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Background: The COVID-19 pandemic has had a negative impact on the mental health of people with intellectual and developmental disabilities. Numerous pandemic-related stressors experienced by people with intellectual and developmental disabilities may have impacted their ability to thrive, which has been linked to mental health outcomes. The current study examined the associations among COVID-19 stressors, thriving, and mental health problems among youth and adults with intellectual and developmental disabilities., Method: Caregivers of 159 people with intellectual and developmental disabilities between 12 and 35 years of age from Canada completed an online questionnaire., Results: A mediation analysis revealed that COVID-19 stressors were positively associated with mental health problems, and that thriving partially mediated this association., Conclusion: Our findings suggest that experiences of thriving may be an important target for mental health support for people with intellectual and developmental disabilities., (© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

The COVID-19 pandemic led to the widespread adoption of virtual care-the use of communication technologies to receive health care at home. We explored the differential impacts of the rapid transition to virtual care during the COVID-19 pandemic on health-care access and delivery for gay, bisexual and queer men (GBQM), a population that disproportionately experiences sexual and mental health disparities in Canada. Adopting a sociomaterial theoretical perspective, we analysed 93 semi-structured interviews with GBQM (n = 93) in Montreal, Toronto and Vancouver, Canada, conducted between November 2020 and February 2021 (n = 42) and June-October 2021 (n = 51). We focused on explicating how the dynamic relations of humans and non-humans in everyday virtual care practices have opened or foreclosed different care capacities for GBQM. Our analysis revealed that the rapid expansion and implementation of virtual care during the COVID-19 pandemic enacted disruptions and challenges while providing benefits to health-care access among some GBQM. Further, virtual care required participants to change their sociomaterial practices to receive health care effectively, including learning new ways of communicating with providers. Our sociomaterial analysis provides a framework that helps identify what works and what needs to be improved when delivering virtual care to meet the health needs of GBQM and other diverse populations., (© 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Aim: We sought to describe the impact of the COVID-19 pandemic on the care provided by Canadian emergency medical system (EMS) clinicians to patients suffering out of hospital cardiac arrest (OHCA), and whether any observed changes persisted beyond the initial phase of the pandemic., Methods: We analysed cases of adult, non-traumatic, OHCA from the Canadian Resuscitation Outcome Consortium (CanROC) registry who were treated between January 27th, 2018, and December 31st, 2021. We used adjusted regression models and interrupted time series analysis to examine the impact of the COVID-19 pandemic (January 27th, 2020 - December 31st, 2021)on the care provided to patients with OHCA by EMS clinicians., Results: There were 12,947 cases of OHCA recorded in the CanROC registry in the pre-COVID-19 period and 17,488 during the COVID-19 period. We observed a reduction in the cumulative number of defibrillations provided by EMS (aRR 0.91, 95% CI 0.89 - 0.93, p < 0.01), a reduction in the odds of attempts at intubation (aOR 0.33, 95% CI 0.31 - 0.34, p < 0.01), higher rates of supraglottic airway use (aOR 1.23, 95% CI 1.16-1.30, p < 0.01), a reduction in vascular access (aOR for intravenous access 0.84, 95% CI 0.79 - 0.89, p < 0.01; aOR for intraosseous access 0.89, 95% CI 0.82 - 0.96, p < 0.01), a reduction in the odds of epinephrine administration (aOR 0.89, 95% CI 0.85 - 0.94, p < 0.01), and higher odds of resuscitation termination on scene (aOR 1.38, 95% CI 1.31 - 1.46, p < 0.01). Delays to initiation of chest compressions (2 min. vs. 3 min., p < 0.01), intubation (16 min. vs. 19 min., p = 0.01), and epinephrine administration (11 min. vs. 13 min., p < 0.01) were observed, whilst supraglottic airways were inserted earlier (11 min. vs. 10 min., p < 0.01)., Conclusion: The COVID-19 pandemic was associated with substantial changes in EMS management of OHCA. EMS leaders should consider these findings to optimise current OHCA management and prepare for future pandemics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

This paper considers the social role of collaborative ethnographic research amid our current intersecting social, political and ecological crises. It investigates how the multi-sited, arts-based, ethnographic study, "Global Youth (Digital) Citizen-Artists and their Publics: Performing for Socio-Ecological Justice (2019-2024)," adopts drama as a tool to at once respond compassionately and imaginatively to crisis, and envision alternative social, political and ecological futures in its wake. A "metho-pedagogical" paradigm is mobilized as a framework to consider how drama is put to work, methodologically and pedagogically, at a time of climate emergency and pandemic. This framework is illustrated across two vignettes, which attend to the social challenges and impacts of emergent drama-based ethnographic research across two years of the study, in varying geographic locations with different cultural orientations, in live classrooms and in virtual theatre spaces. Attention, risk, desire, trust and reciprocity emerge as important proposals for engaging in arts-led research with youth in these times.

Canadian social workers were surveyed about early adversities, mental health, and resilience. Bivariate analysis (n = 236) was conducted to understand relationships between predictor and outcome variables; and logistic regression analyses were conducted for depression, post-traumatic stress disorder, anxiety, and resilience. The impact of pandemic-related factors was also investigated. The results indicate that social workers are experiencing concerning levels of mental health issues, with significantly lower levels of resilience in younger social workers. A trauma and resilience informed approach to workplace policies and practices is urgently required to support social workers' mental health needs. [ABSTRACT FROM AUTHOR]

This paper is located within a larger study of children's voice and storytelling. The focus is on how children use artifacts, such as special objects and photographs, to tell stories about their lives. We studied the collaborative learning of educators, in two schools in Eastern Canada, as they used sharing circles and multimodal pedagogies, and worked to elevate and listen to children's voices during a period of pandemic teaching. This study examines children's things/artifacts as material culture and relates things/artifacts to artifactual literacies. The action research design included a consideration of children's voice in early years research alongside the collaborative professional development inquiry undertaken by educators in the study. An analysis of key findings as they relate to evolving pedagogies, including how artifacts were used to tell stories, and how voice can be viewed through this artifact sharing is presented. We argue that building voice and collaboration can result from pedagogies of classroom sharing and listening. Educators' challenges in this research and their classroom teaching during a constantly shifting set of teaching conditions are fore fronted. Insights from children's particular artifacts and their stories enhanced educator and peer awareness of difference, and of cultural practices in families. Finally, implications for practice, and future research possibilities are presented, along with an argument for viewing children's voice as emergent alongside classroom multimodal pedagogical practices that augment children's voices.

