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1.
BMC Health Serv Res ; 21(1): 950, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507571

RESUMO

BACKGROUND: A disconnect exists between the idealized model of every patient having a family physician (FP) who acts as the central hub for care, and the reality of health care where patients must navigate a network of different providers. This disconnect is particularly evident when hospitalized multimorbid patients transition back into the community. These discharges are identified as high-risk due to lapses in care continuity. The aim of this study was to identify and explore the networks of care providers in a sample of hospitalized, complex patients, and better understand the nature of their attachments to these providers as a means of discovering novel approaches for improving discharge planning. METHODS: This was a constructivist grounded theory study. Data included interviews from 30 patients admitted to an inpatient internal medicine service of a midsized academic hospital in Ontario, Canada. Analysis and data collection proceeded iteratively with sampling progressing from purposive to theoretical. RESULTS: We identified network of care configurations commonly found in patients with multiple medical comorbidities receiving care from multiple different providers admitted to an internal medicine service. FPs and specialists form the network's scaffold. The involvement of physicians in the network dictated not only how patients experienced transitions in care but the degree of reliance on social supports and personal capacities. The ideal for the multimorbid patient is an optimally involved FP that remains at the centre, even when patients require more subspecialized care. However, in cases where a rostered FP is non-existent or inadequate, increased involvement and advocacy from specialists is crucial. CONCLUSIONS: Our results have implications for transition planning in hospitalized complex patients. Recognizing salient network features can help identify patients who would benefit from enhanced discharge support.


Assuntos
Continuidade da Assistência ao Paciente , Alta do Paciente , Humanos , Ontário , Médicos de Família , Pesquisa Qualitativa
2.
BMC Res Notes ; 14(1): 357, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507612

RESUMO

OBJECTIVE: Historically, persons from minority ethnic, religious and linguistic backgrounds have been un- or under-represented in population-based research studies. Emerging scholarship suggests challenges in representative sampling, particularly of minority ethnocultural groups, has been exacerbated by the COVID-19 pandemic. This research note offers additional insights concerning these challenges in the context of a population-based survey of unpaid caregivers conducted in Ontario, Canada, between August and December, 2020, the analysis of which is currently underway. RESULTS: Beyond limitations intrinsic to study design, including time and budget constraints, the study sample underrepresents unpaid caregivers from minority ethnocultural backgrounds due to differences in conceptions of caregiving across minority cultures, the time-consuming nature of caregiving that disproportionately affects minority groups, and a propensity to avoid research which is rooted in tokenism. These hypotheses are non-exhaustive, speculative and warrant further empirical investigation.


Assuntos
COVID-19 , Cuidadores , Humanos , Grupos Minoritários , Ontário , Pandemias , SARS-CoV-2
3.
BMC Public Health ; 21(1): 1634, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493258

RESUMO

INTRODUCTION: Physical distancing (PD) is an important public health strategy to reduce the transmission of COVID-19 and has been promoted by public health authorities through social media. Although youth have a tendency to engage in high-risk behaviors that could facilitate COVID-19 transmission, there is limited research on the characteristics of PD messaging targeting this population on social media platforms with which youth frequently engage. This study examined social media posts created by Canadian public health entities (PHEs) with PD messaging aimed at youth and young adults aged 16-29 years and reported behavioral change techniques (BCTs) used in these posts. METHODS: A content analysis of all social media posts of Canadian PHEs from Facebook, Twitter, Instagram and YouTube were conducted from April 1st to May 31st, 2020. Posts were classified as either implicitly or explicitly targeting youth and young adults. BCTs in social media posts were identified and classified based on Behavior Change Technique Taxonomy version 1 (BCTTv1). Frequency counts and proportions were used to describe the data. RESULTS: In total, 319 youth-targeted PD posts were identified. Over 43% of the posts originated from Ontario Regional public health units, and 36.4 and 32.6% of them were extracted from Twitter and Facebook, respectively. Only 5.3% of the total posts explicitly targeted youth. Explicit posts were most frequent from federal PHEs and posted on YouTube. Implicit posts elicited more interactions than explicit posts regardless of jurisdiction level or social media format. Three-quarters of the posts contained at least one BCT, with a greater portion of BCTs found within implicit posts (75%) than explicit posts (52.9%). The most common BCTs from explicit posts were instructions on how to perform a behavior (25.0%) and restructuring the social environment (18.8%). CONCLUSIONS: There is a need for more PD messaging that explicitly targets youth. BCTs should be used when designing posts to deliver public health messages and social media platforms should be selected depending on the target population.


