Objective
Alcohol use is a known risk factor for suicidality, yet this relationship has not been explored during the pandemic in Canada. As a growing body of evidence demonstrates the negative impact of COVID-19 on alcohol consumption and associated harms in Canada, there is a need to examine this more closely.

Methods
Using the Survey on COVID-19 and Mental Health 2020, we compared the prevalence of suicide ideation among: (1) individuals who reported an increase in alcohol consumption vs those who reported a decrease/no change, and (2) individuals who reported past month heavy episodic drinking vs those who did not. We compared overall unadjusted odds ratios and across a number of sociodemographic and mental health variables. All estimates were weighted to ensure they were nationally representative.

Results
The prevalence and likelihood of suicide ideation were significantly higher among people who reported increased alcohol consumption during the pandemic (4.9% vs 2.0%; OR = 2.6, 95% CI: 1.8, 3.7) and people who reported past month heavy episodic drinking (3.4% vs 2.1%; OR = 1.7, 95% CI: 1.2, 2.3). Males and middle-aged and older-aged individuals had the highest odds ratios for increased alcohol consumption and past month heavy episodic drinking with suicide ideation.

Conclusion
In the Canadian general population during the COVID-19 pandemic, there were significant associations between suicide ideation and increased alcohol use as well as past month heavy episodic drinking across specific sociodemographic subgroups. Future research could explore these associations while adjusting for social determinants of health such as income security, employment, education, social support, stress, and mental health.

Lorsqu’une éclosion de cas de COVID-19 est suspectée ou confirmée dans une installation ou sur une unité de soins, la rapidité d’intervention permet d’évaluer le potentiel de transmission, la gravité de la situation et d’instaurer les mesures requises afin de limiter l’ampleur de la transmission.

Ce document fournit les recommandations et les différentes modalités concernant les dépistages et les mesures de PCI à mettre en place chez les travailleurs de la santé (TdeS) et les usagers lors d’une éclosion de COVID-19 dans tous les milieux de soins visés.

Les milieux de soins visés par ce document sont :

Milieux de soins de courte durée (unités de soins et urgence).
Installations de santé mentale, unités de soins en santé mentale en milieu hospitalier et urgences psychiatriques.
Installations de réadaptation (déficience physique, santé physique et mentale), ainsi que les autres milieux de soins ou de vie en réadaptation physique, déficience intellectuelle et trouble du spectre de l'autisme.
Centres d’hébergement et de soins de longue durée (CHSLD.
Certains autres milieux de vie comportent des unités de soins qui s’apparentent à des soins de longue durée (ex. : RPA, RI, RTF). Il convient alors pour ces unités d’appliquer ces recommandations.
Les dépistages recommandés dans ce document ont pour but de rechercher la source d’une éclosion et de déterminer s’il y a eu transmission dans le milieu de soins. Ce document doit être utilisé en complémentarité avec le document SRAS-CoV-2 : Gestion des travailleurs de la santé en milieux de soins afin de déterminer les mesures à mettre en place pour les TdeS ayant eu un bris dans le port de l’équipement de protection individuelle (ÉPI).

Ce document doit être consulté de façon complémentaire aux autres documents sur la COVID-19 produits par l’Institut national de santé publique du Québec (INSPQ).

L’INSPQ a reçu de la Direction générale de la santé publique du ministère de la Santé et des Services sociaux le mandat de produire une synthèse des connaissances de la littérature scientifique pour 1) repérer, dans les recensions d’écrits, les facteurs associés à la santé mentale en contexte de pandémie ou d’événements extrêmes, facteurs sur lesquels les municipalités peuvent agir; et 2) recenser les actions à l’échelle des municipalités ou des communautés qui influencent ces facteurs et permettent de promouvoir la santé mentale à la suite d’un événement extrême.

Les recensions analysées montrent une forte convergence sur plusieurs facteurs associés à l’état de santé mentale, notamment ceux qui relèvent de l’environnement social : le soutien social, le fait de mener des actions prosociales (ex., offrir du soutien aux amis ou à des voisins, lors d’une quarantaine), l’isolement social et le sentiment de solitude ou encore la restriction des contacts et les périodes de confinement. Il en est de même pour les facteurs en lien au statut socioéconomique des personnes, notamment le revenu, la scolarité et la précarité d’emploi à la suite d’un événement extrême. Cependant, seules quelques recensions portent sur les caractéristiques de l’environnement physique.

