Search

Introduction: Throughout the COVID-19 pandemic, primary care nurses were often redeployed to areas outside of primary care to mitigate staffing shortages. Despite this, there is a scarcity of literature describing their perceptions of and experiences with redeployment during the pandemic. Objectives: This paper aims to: 1) describe the perspectives of primary care nurses with respect to redeployment, 2) discuss the opportunities/challenges associated with redeployment of primary care nurses, and 3) examine the nature (e.g., settings, activities) of redeployment by primary care nurses during the COVID-19 pandemic. Methods: In this qualitative study, semi-structured interviews were conducted with primary care nurses (i.e., Nurse Practitioners, Registered Nurses, and Licensed/Registered Practical Nurses), from four regions in Canada. These include the Interior, Island, and Vancouver Coastal Health regions in British Columbia; Ontario Health West region in Ontario; the province of Nova Scotia; and the province of Newfoundland and Labrador. Data related to redeployment were analyzed thematically. Results: Three overarching themes related to redeployment during the COVID-19 pandemic were identified: (1) Call to redeployment, (2) Redeployment as an opportunity/challenge, and (3) Scope of practice during redeployment. Primary care nurses across all regulatory designations reported variation in the process of redeployment within their jurisdiction (e.g., communication, policies/legislation), different opportunities and challenges that resulted from redeployment (e.g., scheduling flexibility, workload implications), and scope of practice implications (e.g., perceived threat to nursing license). The majority of nurses discussed experiences with redeployment being voluntary in nature, rather than mandated. Conclusions: Redeployment is a useful workforce strategy during public health emergencies; however, it requires a structured process and a decision-making approach that explicitly involves healthcare providers affected by redeployment. Primary care nurses ought only to be redeployed after other options are considered and arrangements made for the care of patients in their original practice area. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. Methods: A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. Results: Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. Conclusion: The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic. Plain language summary: Access to sexual and reproductive health (SRH) services is a basic human right. All individuals require access to appropriate SRH services to maintain their optimal sexual and reproductive health. Adolescents require special guidance, support, and youth-friendly services in matters of SRH as they enter puberty and explore their sexual identity. However, during the COVID-19 pandemic, many health and SRH services were suspended. Access to SRH products and services became difficult due to public health restrictions, which has possible negative consequences for adolescents' SRH. The experiences of adolescents during the COVID-19 pandemic regarding their SRH are not reported in Alberta, Canada. Therefore, we explored the impacts of these public health restrictions on adolescents' SRH. We performed qualitative interviews with adolescents and SRH service providers to know their perspectives on how the pandemic influenced the SRH of adolescents. This paper provides insights into the barriers faced by adolescents while accessing SRH services during the pandemic, as well as their perceptions of digital strategies, such as mobile applications, and other recommendations for supporting SRH education and services. Based on the study findings, an adolescent-friendly mobile application will be developed to provide a virtual platform connecting adolescents to SRH educational resources, services, and support. [ABSTRACT FROM AUTHOR]

The procurement and provision of expert-driven, evidence-informed, and independent science advice is integral to timely decision-making during public health emergencies. The 2019 coronavirus disease (COVID-19) pandemic has underscored the need for sound evidence in public health policy and exposed the challenges facing government science advisory mechanisms. This paper is a jurisdictional case study describing (i) the federal science advice bodies and mechanisms for public health in Canada (i.e., the federal science advice "ecosystem"); and (ii) how these bodies and mechanisms have mobilized and evolved to procure expertise and evidence to inform decisions during the first two years of the COVID-19 pandemic. We reviewed publicly accessible Government of Canada documents, technical reports, and peer-reviewed articles available up to December 2021. Canada's federal landscape of science advisory bodies for public health within the Health Portfolio was largely shaped by Canada's experiences with the 2003 severe acute respiratory syndrome and 2009 H1N1 outbreaks. In parallel, Canada has a designated science advisory apparatus that has seen frequent reforms since the early 2000s, with the current Office of the Chief Science Advisor created within the Science Portfolio in 2018. The COVID-19 pandemic has further complicated Canada's science advice ecosystem, with involvement from departments, expert advisory groups, and partnerships within both the federal Health and Science Portfolios. Although the engagement of federal departments outside the health sector is promising, the COVID-19 experience in Canada supports the need to institutionalize science advisory bodies for public health to improve pandemic preparedness and ensure rapid mobilization of well-coordinated and independent advice in future emergencies. This review also identified pressing areas for further inquiry to strengthen science advice for public health in Canada, including to assess the independence of science advisory actors and the interaction between federal and subnational authorities. [ABSTRACT FROM AUTHOR]

Background: Following the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics-one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this framework from young people's perspectives, informed by advances in childhood ethics and children's rights.Main Body: In this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted-aligned with the approach used by Thompson and colleagues-to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health.Conclusion: Efforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts. [ABSTRACT FROM AUTHOR]

Many governments in the world reacted to the coronavirus disease 2019 pandemic by swiftly offering stimulus packages to their populations. While public unpreparedness was dramatic, it was not unexpected: many alarms had been sounded. Strategies by the federal and various provincial governments of Canada in core sectors predisposed the country to the current situation and weakened its capacity to respond adequately. This paper reviews the cumulative effects of these strategic orientations: a deficient investment strategy in fundamental science; disconnect between laboratory work and the country's capacity to produce vaccines and antiviral drugs; the priority of cost efficiency that led to overwhelming dependency on foreign production of medical supplies; and dramatic spending cuts in public health. We will discuss a Mission strategy to exit the crisis that takes a long-term perspective, in which public interest and public health, combined with a strong State leadership, stimulate innovation and collaboration between national and international actors. [ABSTRACT FROM AUTHOR]