The COVID-19 pandemic had a significant impact on university enrollments around the world and caused significant challenges for students. This study examined how Canadian universities responded to the financial impacts of the pandemic on international and domestic students and how these responses differed. This work involved the identification and collection of public statements issued by selected Canadian universities during the first two years of the pandemic. This consisted of about 14,000 items posted on university public websites. Under the broad framework of the ecological theory of inclusion, an emergent theme content analysis was used to examine and organize data. This analysis confirmed that there was far less financial assistance provided to international students, and the amount of assistance provided to them was significantly disproportionate to the overall revenues generated by their enrollment at Canadian institutions. [ABSTRACT FROM AUTHOR]

This paper presents the results of a collaborative study highlighting the pedagogical approaches used by faculty during visits to the Musée acadien de l'Université de Moncton (MAUM). This qualitative-based study was conducted with a sample of nine participants representing various disciplines from three major faculties. Thematic analysis revealed the main themes related to the pedagogical practices used by the participants: teaching and learning models, pedagogical approaches, and methods. The results indicate that the faculty preferred collaborative, project-based, experiential, and inter- and trans-disciplinary approaches. This study initiated discussions among professors about teaching practices used by faculty members during distance learning. Innovative thoughts have emerged from e-learning practices used by faculty during the Covid-19 pandemic. Feedback from students contributed greatly to enriching and evolving the approaches. The cross-referencing of the results has made it possible to identify tools for inspiring pedagogical approaches, whatever the subject being taught.

In this paper, we report on data from 40 middle and secondary school mathematics teachers and teacher candidates as they begin to articulate the intersection of language-friendly pedagogy, mathematics teaching, and a multilingual technological tool by way of a two-hour introductory workshop. We use an Anthropological Theory of the Didactic which recognises that mathematics instruction and language instruction are done differently under distinct institutional conditions (curriculum, culture, language, etc.) to analyse our data. Our findings suggest that teachers' beliefs and perspectives regarding their multilingual students guide their choices about how to use a powerful digital multilingual platform to either remediate what they perceive as deficits in their students or leverage the assets of multilingual learners.

The aim of this study was to explore the sociodemographic and individual-level factors associated with vaccine hesitancy in general, including political affiliation and beliefs in vaccine conspiracy theories, in a diverse group of Canadian adults within the context of the COVID-19 pandemic. 641 responses were included in the analysis, with those self-identifying as Indigenous, Black Canadian, and low-income (household income <$40,000) being sampled to yield data from historically marginalized populations. Demographic variables and responses to questions on vaccine hesitancy, and beliefs in vaccine conspiracy theories were used to explore explanatory variables of vaccine hesitancy. General linear regression models were fit using the method of least squares via PROC GLM and used to examine sociodemographic and individual explanatory variables of vaccine hesitancy. Age, ethnicity, political affiliation, and beliefs in vaccine conspiracies were associated with vaccine hesitancy. Findings are discussed in relation to the critical role of distrust and misinformation in hesitancy. Our data provide insight into how Canadian provincial governments may promote uptake of vaccines in ways that target diverse groups that may differ from those developed in a pre-pandemic context., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Since the approval of SARS-CoV-2 vaccines for younger children (those under the age of 12), uptake has been low. Despite widespread vaccination among older children and adults, these trends may undermine public health efforts to manage future waves of SARS-CoV-2 or spill over into other childhood vaccines. The objectives of this study were to understand parents' intentions to vaccinate their children (under age 12) against SARS-CoV-2, and to explore reasons for and against SARS-CoV-2 vaccination., Methods: A representative sample of parents of school-aged children (ages 3-11 years) from Canada's four largest provinces were invited in June 2021 to complete a survey on the impact of COVID-19 on schooling. The survey included specific questions on parents' intentions to vaccinate their child(ren) against SARS-CoV-2. Multinomial regression models were run to estimate associations between demographic factors, political affiliation and voting, concerns about individual / family health and vaccination intention., Results: A total of 74.0 % of parents (n = 288) intended to vaccinate their children with the SARS-CoV-2 vaccine, 18.3 % (n = 71) did not intend to vaccinate and 7.7 % (n = 30) were unsure. The strongest predictor of parental hesitancy was whether a parent had themselves been vaccinated. Other factors including past voting behaviour, dissatisfaction with the government's response to the pandemic, and relatively less concern about contracting SARS-CoV-2 were also correlated with hesitancy. Parents of older children were more likely to indicate plans to vaccinate their child(ren). Analysis of the reasons for hesitancy showed parents are concerned about the safety and side effects of the vaccine, as well as with processes of testing and approval., Interpretation: A considerable proportion of Canadian parents of younger school-aged children (ages 3-11) were unsure and/or hesitant about vaccinating their children against SARS-CoV-2. As well, a much larger proportion who are not necessarily hesitant have also not had their children vaccinated. Given the evolving nature of SARS-CoV-2, including the continued emergence of new variants, reaching younger children will be important for population health. Health providers should continue to work with government institutions to ensure clear communication regarding the safety, efficacy, and importance of child vaccines for reaching public health goals., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

The desire to access personal and high-quality health information electronically is increasing, not only in Canada, but globally. With the advent of the COVID - 19 pandemic the desire and demand for telemedicine and timely access to personal health data such as online laboratory (lab) results has increased substantially. This study examines citizens' perspectives of being provided with high-quality information about a specific lab test (i.e., potassium) in the same display as a trend graph. Therefore, the objective of this study is to test how participants managed this additional information about the context of the test, understood, and applied it. The researchers analyzed the responses of semi-structured interviews with Canadian participants (N=24) using conventional content analysis. This paper examined four themes related to providing complementary information concurrently with lab results in the same display: 1) Benefits of Collocated Information, 2) Information Overload, 3) Misinterpretation, 4) Confusion. This study provided examples of some of the difficulties that the participants faced accessing their lab values online, while navigating and discerning complimentary high-quality health information available in their patient portal.

Background: Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry., Methods: The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols., Results: A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols., Discussion and Conclusion: Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2024 American Dental Hygienists' Association and the Canadian Dental Hygienists Association.)

Early in the COVID-19 pandemic, multiple event stressors converged to exacerbate a growing mental health crisis in Canada with differing effects across status groups. However, less is known about changing mental health situations throughout the pandemic, especially among individuals more likely to experience chronic stress because of their disability and health status. Using data from two waves of a targeted online survey of people with disabilities and chronic health conditions in Canada (N = 563 individuals, June 2020 and July 2021), we find that approximately 25% of respondents experienced additional increases in stress and anxiety levels in 2021. These increases were partly explained by worsening perceived financial insecurity and, in the case of stress, additional negative financial effects tied to the pandemic. This paper understands mental health disparities as a function of social status and social group membership. By linking stress process models and a minority stress framework with a social model of disability, we allude to how structural and contextual barriers make functional limitations disabling and in turn, life stressors., (© 2024 Canadian Sociological Association/La Société canadienne de sociologie.)

Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosol generating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the existing evidence about the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods The authors searched six databases, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar, for relevant scientific evidence published in the last ten years (January 2012 to December 2022) to answer six research questions about the the aspects of risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results A total of 78 studies fulfilled the eligibility criteria. There was limited literature to indicate the risk of infection transmission of SARS-CoV-2 between dental hygienists and their patients. A number of mouthrinses are effective in reducing bacterial contaminations in aerosols; however, their effectiveness against SARS-CoV-2 was limited. The combined use of eyewear, masks, and face shields are effective for the prevention of contamination of the facial and nasal region, while performing AGPs. High volume evacuation with or without an intraoral suction, low volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories are effective in limiting the spread of aerosols. Conclusion Aerosols produced during clinical procedures can potentially pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence are best practices to ensure patient and provider safety in oral health settings. More studies in dental clinical environment would shape future practices and protocols, ultimately to ensure safe clinical care delivery., (Copyright © 2024 The American Dental Hygienists’ Association.)

Introduction: E-cigarette and cigarette use may have changed during the COVID-19 pandemic, however, there is no consensus in existing literature, and current Canadian studies have not used representative samples. Thus, there is a need for robust national estimates., Objective and Methods: The primary objective was to describe the 30-day period prevalence of smoking and vaping before and during the COVID-19 pandemic in Canada. This study analyzed three years of the cross-sectional Canadian Tobacco and Nicotine Survey: 2019 (pre-pandemic), 2020 (9 months into the pandemic) and 2021 (21 months into pandemic)., Results: Thirty-day period prevalence of vaping over the 2019, 2020, and 2021 study periods were 4.8 (95%CI: 4.2-5.3), 4.6% (95%CI: 4.1-5.2), and 5.2% (95%CI: 4.7-5.7), respectively. The 30-day period prevalence of smoking over the 2019, 2020, and 2021 study periods were 11.9% (95%CI: 10.9-12.7), 10.3% (95%CI: 9.4-11.2), and 10.3% (95%CI: 9.4-11.1), respectively. Notably, estimates of smoking for females decreased considerably from 2019 (11.0%; 95%CI: 9.9--12.2%) to 2020 (8.6%; 95%CI: 7.5-9.7). Estimates of vaping in those aged 20-24 increased substantially from 2020 (13.0%; 95%CI: 10.9-15.1) to 2021 (17.2%; 95%CI: 15.4-18.9)., Conclusions: Changes to smoking and vaping were restricted to subsets within the population. In those aged 20-24, there was a modest increase in vaping from 2020 to 2021. In females, there was a decrease in smoking from 2019 to 2020, which persisted in 2021., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

The COVID-19 pandemic caused a global health crisis directly impacting the healthcare system. Healthcare leaders influence and shape the ability of an organization to cope with and recover from a crisis such as the COVID-19 pandemic. Their actions serve to guide and support nurses' actions through unpredictable health service demands. The purpose of this paper was to examine frontline managers' experiences and organizational leadership responses that activated organizational resilience during the COVID-19 pandemic, and to learn for ongoing and future responses to healthcare crises. Fourteen managers participated in semi-structured interviews. We found that: (1) leadership challenges (physical resources and emotional burden), (2) the influence of senior leader decision-making on managers (constant change, shortage of human resources, adapting care delivery, and cooperation and collaboration), and (3) lessons learned (managerial caring behaviours and role modelling, adaptive leadership, education and training, culture of care for self, and others) were evidence of managers' responses to the crisis. Overall, the study provides evidence of managers experiences during the early waves of the pandemic in supporting nurses and fostering organizational resilience. Knowing manager's experiences can facilitate planning, preparing, and strengthening their leadership strategies to improve work conditions is a high priority to manage and sustain nurses' mental health and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Severe grief is highly distressing and prevalent up to 1 year post-death among people bereaved during the first wave of COVID-19, but no study has assessed changes in grief severity beyond this timeframe. Aim: Understand the trajectory of grief during the pandemic by reassessing grief symptoms in our original cohort 12–18 months post-death. Design: Prospective matched cohort study. Settings/participants: Family members of decedents who died in an acute care hospital between November 1, 2019 and August 31, 2020 in Ottawa, Canada. Family members of patients who died of COVID (COVID +ve) were matched 2:1 with those who died of non-COVID illness (COVID −ve) during pandemic wave 1 or immediately prior to its onset (pre-COVID). Grief was assessed using the Inventory of Complicated Grief (ICG). Results: Follow-up assessment was completed by 92% (111/121) of family members in the initial cohort. Mean ICG score on the 12–18-month assessment was 19.9 (SD = 11.8), and severe grief (ICG > 25) was present in 28.8% of participants. One-third (33.3%) had either a persistently high (>25) or worsening ICG score (⩾4-point increase between assessments). Using a modified Poisson regression analysis, persistently high or worsening ICG scores were associated with endotracheal intubation in the deceased, but not cause of death (COVID +ve, COVID −ve, pre-COVID) or physical presence of the family member in the final 48 h of life. Conclusions: Severe grief is a substantial source of psychological morbidity in the wake of the COVID-19 pandemic, persisting more than a year post-death. Our findings highlight an acute need for effective and scalable means of addressing severe grief. [ABSTRACT FROM AUTHOR]

Background: To assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents. Methods: Prospective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour. Results: Adjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020–2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected. Conclusions: Results support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population. Trial Registration: Not a trial. [ABSTRACT FROM AUTHOR]

