COVID-19 Pandemic Mental Health Trajectories: Patterns From a Sample of Canadians Primarily Recruited From Alberta and Ontario

Public Significance Statement Public health responses to the pandemic coronavirus disease (COVID-19) could adversely impact the mental health of Canadians. Understanding changes in Canadian mental health during the pandemic and the factors that confer risk and resilience could guide future pandemic public health policies. During the first 6 months of the COVID-19 pandemic, Canadians experienced changes in depressive and anxiety symptoms that paralleled COVID-19 infection rates and Health Canada pandemic response recommendations. Coronavirus disease (COVID-19) is a highly contagious and novel virus that has prompted government officials to implement restrictive public health orders. It is hypothesized that pandemic-related restrictions may have a detrimental impact on mental health. Longitudinal data were collected through 13 assessments, repeated every 2 weeks for the initial 6 months of the COVID-19 pandemic. Participants were recruited through [Masked] University and social media. The final sample consisted of 280 adults from across Canada, with the majority of participants residing in Alberta (63%) and Ontario (20%). Sociodemographic characteristics, COVID-19 related risk factors, prepandemic and pandemic physical activity, and COVID-19 related risk factors were collected at study entry, and mental health (depressive symptoms, anxiety, and loneliness) were collected at each assessment. Multilevel modeling was used to identify mental health trajectories during the initial 6 months of the pandemic. Mental health symptoms tracked with rising cases of infection and subsequent public health restrictions during the pandemic. Specifically, anxiety and depressive symptoms demonstrated strong longitudinal quadratic trends. Both anxiety and depressive symptoms were high at study entry (May 2020) and decreased over the summer, followed by an increase in the fall and winter months. Loneliness was stable over the follow-up period. Age, sex, living alone, socioeconomic factors, and preexisting mental health conditions correlated with mental health symptoms during the pandemic's initial 6 months. This study characterizes within-person changes to mental health (anxiety, depressive symptoms, and loneliness) in a Canadian sample from May 2020 to January 2021 during the COVID-19 pandemic.

Delayed Surgery for localised prostate cancer: A systematic review for the COVID-19 Pandemic

Introduction: The risks of delaying cancer surgery and the best management for these patients during COVID-19 is unknown. This systematic review aims to compare outcomes of patients with localised prostate cancer (PCa) who experienced any delay of radical prostatectomy (RP) (including surgical waiting times and use of neoadjuvant hormone therapy [NHT]), compared to those who underwent immediate RP. Methods: MEDLINE and Cochrane CENTRAL were searched for studies pertaining to the review question. Outcomes included (Biochemical) Recurrence-free survival, cancer-specific survival, overall survival and positive surgical margin (PSM). Results: 4,120 studies were retrieved. 36 observational studies investigated the effects of delayed RP. A variety of PCa risks and delay periods contributed to considerable heterogeneity in the include studies. When stratifying by PCa risk groups, low risk PCa (Grade Group [GG] 1) can be delayed safely from at least 26 weeks to 2.6 years, without significant effects on all outcomes. Similarly, RP can be safely delayed for 6 to 9 months in intermediate risk patients (GG 2/3). In high-risk patients (GG 4/5), the delay of RP for 2 or more months tends to associate with worsen recurrences, hence NHT should be considered. Ten RCTs show 3-months of NHT is non-inferior for oncological outcomes and superior for PSM compared to immediate RP. The risk of biases of the included studies ranged from low to serious risk. Conclusion: RP is safe to be delayed in low-risk and intermediate-risk PCa patients. High-risk patients should be offered NHT;there is no sufficient evidence extending NHT over 3-months.

Effect of SARS and COVID-19 outbreaks on urology practice and training.

INTRODUCTION: The objective was to investigate the changes in urology practice during coronavirus disease 2019 (COVID-19) pandemic with a perspective from our experience with severe acute respiratory syndrome (SARS) in 2003. METHODS: Institutional data from all urology centres in the Hong Kong public sector during the COVID-19 pandemic (1 Feb 2020-31 Mar 2020) and a non-COVID-19 control period (1 Feb 2019-31 Mar 2019) were acquired. An online anonymous questionnaire was used to gauge the impact of COVID-19 on resident training. The clinical output of tertiary centres was compared with data from the SARS period. RESULTS: The numbers of operating sessions, clinic attendance, cystoscopy sessions, prostate biopsy, and shockwave lithotripsy sessions were reduced by 40.5%, 28.5%, 49.6%, 44.8%, and 38.5%, respectively, across all the centres reviewed. The mean numbers of operating sessions before and during the COVID-19 pandemic were 85.1±30.3 and 50.6±25.7, respectively (P=0.005). All centres gave priority to cancer-related surgeries. Benign prostatic hyperplasia-related surgery (39.1%) and ureteric stone surgery (25.5%) were the most commonly delayed surgeries. The degree of reduction in urology services was less than that during SARS (47.2%, 55.3%, and 70.5% for operating sessions, cystoscopy, and biopsy, respectively). The mean numbers of operations performed by residents before and during the COVID-19 pandemic were 75.4±48.0 and 34.9±17.2, respectively (P=0.002). CONCLUSION: A comprehensive review of urology practice during the COVID-19 pandemic revealed changes in every aspect of practice.