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Objective We aimed to measure the change in proportion of opioid-related overdose deaths attributed to people experiencing homelessness and to compare the opioid-related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death. Approach We conducted a population-based, time-trend analysis using coroner and health administrative databases from Ontario, Canada (2017-2021). Quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness were reported. We also obtained socio-demographic and health characteristics, healthcare encounters preceding death, substances directly contributing to death and circumstances surrounding deaths. Results Overall, 13.3% individuals who died of an opioid-related overdose between 2017 and 2021 were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness increased from 7.2% in 2017 to 16.8% by 2021. Compared with housed decedents, those experiencing homelessness were younger, had higher prevalence of mental health or substance use disorders and more often visited hospitals and emergency departments in the year prior to death. Fentanyl and stimulants more often directly contributed to death, whereas methadone was less often present. Individuals experiencing homelessness were more often in the presence of a bystander during the event that led to death and more often had a resuscitation attempted or naloxone administered. Conclusions and implications People experiencing homelessness account for an increasing proportion of fatal opioid-related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021. Effective interventions are needed to combat homelessness and opioid related toxicity in homeless populations.

Background Cognitive decline in people experiencing homelessness (PEH) is an increasingly recognized issue. We compared the prevalence of dementia among PEH to housed individuals in the general population and those living in low-income neighborhoods. Approach A population-based cross-sectional comparative analysis using linked healthcare administrative data from Ontario, Canada. We included individuals ≥45 years on January 1, 2019 who visited hospital-based ambulatory care (eg, emergency department), were hospitalized, or visited a Community Health Centre in 2019; and identified PEH if they had one or more healthcare records with an indication of homelessness or unstable housing. Prevalence of dementia was ascertained using a validated case definition for Alzheimer’s disease and related dementia. Poisson models were used to generate estimates of prevalence. Findings 12,863 PEH, 475,544 low-income comparators, and 2,273,068 general population comparators were assembled. Among these groups, dementia prevalence was 68.7, 62.6, and 51.0 per 1,000, respectively. Descriptively, prevalence ratios between PEH and the comparator groups were highest within the ages of 55-64 and 65-74 in both sexes, ranging from 2.98 to 5.00. After adjusting for age, sex, geographical location of residence, and health conditions associated with dementia, prevalence of dementia among PEH was found to be 1.71 (95% CI: 1.60–1.82) and 1.90 (1.79–2.03) times greater than the low-income and general population comparators, respectively. Interpretation PEH experience high burden of dementia compared to housed populations in Ontario. Findings suggest that PEH may experience dementia at younger ages and may benefit from the development of proactive screening and housing interventions.

Homelessness was already a well-known risk factor contributing to premature death, morbidity, mental illness, and substance use disorder. The coronavirus disease for 2019 (COVID-19) pandemic has amplified disparities in Canada’s public health system, disproportionately impacting people experiencing homelessness. The present study aimed to investigate the impact of the COVID-19 pandemic on the homelessness situation in Canada from community stakeholders’ perceptions. The study used qualitative research approaches underlain by focused ethnography tenets. The sample includes 200 service providers from 28 communities across Canada (at least one site in each province and territory) to participate in virtual focus groups. Data analysis followed a four-step ethnographic approach for thematic analysis in qualitative research. Six main themes emerged: (a) system changes precipitated by the COVID-19 pandemic; (b) personal changes in life circumstances; (c) previous strategies no longer working; (e) opportunities; (d) some things getting better; (f) an overall increase in first time and recurrent homelessness in Canada. The study findings underscored mechanisms required to help ‘tip the scale’ in affording people experiencing homelessness the opportunity to avoid or exit homelessness.

