental distress in healthcare workers (HCWs) relative to the community as the COVID-19 pandemic progressed. METHODS: HCWs in Alberta, Canada, recruited to an interprovincial cohort, were asked consent to link to Alberta's administrative health database (AHDB) and to information on COVID-19 immunization and polymerase chain reaction (PCR) testing. Those consenting were matched to records of up to five community referents (CRs). Physician diagnoses of COVID-19 were identified in the AHDB from the start of the pandemic to 31 March 2022. Physician consultations for mental health (MH) conditions (anxiety, stress/adjustment reaction, depressive) were identified from 1 April 2017 to 31 March 2022. Risks for HCW relative to CR were estimated by fitting wave-specific hazard ratios. RESULTS: Eighty percent (3050/3812) of HCWs consented to be linked to the AHDB; 97% (2959/3050) were matched to 14,546 CRs. HCWs were at greater risk of COVID-19 overall, with first infection defined from either PCR tests (OR=1.96, 95%CI 1.76-2.17) or physician records (OR=1.33, 95%CI 1.21-1.45). They were also at increased risk for each of the three MH diagnoses. In analyses adjusted for confounding, risk of COVID-19 infection was higher than for CRs early in the pandemic and during the fifth (Omicron) wave. The excess risk of stress/adjustment reactions (OR=1.52, 95%CI 1.35-1.71) and depressive conditions (OR=1.39, 95%CI 1.24-1.55) increased with successive waves during the epidemic, peaking in the fourth wave. CONCLUSION: HCWs were at increased risk of both COVID-19 and mental ill-health with the excess risk continuing late in the pandemic.

RéSUMé: OBJECTIFS: Étudier l'évolution du risque d'infection et de problèmes de santé mentale (PSM) chez les travailleurs de la santé (TdS), comparé à la population générale, au cours de la pandémie de COVID-19. MéTHODES: Certains TdS de l'Alberta (Canada) participant à une cohorte interprovinciale, ont consenti à ce que la base administrative de santé de l'Alberta (AHDB) nous transmette leurs données de vaccination contre la COVID-19 et de tests d'amplification des acides nucléiques (TAAN). Ceux ayant consenti ont été appariés à un maximum de cinq témoins de population générale. Les diagnostics médicaux (par médecins) de COVID-19 ont été identifiés dans l'AHDB du début de la pandémie jusqu'au 31 mars 2022. Les consultations médicales pour PSM (anxiété, stress/troubles de l'adaptation, dépression) ont été identifiées entre le 1er avril 2017 et le 31 mars 2022. Les rapports de cotes (RC) comparant les TdS aux témoins de la population générale ont été estimés pour chaque vague d'infection. RéSULTATS: Quatre-vingts pourcent (80 %; 3050/3812) des TdS ont donné leur consentement à ce que leurs données nous soient transmises par l'AHDB; 97 % d'entre eux (2959/3050) ont été appariés à 14 546 témoins. Dans l'ensemble, les TdS étaient plus à risque de COVID-19, avec une première infection identifiée soit par les TANN (RC=1,96, IC de 95% 1,76-2,17), soit via les dossiers médicaux (RC=1,33, IC de 95% 1,21-1,45). Ils étaient également plus à risque pour chacun des trois problèmes de SM. Le risque de COVID-19 ajustés pour les facteurs de confusion était plus élevé que chez les témoins au début de la pandémie et durant la cinquième vague (variant Omicron). Les excès de risque de stress/troubles de l'adaptation (RC=1,52, IC de 95% 1,35-1,71) et de dépression (RC=1,39, IC de 95% 1,24-1,55) ont augmenté au fil des vagues de l'épidémie, avec un pic à la quatrième vague. CONCLUSION: Les TdS étaient plus à risque d'infection de COVID-19 et de troubles de santé mentale avec cet excès de risque se prolongeant plus tard dans la pandémie.

Cohort profile: recruitment and retention in a prospective cohort of Canadian healthcare workers during the COVID-19 pandemic.

PURPOSE: Healthcare workers were recruited early in 2020 to chart effects on their health as the COVID-19 pandemic evolved. The aim was to identify modifiable workplace risk factors for infection and mental ill health. PARTICIPANTS: Participants were recruited from four Canadian provinces, physicians (medical doctors, MDs) in Alberta, British Columbia, Ontario and Quebec, registered nurses (RNs), licensed practical nurses (LPNs) and healthcare aides (HCAs) in Alberta and personal support workers (PSWs) in Ontario. Volunteers gave blood for serology testing before and after vaccination. Cases with COVID-19 were matched with up to four referents in a nested case-referent study. FINDINGS TO DATE: Overall, 4964/5130 (97%) of those recruited joined the longitudinal cohort: 1442 MDs, 3136 RNs, 71 LPNs, 235 PSWs, 80 HCAs. Overall, 3812 (77%) were from Alberta. Prepandemic risk factors for mental ill health and respiratory illness differed markedly by occupation. Participants completed questionnaires at recruitment, fall 2020, spring 2021, spring 2022. By 2022, 4837 remained in the cohort (127 had retired, moved away or died), for a response rate of 89% (4299/4837). 4567/4964 (92%) received at least one vaccine shot: 2752/4567 (60%) gave postvaccine blood samples. Ease of accessing blood collection sites was a strong determinant of participation. Among 533 cases and 1697 referents recruited to the nested case-referent study, risk of infection at work decreased with widespread vaccination. FUTURE PLANS: Serology results (concentration of IgG) together with demographic data will be entered into the publicly accessible database compiled by the Canadian Immunology Task Force. Linkage with provincial administrative health databases will permit case validation, investigation of longer-term sequelae of infection and comparison with community controls. Analysis of the existing dataset will concentrate on effects on IgG of medical condition, medications and stage of pregnancy, and the role of occupational exposures and supports on mental health during the pandemic.