The use of participatory visual methods and integration of cellphone technology is expanding in global public health research. Cellphilm method capitalises on these trends by inviting participants to use mobile devices to create short videos about health topics. This paper presents the quilted cellphilm method, which supports the participation of stigmatised populations to engage in research. We present the method with reference to the Celling Sex project, which worked with young women who have transactional sex experience. Four key steps in our unique model are discussed: (a) individual cellphilm-making; (b) participatory analysis; (c) creating a composite video; (d) publicly screening the work. We consider how working individually with participants in the cellphilm-making process built trust. We unpack how offering participants opportunities to engage in either group or one-on-one activities promoted participation in collaborative analysis. We outline how creating a composite video of the cellphilms and organising screenings facilitated knowledge translation and exchange. Overall, the quilted cellphilm method created a supportive community for vulnerable participants to generate products that challenged social stigma. Increased reliance on mobile media, especially during the COVID-19 pandemic, makes the quilted cellphilm method an opportune, exciting and accessible approach for participatory public health research. [ABSTRACT FROM AUTHOR]

The compassionate community movement as both a public health approach and a social model of care for various life stages is gaining traction in Canada and elsewhere. One example is the Windsor-Essex Compassion Care Community (WECCC), an evidence-based model and set of tools to improve the quality of life, health and wellness of vulnerable and aging populations by identifying and addressing upstream and downstream social and other risks to physical and mental health. This paper presents findings from the WECCC pilot evaluation. The WECCC initiative provided one-on-one volunteer-supported quality of life assessment, resource navigation and goals support program (Catalyzing Community Connections). This was augmented with public education sessions on social connection and loneliness (Importance of Being Connected) for the broader population. The RE-AIM framework was used to frame evaluation of WECCC through the first 4 years. Questionnaires were used to evaluate participant outcomes related to implementation and effectiveness. Interviews and focus groups were completed to understand impacts. From 2017 to 2020, WECCC has engaged over 2,500 individuals, 65 organizations and 400 volunteers combined in both programs. Nearly all (82% to 95%) participants reported positive changes to health, quality of life and/or social connections. This developmental phase of a compassionate community initiative has allowed piloting of an evaluation framework focusing on reach, adoption, implementation and early signals of effectiveness and maintenance. This demonstration provides information on feasibility, acceptability and potential impacts of this type of over-arching community initiative. [ABSTRACT FROM AUTHOR]

Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the country. This accounting of the first 12 months of the pandemic highlights opportunities for a strengthened federal role in the short term, and some important lessons to be applied in preparing for future pandemics. [ABSTRACT FROM AUTHOR]

COVID-19 had an unprecedented impact on transit demand and usage. Stiff and vigilant hygiene safety requirements changed travellers' mode choice preferences during the COVID-19 pandemic. Specifically, transit modal share is radically impacted. Therefore, quantitative measurements on transit demand impact are urgently needed to facilitate evidence-based policy responses to COVID-19. Thus, we collected 1000 random samples through a web-based survey in the Greater Toronto Area (GTA), Canada, on traveler's modal choices behavior during the COIVD-19 pandemic. The paper presents an analysis with this firsthand dataset to understand transit users' behavioral adaptation resulting from the spreading of COVID-19 in 2020. We found that the transit frequency dropped by 21% to 71% for various socioeconomic groups in the GTA during the pandemic. The transit modal share dipped for all trip purposes. For private vehicle owners, around 70% of transit users switched to their private vehicles. More than 60% of those without cars switched to active transport for all travel purposes. Also, ride-hailing services are the second most popular substitution of transit for them. More than 80% of the respondents agreed with all transit safety policies, such as mandatory face-covering listed in the survey. Moreover, a similar proportion of the respondents agreed to return to public transit in the future. Multinomial, nested, and mixed logit models are estimated to capture relationships between modal choices and various factors. We found that the daily number of new COVID-19 cases impacts the choice of transit negatively. However, vaccine availability and mandatory face-covering onboard positively affect travellers' choices of riding transit during the pandemic. [ABSTRACT FROM AUTHOR]

Background: In response to the devastating drug toxicity crisis in Canada driven by an unregulated opioid supply predominantly composed of fentanyl and analogues, safer supply programs have been introduced. These programs provide people using street-acquired opioids with prescribed, pharmaceutical opioids. We use six core components of safer supply programs identified by people who use drugs to explore participant perspectives on the first year of operations of a safer supply program in Victoria, BC, during the dual public health emergencies of COVID-19 and the drug toxicity crisis to examine whether the program met drug-user defined elements of an effective safer supply model. Methods: This study used a community-based participatory research approach to ensure that the research was reflective of community concerns and priorities, rather than being extractive. We interviewed 16 safer supply program participants between December 2020 and June 2021. Analysis was structured using the six core components of effective safer supply from the perspective of people who use drugs, generated through a prior study. Results: Ensuring access to the 'right dose and right drugs' of medications was crucial, with many participants reporting success with the available pharmaceutical options. However, others highlighted issues with the strength of the available medications and the lack of options for smokeable medications. Accessing the safer supply program allowed participants to reduce their use of drugs from unregulated markets and manage withdrawal, pain and cravings. On components related to program operations, participants reported receiving compassionate care, and that accessing the safer supply program was a non-stigmatizing experience. They also reported receiving support to find housing, access food, obtain ID, and other needs. However, participants worried about long term program sustainability. Conclusions: Participants in the safer supply program overwhelmingly appreciated it and felt it was lifesaving, and unlike other healthcare or treatment services they had previously accessed. Participants raised concerns that unless a wider variety of medications and ability to consume them by multiple routes of administration became available, safer supply programs would remain unable to completely replace substances from unregulated markets. [ABSTRACT FROM AUTHOR]