Assuntos
COVID-19 , Mídias Sociais , Adolescente , Humanos , Ontário , Distanciamento Físico , Saúde Pública , SARS-CoV-2 , Adulto Jovem
4.
BMC Public Health ; 21(1): 1595, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34496825

RESUMO

BACKGROUND: Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. METHODS: We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regression guided the mediation analysis. A parallel mediation model was created with enacted stigma as the antecedent, internalized stigma and depression as the mediators, and self-rated health as the outcome. RESULTS: In the multiple regression analysis, internalized stigma (coefficient = -0.20, p < 0.01) and depression (coefficient = -0.07, p < 0.01) were both significant and independent predictors of health. Mediation analyses demonstrated that the relationship between enacted stigma and self-rated health is mediated in parallel by both internalized stigma [coefficient = -0.08, se = 0.03, 95% CI (-0.14, -0.02)] and depression [coefficient = -0.16, se = 0.03, 95% CI (-0.22, -0.11)]. CONCLUSIONS: We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one's HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape the development of targeted intervention strategies aimed at reducing the burden of stigma and improving the health and wellbeing of people living with HIV.


Assuntos
Depressão , Infecções por HIV , Depressão/epidemiologia , Humanos , Ontário/epidemiologia , Preconceito , Estigma Social
5.
BMJ Open ; 11(8): e051192, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433609

RESUMO

BACKGROUND: Effective teamwork between anaesthesiologists and surgeons is essential for optimising patient safety in the cardiac operating room. While many factors may influence the relationship between these two physicians, the role of sex and gender have yet to be investigated. OBJECTIVES: We sought to determine the association between cardiac physician team sex discordance and patient outcomes. DESIGN: We performed a population-based, retrospective cohort study. PARTICIPANTS AND SETTING: Adult patients who underwent coronary artery bypass grafting (CABG) and/or aortic, mitral or tricuspid valve surgery between 2008 and 2018 in Ontario, Canada. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause 30-day mortality. Secondary outcomes included major adverse cardiovascular events at 30 days and hospital and intensive care unit lengths of stay (LOS). Mixed effects logistic regression was used for categorical outcomes and Poisson regression for continuous outcomes. RESULTS: 79 862 patients underwent cardiac surgery by 98 surgeons (11.2% female) and 279 anaesthesiologists (23.3% female); 19 893 (24.9%) were treated by sex-discordant physician teams. Physician sex discordance was not associated with overall patient mortality or LOS; however, patients who underwent isolated CABG experienced longer hospital LOS when treated by an all-male physician team as compared with an all-female team (adjusted OR=1.07; p=0.049). When examining the impact of individual physician sex, the length of hospital stay was longer when isolated CABG procedures were attended by a male surgeon (OR=1.10; p=0.004) or anaesthesiologist (OR=1.02; p=0.01). CONCLUSIONS: Patient mortality and length of stay after cardiac surgery may vary by sex concordance of the attending surgeon-anaesthesiologist team. Further research is needed to examine the underlying mechanisms of these observed relationships.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cirurgiões , Cirurgia Torácica , Adulto , Feminino , Humanos , Tempo de Internação , Masculino , Ontário/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-34444297