The “No Fixed Address” version 2 (NFAv.2) project tested the efficacy of a potential best practice program that aimed to prevent discharge from hospital into homelessness. Forchuk and colleagues developed a system that streamlined housing and social supports using on-site access to help inpatients in a psychiatric unit who were homeless or at-risk of homelessness find safe, affordable housing. A total of 370 individuals accessed the NFAv.2 program between August 2017 and May 2020. Of these, 88 participants who accessed the intervention were enrolled in the evaluation of the project. Information on housing history and housing outcomes were collected during hospital admission and at 3-time points post-discharge. Focus groups were conducted for program participants, health care staff, and community partners to gather information regarding their experiences with the program. Of those who participated in the intervention, 80% were housed and remained housed at 12 months post-discharge. Results from focus groups also indicated that the majority of NFAv.2 clients, staff, and community partners were satisfied with the intervention. Since homelessness has a detrimental effect on recovery, client safety, and healthcare expenditures, locating safe housing has had a positive impact on treatment, rehabilitation, and the healthcare system as a whole. The findings of this project offer policy alternatives for the prevention of homelessness for at-risk individuals.

BackgroundSocial support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer–specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV. ObjectiveThis study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit. MethodsThis exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes. ResultsSeven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community. ConclusionsFindings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients’ holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes.

BackgroundPodcasts have proven to be a successful alternative source of educational material for students. Given the ability to listen to podcasts 24/7 and while on the go, this technology has the potential to provide informative and educational material to a large number of people at any given time. Podcasts are usually freely available on commonly used mobile devices, such as smartphones, laptops, and tablets. ObjectiveThis paper describes the impact of health-related podcasts as an intervention tool to support the knowledge and awareness of nursing students on a given topic. MethodsPre- and postpodcast questionnaires will gather data regarding the participants’ knowledge and awareness of two topics—gestational diabetes and mental health. This intervention will be tested on general nursing undergraduate students. The total number of students (N=2395) from the participating universities are broken down as follows: (1) University College Cork (n=850) and the University of Galway (n=450) in Ireland, (2) Mzuzu University in Malawi (n=719), and (3) University of Fort Hare in South Africa (n=376). ResultsThe study received ethical approval from the University College Cork Ethics Committee (2022-027A1). The approval obtained from University College Cork sufficed as ethics coverage for the University of Galway in Ireland. Ethics approval was also received from the Mzuzu University Research Ethics Committee (ID MZUNIREC/DOR/23/28) and the Inter-Faculty Research Ethics Committee of the University of Fort Hare (ID CIL002-21). Data collection is currently underway and will continue until the end of February 2024. The quantitative and qualitative data are expected to be analyzed in March 2024. ConclusionsResults from this study will allow for an investigation into the impact of podcasts in different settings: a high-income country (Ireland), an upper-middle–income country (South Africa), and a low-to-middle–income country (Malawi). The data gathered from this feasibility study will provide more clarity on the potential utility of podcasts as an intervention tool. We will gather data regarding listener demographics (eg, country of residence, age, gender, and year of study). International Registered Report Identifier (IRRID)DERR1-10.2196/50735

Conclusion: Group homes such as CHO positively impact the well-being and quality of life of persons with mental health and addiction problems while enhancing their independence and social integration for improved recovery outcomes.

Introduction. Stigma is noted to be one of the greatest barriers to the recovery of persons with mental health problems. Stigma has been acknowledged as both an individual and a social orchestration that has an overpowering impact on the social standing of marginalized persons in a society. This study examined the extant literature to ascertain if any evidence(s) suggested a relationship between perceived public attitudes, religious and cultural beliefs, and structural violence in perpetuating stigma against persons with mental illness. Method. We applied a five-step scoping review framework by Arksey and O’Malley to examine evidence in the literature that suggests relationships between perceptions, religious and cultural beliefs, and structural violence in perpetuating stigma. The researchers systematically conducted a literature search from six databases, including CINAHL, Ovid MEDLINE(R), ProQuest Dissertations & Theses Global, Sociology Collection, PsycINFO, and Sociological Abstracts, using search terms that included stigma, mental illness, perception, religious and cultural beliefs, and structural violence. Results. An initial search in six databases yielded 1223 articles. Checking in the Google Search engine yielded 30 more articles. After removing 25 duplicates, 1198 articles remained for title and abstract screening. After a full-text review, 1143 articles were removed. Overall, 30 articles were selected for data extraction. Thematic analysis of the extracted data resulted in three main themes. These include perceptions about mental illness, perceptions about stigma and discrimination, and forms of stigma perception. Conclusion. This study revealed that individual perceptions of public attitudes contributed to their construction of stigma. It is incumbent on everyone to play their part in mitigating all the negative outcomes that stigma brings, especially to persons with mental illness.