In this article, we apply theories of non-citizenship assemblage to conceptualise the dynamic relationship of social determinants of health for international students in Canada who face barriers to accessing COVID-19 vaccines and verifying their vaccination status. Social workers' roles in responding to and reducing these inequities are also discussed with attention to micro practice, meso service integration, and macro public policy advocacy. Through theorising assembled inequities emerging from Canada's COVID-19 vaccination policies, this article offers guidance for future social work research and practice towards promoting justice and equity for transnational populations who are often excluded from domestic social welfare programmes. [ABSTRACT FROM AUTHOR]

Background: Public Health Ontario (PHO) infection prevention and control (IPAC) specialists provided field support during the COVID-19 pandemic by conducting on-site and virtual IPAC assessments to long-term care and retirement homes (LTC/RHs) between April 2020 and June 2021. Reports from these IPAC assessments were analyzed and the most common challenges were identified. Methods: IPAC specialists in collaboration with local public health units (PHU) conducted 139 on-site and 33 virtual visits to LTC/RHs in Ontario, using an assessment tool developed by PHO. Following each assessment, a report with findings and recommendations for enhancing IPAC practices in the LTC/RHs were shared with the home and PHU. A thematic analysis of the reports found common challenges in several areas. Results: Analysis of 172 assessment reports identified challenges and gaps in several areas resulting in a total of 415 recommendations made to LTC/RHs. Recommendation areas addressed included: personal protective equipment (PPE) use -- 115 (28%), screening process -- 89 (21%), physical distancing -- 66 (16%), environmental cleaning -- 66 (16%), hand hygiene -- 44 (11%), cohorting -- 26 (6%), and other areas -- 9 (2%). Inappropriate use and reuse of PPE, such as universal wearing of full droplet and contact PPE regardless of resident COVID-19 status and double masking were observed. Other common themes included incorrect screening and physical distancing practices, and improper use of the disinfecting wipes and cleaning products. Often, there was no defined process for cleaning high-touch surfaces or tracking when cleaning had occurred and deficiencies in the auditing process were noted. Conclusion: These findings highlight pre-existing IPAC challenges as well as new issues in LTC/RHs infection prevention and control efforts. The data in this report may be useful in identifying additional actions to support the needs of IPAC leads in these settings. Comprehensive support through coaching/mentorship, and the creation of resources to implement IPAC programs and capacity-building interventions with LTC/RH IPAC leads are needed. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Law & Society/Revue Canadienne Droit et Societe (Cambridge University Press) is the property of Cambridge University Press 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Evidence is building regarding the association between government implemented public health measures aimed at combating COVID-19 and their impacts on health. This study investigated the relationship between the stringency of public health measures implemented in Canada and self-reported mental health, physical health, stress, and wellbeing among a random sample of 6647 Canadians 18 years of age and older. The analysis was based on self-reported health data from the Canadian Perspectives on Environmental Noise Survey. This data was combined with the Oxford COVID-19 Government Response Tracker database, which included overall stringency index (SI), and four of its sub-components, i.e., school and business closures, restrictions on gatherings, and stay at home policies. Adjusted multivariate logistic regression models indicated that the magnitude of the overall SI was associated with higher or lower odds of reporting worse physical health, mental health, stress and/or overall wellbeing, depending on the measure evaluated. Similarly, policy directed at the four sub-components had varying impacts on the odds of reporting worse health, depending on the sub-component, the strength of the policy restriction, and the health outcome evaluated. The association between the strength of the public health measures and self-reported health, and how this may inform future policy, is discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID-19 pandemic increased demand for app-based platform-based couriers, creating job opportunities for individuals who have lost income because of COVID-19. Through various stages of lockdown, courier workers (e.g., delivering for Uber Eats, Amazon Flex, and Lyft) provide an essential service. At the same time, this form of work poses risks for exposure to the SARS-CoV-2 virus as these workers are highly mobile and in contact with many individuals. OBJECTIVE: To explore how platform-based couriers discuss risks associated with their work during periods of high (first wave, second wave, third wave/rise in concerns regarding variants) and low risk during the COVID-19 pandemic, 2020–2021. METHODS: We provide a narrative analysis of user posts (n = 2,866) on Reddit during periods of interest. RESULTS: Our analysis resulted in three central findings. First, we identified changing patterns in discourse as the pandemic went on. Second, we found that the theme of risk prevailed largely in the first wave, with dialogue dominated by tips and asking for advice about how to manage risk. Third, our findings reveal a growing polarization among users during the latter phases of the study. CONCLUSION: Polarization largely focused on acceptance (or not) of public health measures and the nature of their work as independent contractors and the role/responsibility of courier companies to offer protection. Our study is the first to document risks, from the perspectives of anonymous couriers who may be unwilling to share their honest opinions and thoughts through primary data collection where anonymity is not guaranteed. [ABSTRACT FROM AUTHOR]