RESUMO

Since the beginning of the HIV/AIDS epidemic, gay, bisexual, and other men who have sex with men (gbMSM) have been disproportionately impacted by HIV/AIDS health disparities. Research showed that resilience to HIV/AIDS is associated with increased use of relevant health services, lower sexual health risks, and improved mental health outcomes among racially and ethnically diverse gbMSM. As the subpopulation that has historically been impacted by HIV/AIDS the longest, older gbMSM living with HIV/AIDS have inarguably exhibited resilience to HIV/AIDS the most. The qualitative study described in this paper sought to identify and examine protective factors that fostered resilience to HIV/AIDS based on the insights and lived experiences of racially and ethnically diverse, older gbMSM. Applying a community-based participatory research approach that included the meaningful involvement of older gbMSM living with HIV/AIDS in different roles (i.e., advisory committee member, collaborator, peer researcher, and participant), the study recruited and included forty-one older gbMSM living with HIV/AIDS from Ontario, Canada, in confidential, semi-structured interviews. Utilizing thematic analysis, we identified three major themes from the participant interviews as factors that fostered the resilience of older gbMSM to HIV/AIDS and helped to address HIV/AIDS health disparities: (1) established protective factors, (2) behavioral protective factors, and (3) controversial protective factors. This paper argues for the importance of valuing and capitalizing on these protective factors in the conceptualization and development of interventions, services, and programs that are dedicated to fostering resilience to HIV/AIDS.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Bissexualidade , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Ontário/epidemiologia , Fatores de Proteção
8.
BMJ ; 374: n1943, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417165

RESUMO

OBJECTIVE: To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death). DESIGN: Test negative design study. SETTING: Ontario, Canada between 14 December 2020 and 19 April 2021. PARTICIPANTS: 324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2. INTERVENTIONS: BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. MAIN OUTCOME MEASURES: Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes. RESULTS: Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation. CONCLUSIONS: Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.


Assuntos
Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , Vacinas contra COVID-19/uso terapêutico , COVID-19/mortalidade , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/diagnóstico , COVID-19/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , SARS-CoV-2 , Resultado do Tratamento , Adulto Jovem
9.
BMJ Open ; 11(8): e048137, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353798

RESUMO

OBJECTIVE: This study will add to existing literature by examining the impact of smoke-free legislation in outdoor areas among children with asthma. We aimed to examine the effect of the 2015 Smoke-Free Ontario Act (SFOA) amendment, which prohibited smoking on patios, playgrounds and sports fields, on health services use (HSU) rates in children with asthma. METHODS: We conducted a population-based open cohort study using health administrative data from the province of Ontario, Canada. Each year, all Ontario residents aged 0-18 years with physician diagnosed asthma were included in the study. Annual rates of HSU (emergency department (ED) visits, hospitalisations and physician office visits) for asthma and asthma-related conditions (eg, bronchitis, allergic rhinitis, influenza and pneumonia) were calculated. Interrupted time-series analysis, accounting for seasonality, was used to estimate changes in HSU following the 2015 SFOA. RESULTS: The study population ranged from 618 957 individuals in 2010 to 498 812 in 2018. An estimated average increase in ED visits for asthma in infants aged 0-1 years of 0.42 per 100 individuals (95% CI: 0.09 to 0.75) and a 57% relative increase corresponding to the 2015 SFOA was observed. A significant decrease in ED visits for asthma-related conditions of 0.19 per 100 individuals (95% CI: -0.37 to -0.01) and a 22% relative decrease corresponding to the 2015 SFOA was observed. CONCLUSION: Based on the observed positive effect of restricting smoking on patios, playgrounds and sports fields on respiratory morbidity in children with asthma, other jurisdictions globally should consider implementing similar smoke-free policies.