Background: Social networks have an important impact on our health behaviours, including vaccination. People's vaccination beliefs tend to mirror those of their social network. As social networks are homogenous in many ways, we sought to determine in the context of COVID-19 which factors were most predictive of belonging to a mostly vaccinated or unvaccinated social group., Methods: We conducted a cross-sectional survey among Canadian residents in November and December 2021. Participants were asked about the vaccination status of their social networks their beliefs relating to COVID-19, and various sociodemographic factors. Respondents were split into three groups based on social network vaccination: low-, medium-, and high-risk. Chi-squared tests tested associations between factors and risk groups, and an ordinal logistic model was created to determine their direction and strength., Results: Most respondents (81.1 %) were classified as low risk (i.e., a mostly vaccinated social network) and few respondents (3.7 %) were classified as high-risk (i.e., an unvaccinated social group). Both the chi-square test (29.2 % difference between the low- and high- risk groups [1.8 % vs. 31.0 %], p < 0.001) and the ordinal logistic model (odds ratio between the low- and high-risk groups: 14.45, p < 0.01) found that respondents' perceptions of COVID-19 as a "not at all serious" risk to Canadians was the most powerful predictor of belonging to a predominantly unvaccinated social circle. The model also found that those in mostly unvaccinated social circles also more often reported severe COVID-19 symptoms (odds ratio between the low- and high-risk groups: 2.26, p < 0.05)., Conclusion: Perception of COVID-19 as a threat to others may signal communities with lower vaccination coverage and higher risk of severe outcomes. This may have implications for strategies to improve public outreach, messaging, and planning for downstream consequences of low intervention uptake., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: COVID-19-related global health governance (GHG) processes and public health measures taken influenced population health priorities worldwide. We investigated the intersection between COVID-19-related GHG and how it redefined population health priorities in Canada and other G20 countries. We analysed a Canada-related multilevel qualitative study and a scoping review of selected G20 countries. Findings show the importance of linking equity considerations to funding and accountability when responding to COVID-19. Nationalism and limited coordination among governance actors contributed to fragmented COVID-19 public health responses. COVID-19-related consequences were not systematically negative, but when they were, they affected more population groups living and working in conditions of vulnerability and marginalisation. Policy options and recommendations: Six policy options are proposed addressing upstream determinants of health, such as providing sufficient funding for equitable and accountable global and public health outcomes and implementing gender-focused policies to reduce COVID-19 response-related inequities and negative consequences downstream. Specific programmatic (e.g., assessing the needs of the community early) and research recommendations are also suggested to redress identified gaps. Conclusion: Despite the consequences of the COVID-19 pandemic, programmatic and research opportunities along with concrete policy options must be mobilised and implemented without further delay. We collectively share the duty to act upon global health justice. [ABSTRACT FROM AUTHOR]

Multiple studies have focused on the role of psychosocial factors as predictors of COVID-19 vaccination willingness and uptake, with less attention paid to whether vaccination itself could influence wellbeing. The current study evaluated this possibility with respect to sense of purpose, the perception one has goals and a direction in life, building on previous evidence this factor may influence vaccination willingness and decision-making. Across seven waves of monthly data from February to August 2021, participants (n = 2169, m age  = 48.0 years) across Canada and the United States reported on their sense of purpose and vaccination status. Using piecewise regression models, results indicated that sense of purpose did not appear to fluctuate in the month prior to, during, or following COVID-19 vaccination. However, across most months of the survey, vaccinated participants did report greater sense of purpose relative to unvaccinated participants. These findings are discussed with respect to whether health behaviors, such as vaccination, should be viewed as behaviors indicative of leading a purposeful life., Competing Interests: Declaration of competing interest The author declares the following financial interests/personal relationships which may be considered as potential competing interests: Nancy Sin reports financial support was provided by Government of Canada Social Sciences and Humanities Research Council. The remaining authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This work was supported by the Social Sciences and Humanities Research Council of Canada (430-2019-00608 to NLS and 435-2016-1350 to AD)., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The COVID-19 pandemic has highlighted several issues among health care workers in Canada's long-term care and seniors' (LTCS) homes, including labour shortages, staff retention difficulties, overcrowding, and precarious working conditions. There is currently a lack of information on the health, well-being and working conditions of health care workers in LTCS homes - many of them immigrants - and a limited understanding of the relationship between them. This paper examines differences between immigrant and non-immigrant workers' health outcomes and precarious working conditions during the pandemic., Data and Methods: The data were from the 2021 Survey on Health Care Workers' Experiences During the Pandemic, which collected information on LTCS home health care workers' (n=2,051) health, employment or work experiences, and working environment during the COVID-19 pandemic. Summary statistics and multivariable logistic regressions were conducted to examine the association between precarious work and workers' health (life stress, mental health and general health), stratified by immigrant status. Selected working characteristics were included in the regression models as covariates, namely occupation, number of locations worked, facility ownership status and number of years worked., Results: Immigrant health care workers were more likely than non-immigrant health care workers to experience precarious work in LTCS homes. Precarious work - characterized by income loss, reduced hours of work, and unpaid leave - was associated with stress and poor general health among immigrant and non-immigrant workers in the sector. Employment precarity was also associated with poor mental health for immigrant workers, but there was no association for non-immigrant workers., Interpretation: Employment precarity and the health and well-being of health care workers warrants further attention, in particular among immigrants employed in the LTCS residential care sector.

Background: Harm reduction (HR) is a critical response to the pronounced toxicity deaths being experienced in Canada. HR providers report many benefits of their jobs, but also encounter chronic stress from structural inequities and exposure to trauma and death. This research study sought to quantify the emotional toll the toxicity emergency placed on HR providers (Cycle One; 2019). Study objectives were later expanded to determine the impact of the ongoing toxicity as well as the pandemic's impact on well-being (Cycle Two; 2021). Methods: Standardized measures of job satisfaction, burnout, secondary traumatic stress, and vulnerability to grief were used in an online national survey. Open-ended questions addressed resources and supports. HR partners across Canada validated the findings and contributed to alternative interpretations and implications. Results: 651 respondents in Cycle One and 1,360 in Cycle Two reported moderately high levels of job satisfaction; they reported finding great meaning in their work. Yet, mean levels of burnout and secondary traumatic stress were moderate, with the latter significantly increasing in Cycle Two. Reported vulnerability to grief was moderate but increased significantly during COVID. When available, supports lacked the quality necessary to respond to the complexities of HR workers' experiences, or an insufficient number of sessions were covered through benefits. Respondents shared that their professional quality of life was affected more by policy failures and gaps in the healthcare system than it was by the demands of their jobs. Conclusion: Both the benefits and the strain of providing harm reduction services cannot be underestimated. For HR providers, these impacts are compounded by the drug toxicity emergency, making the service gaps experienced by them all the more critical to address. Implications highlight the need for integration of HR into the healthcare system, sustainable and reliable funding, sufficient counselling supports, and equitable staffing models. Support for this essential workforce is critical to ensuring the well-being of themselves, the individuals they serve, and the health of the broader healthcare system. [ABSTRACT FROM AUTHOR]