Abstract Objective To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. Method A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. Results Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. Discussion This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. Conclusion For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).

Abstract Background The global extant literature acknowledge that housing serves as a key social determinant of health. Housing interventions that involve group homes have been found to support the recovery of persons with mental illness and those with addiction issues. The current study explored the views of homeowners in relation to a supportive housing program called Community Homes for Opportunity (CHO) that modernised a provincial group home program (Homes for Special Care [HSC]) and provided recommendations for improving the program implementation in other geographical areas of Ontario. Methods We applied ethnographic qualitative techniques to purposefully recruit 36 homeowner participants from 28 group homes in Southwest Ontario, Ontario Canada. Focus group discussions were conducted at two time points, during CHO program implementation (Fall 2018, and post implementation phases (Winter 2019) respectively. Results Data analysis yielded 5 major themes. These include: (1) general impressions about the modernization process, (2) perceived social, economic and health outcomes, (3) enablers of the modernization program, (4) challenges to implementation of the modernization program, and (5) suggestions for implementation of the CHO in future. Conclusions A more effective and expanded CHO program will need the effective collaboration of all stakeholders including homeowners for successful implementation.

BackgroundThe COVID-19 pandemic and resultant restrictions on social gatherings significantly impacted many peoples’ sense of social connectedness, defined as an individual’s subjective sense of having close relationships with others. Older adults living in long-term care homes (LTCHs) experienced extreme restrictions on social gatherings, which negatively impacted their physical and mental health as well as the health and well-being of their family caregivers. Their experiences highlighted the need to reconceptualize social connectedness. In particular, the pandemic highlighted the need to explore novel ways to attain fulfilling relationships with others in the absence of physical gatherings such as through the use of a hybridized system of web-based and in-person presence. ObjectiveGiven the potential benefits and challenges of web-based presence technology within LTCHs, the proposed research objectives are to (1) explore experiences regarding the use of web-based presence technology (WPT) in support of social connectedness between older adults in LTCHs and their family members, and (2) identify the contextual factors that must be addressed for successful WPT implementation within LTCHs. MethodsThis study will take place in south western Ontario, Canada, and be guided by a qualitative multimethod research design conducted in three stages: (1) qualitive description with in-depth qualitative interviews guided by the Technology Acceptance Model (TAM) and analyzed using content analysis; (2) qualitative description and document analysis methodologies, informed by content and thematic analysis methods; and (3) explicit between-methods triangulation of study findings from stages 1 and 2, interpretation of findings and development of a guiding framework for technology implementation within LTCHs. Using a purposeful, maximum variation sampling approach, stage 1 will involve recruiting approximately 45 participants comprising a range of older adults, family members (30 participants) and staff (15 participants) within several LTCH settings. In stage 2, theoretical sampling will be used to recruit key LTCH stakeholders (directors, administrators, and IT support). In stage 3, the findings from stages 1 and 2 will be triangulated and interpreted to develop a working framework for WPT usage within LTCHs. ResultsData collection will begin in fall 2023. The findings emerging from this study will provide insights and understanding about how the factors, barriers, and facilitators to embedding and spreading WPT in LTCHs may benefit or negatively impact older adults in LTCHs, family caregivers, and staff and administrators of LTCHs. ConclusionsThe results of this research study will provide a greater understanding of potential approaches that could be used to successfully integrate WPTs in LTCHs. Additionally, benefits as well as challenges for older adults in LTCHs, family caregivers, and staff and administrators of LTCHs will be identified. These findings will help increase knowledge and understanding of how WPT may be used to support social connectedness between older adults in LTCHs and their family members. International Registered Report Identifier (IRRID)PRR1-10.2196/50137