Assuntos
Asma , Asma/epidemiologia , Asma/terapia , Criança , Estudos de Coortes , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Lactente , Ontário/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-34444623

RESUMO

The burden of oral diseases and need for dental care are high among refugees and asylum seekers (humanitarian migrants). Canada's Interim Federal Health Program (IFHP) provides humanitarian migrants with limited dental services; however, this program has seen several fluctuations over the past decade. An earlier study on the experiences of humanitarian migrants in Quebec, Canada, developed the dental care pathways of humanitarian migrants model, which describes the care-seeking processes that humanitarian migrants follow; further, this study documented shortfalls in IFHP coverage. The current qualitative study tests the pathway model in another Canadian province. We purposefully recruited 27 humanitarian migrants from 13 countries in four global regions, between April and December 2019, in two Ontario cities (Toronto and Ottawa). Four focus group discussions were facilitated in English, Arabic, Spanish, and Dari. Analysis revealed barriers to care similar to the Quebec study: Waiting time, financial, and language barriers. Further, participants were unsatisfied with the IFHP's benefits package. Our data produced two new pathways for the model: transnational dental care and self-medication. In conclusion, the dental care needs of humanitarian migrants are not currently being met in Canada, forcing participants to resort to alternative pathways outside the conventional dental care system.


Assuntos
Refugiados , Migrantes , Assistência Odontológica , Acesso aos Serviços de Saúde , Humanos , Ontário
11.
Vaccine ; 39(37): 5265-5270, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34373124

RESUMO

BACKGROUND: Nursing home (NH) residents are prioritized for COVID-19 vaccination. We report monthly mortality, hospitalizations, and emergency department (ED) visit incidence rates (IRs) during 2010-2020 to provide context for COVID-19 vaccine safety assessments. METHODS: We observed outcomes among all NH residents in Ontario using administrative databases. IRs were calculated by month, sex, and age group. Comparisons between months were assessed using one-sample t-tests; comparisons by age and sex were assessed using chi-squared tests. RESULTS: From 2010 to 2019, there were 83,453 (SD: 652.4) NH residents per month, with an average of 2.3 (SD: 0.28) deaths, 3.1 (SD: 0.16) hospitalizations, and 3.6 (SD: 0.17) ED visits per 100 residents per month. From March to December 2020, mortality IRs were increased, but hospitalization and ED visit IRs were reduced (p < 0.05). CONCLUSION: We identified consistent monthly mortality, hospitalization, and ED visit IRs during 2010-2019. Marked differences in these rates were observed during 2020, coinciding with the COVID-19 pandemic.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Casas de Saúde , Vacinas contra COVID-19/efeitos adversos , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Ontário/epidemiologia , Pandemias , SARS-CoV-2
12.
BMC Psychiatry ; 21(1): 417, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419001

RESUMO

BACKGROUND: With the growing need for accessible, high-quality mental health services, especially during the COVID-19 pandemic, there has been increasing development and uptake of web-based interventions in the form of self-directed mental health platforms. The Big White Wall (BWW) is a web-based platform for people experiencing mental illness and addiction that offers a range of evidence-based self-directed treatment strategies. Drawing on existing data from a large-scale evaluation of the implementation of BWW in Ontario, Canada (which involved a pragmatic randomized controlled trail with an embedded qualitative process evaluation), we sought to investigate the influences on the extent to which people engage with BWW. METHODS: In this paper we drew on BWW trial participants' usage data (number of logins) and the qualitative data from the process evaluation that explored participants' experiences, engagement with and reactions to BWW. RESULTS: Our results showed that there were highly complex relationships between the influences that contributed to the level of engagement with BWW intervention. We found that a) how people expected to benefit from using a platform like BWW was an important indicator of their future usage, b) moderate perceived symptoms were linked with higher engagement; whereas fewer actual depressive symptoms predicted use and anxiety had a positive linear relationship with usage, and that c) usage depended on positive early experiences with the platform. CONCLUSIONS: Our findings suggest that the nature of engagement with platforms such as BWW is not easily predicted. We propose a theoretical framework for explaining the level of user engagement with BWW that might also be generalizable to other similar platforms.