News media are an underused source of localized information on complex and structural public health issues that are neglected in policy and unaccounted for in mainstream data collection. We applied systematic review search methods to online news media and developed a dataset highlighting municipal reactions and initiatives in response to public washroom pressures during the first year of the COVID-19 pandemic. Reliance on consumer-based models of washroom access “became news” amid the closures and lockdowns. Our results showed that many municipalities were grappling with the issue, but overwhelmingly responding with temporary and pandemic-specific measures that did not address the needs of marginalized groups. [ABSTRACT FROM AUTHOR]

Play is a human right, yet opportunities for unstructured play are declining. The COVID-19 pandemic further reduced children's play opportunities. We conducted an observational study of a novel community-based intervention (play hubs) that facilitated unstructured play by offering loose parts in parks (Calgary, Canada) during the pandemic. Our descriptive study included systematic observation using the System for Observing Children's Activity and Relationships During Play (SOCARP) and Tool for Observing Play Outdoors (TOPO) to capture physical activity, play, and social and environment interactions among children participating in the play hubs for 10-weeks in 2021 (n = 160) and 2022 (n = 147). Play hub attendance was low. Most children observed were aged 5 to 12 years (2021: 93% and 2022 98%), with boys and girls represented (2021: 58% male/42% female and 2022: 52% male/48% female). Standing, sitting, and moderate activity were common activities. Physical, exploratory, and expressive play were common, while digital, bio, and rule-based play were less common. Children typically played alone or in small groups and engaged with loose parts or played in the open spaces. The play hubs encouraged unstructured play and promoted positive social interactions among children, despite the challenges of implementing a community-based intervention under pandemic public health restrictions. [ABSTRACT FROM AUTHOR]

Background: Aided by a collaborative partnership dating back to 2011, the Canadian Network for Public Health Intelligence (CNPHI) and the Canadian Paediatric Surveillance Program (CPSP) quickly undertook substantial enhancements to the CPSP's data collection instruments on the CNPHI platform to characterize the impacts of the coronavirus disease 2019 (COVID-19) on children and youth in Canada. Faced with an emerging public health threat with impacts yet unknown, the objective of the intervention was to rapidly complete enhancements to existing data collection and analytical tools to enable the CPSP's ability to characterize the impacts of COVID-19 in Canadian children and youth. Intervention: Reporting frequency from CPSP's network of paediatric practitioners was increased from monthly to weekly, and the flexibility of detailed case data collection was substantially enhanced using complex survey instruments, interactively designed using CNPHI's Web Data technology. To ensure their data collection proceeded along all required lines of surveillance, CPSP's data collection tools were enhanced to collect demographic, epidemiological, microbiological and clinical data including comorbidities of cases identified. Outcomes: Less than a month after the World Health Organization declared the COVID-19 pandemic, CPSP was able to start collecting detailed weekly case data on emerging cases of COVID-19 among Canadian children and youth. By May 2020, CPSP was able to launch a detailed study, supporting research into potential risk factors for severe COVID-19-related illness in children and youth. Conclusion: In response to a novel public health threat, CNPHI and CPSP were able to implement rapid adaptations and enhancements to existing data collection instruments while fortifying their preparedness to do the same in the future, when needed. With innovative and agile technologies at the ready, this experience helps to emphasize the importance of established collaborative partnerships across public health disciplines as a factor contributing to preparedness and agility to respond to the unforeseen. Canadian Network for Public Health Intelligence's Web Data technology showed agile adaptability and a capacity for complex and detailed data collection, supporting timely surveillance and response. [ABSTRACT FROM AUTHOR]

Background: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. Methods: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. Results: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. Conclusions: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives. [ABSTRACT FROM AUTHOR]

Environmental Public Health Professionals (EPHPs) are an essential frontline workforce that aims to keep the Canadian population healthy and safe. Our study explores the multidimensional aspects of work-life related Quality of Work (QoW) among EPHPs in Canada. A mixed-method cross-sectional online survey was used. The data collection was completed in September--October 2022 with 96 participants. The study included EPHPs such as Public Health Inspectors and Environmental Health Officers in Canada who are currently working in Canada and during the COVID-19 pandemic and managers/supervisors of EPHPs. Our Study results reveal that there have been significant challenges to ensuring QoW in work-life settings for EPHPs, ranging from negative attitudes from the employer, challenges with varying guidelines due to geographic locations of health authorities, and increased levels of workload leading to stress, anxiety, depression and burnout -- all of which has affected the work-life balance and mental health and well-being of EPHPs. [ABSTRACT FROM AUTHOR]

Research documenting the impact of COVID-19 on Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) populations in Canada is limited. Our objectives were to investigate the impact of COVID-19 lockdown measures on the lives of trans, nonbinary, and other gender nonconforming (TGNC) people. Engage COVID-19 is a mixed methods study examining the impact of COVID-19 on gay, bisexual, queer, and other men who have sex with men (GBQM) living in Vancouver, Toronto, and Montreal, Canada. Using purposive sampling, we conducted in-depth qualitative interviews (between November 2020–February 2021 and June–October 2021) with 93 participants who discussed the impact of COVID-19 on their lives. Seventeen participants were identified as TGNC. TGNC participants reported barriers to trans healthcare during the initial months of the COVID-19 pandemic. Several participants indicated that some public health interventions during COVID-19 (i.e., lockdowns) eased the pressure to "perform" gender due to fewer in-person interactions. During lockdowns, TGNC participants increasingly cultivated community networks online. Nevertheless, participants reported longing for the social support that was available to them during pre-COVID. Lack of access to community spaces during lockdowns had a negative impact on participants' mental health, despite reduced pressure to perform gender and opportunities for social engagement in online spaces. [ABSTRACT FROM AUTHOR]