Background: Post-COVID-19 Condition (PCC), as defined by the World Health Organization (WHO), currently lacks any regulatory-approved treatments and is characterized by persistent and debilitating cognitive impairment and mood symptoms. Additionally, metabolic dysfunction, chronic inflammation and the associated risks of elevated body mass index (BMI) have been reported. In this study, we aim to investigate the efficacy of vortioxetine in improving cognitive deficits in individuals with PCC, accounting for the interaction of metabolic dysfunction, elevated inflammation and BMI. Methods: This is a post-hoc analysis of an 8-week randomized, double-blind, placebo-controlled trial that was conducted among adults aged 18 years and older living in Canada who were experiencing WHO-defined PCC symptoms. The recruitment of participants began in November 2021 and concluded in January 2023. A total of 200 individuals were enrolled, where 147 were randomized in a 1:1 ratio to receive either vortioxetine (5–20 mg, n = 73) or placebo (n = 74) for daily treatment under double-blind conditions. The primary outcome measure was the change in the Digit Symbol Substitution Test (DSST) score from baseline to endpoint. Results: Our findings showed significant effects for time (χ2 = 7.771, p = 0.005), treatment (χ2 = 7.583, p = 0.006) and the treatment x time x CRP x TG-HDL x BMI interaction (χ2 = 11.967, p = 0.018) on cognitive function. Moreover, the between-group analysis showed a significant improvement with vortioxetine at endpoint (mean difference = 0.621, SEM = 0.313, p = 0.047). Conclusion: Overall, vortioxetine demonstrated significant improvements in cognitive deficits among individuals with baseline markers of metabolic dysfunction, elevated inflammation and higher BMI at endpoint as compared to placebo. Trial Registration: NCT05047952 (ClinicalTrials.gov; Registration Date: September 17, 2021). [ABSTRACT FROM AUTHOR]

Background: Despite the swift governments' response to the COVID-19 pandemic, there remains a paucity of literature assessing the degree to which; priority setting (PS) was included in the pandemic plans and the pandemic plans were publicly accessible. This paper reflects on the methods employed in a global comparative analysis of the degree to which countries integrated PS into their COVID-19 pandemic plans based on Kapiriri & Martin's framework. We also assessed if the accessibility of the plans was related to the country's transparency index., Methods: Through a three stage search strategy, we accessed and reviewed 86 national COVID-19 pandemic plans (and 11 Canadian provinces and territories). Secondary analysis assessed any alignment between the readily accessible plans and the country's transparency index., Results and Conclusion: 71 national plans were readily accessible while 43 were not. There were no systematic differences between the countries whose plans were readily available and those whose plans were 'missing'. However, most of the countries with 'missing' plans tended to have a low transparency index. The framework was adapted to the pandemic context by adding a parameter on the need to plan for continuity of priority routine services. While document review may be the most feasible and appropriate approach to conducting policy analysis during health emergencies, interviews and follow up document review would assess policy implementation., Competing Interests: Declaration of competing interest We declare no conflict., (Copyright © 2024. Published by Elsevier B.V.)

The objective of the paper is to assess the resilience of the economy of Australia following the Covid‐19 pandemic that hit the global economy in Q4 2019, in years 2020, 2021 and 2022. Quarterly growth rates (annualised) of the Real GDP of Australia and Canada are forecasted between Q2 2022 and Q4 2050. Two sets of forecasts are generated: forecasts using historical data including the pandemic (from Q1 1961 to Q1 2022) and excluding the pandemic (from Q1 1961 to Q3 2019). The computation of the difference of their averages is an indicator of the resilience of the economies during the pandemic, the greater the difference the greater the resilience. Used as a benchmark, Canada's economy shows a slightly lower resilience to the Covid‐19 pandemic (+0.37%) than Australia's economy (+0.39%) based on Q2 2022–2050 forecasts. However, driven by stronger growth than Canada, the average estimate of the Q2 2022–Q4 2050 quarterly (annualised) growth rate forecasts of Australia is expected to be +2.09% with the Q1 1961–Q1 2022 historical data while it should be +1.61% for Canada. Supported by higher growth, Australia's Real GDP is expected to overtake Canada's in Q1 2040. [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]

The COVID-19 pandemic has negatively impacted the mental health of individuals globally. However, less is known about the characteristics that contributed to some people having mental health problems during the pandemic, while others did not. Mental health problems can be understood on a continuum, ranging from acute (e.g., depression following a stressful event) to severe (e.g., chronic conditions that disrupt everyday functioning). Therefore, the purpose of this article was to generate profiles of adults who were more or less at risk for the development of mental health problems, in general, during the first 16-months of the COVID-19 pandemic in Ontario, Canada. Data were collected via online surveys at two time points: April-July 2020 and July-August 2021; 2,188 adults (Mage = 43.15 years; SD = 8.82) participated. Surveys included a demographic questionnaire and four previously validated tools to measure participants' mental health, subjective wellbeing, physical activity and sedentary behaviour, and sleep. A decision tree was generated at each time point for those with mental health problems, and those with no mental health problems. Results showed that subjective wellbeing was the biggest contributor to mental health status. Characteristics associated with no mental health problems among adults included having good wellbeing, being a good sleeper (quantity, quality, and patterns of sleep), and being over the age of 42. Characteristics associated with mental health problems included having poor wellbeing and being a poor sleeper. Findings revealed that specific characteristics interacted to contribute to adults' mental health status during the first 16 months of the COVID-19 pandemic. Given that wellbeing was the biggest contributor to mental health, researchers should focus on targeting adults' wellbeing to improve their mental health during future health crises. [ABSTRACT FROM AUTHOR]