Assuntos
COVID-19 , Saúde Mental , Humanos , Internet , Modelos Teóricos , Ontário , Pandemias , SARS-CoV-2
13.
BMC Psychiatry ; 21(1): 420, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-34425787

RESUMO

BACKGROUND: Severe mental illness (SMI) comprises a range of chronic and disabling conditions, such as schizophrenia, bipolar disorder and other psychoses. Despite affecting a small percentage of the population, these disorders are associated with poor outcomes, further compounded by disparities in access, utilisation, and quality of care. Previous research indicates there is pro-poor inequality in the utilisation of SMI-related psychiatric inpatient care in England (in other words, individuals in more deprived areas have higher utilisation of inpatient care than those in less deprived areas). Our objective was to determine whether there is pro-poor inequality in SMI-related psychiatric admissions in Ontario, and understand whether these inequalities have changed over time. METHODS: We selected all adult psychiatric admissions from April 2006 to March 2011. We identified changes in socio-economic equity over time across deprivation groups and geographic units by modeling, through ordinary least squares, annual need-expected standardised utilisation as a function of material deprivation and other relevant variables. We also tested for changes in socio-economic equity of utilisation over years, where the number of SMI-related psychiatric admissions for each geographic unit was modeled using a negative binomial model. RESULTS: We found pro-poor inequality in SMI-related psychiatric admissions in Ontario. For every one unit increase in deprivation, psychiatric admissions increased by about 8.1%. Pro-poor inequality was particularly present in very urban areas, where many patients with SMI reside, and very rural areas, where access to care is problematic. Our main findings did not change with our sensitivity analyses. Furthermore, this inequality did not change over time. CONCLUSIONS: Individuals with SMI living in more deprived areas of Ontario had higher psychiatric admissions than those living in less deprived areas. Moreover, our findings suggest this inequality has remained unchanged over time. Despite the debate around whether to make more or less use of inpatient versus other care, policy makers should seek to address suboptimal supply of primary, community or social care for SMI patients. This may potentially be achieved through the elimination of barriers to access psychiatrist care and the implementation of universal coverage of psychotherapy.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Pessoas Mentalmente Doentes , Adulto , Humanos , Pacientes Internados , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Ontário/epidemiologia
14.
Waste Manag ; 133: 59-70, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34385121

RESUMO

Electricity production by wind turbines is considered a clean energy technology, but the life cycle of wind turbines could introduce environmental risks due to waste generation, especially at the decommissioning process. This study predicts the future wind turbine blade waste arising in Canada, throughout all life cycle stages, from manufacturing until end of life, based on the installed capacities of existing Canadian wind farms and projected future installations. Five alternative strategies for managing this waste stream are assessed in terms of life cycle greenhouse gas emissions and primary energy demand, including landfilling, incineration, and mechanical recycling. For the base case scenario, it is observed that the total cumulative waste until 2050 is 275,299 tonnes, with on-site waste accounting for around 75% of this total. Waste generation is concentrated in provinces with greater wind power deployment: Ontario and Quebec alone account for 70% of total blade waste. Life cycle environmental impacts of waste management strategies are dependent on background energy systems, with incineration a significant source of greenhouse gas emissions, particularly when displacing low-carbon grid mixes. Cement kiln coprocessing achieves net zero emission by converting waste into energy and raw materials for the cement. Mechanical recycling can achieve substantial reductions in primary energy demand and greenhouse gas emissions but achieving financial viability would likely require substantial regulatory support.


Assuntos
Eliminação de Resíduos , Fontes Geradoras de Energia , Meio Ambiente , Ontário , Vento
15.
BMJ Open ; 11(8): e053075, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446503