As cases of COVID-19 began to increase in Ontario, Canada, throughout 2020, early evidence from surveillance and media highlighted disproportionately higher rates of COVID-19 infection, hospitalization and mortality among racialized and low-income populations. This disproportionate impact on underserved populations calls for a shift in approach away from what has traditionally occurred in health protection, that is the use of a universal approach which assumes everyone is affected and benefits equally from the same type and intensity of interventions. In this article, public health agencies are, therefore, being called to consider moving away from using a purely universal approach, often used in the control of communicable diseases, and apply a more tailored approach and use principles of health equity and proportionate universalism to reduce COVID-19 cases and their impacts among underserved groups and address health inequities exacerbated by the pandemic. We highlight examples from York Region Public Health, one of the largest health units in Ontario, to demonstrate areas of possible impact of this paradigm shift. It is clear that with a health equity lens applied to the pandemic response, the impact of COVID-19 can be further reduced and health inequities that predated the global pandemic can improve. [ABSTRACT FROM AUTHOR]

This exploratory study examines the likely causes of the alarming global rise of antisemitism during the COVID-19 pandemic. Beginning with an appraisal of today's world Jewry, this exploratory study highlights the main social, health, and religious impacts COVID-19 has had on Jews worldwide and goes on to highlight how various Jewish communities managed and adjusted to COVID-19 public health restrictions. From this contextual backdrop, an assessment of how and why antisemitism has surged during the pandemic is presented, along with a review of what efforts are being taken to curtail this rise in hatred toward Jews. A central aim of this study is to underline the point that until meaningful, broad, and international steps are taken to curb online hate, the historic antisemitic tropes and myths suggesting Jews are the cause of disease will undoubtedly evolve and surge (especially across social media) during future pandemics and times of global crisis and unrest. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlighted and exacerbated inequities in health for structurally marginalised Canadians. Their location on society's hierarchies constrained their ability to access healthcare and follow recommended health behaviours. The aim of this article is to identify, from the perspective of marginalised populations, factors influencing the acceptance or rejection of COVID-19 countermeasures by structurally marginalised Canadians. Interviews were conducted with Canadians 18 + who identified as Black (n = 8), First Nations, Métis, or Inuit (n = 7) and low-income (<40,000 annual household income) (n = 8) between August and December 2021. Measures were said to impact well-being and interfere with revenue generating activities. Longstanding unfavourable living and environmental conditions as they relate to structural marginalisation was said to fuel anger toward the government and lead to a greater reluctance to accept countermeasures. Participants described concerns about government decisions being made without considering their unique contexts, or knowledge of the experiences of the population for whom these decisions were being made. Effective proactive action from government is important to foster trust with marginalised populations to support acceptance of health information and address growing inequities. Action that demonstrates government competence and commitment to the interests of marginalised populations is critical. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had broad impacts on individuals, families and communities which will continue to require multidimensional responses from service providers, program developers, and policy makers. Objectives: The purpose of this study was to use Life Course theory to understand and imagine public health and policy responses to the multiple and varied impacts of the COVID-19 pandemic on different groups. Methods: "The Cost of COVID-19" was a research study carried out in Kingston, Frontenac, Lennox and Addington counties in South Eastern Ontario, Canada, between June and December 2020. Data included 210 micronarrative stories collected from community members, and 31 in-depth interviews with health and social service providers. Data were analyzed using directed content analysis to explore the fit between data and the constructs of Life Course theory. Results: Social pathways were significantly disrupted by changes to education and employment, as well as changes to roles which further altered anticipated pathways. Transitions were by and large missed, creating a sense of loss. While some respondents articulated positive turning points, most of the turning points reported were negative, including fundamental changes to relationships, family structure, education, and employment with lifelong implications. Participants' trajectories varied based on principles including when they occurred in their lifespan, the amount of agency they felt or did not feel over circumstances, where they lived (rural versus urban), what else was going on in their lives at the time the pandemic struck, how their lives were connected with others, as well as how the pandemic impacted the lives of those dear to them. An additional principle, that of Culture, was felt to be missing from the Life Course theory as currently outlined. Conclusions: A Life Course analysis may improve our understanding of the multidimensional long-term impacts of the COVID-19 pandemic and associated public health countermeasures. This analysis could help us to anticipate services that will require development, training, and funding to support the recovery of those who have been particularly affected. Resources needed will include education, mental health and job creation supports, as well as programs that support the development of individual and community agency. [ABSTRACT FROM AUTHOR]

Aims: Government alcohol sales data were used to examine whether age 15+ per‐capita alcohol consumption (PCAC) (i) changed during COVID‐19 and (ii) predicted COVID‐19 infections 2–5 weeks later. Design: Interrupted time‐series analyses were applied to panels of data before and after COVID‐19 restrictions were introduced in Canada. Setting and participants: The populations, aged 15+, of the provinces of Ontario (ON), British Columbia (BC) and Nova Scotia (NS), Canada. Intervention: Expansion of home delivery options and hours of trading for liquor stores while restrictions on travel, social and economic activities were imposed by governments during COVID‐19 from 17 March 2020 until 29 March 2021. Measurements Weekly estimates of (i) age 15+ PCAC using sales data supplied by provincial government alcohol distributors for liquor stores, bars and restaurants, (ii) stringency of public health measures assessed by the Public Health Agency of Canada (PHAC) and (iii) new COVID‐19 infections reported by PHAC. Findings PCAC increased by 7.10% (P = 0.013) during the pandemic versus previous years, with increased private liquor store sales partly offset by reduced bar/restaurant sales. Consumption was positively associated with stringency of public health measures. Weekly PCAC was positively associated with new COVID‐19 infections 2 weeks later (+6.34% for a one drink/week increase, P < 0.001). Lagged associations with COVID‐19 infections 2 or 3 weeks later were observed for PCAC from all sales channels, with larger effect sizes per standard drink/person/week increase for on‐premise outlets (+77.27% week 2, P = 0.009) than government liquor stores (+6.49%, week 2, P < 0.001) or private liquor stores (+7.13%, week 4, P < 0.001). Conclusions: Alcohol consumption increased in three Canadian provinces during COVID‐19 to degrees corresponding to the extent of the strictness of measures imposed to prevent viral spread. Increased consumption of alcohol was associated with increased COVID‐19 infection rates 2 weeks later. [ABSTRACT FROM AUTHOR]