Objectives: This qualitative study aimed to explore how young adults experienced the COVID-19 pandemic in relation to extensive lockdowns, social isolation and psychosocial distress. Specifically, this research focused on how the pandemic impacted those who did not contract COVID-19 and lived in a low-risk geographical location. The focus was young adults given they have large social circles (high risk for disease transmission) and have an increased propensity to mental health conditions. These insights can inform planning for future pandemics., Design: This paper draws on 30 in-depth semistructured interviews. Data were analysed inductively following the principles of a constructivist grounded theory approach., Setting and Participants: 30 young adults living in Prince Edward Island during the COVID-19 pandemic, a Canadian province with a low number of COVID-19 cases at the time of data collection., Results: We developed four themes that describe the experience of young adults during the COVID-19 pandemic: (1) life course disruption, (2) fear and anxiety about the COVID-19 virus, (3) isolation and loss of hope and (4) strategies for managing adversity. Our findings highlight the areas of young adults' lives that were affected by extensive social changes related to the COVID-19 pandemic. We demonstrate that even individuals who had not contracted the virus were considerably impacted., Conclusion: We provide a detailed description of the comprehensive impact of COVID-19 on low-risk young adults not previously infected with the COVID-19 virus. By reflecting on the biographical disruption experienced by young adults, we highlight the need and opportunity to direct healthcare resources towards identifying and addressing the secondary impacts of pandemics. Consequently, these findings can guide decisions relating to future pandemic restrictions to better account for the experiences of individuals living through them., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The COVID-19 pandemic exposed long-standing inequities in Canada's long-term residential care (LTRC) sector with life-threatening consequences. People from marginalized groups are overrepresented among those who live in, and work in LTRC facilities, yet their voices are generally silenced in LTRC research. Concerns about these silenced voices have sparked debate around ways to change LTRC policy to better address long-standing inequities and enhance the conditions that foster dignity for those who live and work in LTRC. Weaving an analysis of historical and cultural attitudes about LTRC, and promising strategies for engaging people with lived experience, we argue that the voices of people with lived experience of life and work (paid and unpaid) in LTRC are essential for ethically and effectively shifting long-standing inequities. Lessons from a 4-year, national, multi-disciplinary research study, known as the Seniors Adding Life to Years (SALTY) project, suggest that resident-determined quality of life can be prioritized by centring the perspectives of residents, their family/friends, direct care workers, volunteers, and people living with dementia in the research process. Accordingly, we highlight strategies to include these voices so that meaningful and impactful system change can be realized. Plain Language Summary: This article argues that long-term residential care facilities in Canada have a long history of perpetuating social inequalities, beginning with seventeenth century poor houses and almshouses, from which long-term residential care facilities evolved in North America. We highlight that those who currently reside in long-term residential care are more likely to be people with less social power—for example women, people living with dementia, and people with low-income. These residents are rarely included in research projects as co-designers of research, co-producers of knowledge, or experts on the realities of long-term residential care. We explore strategies for addressing these underrepresented voices and inequalities in research by highlighting promising examples of resident, family, and worker-engagement emerging from a pre-pandemic to early pandemic pan-Canadian research project on quality of life in long-term residential care. We argue that long-term residential care residents, their family/friend caregivers, people living with dementia, and direct care workers have voices that are essential in residential care design and research engagement strategies. By prioritizing these voices in research, we can better amplify their critical perspectives in broader policy and decision-making processes that guide meaningful and impactful system change. [ABSTRACT FROM AUTHOR]

Background: The onset of the COVID-19 pandemic has had an adverse impact on children, youth, and families with eating disorders (EDs). The COVID-19 pandemic exacerbated pre-existing personal and financial costs to youth, caregivers, and health professionals accessing or delivering ED services. The objectives of this mixed methods study were to (1) understand the indirect, direct medical and non-medical costs reported by youth, caregivers, and clinicians; (2) understand how the COVID-19 pandemic may have impacted these costs, and (3) explore implications of these costs with regards to barriers and resources to inform future decisions for the ED system of care. Methods: Youth (aged 16–25 years) with lived/living experience, primary caregivers, clinicians, and decision-makers were recruited with support from various partners across Canada to complete group specific surveys. A total of 117 participants responded to the survey. From those respondents, 21 individuals volunteered to further participate in either a discussion group or individual interview to provide additional insights on costs. Results: Youth and primary caregivers reported costs relating to private services, transportation and impacts of not attending school or work. Additionally, primary caregivers reported the top direct medical cost being special food or nutritional supplements (82.8%). In discussion groups, youth and caregivers elaborated further on the challenges with long waitlists and cancelled services, impact on siblings and effect on family dynamics. Clinicians and decision-makers reported increased work expectations (64.3%) and fear/isolation due to COVID-19 in the workplace (58.9%). Through discussion groups, clinicians expanded further on the toll these expectations took on their personal life. Approximately 1 in 3 health professionals reported contemplating leaving their position in 1–2 years, with greater than 60% of this group stating this is directly related to working during the pandemic. Conclusions: Findings demonstrate the need for increased support for youth and caregivers when accessing ED services both during crisis and non-crisis times. Additionally, attention must be given to acknowledging the experience of health professionals to support better retention and resource management as they continue to navigate challenges in the health care system. Plain English summary: The COVID-19 pandemic has had significant impacts for children, youth and families with eating disorders (EDs) and those who care for them. The objective of this study was to understand the impacts on financial and personal costs to youth, caregivers and clinicians when either accessing or delivering ED services during the pandemic. This study consisted of an online survey and discussion groups with youth (16-25 years old) with lived experience of an ED, primary caregivers, clinicians and decision-makers delivering ED services to understand the costs they experienced. Although many reported costs were financial, including direct medical costs (i.e. private therapy) and direct non-medical costs (i.e. transportation, accommodation costs), there were also significant personal costs to individuals and their families. Healthcare professionals also reported extensive challenges with resources and increased work expectations due to the pandemic context. Acknowledging the costs experienced by young people, families and healthcare professionals during the pandemic allows for the discussion of how we can better support those accessing or delivering ED services in times of crisis and non-crisis. [ABSTRACT FROM AUTHOR]

Canada and Australia, two liberal welfare states whose market-based ECEC systems consistently rank poorly on international measures, embraced similar short-term childcare policy responses to the onset of the COVID-19 pandemic: widespread closures, reduced capacity of centers, establishment of publicly funded emergency childcare programs for essential workers, and short-term wage subsidies for essential workers (sometimes including educators). Rooted in a feminist political economy (FPE) theoretical framework and using a what-is-the-problem-represented-to-be (WPR) methodological approach, this article explores the extent to which the first and second "waves" of the COVID-19 pandemic policy responses in Canada and Australia framed childcare as a concern about gendered, reproductive labor within political representations of the policy problems to be solved. [ABSTRACT FROM AUTHOR]

We study how social connectedness affected active mutual fund manager trading behavior in the first half of 2020. In the first quarter during which the coronavirus disease 2019 (COVID-19) outbreak occurred, fund managers located in or socially connected to COVID-19 hotspots sold more stock holdings compared with a control group of unconnected managers. The economic impact of social connectedness on stock holdings was comparable with that of COVID-19 hotspots and was elevated among "epicenter" stocks most susceptible to the pandemic shock. In the second quarter, social interaction had an overall negative effect on fund performance, but this effect depended on manager skill; unskilled managers who were connected to the hotspots underperformed, whereas skillful managers suffered no deleterious effect. Our evidence suggests that social connections can intensify salience bias for all but the most skilled institutional investors, and policy makers should be wary of the destabilizing role of social networks during market downturns. This paper was accepted by Gustavo Manso, finance. Funding: This work was supported by the Social Science and Humanities Research Council of Canada. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4814. [ABSTRACT FROM AUTHOR]

