Length of postpartum hospital stays during COVID-19: Findings from a convergent parallel mixed-methods study.

OBJECTIVE: We examined length of postpartum hospitalization for live births during the COVID-19 pandemic and explored how pandemic circumstances influenced postpartum hospital experiences. METHODS: We conducted a cross-provincial, convergent parallel mixed-methods study in Ontario (ON) and British Columbia (BC), Canada. We included birthing persons (BPs) with an in-hospital birth in ON from 1 January to 31 March 2019, 2021, and 2022 (quantitative), and BPs (≥18 years) in ON or BC from 1 May 2020 to 1 December 2021 (qualitative). We linked multiple health administrative datasets at ICES and developed multivariable linear regression models to examine length of hospital stay (quantitative). We conducted semi-structured interviews using qualitative descriptive to understand experiences of postpartum hospitalization (qualitative). Data integration occurred during design and interpretation. RESULTS: Relative to 2019, postpartum hospital stays decreased significantly by 3.29 hours (95% CI: -3.58 to -2.99; 9.2% reduction) in 2021 and 3.89 hours (95% CI: -4.17 to -3.60; 9.0% reduction) in 2022. After adjustment, factors associated with shortened stays included: giving birth during COVID-19, social deprivation (more ethnocultural diversity), midwifery care, multiparity, and lower newborn birth weight. Postpartum hospital experiences were impacted by risk perception of COVID-19 infection, clinical care and hospital services/amenities, visitor policies, and duration of stay. CONCLUSION: Length of postpartum hospital stays decreased during COVID-19, and qualitative findings described unmet needs for postpartum services. The integration of large administrative and interview data expanded our understanding of observed differences. Future research should investigate the impacts of shortened stays on health services outcomes and personal experiences. OBJECTIF: Nous avons examiné la durée d'hospitalisation post-partum pour les cas de naissance vivante pendant la pandémie de COVID-19 et exploré comment les circonstances de la pandémie ont influencé l'expérience post-partum à l'hôpital. MéTHODES: Nous avons mené une étude interprovinciale selon un modèle mixte parallèle et convergent en Ontario (Ont.) et en Colombie-Britannique (C.-B.), au Canada. Nous avons inclus les personnes ayant accouché à l'hôpital en Ont. entre le 1 janvier et le 31 mars 2019, 2021 et 2022 (quantitatif), et celles ayant accouché (≥ 18 ans) entre le 1 mai 2020 et le 1 décembre 2021 en Ont. ou en C.-B. (qualitatif). Nous avons relié plusieurs ensembles de données de santé administratives à l'ICES et développé des modèles de régression linéaire multivariable pour examiner la durée d'hospitalisation (quantitative). Nous avons mené des entretiens semi-structurés en utilisant une méthode qualitative descriptive pour comprendre les expériences d'hospitalisation post-partum (qualitative). L'intégration des données a eu lieu pendant la conception de l'étude et l'interprétation. RéSULTATS: Par rapport à 2019, la durée de l'hospitalisation post-partum a significativement diminué de 3,29 heures (IC à 95 % : -3,58 à -2,99; réduction de 9,2 %) en 2021 et de 3,89 heures (IC à 95 % : -4,17 à -3,60; réduction de 9,0 %) en 2022. Après ajustement, les facteurs associés à la réduction de la durée d'hospitalisation étaient les suivants : accouchement pendant la pandémie de COVID-19, manque de socialisation (plus grande diversité ethnoculturelle), prise en charge en pratique sage-femme, multiparité et poids plus faible du nouveau-né à la naissance. L'expérience d'hospitalisation post-partum était influencée par la perception du risque de contracter la COVID-19, les soins cliniques et les services et commodités à l'hôpital, les politiques relatives aux visiteurs et la durée de l'hospitalisation. CONCLUSION: La durée d'hospitalisation post-partum a diminué pendant la pandémie de COVID-19, et les résultats qualitatifs ont décrit des besoins non satisfaits en matière de services post-partum. L'intégration de grands ensembles de données administratives et d'entretiens a permis de mieux comprendre les différences observées. Les recherches futures devront se pencher sur l'impact de la réduction de la durée d'hospitalisation sur les résultats des services de santé et les expériences personnelles.

Making waste management public (or falling back to sleep).