Les études analysées qui présentent des actions à l’échelle des municipalités ou des communautés ont comme objectif de renforcer la résilience communautaire tout en appuyant les individus dans le développement de leur capacité d’adaptation et l’amélioration de leur bien‑être. La majorité positionne la santé mentale comme un atout à préserver ou consolider. Toutefois, aucune étude ne fait l’objet d’évaluation robuste quant aux effets d’interventions sur la santé mentale : elles présentent plutôt des observations ou appréciations. Ces dernières, ainsi que plusieurs caractéristiques communes aux études, permettent de dégager des démarches organisationnelles : avoir une préoccupation explicite pour la santé mentale et se doter d’une équipe dédiée; l’importance du travail intersectoriel qui inclut les citoyens et les acteurs locaux dans une dynamique égalitaire; assurer une cohérence des interventions autour d’un objectif de rétablissement en se dotant notamment d’un modèle logique et en misant sur les atouts des communautés. D’autres études offrent des exemples d’interventions directes à la population, notamment la mise sur pied d’actions sensibles aux réalités vécues et qui favorisent la participation.

Objectives: During the coronavirus-19 pandemic, experts recommended delaying routine cancer screening and modifying treatment strategies. We sought to understand the sequalae of these recommendations.

Materials and Methods: We performed a retrospective single-center analysis of screening, diagnosis, and treatment of lung, colorectal, and breast cancer. Data was collected from our institutional cancer registry. Prepandemic (2016-2019) was compared with pandemic (2020) data.

Results: Three thousand three sixty one screening chest computed tomography scans (CTs), 35,917 colonoscopies, and 48,093 screening mammograms were performed. There was no difference in CTs [81.0 (SEM10.0) vs. 65.6 (SEM3.29), P=0.067] or mammograms [1017.0 (SEM171.8) vs. 809.4 (SEM56.41), P=0.177] in 2020 versus prepandemic. There were fewer colonoscopies in 2020 [651.4 (SEM103.5) vs. 758.91 (SEM11.79), P=0.043]. There was a decrease in cancer diagnoses per month in 2020 of lung [22.70 (SEM1.469) vs. 28.75 (SEM0.8216), P=0.003] and breast [38.56 (SEM6.133) vs. 51.82 (SEM1.257), P=0.001], but not colorectal [13.11 (SEM1.467) vs. 15.88 (SEM0.585), P=0.074] cancer. There was no change in stage at presentation for lung (P=0.717), breast (P=0.115), or colorectal cancer (P=0.180). Lung had a shorter time-to-treatment in 2020 [38.92 days (SEM 2.48) vs. 66 (SEM1.46), P=0.002].

Conclusions: In 2020, there was no difference in screening studies for lung and breast cancer but there was a decrease in new diagnoses. Although there were fewer colonoscopies performed in 2020, there was no change in new colorectal cancer diagnoses. Despite changes in guidelines during the pandemic, the time-to-treatment for lung cancer was shorter and was unchanged for colorectal and breast cancer. These findings highlight the importance of continuing care for a vulnerable patient population despite a pandemic.

Objective: It was aimed to reveal the continuing perfusion defect rates in patients with a diagnosis of pulmonary embolism (PE) due to COVID-19 who have completed the third month of anticoagulant therapy but whose symptoms or laboratory elevations continue.

Methods: Patients with COVID-19 who were diagnosed with PE by Q-SPECT-CT between 1 September 2020 and 1 November 2021, who underwent control Q-SPECT/CT were included in the study. Demographic characteristics, laboratory findings, and first and second Q-SPECT/CT evaluation results of the patients were recorded.

Results: It was observed that the pulmonary defect continued in Q-SPECT/CT in the third month of anticoagulant treatment in 58.3% of the patients diagnosed with PE due to COVID-19, and new defects developed in 6.3%. The persistence rate of segment defects was higher than that of subsegment defects. It was observed that the defects persisted more frequently in patients with a history of hospitalization due to COVID-19.

Conclusion: Perfusion defects may still be present in patients diagnosed with PE due to COVID-19 in the presence of persistent dyspnea/chest pain/D-dimer elevation after 3 months of treatment. Perfusion defect persistence rates are higher in defects more proximal to the subsegment level and in people with severe COVID-19, and extended treatment should be considered in these patients.

The aim of this study was to investigate if and how disordered gaming, loneliness, and family relations have changed throughout the COVID-19 pandemic (from 2019 to 2021), and whether there were any changes in the association between these variables across three samples of gamers (for each respective year). Samples from 2019, 2020, and 2021 were matched by using propensity score matching across socio-demographic characteristics. The total effective sample comprised 897 gamers (N = 299 per year). These samples were compared in terms of disordered gaming – separately as Gaming Disorder (GD; WHO framework) and Internet Gaming Disorder (IGD; APA framework), loneliness, and family harmony scores with analyses of covariance (ANCOVAs), with age and gender as covariates. Steiger tests were used for correlation differences testing. ANCOVAs showed that while GD and IGD scores have increased significantly during the pandemic years, loneliness and family harmony did not change significantly. Furthermore, the correlation differences tests indicated that the correlations between both IGD and GD with loneliness as well as poorer family harmony have increased during the pandemic years. This study provides empirical evidence that the well-being of gamers might have been negatively affected during the COVID-19 pandemic. While loneliness and family harmony did not increase, the stronger correlations between Gaming Disorder and other variables might suggest that gaming may have been used to cope with loneliness and poorer family harmony.