Determinants of Sickness Absence Duration After Mild COVID-19 in a Prospective Cohort of Canadian Healthcare Workers.

OBJECTIVE: The aim of the study is to identify modifiable factors associated with sickness absence duration after a COVID-19 infection. METHODS: Participants in a prospective cohort of 4964 Canadian healthcare workers were asked how many working days they had missed after a positive COVID-19 test. Only completed episodes with absence ≤31 working day and no hospital admission were included. Cox regression estimated the contribution of administrative guidelines, vaccinations, work factors, personal characteristics, and symptom severity. RESULTS: A total of 1520 episodes of COVID-19 were reported by 1454 participants. Days off work reduced as the pandemic progressed and were fewer with increasing numbers of vaccines received. Time-off was longer with greater symptom severity and shorter where there was a provision for callback with clinical necessity. CONCLUSIONS: Vaccination, an important modifiable factor, related to shorter sickness absence. Provision to recall workers at time of clinical need reduced absence duration.

Exposures to Polycyclic Aromatic Hydrocarbons and Their Mitigation in Wildland Firefighters in Two Canadian Provinces.

OBJECTIVES: We aimed to characterize polycyclic aromatic hydrocarbons (PAHs) in the breathing zone and on the skin of wildland firefighters and to assess their contribution to urinary 1-hydroxypyrene (1-HP) over repeated firefighting rotations. We asked if improved skin hygiene or discretionary use of an N95 mask would reduce absorption. METHODS: In collaboration with wildfire services of two Canadian provinces, Alberta and British Columbia (BC), we recruited wildland firefighters from crews willing to be followed up over successive rotations and to be randomly assigned to normal practice, enhanced skin hygiene (ESH), or ESH plus discretionary use of an N95 mask. We collected spot urine samples at the beginning and end of up to four rotations/firefighter. On designated fire days, as close as possible to the end of rotation, we collected skin wipes from the hands, throat, and chest at the beginning and end of the fire day and, in BC, start of fire-day urine samples. Volunteers carried air monitoring pumps. Participants completed questionnaires at the beginning and end of rotations. Exposure since the start of the fire season was estimated from fire service records. Urinary 1-HP was analyzed by LC-MS-MS. Analysis of 21 PAHs on skin wipes and 27 PAHs from air sampling was done by GC-MS-MS. Statistical analysis used a linear mixed effects model. RESULTS: Firefighters in Alberta were recruited from five helitack crews and two unit crews, and in BC from two unit crews with 80 firefighters providing data overall. The fire season in BC was very active with five monitored fire days. In Alberta, with more crews, there were only seven fire days. Overall, log 1-HP/creatinine (ng/g) increased significantly from the start (N = 145) to end of rotation (N = 136). Only three PAHs (naphthalene, phenanthrene, and pyrene) were found on >20% of skin wipes. PAHs from 40 air monitoring pumps included 10 PAHs detected on cassette filters (particles) and 5 on sorbent tubes (vapor phase). A principal component extracted from air monitoring data represented respiratory exposure and total PAH from skin wipes summarized skin exposure. Both routes contributed to the end of rotation urinary 1-HP. The ESH intervention was not demonstrated to effect absorption. Allocation of an N95 mask was associated with lower 1-HP when modeling respiratory exposure (ß = -0.62, 95% CI -1.15 to -0.10: P = 0.021). End of rotation 1-HP was related to 1-HP at the start of the next rotation (ß = 0.25, 95% CI 0.12 to 0.39: P < 0.001). CONCLUSIONS: Exposures to PAHs during firefighting were significant, with samples exceeding the American Conference of Governmental Industrial Hygienists Biological Exposure Index for 1-HP suggesting a need for control of exposure. PAH exposure accumulated during the rotation and was not fully eliminated during the break between rotations. Both respiratory and skin exposures contributed to 1-HP. While improved skin hygiene may potentially reduce dermal absorption, that was not demonstrated here. In contrast, those allocated to discretionary use of an N95 mask had reduced 1-HP excretion. Wildland firefighters in North America do not use respiratory protection, but the results of this study support more effective interventions to reduce respiratory exposure.

Respiratory Tract and Eye Symptoms in Wildland Firefighters in Two Canadian Provinces: Impact of Discretionary Use of an N95 Mask during Successive Rotations.

We examined whether discretionary use of an N95 mask reduced symptom reporting in wildland firefighters. The study collected data from two Canadian provinces during the 2021 fire season, with each firefighter followed for up to 4 rotations. Participants completed questionnaires on symptoms at the start and end of each rotation, when they reported also on mask use (if any) and completed a task checklist. Eighty firefighters contributed data. Nineteen firefighters were successfully fit-tested for N95 masks to wear whenever they felt conditions justified. Start-of-rotation symptoms reflected total hours firefighting in 2021. Symptoms of eye, nose and throat irritation and cough were more bothersome at the end of rotation. Cough, throat and nose (but not eye) symptoms were reported as significantly less bothersome at the end of rotation by those allocated masks, having allowed for crew type and start-of-rotation symptoms. Among those allocated a mask, use was most frequent during initial attack and least during driving and patrol. Reasons for not wearing included high work difficulty and low comfort. It is concluded that symptoms in wildland firefighters increased with hours of exposure. While provision of an N95 mask reduced symptoms, work is needed to overcome barriers to respiratory protection.