Human-produced waste is a major environmental concern, with communities considering various waste management practices, such as increased recycling, landfilling, incineration, and waste-to-energy technologies. This article is concerned with how and why publics assemble around waste management issues. In particular, we explore Noortje Marres and Bruno Latour's theory that publics do not exist prior to issues but rather assemble around objects, and through these assemblages, objects become matters of concern that sometimes become political. The article addresses this theory of making things public through a study of a small city in Ontario, Canada, whose landfill is closed and waste diversion options are saturated, and that faces unsustainable costs in shipping its waste to the United States, China, and other regions. The city's officials are undertaking a cost-benefit assessment to determine the efficacy of siting a new landfill or other waste management facility. We are interested in emphasizing the complexity of making (or not making) landfills public, by exploring an object in action, where members of the public may or may not assemble, waste may or may not be made into an issue, and waste is sufficiently routinized that it is not typically transformed from an object to an issue. We hope to demonstrate Latour's third and fifth senses of politics best account for waste management's trajectory as a persistent yet inconsistent matter of public concern.

Exploring the Views, Perspectives, and Current Practices of Educational Speech-Language Pathologists and Psychologists in Canada: How Childhood Developmental Language Disorders Are Identified and Diagnosed.

PURPOSE: Across Canada, speech-language pathologists (SLPs) and educational psychologists (EPs) work in schools to identify and diagnose childhood learning difficulties, including language disorders; however, both professional groups use different terms to identify and diagnose them. Using the term developmental language disorder (DLD), developed by the CATALISE consortium, would provide consistency across fields. To effectively implement the use of DLD, it is crucial to understand how EPs and SLPs currently identify childhood language disorders and to investigate the potential impact of a practice change in this area. METHOD: The study conducted 13 moderated focus groups and one one-on-one semistructured interview across six Canadian provinces in English and French. RESULTS: We found some social and structural barriers that impact SLPs' and EPs' current practice of identifying and diagnosing language disorders generally (e.g., the belief that children should not be labeled "too early," institutions that prioritize certain professional diagnoses over others, board policies that do not allocate funds for language disorders, professionals' reticence to convey difficult information such as a diagnosis to collaborators) and DLD specifically (e.g., different professional taxonomies, lack of familiarity with or uncertainty about the label, not recognized as a condition in schools that may or may not even identify language disorder as a category of exceptionality). Nevertheless, the focus groups also revealed the extent to which DLD could be useful in their current practice. CONCLUSION: Both EPs and SLPs acknowledged the importance of working together; therefore, DLD could inspire more collaborative practice between SLPs and EPs around language disorders.

Patient perspectives of recovery from myalgic encephalomyelitis/chronic fatigue syndrome: An interpretive description study.

AIMS AND OBJECTIVES: Myalgic encephalomyelitis (ME), also called chronic fatigue syndrome (CFS), is characterised by persistent fatigue, postexertional malaise, and cognitive dysfunction. It is a complex, long-term, and debilitating illness without widely effective treatments. This study describes the treatment choices and experiences of ME/CFS patients who have experienced variable levels of recovery. METHOD: Interpretive description study consisting of semi-structured qualitative interviews with 33 people who met the US Centers for Disease Control (2015) diagnostic criteria for ME/CFS and report recovery or symptom improvement. RESULTS: Twenty-six participants endorsed partial recovery, and seven reported full recovery from ME/CFS. Participants reported expending significant time and energy to identify, implement, and adapt therapeutic interventions, often without the guidance of a medical practitioner. They formulated individualised treatment plans reflecting their understanding of their illness and personal resources. Most fully recovered participants attributed their success to mind-body approaches. CONCLUSION: Patients with ME/CFS describe independently constructing and managing treatment plans, due to a lack of health system support. Stigmatised and dismissive responses from clinicians precipitated disengagement from the medical system and prompted use of other forms of treatment.

How do perceptions of Covid-19 risk impact pregnancy-related health decisions? A convergent parallel mixed-methods study protocol.

INTRODUCTION: Pregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic. OBJECTIVES: Quantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people.Qualitative strand: Understand how pregnant people's perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health. METHODS AND ANALYSIS: This is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020- December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation. ETHICS AND DISSEMINATION: This study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics. TRIAL REGISTRATION: Registration: Clinicaltrials.gov registration number: NCT05663762.