Introduction The Baby-friendly Hospital Initiative is a global programme that is meant to support breastfeeding within organisations. Most of the current literature is focused on implementation and uptake of the programme; however, little is known about the patient experience of breastfeeding within these settings. By exploring this current gap in the literature, we may discover important contextual elements of the breastfeeding experience. The objective of this protocol is to provide a framework for a scoping review where we aim to understand the extent and type of evidence in relation to the patient experience of breastfeeding in Baby-friendly Hospital Initiative (BFHI)-certified settings.Methods and analysis The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The databases to be searched for relevant literature include MEDLINE, Embase, PsycINFO, CINAHL and Scopus in April 2023. A grey literature scan will include reviewing documents from professional organisations/associations. For all sources of evidence that meet the inclusion criteria, data will be extracted and presented in a table format. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Participants in this review will include any individual who delivered their baby in a BFHI-certified setting. Exploring the patient experience will involve reviewing their subjective perceptions of events related to breastfeeding. These events must occur in a BFHI-certified hospital, and therefore, home births and other outpatient settings will be excluded.Ethics and dissemination Ethical approval is not required for this scoping review protocol or the final review. Knowledge gained from this research will be disseminated through the primary author’s PhD dissertation work, as well as manuscript publications and conference presentations.

Abstract Background Recovery-oriented programs provide individuals with opportunities for well-being through community integration processes that enhance the degree to which individuals could live, work, and recreate in their community. The current evaluation assessed how tenants experience their home environment after the modernization of Homes for Special Care (HSC) to Community Homes for Opportunity (CHO) in Southwest Ontario, Canada. Our study identifies existing policies and practices that could interfere with or promote the modernization process. Methods We applied ethnographic qualitative techniques to purposefully recruit 188 participants with severe mental illness from 28 group homes. Focus groups were conducted at three time points, i.e., at pre-implementation/Baseline/Time I – spring 2018; Transition/Time II – fall 2018, and Final/Time III – winter 2019. Results Study findings suggest that the transition of HSC to CHO supports activities that empower tenants towards personal growth and development. Participants were largely satisfied with the support they were getting in relation to the program-related services. Tenants disclosed that their quality of life and well-being had been enhanced through participating in the program, and that their social interaction and support for each other had also improved. Most tenants demonstrated autonomy in terms of personal and financial independence. The enhanced financial support for tenants did not only improve their quality of life, but also helped to raise their purchasing power, decision making, sense of responsibility and accountability towards healthy spending of their resources. Despite tenants’ good impression about the CHO, some still encountered problems and provided suggestions to further improve the program. Conclusion It is expected that a more effective and expanded CHO will lead to tenant empowerment and successful social integration.

Abstract Background The onset of the COVID-19 pandemic necessitated a rapid shift in primary health care from predominantly in-person to high volumes of virtual care. The pandemic afforded the opportunity to conduct a deep regional examination of virtual care by family physicians in London and Middlesex County, Ontario, Canada that would inform the foundation for virtual care in our region post-pandemic. Objectives: (1) to determine volumes of in-person and virtual family physicians visits and characteristics of the family physicians and patients using them during the early COVID-19 pandemic; (2) to determine how virtual visit volumes changed over the pandemic, compared to in-person; and (3) to explore family physicians’ experience in virtual visit adoption and implementation. Methods We conducted a concurrent mixed-methods study of family physicians from March to October 2020. The quantitative component examined mean weekly number of total, in-person and virtual visits using health administrative data. Differences in outcomes according to physician and practice characteristics for pandemic periods were compared to pre-pandemic. The qualitative study employed Constructivist Grounded Theory, conducting semi-structured family physicians interviews; analyzing data iteratively using constant comparative analysis. We mapped themes from the qualitative analysis to quantitative findings. Results Initial volumes of patients decreased, driven by fewer in-person visits. Virtual visit volumes increased dramatically; family physicians described using telephone almost entirely. Rural family physicians reported video connectivity issues. By early second wave, total family physician visit volume returned to pre-pandemic volumes. In-person visits increased substantially; family physicians reported this happened because previously scarce personal protective equipment became available. Patients seen during the pandemic were older, sicker, and more materially deprived. Conclusion These results can inform the future of virtual family physician care including the importance of continued virtual care compensation, the need for equitable family physician payment models, and the need to attend to equity for vulnerable patients. Given the move to virtual care was primarily a move to telephone care, the modality of care delivery that is acceptable to both family physicians and their patients must be considered.