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians' (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. Methods: As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. Results: Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs' ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. Conclusions: Recent primary care system reforms implemented in Canada enhanced FPs' ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms. [ABSTRACT FROM AUTHOR]

Various published COVID-19 models have been used in epidemiological studies and healthcare planning to model and predict the spread of the disease and appropriately realign health measures and priorities given the resource limitations in the field of healthcare. However, a significant issue arises when these models need help identifying the distribution of the constituent variants of COVID-19 infections. The emergence of such a challenge means that, given limited healthcare resources, health planning would be ineffective and cost lives. This work presents a universal neural network (NN) computational instrument for predicting the mainstream symptomatic infection rate of COVID-19 and models of the distribution of its associated variants. The NN is based on a mixture density network (MDN) with a Gaussian mixture model (GMM) object as a backbone. Twelve use cases were used to demonstrate the validity and reliability of the proposed MDN. The use cases included COVID-19 data for Canada and Saudi Arabia, two date ranges (300 and 500 days), two input data modes, and three activation functions, each with different implementations of the batch size and epoch value. This array of scenarios provided an opportunity to investigate the impacts of epistemic uncertainty (EU) and aleatoric uncertainty (AU) on the prediction model's fitting. The model accuracy readings were in the high nineties based on a tolerance margin of 0.0125. The primary outcome of this work indicates that this easy-to-use universal MDN helps provide reliable predictions of COVID-19 variant distributions and the corresponding synthesized profile of the mainstream infection rate. [ABSTRACT FROM AUTHOR]

This paper aims to introduce a novel family of probability distributions by the well-known method of the T-X family of distributions. The proposed family is called a "Novel Generalized Exponent Power X Family" of distributions. A three-parameters special sub-model of the proposed method is derived and named a "Novel Generalized Exponent Power Weibull" distribution (NGEP-Wei for short). For the proposed family, some statistical properties are derived including the hazard rate function, moments, moment generating function, order statistics, residual life, and reverse residual life. The well-known method of estimation, the maximum likelihood estimation method is used for estimating the model parameters. Besides, a comprehensive Monte Carlo simulation study is conducted to assess the efficacy of this estimation method. Finally, the model selection criterion such as Akaike information criterion (AINC), the correct information criterion (CINC), the Bayesian information criterion (BINC), the Hannan-Quinn information criterion (HQINC), the Cramer-von-Misses (CRMI), and the ANDA (Anderson-Darling) are used for comparison purpose. The comparison of the NGEP-Wei with other rival distributions is made by Two COVID-19 data sets. In terms of performance, we show that the proposed method outperforms the other competing methods included in this study., (© 2024. The Author(s).)

During the first wave of the COVID-19 pandemic, immigrants were among the most socially vulnerable in Western countries. The Chinese diaspora in Canada were one such group due to the widespread cultural stigma surrounding their purported greater susceptibility to transmit and become infected by COVID-19. This paper aims to understand the social vulnerability of the Chinese diaspora in the Greater Toronto Area, Canada, during the first wave of COVID-19 from an explanation of their risk perception and threat appraisal of risk communication. We conducted secondary data analysis of 36 interviews using critical realism. The participants self-identified as being of Chinese descent. The results were used to develop a model of how social vulnerability occurred. In brief, cognitive dissonance was discovered to generate conflicts of one's cultural identity, shaped by social structures of (i) stigma of contagion, (ii) ethnic stigma, and (iii) public sentiment, and mediated by participants' threat appraisal and (iv) self-reliance. We assert that risk communicators need to consider their audiences' diverse socialization in crafting messages to modify behaviors, create a sense of responsibility, and mitigate public health threats. A lack of awareness of one's cognitive dissonance driven by cultural vulnerability may heighten their social vulnerability and prevent them from taking action to protect themself from high-risk events.

The global COVID-19 pandemic in 2020 required risk communications to mitigate the virus' spread. However, social media not only conveyed health information to minimize the contagion, but also distracted from the threat by linking it to an externalized 'other'-primarily those appearing to be of Chinese descent. This disinformation caused the attribution of blame to Chinese people worldwide. In Canada's Greater Toronto Area, Chinese individuals reported widespread public stigma that compounded their risk of contagion; to the degree that it was driven by cognitive dissonance, it generated experiences of social and cultural vulnerability. In this paper, we draw on the aforementioned study's findings to explain how the risk perception and threat appraisal of Chinese diaspora individuals were impacted by different cognitive dissonance pathways. These findings explore how storytelling is a viable intervention with which to target and mitigate cognitive dissonance. Indeed, the mechanisms of cognitive dissonance can modify risk perception and mitigate social and cultural vulnerability, thereby averting potential long-term negative consequences for one's mental health and well-being. We hope our guidance, training educators to target pathways of cognitive dissonance by drawing on storytelling (with humour), can assist them to better convey information in ways that are more inclusive during public health emergencies.

Background: Virtual care in Canada rapidly expanded during the COVID-19 pandemic in a low-rules environment in response to pressing needs for ongoing access to care amid public health restrictions. Emergency medicine specialists now face the challenge of advising on which virtual urgent care services ought to remain as part of comprehensive emergency care. Consideration must be given to safe, quality, and appropriate care as well as issues of equitable access, public demand, and sustainability (financial and otherwise). The aim of this project was to summarize current literature and expert opinion and formulate recommendations on the path forward for virtual care in emergency medicine., Methods: We formed a working group of emergency medicine physicians from across Canada working in a variety of practice settings. The virtual care working group conducted a scoping review of the literature and met monthly to discuss themes and develop recommendations. The final recommendations were circulated to stakeholders for input and subsequently presented at the 2023 Canadian Association of Emergency Physicians (CAEP) Academic Symposium for discussion, feedback, and refinement., Results: The working group developed and reached unanimity on nine recommendations addressing the themes of system design, equity and accessibility, quality and patient safety, education and curriculum, financial models, and sustainability of virtual urgent care services in Canada., Conclusion: Virtual urgent care has become an established service in the Canadian health care system. Emergency medicine specialists are uniquely suited to provide leadership and guidance on the optimal delivery of these services to enhance and complement emergency care in Canada., (© 2024. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