Medically trained health professionals have been central to the development of policy responses to the coronavirus 2019 (COVID‐19) crisis. In their multiple roles—as clinicians, public health leaders, members of scientific advisory boards, and also as media pundits and health professionals—they have helped shape discourses of science‐based policy options during the first 2 years of the pandemic. In particular, health professionals as a collective voice insisted on the necessity of society‐wide measures of social control to curb the morbidity and mortality of the virus. These measures, in turn, informed the political and moral imagination of the political class, the media and the larger public. Yet, as emerging evidence suggests, measures of social control posed a serious and long‐term risk for health equity. In this discussion piece on the first 2 years of COVID‐related public health directives, we interrogate the tensions that advocating for extensive and protracted measures of social control can pose to the social contract between medicine and society, health equity and democracy. To illustrate these tensions, we discuss the public fallout between vocal members of the OSAT, an ad hoc biomedical‐led organization, and the Government of Ontario in light of the disagreement on the scope of 'stay home' orders to manage the third wave of the pandemic in the Spring of 2021 and, more recently, the mass protest against mass‐scale public health measures in Ottawa, Canada. We argue that while decision making under emergency conditions is a difficult task, the legitimacy of the social contract between medicine and society depends on medical experts' judicious exercise of public health ethics principles. We offer a set of recommendations for building a more collaborative response to future health crises. [ABSTRACT FROM AUTHOR]

Introduction: As a largely social behaviour, substance use may have decreased for some youth overall in Canada during the COVID-19 pandemic; however, continued use may indicate nonadherence to pandemic-related restrictions and social distancing measures. In a sample of Canadian adolescents (aged 12-19 years), our objective was to examine how substance use (cannabis, binge drinking, cigarettes, vaping) is associated with perceptions of, and adherence to, early COVID-19-related public health measures, taking into consideration sociodemographic factors. Methods: Cross-sectional data were retrieved from online data collected during Year 8 of the COMPASS school-based study, during the early months of the COVID-19 pandemic (May-July 2020) in British Columbia, Ontario and Quebec. We fitted two models using generalized estimating equations to examine how substance use was associated with separate measures of (1) perceptions of, and (2) adherence to early COVID-19 restrictions. Results: In our sample, 10% of adolescents perceived COVID-19 restrictions as too weak and 14% perceived them as too strict. Nearly half (46%) reported taking restrictions very seriously, and 5% did not take them seriously at all. Binge drinking, cigarette use and vaping were associated with perceptions that restrictions were too strict and with nonadherence. However, adolescents who used cannabis were less likely to perceive COVID-19-related restrictions as too strict. Conclusion: This study highlights the association of adolescent substance use with perceptions of, and adherence to, COVID-19-related public health restrictions in Canada. Our findings emphasize a need for continual monitoring of substance use behaviours during the COVID-19 pandemic to better characterize adolescent risk and further inform targeted public health strategies accordingly. [ABSTRACT FROM AUTHOR]

Public health responses to the COVID‐19 pandemic, such as business restrictions, social distancing and lockdowns, had social and economic impacts on individuals and communities. Caremongering Facebook groups spread across Canada to support vulnerable individuals by providing a forum for sharing information and offering assistance. We sought to understand the specific impacts of Caremongering groups on individuals 1 year after the pandemic began. We used a convergent parallel mixed‐methods approach that included semi‐structured interviews with group moderators from 16 Caremongering groups and survey data from 165 group members. We used a constant comparative approach for thematic analysis of interview transcripts and open‐ended text responses to the survey. We used source theme tables as joint displays to integrate interview and survey findings. Our results revealed five major themes: providing food, sharing information, supporting health and wellness, acquiring goods and services (non‐food), and connecting communities. Respondents of our survey tended to be 35–65 years of age range, but reported helping adults of all ages. Our findings illustrate the potential of using a social media platform to connect with others and provide and access support. The Caremongering initiative demonstrates a community‐driven, social media solution to issues such as isolation, loneliness and community health promotion. [ABSTRACT FROM AUTHOR]