Summary: Background: The UK National Institute for Health and Care Excellence (NICE), recommended in 2017 the use of the faecal immunochemical test (FIT) to guide investigations in patients presenting with NICE-defined low-risk symptoms suspicious for colorectal cancer (CRC). At that time, NICE did not recommend FIT use for high-risk symptoms. This is the first systematic review to evaluate the diagnostic accuracy of FIT in NICE-defined high and low-risk symptoms and was designed to inform the joint ACPGBI/BSG guidelines. Methods: We performed a systematic literature review and meta-analysis. PROSPERO registration number CRD42021224674. Medline and EMBASE databases were searched from inception to 31st March 2022. We included studies recruiting adult patients presenting with suspected CRC symptoms in whom FIT was performed and diagnostic accuracy data for CRC detection could be derived at a limit of detection (LoD) and/or 10 µg haemoglobin/gram faeces threshold in four commonly used analysers. FIT performance was assessed for high-risk, low-risk and individual symptoms where possible. Bivariate meta-analysis was performed where study numbers allowed. Findings: Thirty-one studies (79566 patients) met inclusion criteria. At 10 µg/g, for “all symptoms” (n = 35,945) sensitivity and specificity were 91.0% (95% CI: 88.9, 92.7) and 75.2% (95% CI: 69.6, 80.1); for “high-risk” symptoms (n = 18,264), 88.7% (95% CI: 84.4, 92.0) and 78.5% (95% CI: 73.0, 83.2); and for “low-risk” symptoms (n = 2161), 88.7% (95% CI: 78.1, 95.3) and 88.5% (95% CI: 87.1, 89.9), respectively. At LoD, for “all symptoms” (n = 26,056) sensitivity and specificity were 94.7% (95% CI: 90.5, 97.1) and 66.5% (95% CI: 58.7, 73.6); for “high-risk” symptoms (n = 16,768), 92.8% (95% CI: 86.4, 96.3) and 70.3% (95% CI: 66.5, 73.8); and for “low-risk” symptoms (n = 2082), 94.7% (95% CI: 85.4, 98.9) and 71.9% (95% CI: 69.9, 73.9), respectively. Summary estimates were similar across different analysers. Interpretation: FIT sensitivity for CRC detection is maximised at the LoD; its performance is similar in high and low-risk symptoms, and across different analysers where a common threshold is used. FIT performance for CRC detection is adequate and transferrable to clinical diagnostic pathways. Funding: This review was part-funded by NHS England awarded to RM Partners. RB and RC were funded by research fellowships awarded by Croydon University Hospital.

One-dimensional (1D) supramolecular polymers are commonly found in natural and synthetic systems but very little is currently known about the physico-chemical consequences and functional role of 1D supramolecular polymerisation confined in aqueous compartments. Here, the authors describe the different phenomena that resulted from the chemically triggered supramolecular fibrillation of synthetic peptide amphiphiles inside water microdroplets.