The global health workforce crisis, simmering for decades, was brought to a rolling boil by the COVID-19 pandemic in 2020. With scarce literature, evidence, or best practices to draw from, countries around the world moved to flex their workforces to meet acute challenges of the pandemic, facing demands related to patient volume, patient acuity, and worker vulnerability and absenteeism. One early hypothesis suggested that the acute, short-term pandemic phase would be followed by several waves of resource demands extending over the longer term. However, as the acute phase of the pandemic abated, temporary workforce policies expired and others were repealed with a view of returning to 'normal'. The workforce needs of subsequent phases of pandemic effects were largely ignored despite our new equilibrium resting nowhere near our pre-COVID baseline. In this paper, we describe Canada's early pandemic workforce response. We report the results of an environmental scan of the early workforce strategies adopted in Canada during the first wave of the COVID-19 pandemic. Within an expanded three-part conceptual framework for supporting a sustainable health workforce, we describe 470 strategies and policies that aimed to increase the numbers and flexibility of health workers in Canada, and to maximise their continued availability to work. These strategies targeted all types of health workers and roles, enabling changes to the places health work is done, the way in which care is delivered, and the mechanisms by which it is regulated. Telehealth strategies and virtual care were the most prevalent, followed by role expansion, licensure flexibility, mental health supports for workers, and return to practice of retirees. We explore the degree to which these short-term, acute response strategies might be adapted or extended to support the evolving workforce's long-term needs., (© 2024 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Background: Children's educational experiences worldwide have been significantly impacted as a result of global school closures during the COVID-19 pandemic of Spring 2020. A growing number of studies aim to analyse impacts of these changes on social well-being, with limited studies placing an emphasis on the experiences of students with special educational needs (SENs). This article focusses on parent perspectives regarding impacts of school closures on social well-being in Canadian children with SEN., Methods: This study uses a mixed-methods approach, drawing from both qualitative and quantitative survey data from Spring/Summer 2020. Participants (n = 263) were eligible for participation if they were a parent/guardian of a child or adolescent with an SEN. We first conducted a descriptive analysis of the key variables, namely, social well-being, grade level of the child, internet and device availability, and the presence of other school-aged children in the home (single child vs. multiple children). Next, we explored the relationship between these using a bivariate correlation. Finally, open-ended responses were analysed using an inductive approach to qualitative thematic analysis., Results: The majority of parents expressed concern for their child's social well-being during the Spring 2020 school closures, with increased concerns for younger children. According to parents, children experienced communication barriers to peer interaction and many experienced emotional difficulties as a result. Technology was described as critical for some in maintaining social connections. Parents raised concerns about the impact of limited peer interaction on broader social skill development, in the short and long term. A small number of participants noted feelings of relief and reduced anxiety among their children with SEN., Conclusions: Findings highlight parent views of the negative impact of the pandemic on social well-being and the critical role in-person schooling plays in supporting peer relationships for children with SEN., (© 2024 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.)

The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The COVID-19 pandemic had a disproportionate impact on the health and wellbeing of people who use drugs (PWUD) in Canada. However less is known about jurisdictional commonalities and differences in COVID-19 exposure and impacts of pandemic-related restrictions on competing health and social risks among PWUD living in large urban centres. Methods: Between May 2020 and March 2021, leveraging infrastructure from ongoing cohorts of PWUD, we surveyed 1,025 participants from Vancouver (n = 640), Toronto (n = 158), and Montreal (n = 227), Canada to describe the impacts of pandemic-related restrictions on basic, health, and harm reduction needs. Results: Among participants, awareness of COVID-19 protective measures was high; however, between 10 and 24% of participants in each city-specific sample reported being unable to self-isolate. Overall, 3–19% of participants reported experiencing homelessness after the onset of the pandemic, while 20–41% reported that they went hungry more often than usual. Furthermore, 8–33% of participants reported experiencing an overdose during the pandemic, though most indicated no change in overdose frequency compared the pre-pandemic period. Most participants receiving opioid agonist therapy in the past six months reported treatment continuity during the pandemic (87–93%), however, 32% and 22% of participants in Toronto and Montreal reported missing doses due to service disruptions. There were some reports of difficulty accessing supervised consumption sites in all three sites, and drug checking services in Vancouver. Conclusion: Findings suggest PWUD in Canada experienced difficulties meeting essential needs and accessing some harm reduction services during the COVID-19 pandemic. These findings can inform preparedness planning for future public health emergencies. [ABSTRACT FROM AUTHOR]

Classroom and staffroom floor swabs across six elementary schools in Ottawa, Canada were tested for SARS-CoV-2. Environmental test positivity did not correlate with student grade groups, school-level absenteeism, pediatric COVID-19-related hospitalizations, or community SARS-CoV-2 wastewater levels. Schools in neighbourhoods with historically elevated COVID-19 burden showed a negative but non-significant association with lower swab positivity., Competing Interests: ED works for DNA Genotek that provided sampling swabs in-kind for this study in an unrestricted fashion. DNA Genotek had no control over the findings, interpretations, or conclusions published in this paper. MF is a consultant for ProofDx, a start-up company that has created a point of care testing device for adults with COVID-19 using CRISPR. DM is a consultant for wastewater surveillance, World Bank. All other authors have no relevant conflicts to disclose. “This does not alter our adherence to PLOS ONE policies on sharing data and materials.”, (Copyright: © 2024 Thampi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Examining the spectrum of vaccine attitudes within the general public, spanning from hesitancy to confidence, is pivotal in addressing the challenges posed by the COVID-19 pandemic. Despite widespread campaigns advocating for vaccine uptake, a proportion of the population harbour reservations about the safety and efficacy of vaccines. This study seeks to explore the determinants of vaccine attitudes in Canada, leveraging key concepts from the well-established Self-Determination Theory (SDT), including basic psychological needs and the quality of an individual's motivation. During a crucial juncture in the COVID-19 pandemic (December 2021), 292 participants were recruited and completed an online survey assessing levels of satisfaction/frustration of basic psychological needs (sense of autonomy, relatedness, and competence), vaccine attitudes (confidence and hesitancy), and motivation towards vaccination (controlled and autonomous). Two mediation models were employed to examine whether autonomous-controlled motivation mediated the relationship between need satisfaction-frustration and vaccine attitudes. Model 1 revealed a full mediating effect, indicating that need satisfaction influenced vaccine confidence only through autonomous motivation (ab 1  = 0.09, SE = 0.04, z = 2.19, 95 % CI [0.01, 0.18]). Meanwhile, Model 2 demonstrated that need frustration was associated with vaccine hesitancy partially through controlled motivation (ab 2  = 0.05, SE = 0.02, z = 2.54, 95 % CI [0.02, 0.10]). These findings underscore the applicability of SDT in investigating the motivational mechanisms that shape vaccine attitudes. Recognizing psychosocial factors, including the balance of basic needs and quality of motivations, may be integral to informing effective public health strategies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)