The effects of the coronavirus disease‐2019 (COVID‐19) pandemic on the lives of underserved populations are underexplored. This study aimed to identify the impacts of the COVID‐19 pandemic and associated public health responses on the health and social well‐being, and food security of users of Housing First (HF) services in Toronto (Canada) during the first wave of the COVID‐19 pandemic. This qualitative descriptive study was conducted from July to October 2020 in a subsample of 20 adults with a history of homelessness and serious mental disorders who were receiving HF services in Toronto. A semi‐structured interview guide was used to collect narrative data regarding health and social well‐being, food security and access to health, social and preventive services. A thematic analysis framework guided analyses and interpretation of the data. The COVID‐19 pandemic and response measures had a variable impact on the health, social well‐being and food security of participants. Around 40% of participants were minimally impacted by the COVID‐19 pandemic. Conversely, among the remaining participants (impacted group), some experienced onset of new mental health problems (anxiety, stress, paranoia) or exacerbation of pre‐existing mental disorders (depression, post‐traumatic stress disorder and obsessive‐compulsive disorder). They also struggled with isolation and loneliness and had limited leisure activities and access to food goods. The pandemic also contributed to disparities in accessing and receiving healthcare services and treatment continuity for non‐COVID‐19 health issues for the negatively impacted participants. Overall, most participants were able to adhere to COVID‐19 public health measures and get reliable information on COVID‐19 preventive measures facilitated by having access to the phone, internet and media devices and services. In conclusion, the COVID‐19 pandemic and associated response measures impacted the health, social well‐being, leisure and food security of people with experiences of homelessness and mental disorders who use supportive social and housing services in diverse ways. [ABSTRACT FROM AUTHOR]

Background: The mental health of healthcare workers (HCWs) has been at the forefront throughout the COVID-19 pandemic. While workplace-based support programs have been developed in hospitals globally, few systematically collected data. While critical to their success, information on these programs and the experience of mental healthcare providers (MHP) who support colleagues is limited. The objective of this study was to explore the experiences of MHP caring for HCW colleagues within a novel workplace-based mental health support program during the COVID-19 pandemic, to provide insights on facilitators, areas for improvement and barriers to program sustainability. Methods: This qualitative study used semi-structured interviews conducted by videoconference between September 2020 to October 2021. UHN CARES (University Health Network Coping and Resilience for Employees and Staff) Program was developed during the first wave of the COVID-19 pandemic in March 2020. It supports over 21,000 staff members within the UHN, Canada's largest academic health research institution, in Toronto, Canada. Purposive sampling was used to select 10 of the 22 MHP in the UHN CARES Program (n = 10). Using a critical realism framework, key components required to sustain a successful workplace-based mental health support program for HCWs and balance the needs of MHP were determined. Results: Six psychiatrists and four psychologists (n = 10) with varying roles at UHN participated in 17 interviews, including seven repeat interviews exploring changes over time within the pandemic and program. Components which facilitated the success of the program included flexibility in scheduling, confidential health record storage, comprehensive administrative support, availability of resources and adaptive quality improvement approach. Recommendations for improvement included opportunities for peer supervision, triaging of cases, and managing HCW expectations. MHP found caring for HCWs to be meaningful and they utilized existing clinical skills during sessions. Challenges included working in a virtual setting, navigating boundaries when caring for colleagues, and managing the range of service users and their needs. Conclusions: These findings suggest how support programs can be structured for HCWs, how to provide support, and how to sustain this support, allowing health systems to balance the needs of HCWs and MHPs in preparation for future public health emergencies. [ABSTRACT FROM AUTHOR]

Background: Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. Objective: We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support-related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. Methods: This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI =85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children's physical activity, dietary and sedentary behaviors, and screen time, and the parent's support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. Results: Both the virtual and blended GH programs improved children's moderate-to-vigorous physical activity (F1,380=18.37; P<.001; ηp2=0.07) and reduced screen time (F1,380=9.17; P=.003; ηp2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; ηp2=0.004). Parents in both groups showed significant improvements in support behaviors for children's physical activity (F1,380=5.55; P=.02; ηp2=0.002) and healthy eating (F1,380=3.91; P<.001; ηp2=0.01), as well as self-regulation of parental support for children's physical activity (F1,380=49.20; P<.001; ηp2=0.16) and healthy eating (F1,380=91.13; P<.001; ηp2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). Conclusions: The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support-related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions. [ABSTRACT FROM AUTHOR]

Background: Along with rapid diagnostic testing, contact tracing, and public health measures, an effective pandemic response incorporates genomics-based surveillance. Large-scale SARS-CoV-2 genome sequencing is a crucial component of the global response to COVID-19. Characterizing the state of genomics readiness among Canada's public health laboratories was necessary to inform strategic planning and deployment of capacity-building resources in the early stages of the pandemic.Methods: We used a qualitative study design and focus group discussions, encompassing both technical and leadership perspectives, to perform an in-depth evaluation of the state of pathogen genomics readiness in Canada.Results: We found substantial diversity in the state of readiness for SARS-CoV-2 genomic surveillance across Canada. Despite this variability, we identified common barriers and needs in the areas of specimen access, data flow and sharing, computing infrastructure, and access to highly qualified bioinformatics personnel.Conclusions: These findings enable the strategic prioritization and deployment of resources to increase Canada's ability to perform effective public health genomic surveillance for COVID-19 and prepare for future emerging infectious diseases. They also provide a unique qualitative research model for use in capacity building. [ABSTRACT FROM AUTHOR]