RESUMO

OBJECTIVES: The COVID-19 pandemic has changed patterns of smoking, other substance use and other health-related behaviours, leading to a virtualisation of non-urgent medical care. In this study, we examine associated changes in outcomes of smoking-cessation treatment. DESIGN: Observational study. SETTING: Data are drawn from 221 physician-led primary care practices participating in a smoking cessation program in Ontario, Canada. PARTICIPANTS: 43 509 patients (53% female), comprising 35 385 historical controls, 6109 people enrolled before the pandemic and followed up during it, and 1815 people enrolled after the pandemic began. INTERVENTION: Nicotine-replacement therapy with counselling. PRIMARY OUTCOME MEASURE: 7-day self-reported abstinence from cigarettes at a follow-up survey 6 months after entry. RESULTS: For people followed up in the 6 months (6M) after the pandemic began, quit probability declined with date of enrolment. Predicted probabilities were 31.2% (95% CI 30.0% to 32.5%) for people enrolled in smoking cessation treatment 6 months prior to the emergency declaration and followed up immediately after the state of emergency was declared, and 24.1% (95% CI 22.1% to 26.2%) for those enrolled in treatment immediately before the emergency declaration and followed up 6M later (difference=-6.5%, 95% CI -9.0% to -3.9%). Seasonality and total treatment use did not explain this decline. CONCLUSION: The probability of successful smoking cessation following treatment fell during the pandemic, with the decline consistent with an effect of 'exposure' to the pandemic-era environment. As many changes happened simultaneously, specific causes cannot be identified; however, the possibility that virtual care has been less effective than in-person treatment should be explored.


Assuntos
COVID-19 , Abandono do Hábito de Fumar , Feminino , Humanos , Masculino , Ontário/epidemiologia , Pandemias , Atenção Primária à Saúde , SARS-CoV-2 , Dispositivos para o Abandono do Uso de Tabaco
16.
BMJ Open ; 11(8): e046171, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429307

RESUMO

OBJECTIVES: There has been relatively little exploration to date of potential protective effects within school neighbourhoods, such as those conferred by facilities that seek to promote health with respect to substance use and related harms. This study examined how the density of sports and recreation facilities in the school neighbourhood is associated with the likelihood of binge drinking, e-cigarette use, cigarette smoking and cannabis use among Canadian secondary school students. DESIGN: Longitudinal data from the COMPASS study on Canadian youth health behaviours from 2015/2016 to 2017/2018 was linked with school neighbourhood data capturing the number of sports and recreation facilities within a 1500 m radius of schools. SETTING: Secondary schools and school neighbourhoods in Alberta, British Columbia, Ontario and Quebec who participated in the COMPASS study. PARTICIPANTS: 16 471 youth who participated in the COMPASS study over three school years (2015/2016-2017/2018). PRIMARY AND SECONDARY OUTCOME MEASURES: Binge drinking, e-cigarette use, cigarette use, cannabis use. RESULTS: Logistic regression models using generalised estimating equations identified that greater density of sports and recreation facilities within the school neighbourhood was significantly associated with lower likelihood of binge drinking and e-cigarette use but was not associated with cigarette smoking or cannabis use. CONCLUSIONS: This research can help to support evidence-informed school community-based efforts to prevent substance-related harms among youth.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Esportes , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Promoção da Saúde , Humanos , Ontário , Instituições Acadêmicas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
17.
Harm Reduct J ; 18(1): 85, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353323

RESUMO

BACKGROUND: Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI's) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. METHODS: Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. RESULTS: We interviewed 20 individuals between 08/2020-11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. CONCLUSION: Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI's prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.


Assuntos
COVID-19 , Comunicação , Overdose de Drogas/terapia , Pandemias , Transtornos Relacionados ao Uso de Substâncias/complicações , Crime , Tratamento de Emergência , Medo , Redução do Dano , Humanos , Programas de Troca de Agulhas , Nova Escócia , Ontário , Estigma Social , Fatores Socioeconômicos , Inquéritos e Questionários
18.
Artigo em Inglês | MEDLINE | ID: mdl-34360376