Objectives To describe COVID-19 vaccine coverage (i.e., the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent experience of homelessness in Ontario, Canada. Approach We conducted a retrospective, population-based cohort study of 23,247 individuals (≥18 years) with a recent experience of homelessness as recorded in routinely collected healthcare databases. Participants were followed from December 14, 2020 to September 30, 2021 for the receipt of a COVID-19 vaccine. Using modified Poisson regression, we identified sociodemographic, healthcare usage, and clinical factors associated with the receipt of one or more doses of a COVID-19 vaccine. Results By September 30, 14,271 (61.4%) of participants with a recent experience of homelessness had received a first dose of a COVID-19 vaccine and 11,082 (47.7%) had received two doses. Over the same period, 86.6% and 81.6% of the total adult population of Ontario had received a first dose and second dose, respectively. In multivariable analysis, factors associated with increased COVID-19 uptake included ≥1 visit to a general practitioner (adjusted Risk Ratio [aRR]:1.37[95% CI 1.31-1.42]), older age (vs. 18-29 years: 50-59 years, aRR:1.18[1.14-1.22]; 60+ years, aRR:1.27[1.22-1.31]), receipt of an influenza vaccine (aRR:1.25[1.23-1.28]), receipt of ≥1 SARS-CoV-2 test (aRR:1.23[1.20-1.26]) and the presence of chronic health conditions (vs. 0 conditions: 1 condition, aRR:1.05[1.03, 1.08]; 2+ conditions, aRR:1.11[1.08-1.14]). In contrast, living in a smaller metropolitan region (aRR:0.92[0.90-0.94]) or rural location (aRR:0.93[0.90-0.97]) compared to a large metropolitan region was associated with lower uptake. Conclusions As of September 30, 2021, COVID-19 vaccine coverage among individuals with a recent experience of homelessness in Ontario was substantially lower than the general adult population of Ontario for a first and second dose. Findings underscore the importance of leveraging organizations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery.

Abstract The overall objective of this research is to evaluate the use of a mobile health smartphone application (app) to improve the mental health of youth between the ages of 14 and 25 years, with symptoms of anxiety and/or depression. This project includes 122 youth who are accessing outpatient mental health services at one of three hospitals and two community agencies. The youth and care providers are using the Smart technology to enhance care. The technology uses mobile questionnaires (QnairesTM) to help promote self‐assessment and track changes to support the plan of care. The youth were provided a smartphone and talk/text/data plan, if needed. The majority of participants identified themselves as Caucasian (73.5%). Expectedly, the demographics revealed that Anxiety Disorders and Mood Disorders were highly prevalent within the sample (73.6% and 66.9% respectively). Findings from the qualitative summary established that both staff and youth found having a smartphone and data plan beneficial. Demographic variables such as age, sex, mental health and physical health did not predict which youth were more likely to use the application.

Summary: Background: People experiencing homelessness face a high risk of SARS-CoV-2 infection and transmission, as well as health complications and death due to COVID-19. Despite being prioritised for receiving the COVID-19 vaccine in many regions, little data are available on vaccine uptake in this vulnerable population. Using population-based health-care administrative data from Ontario, Canada—a region with a universal, publicly funded health system—we aimed to describe COVID-19 vaccine coverage (ie, the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent history of homelessness. Methods: We conducted a retrospective, population-based cohort study of adults (aged ≥18 years) with a recent experience of homelessness, inadequate housing, or shelter use as recorded in routinely collected health-care databases between June 14, 2020, and June 14, 2021 (a period within 6 months of Dec 14, 2020, when COVID-19 vaccine administration was initiated in Ontario). Participants were followed up from Dec 14, 2020, to Sept 30, 2021, for the receipt of one or two doses of a COVID-19 vaccine using the province's real-time centralised vaccine information system. We described COVID-19 vaccine coverage overall and within predefined subgroups. Using modified Poisson regression, we further identified sociodemographic factors, health-care usage, and clinical factors associated with receipt of at least one dose of a COVID-19 vaccine. Findings: 23 247 individuals with a recent history of homelessness were included in this study. Participants were predominantly male (14 752 [63·5%] of 23 247); nearly half were younger than 40 years (11 521 [49·6%]) and lived in large metropolitan regions (12 123 [52·2%]); and the majority (18 226 [78·4%]) visited a general practitioner for an in-person consultation during the observation period. By Sept 30, 2021, 14 271 (61·4%; 95% CI 60·8–62·0) individuals with a recent history of homelessness had received at least one dose of a COVID-19 vaccine and 11 082 (47·7%; 47·0–48·3) had received two doses; in comparison, over the same period, 86·6% of adults in the total Ontario population had received a first dose and 81·6% had received a second dose. In multivariable analysis, factors positively associated with COVID-19 uptake were one or more outpatient visits to a general practitioner (adjusted risk ratio [aRR] 1·37 [95% CI 1·31–1·42]), older age (50–59 years vs 18–29 years: 1·18 [1·14–1·22], ≥60 years vs 18–29 years: 1·27 [1·22–1·31]), receipt of an influenza vaccine in either of the two previous influenza seasons (1·25 [1·23–1·28]), being identified as homeless via a visit to a community health centre versus exclusively a hospital-based encounter (1·13 [1·10–1·15]), receipt of one or more SARS-CoV-2 tests between March 1, 2020, and Sept 30, 2021 (1·23 [1·20–1·26]), and the presence of chronic health conditions (one condition: 1·05 [1·03–1·08]; two or more conditions: 1·11 [1·08–1·14]). By contrast, living in a smaller metropolitan region (aRR 0·92 [95% CI 0·90–0·94]) or rural location (0·93 [0·90–0·97]) versus large metropolitan regions were associated with lower uptake. Interpretation: In Ontario, COVID-19 vaccine coverage among adults with a recent history of homelessness has lagged and, as of Sept 30, 2021, was 25 percentage points lower than that of the general adult population in Ontario for a first dose and 34 percentage points lower for a second dose. With high usage of outpatient health services among individuals with a recent history of homelessness, better utilisation of outpatient primary care structures might offer an opportunity to increase vaccine coverage in this population. Our findings underscore the importance of leveraging existing health and service organisations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery. Funding: The Public Health Agency of Canada. Translation: For the French translation of the abstract see Supplementary Materials section.