Introduction: Household food insecurity (HFI) is a persistent public health issue in Canada that may have disproportionately affected certain subgroups of the population during the COVID-19 pandemic. The purpose of this systematic review is to report on the prevalence of HFI in the Canadian general population and in subpopulations after the declaration of the COVID-19 pandemic in March 2020. Methods: Sixteen databases were searched from 1 March 2020 to 5 May 2021. Abstract and full-text screening was conducted by one reviewer and the inclusions verified by a second reviewer. Only studies that reported on the prevalence of HFI in Canadian households were included. Data extraction, risk of bias and certainty of the evidence assessments were conducted by two reviewers. Results: Of 8986 studies identified in the search, four studies, three of which collected data in April and May 2020, were included. The evidence concerning the prevalence of HFI during the COVID-19 pandemic is very uncertain. The prevalence of HFI (marginal to severe) ranged from 14% to 17% in the general population. Working-age populations aged 18 to 44 years had higher HFI (range: 18%–23%) than adults aged 60+ years (5%–11%). Some of the highest HFI prevalence was observed among households with children (range: 19%–22%), those who had lost their jobs or stopped working due to COVID-19 (24%–39%) and those with job insecurity (26%). Conclusion: The evidence suggests that the COVID-19 pandemic may have slightly increased total household food insecurity in Canada during the pandemic, especially in populations that were already vulnerable to HFI. There is a need to continue to monitor HFI in Canada. [ABSTRACT FROM AUTHOR]

Introduction: We explored associations between sociodemographic factors and public beliefs, behaviors, and information acquisition related to the coronavirus disease 2019 (COVID-19) to identify how the experiences of subpopulations in Canada may vary.Methods: We administered a national online survey through Ipsos Incorporated to adults residing in Canada. Sampling was stratified by population age, sex, and regional distributions. We used descriptive statistics to summarize responses and test for differences based on gender, age, educational attainment, and household income using chi-squared tests, followed by weighted logistic regression.Results: We collected 1996 eligible questionnaires between April 26th and May 1st, 2020. Respondents mean age was 50 years, 51% were women, 56% had a post-secondary degree, and 72% had a household income <$100,000. Our analysis found differences within the four demographic groups, with age effects most acutely evidenced. Respondents 65 years and older were more likely to perceive the pandemic as very serious, less likely to report declines in overall health, and more likely to intend to get vaccinated, compared to 18-29 year olds. Women overall were more likely to report negative outcomes than men, including stress due to the pandemic, and worsening social, mental/emotional, and spiritual health. Respondents 45 and older were more likely to seek and trust information from traditional Canadian news sources, while 18-29 year olds were more likely to seek and trust information on social media; overall, women and respondents with a post-secondary degree were more likely to access and trust online information from public health sites.Conclusion: This study found important demographic differences in how adults living in Canada perceived the COVID-19 pandemic, the impacts on their health, and their preferences for information acquisition. Our results highlight the need to consider demographic characteristics in tailoring the format and information medium to improve large scale acceptance and uptake of mitigation and containment measures. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic poses mental health challenges to frontline healthcare workers. Eye care professionals may be especially susceptible to mental health problems due to high-risk exposures to patients. Yet, no prior research has studied mental health issues among eye care professionals during the COVID-19 pandemic. Objective: The purpose of this study was to identify risk factors for mental health problems during the COVID-19 pandemic among eye care professionals. Methods: We conducted a cross-sectional survey study among eye care professionals and students in the United States and Canada from June 23 to July 8, 2020 during the COVID-19 pandemic. A total of 8505 eye care professionals and students received email invitations to the survey and 2134 participated. We measured mental health outcomes including symptoms of depression, anxiety, and stress using validated scales, as well as potential risk factors including demographic characteristics, state-level COVID-19 case counts, participants' patient interactions, childcare responsibilities, and pre-pandemic stress levels. Linear multiple regression and logistic regression analyses were used to determine relationships between risk factors and mental health outcomes. Results: We found that 38.4% of eyecare professional participants in the survey met screening threshold as probable cases of anxiety, depression, or both during the COVID-19 pandemic. Controlling for self-reported pre-pandemic stress level and state COVID-19 case daily cases, significant risk factors for depression, anxiety, and psychological stress during the COVID-19 pandemic included: being female, younger age, and being Black or Asian. Interestingly, we found two somewhat surprising protective factors against depression symptoms: more frequent interactions with patients and having a greater proportion of childcare responsibilities at home. Conclusions: This study showed a high prevalence of mental health problems and revealed disparities in mental health among eye care personnel and students: Female, younger, Black, and Asian populations are particularly vulnerable to mental health issues. These results indicate that it is critical to identify mental health issues more effectively and develop interventions among this population to address this significant and growing public health issue. The strategies and policies should be reflective of the demographic disparities in this vulnerable population. [ABSTRACT FROM AUTHOR]

Early in the COVID-19 pandemic, Canadians faced much ambiguity in the public health messages around face mask use. As public health messaging plays a pivotal role in the provision of directives during a health crisis, this study examines Canadians' opinions on the early messaging they received regarding personal protection, especially around mask use, with the goal of identifying potential improvements to strengthen future health messaging. Nine online focus group interviews with 47 Canadians were conducted. These natural conversations focused on personal protective equipment (PPE) choices, mask-relevant public health information sources, and advice to Canadian authorities to improve public health messaging on mask use. Responses were imported into NVivo for thematic analysis. Four meta-themes of relevance were identified. Despite demonstrating trust in scientific evidence and public health authorities, the inconsistencies in public health messaging fostered confusion, and induced mistrust toward health professionals. Further, several information deficits were identified pertaining to the scientific efficacy, safe use, and disposal of masks. Rooted in loyalty to healthcare workers, these Canadians eschewed using medical grade masks during PPE shortages to ensure a sufficient supply for medical workers. The findings stress that consistency in public health messages should be prioritized, with necessary changes clearly justified and explained. More information should reach the public on the scientific benefits and proper use of masks. Public health recommendations should be evidence-based, simple, transparent, and realistic in the current circumstances to guide Canadians to make more informed personal protection choices in the rapidly evolving pandemic. [ABSTRACT FROM AUTHOR]