RESUMO

Evidence-based research has highlighted the need for exploring factors that support the mental health of men who have sex with men living with HIV/AIDS (MSMLWH), and environmental influences that promote their resilience to HIV/AIDS. This exploratory study utilized a community-based participatory research approach to investigate barriers and facilitators to promoting resilience to HIV/AIDS, specifically among racial and ethnic minority, middle-aged and older MSMLWH, a population that continues to be significantly impacted by HIV/AIDS today. This collaborative, qualitative study recruited participants who identified as racial or ethnic minority MSMLWH, were aged 40 or older, and resided in Ontario, Canada. Participants (n = 24) discussed in their interviews barriers and facilitators to promoting resilience to HIV/AIDS, which they recognized from their lived experiences. Utilizing thematic analysis, themes related to barriers and facilitators to promoting resilience to HIV/AIDS were identified. Themes related to identified barriers included: (1) language proficiency, (2) racism, (3) pernicious norms in North American gay culture, and (4) HIV stigma. Themes related to identified facilitators included: (1) compartmentalization, (2) perseverance, and (3) community-based health and social services. This article discusses the implications of the study's findings, particularly on how they may influence the development of future services for racial and ethnic minority, middle-aged and older MSMLWH.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Idoso , Grupos Étnicos , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Ontário , Pesquisa Qualitativa , Estigma Social
19.
Artigo em Inglês | MEDLINE | ID: mdl-34360428

RESUMO

Promoting adequate levels of physical activity in the population is important for diabetes prevention. However, the scale needed to achieve tangible population benefits is unclear. We aimed to estimate the public health impact of increases in walking as a means of diabetes prevention and health care cost savings attributable to diabetes. We applied the validated Diabetes Population Risk Tool (DPoRT) to the 2015/16 Canadian Community Health Survey for adults aged 18-64, living in the Greater Toronto and Hamilton area, Ontario, Canada. DPoRT was used to generate three population-level scenarios involving increases in walking among individuals with low physical activity levels, low daily step counts and high dependency on non-active forms of travel, compared to a baseline scenario (no change in walking rates). We estimated number of diabetes cases prevented and health care costs saved in each scenario compared with the baseline. Each of the three scenarios predicted a considerable reduction in diabetes and related health care cost savings. In order of impact, the largest population benefits were predicted from targeting populations with low physical activity levels, low daily step counts, and non active transport use. Population increases of walking by 25 min each week was predicted to prevent up to 10.4 thousand diabetes cases and generate CAD 74.4 million in health care cost savings in 10 years. Diabetes reductions and cost savings were projected to be higher if increases of 150 min of walking per week could be achieved at the population-level (up to 54.3 thousand diabetes cases prevented and CAD 386.9 million in health care cost savings). Policy, programming, and community designs that achieve modest increases in population walking could translate to meaningful reductions in the diabetes burden and cost savings to the health care system.


Assuntos
Diabetes Mellitus , Caminhada , Adulto , Redução de Custos , Análise Custo-Benefício , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Custos de Cuidados de Saúde , Humanos , Ontário/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-34360482

RESUMO

Canadian, municipally funded recreation/sport facilities typically have unhealthy food environments. Ontario, unlike some provinces, lacks a voluntary recreation facility nutrition policy. This study assessed the healthfulness of food environments and vending sales in 16 Ontario recreation/sport facilities and, secondarily, compared data from facilities within municipalities that banned versus permitted plastic bottled-water sales (water-ban, n = 8; water, n = 8) to test the nutritional effects of environmental policy. Concession and vending packaged food/beverage offerings and vending sales were audited twice, eighteen months apart. The products were categorized using nutrition guidelines as Sell Most (SM), Sell Sometimes (SS), and Do Not Sell (DNS). Both water and water-ban facilities offered predominantly (>87%) DNS packaged food items. However, proportions of DNS and SM concession and vending beverages differed (p < 0.01). DNS beverages averaged 74% and 88% of vending offerings in water and water-ban facilities, respectively, while SM beverages averaged 14% and 1%, respectively. Mirroring offerings, DNS beverages averaged 79% and 90% of vending sales in water versus water-ban facilities. Ontario recreation/sport facilities provided unhealthy food environments; most food/beverage offerings were energy-dense and nutrient-poor. Water bans were associated with increased facility-based exposure to DNS beverage options. A nutrition policy is recommended to make recreation facility food/beverage environments healthier and to mitigate unintended negative consequences of bottled-water bans.


Assuntos
Distribuidores Automáticos de Alimentos , Esportes , Bebidas , Alimentos , Humanos , Política Nutricional , Ontário , Recreação
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