Appropriate support in the home may not be readily available for people living in the community with mental illness and physical comorbidities. This mixed-method study evaluated a smart home technology intervention for individuals within this population as well as providing health care providers with health monitoring capabilities. The study recruited 13 participants who were offered a smartphone, a touchscreen monitor, and health devices, including smartwatches, weigh scales, and automated medication dispensers. Healthcare providers were able to track health device data, which were synchronized with the Lawson Integrated DataBase. Participants completed interviews at baseline as well as at 6-month and 12-month follow-ups. Focus groups with participants and care providers were conducted separately at 6-month and 12-month time points. As the sample size was too small for meaningful statistical inference, only descriptive statistics were presented. However, the qualitative analyses revealed improvements in physical and mental health, as well as enhanced communication with care providers and friends/family. Technical difficulties and considerations are addressed. Ethics analyses revealed advancement in equity and fairness, while policy analyses revealed plentiful opportunities for informing policymakers. The economic costs are also discussed. Further studies and technological interventions are recommended to explore and expand upon in-home technologies that can be easily implemented into the living environment.

Research on male intimate partner violence (IPV) survivors is limited. The sparse research on male IPV disclosure suggest males receive more negative and less helpful responses from potential sources of formal or informal support. Males may seek support on social networking sites (SNSs), hence, it is important to understand their emerging experiences of virtual disclosures. This study examined the nature and content of responses to IPV disclosures by male IPV survivors on a popular SNS (reddit.com). Search of Reddit submissions related to male IPV were carried out using three IPV related keywords for the calendar month of February 2019, resulting in 917 submissions. Twelve submissions that focused on male IPV disclosure were examined in detail. The 12 submissions were analyzed using quantitative content analysis while associated comments ( n = 569) were analyzed using qualitative approach. Two-thirds of the disclosures (8/12) were of personal IPV experiences. All disclosure narratives identified the sex of perpetrator, most stated the types of abuse (7/12), and some revealed the outcomes of past disclosures (4/12). Six major themes were developed through qualitative analysis of the associated comments: (1) Informational Support, (2) Nurturant Support, (3) Tangible Aid, (4) Negative Response (5) Self-Defence, and (6) Reciprocal Disclosure. Overall, males experienced a majority of supportive responses to IPV disclosures and some negative responses including criticism and minimizing the abuse. Males take risks in disclosure of IPV in person and online.

Multi-compartmentalised soft micro-systems are used as models of synthetic protocells. Here, the authors developed nested host–guest protocell constructs capable of self-reconfiguration in response to changes in pH generated by antagonistic modes of enzyme-mediated coupling.

Depression is associated with altered sensitivity to reward and punishment, which can influence complex decision-making. We examined punishment sensitivity in the performance of participants with major depressive disorder (MDD) with that of a comparison group on the automatic Balloon Analogue Risk Task (BART), which is a direct measure of risk taking. The present study examined the BART performance of 30 individuals with MDD and 30 matched comparison individuals. The comparison group (M = 63.25) entered a significantly (p < 0.001; d = 1.1) higher number of pumps on the BART than the MDD group (M = 50.83). Higher levels of depression symptoms were significantly correlated (r = -0.40, p < 0.05) with entering a lower number of pumps in the MDD group. MDD patients showed an increased sensitivity to punishment on the BART: after a loss, the MDD group decreased (M = 13.7) the number of subsequent pumps they entered by a significantly (p < 0.001, d = 0.81) greater amount than the comparison group (M = 4.35). This difference applied to losses only: no difference was found between the groups regarding the magnitude of change in pumps selected after a win. Findings suggest the presence of elevated punishment sensitivity among individuals with MDD, which may contribute to the maintenance of depressive symptoms.

Since 2007, mortality associated with a previously unreported haemorrhagic disease has been observed in young calves in several European countries. The syndrome, which has been named 'bovine neonatal pancytopenia' (BNP), is characterised by thrombocytopenia, leukocytopenia and a panmyelophthisis. A herd-level case-control study was conducted in four BNP affected countries (Belgium, France, Germany and the Netherlands) to identify herd management risk factors for BNP occurrence. Data were collected using structured face-to-face and telephone interviews of farm managers and their local veterinarians. In total, 363 case farms and 887 control farms were included in a matched multivariable conditional logistic regression analysis. Case-control status was strongly associated with the odds of herd level use of the vaccine PregSure® BVD (PregSure, Pfizer Animal Health) (matched adjusted odds ratio (OR) 107.2; 95% CI: 41.0-280.1). This was also the case for the practices of feeding calves colostrum from the calf's own dam (OR 2.0; 95% CI: 1.1-3.4) or feeding pooled colostrum (OR 4.1; 95% CI: 1.9-8.8). Given that the study had relatively high statistical power and represented a variety of cattle production and husbandry systems, it can be concluded with some confidence that no other herd level management factors are competent causes for a sufficient cause of BNP occurrence on herd level. It is suggested that genetic characteristics of the dams and BNP calves should be the focus of further investigations aimed at identifying the currently missing component causes that together with PregSure vaccination and colostrum feeding represent a sufficient cause for occurrence of BNP in calves.

Bovine neonatal pancytopenia (BNP), a high fatality condition causing haemorrhages in calves aged less than 4 weeks, was first reported in 2007 in Germany and subsequently observed at low incidence in other European countries and New Zealand. A multi-country matched case-control study was conducted in 2011 to identify calf-level risk factors for BNP. 405 BNP cases were recruited from 330 farms in Belgium, France, Germany and the Netherlands by laboratory confirmation of farmer-reported cases. Up to four calves of similar age from the same farm were selected as controls (1154 calves). Risk factor data were collected by questionnaire. Multivariable modelling using conditional logistic regression indicated that PregSure®BVD (PregSure, Pfizer Animal Health) vaccination of the dam was strongly associated with BNP cases (adjusted matched Odds Ratio - amOR 17.8 first lactation dams; 95% confidence interval - ci 2.4, 134.4; p = 0.005), and second or more lactation PregSure-vaccinated dams were more likely to have a case than first lactation vaccinated dams (amOR 2.2 second lactation; ci 1.1, 4.3; p = 0.024; amOR 5.3 third or more lactation; ci 2.9, 9.8; p =