Avec l’arrivée de la pandémie en mars 2020, le Québec a restreint de façon significative la présence des proches auprès des patients dans le réseau de la santé et des services sociaux (RSSS). Plusieurs personnes en fin de vie sont décédées seules, sans confort, soins de base, ni accompagnement, dans des conditions discordantes avec la philosophie des soins palliatifs.

L’intervalle de temps entre les deux premières vagues de la pandémie a permis au gouvernement de réaliser un exercice rétrospectif sur la question. Le ministère de la Santé et des Services sociaux (MSSS) invitait alors à une plus grande contextualisation des directives émises sur les visites, reconnaissant l’importance et le rôle que jouent les proches dans la vie et les soins aux patients.

Appuyées par les mots prononcés par des patients, des proches, des membres du personnel soignant et des gestionnaires, nous partageons nos réflexions et observations en tant qu’éthiciennes cliniques. Plus précisément, nous présentons trois enjeux éthiques liés à la présence des proches : l’iniquité découlant de l’interprétation variable des directives, la détresse morale et l’entrave aux valeurs des soins de fin de vie. Nous proposons une approche intégrée des valeurs et abordons la communication comme source de mitigation des enjeux. Nous présentons enfin en quoi les services en éthique clinique peuvent soutenir les équipes, les gestionnaires, les proches et les patients dans la résolution des enjeux liés aux visites.

Background
The COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to review existing evidence of the COVID-19 pandemic’s global impact on the mental health of children and adolescents <19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes.

Methods
We conducted a search of peer-reviewed and preprint research published in English from January 1, 2020, to February 22, 2021. We included studies collecting primary data on COVID-19-related mental health impacts on children and adolescents. We graded the strength of included articles using the Oxford Centre for Evidence-Based Medicine rating scheme.

Results
Our search and review yielded 116 articles presenting data on a total of 127,923 children and adolescents; 50,984 child and adolescent proxy reports (e.g., parents, healthcare practitioners); and >3,000 chart reviews. A high prevalence of COVID-19-related fear was noted among children and adolescents, as well as more depressive and anxious symptoms compared with prepandemic estimates. Older adolescents, girls, and children and adolescents living with neurodiversities and/or chronic physical conditions were more likely to experience negative mental health outcomes. Many studies reported mental health deterioration among children and adolescents due to COVID-19 pandemic control measures. Physical exercise, access to entertainment, positive familial relationships, and social support were associated with better mental health outcomes.

Conclusions
This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents, especially those in higher risk subgroups, to mitigate short- and long-term pandemic-associated mental health effects.

Purpose
The economic downturn due to the Coronavirus Disease 2019 (COVID-19) pandemic initially led to a large increase in the US unemployment rate. Being laid-off or losing a job could cause financial stress and have an impact on the relationship between parents or other adults in the home and children. We aimed to assess the effect of household unemployment on child physical and emotional abuse during the early part of the COVID-19 pandemic, with an older population of children.
Methods
Data were from a sample of 7,555 students from 51 schools that participated in a survey administered from October to December 2020. We conducted weighted multivariable logistic regression models and report adjusted odds ratio to estimate associations between recent household unemployment and emotional and physical abuse.
Results
Having a parent or other adult in the home with a job loss was associated with higher odds of emotional or physical abuse.
Conclusions
The findings are consistent with child maltreatment prevention strategies focused on alleviating economic hardship.

To prevent deterioration in physical and mental health and cognitive function that could prejudice the autonomy and independence of persons 65 and older, it is important for them to adopt a physically active lifestyle.

To mitigate the impact of public health measures on physical activity, additional strategies are proposed for the public health network, its partners, and municipalities.

For the public health network and its partners:
Raise awareness of the importance of being active at home and promote regular physical activity to foster wellness and quality of life and help maintain independence (1–7) and good mental health (8) (e.g., targeted campaigns promoting physical activity, promotion of physical activities all year long).
Encourage the reduction of extended sedentary behaviours and of their total duration (e.g., active breaks, walking, housekeeping activities).
Support the regular practice of simple, safe, and pleasant exercise (e.g., exercise in the home).
For municipalities:
Promote active travel by seniors by providing more pedestrian-friendly spaces.
Encourage physical activity by seniors in parks and green spaces by providing universal access to attractive infrastructure, in keeping with public health guidelines.
Offer an activity program tailored to seniors and to pandemic conditions in collaboration with sports and recreation organizations

Ce rapport présente les résultats de l’analyse d’entrevues de groupe qui ont été réalisées à l’hiver 2021 afin de documenter l’expérience de gestionnaires et de médecins œuvrant dans le réseau de la santé et des services sociaux durant la pandémie de la COVID-19. L’objectif principal de la démarche était de guider les acteurs de ce réseau vers le développement de stratégies préventives appropriées en vue de protéger la santé mentale des personnes appartenant à ces deux groupes. Voici, de façon synthétique, ce que les analyses nous ont appris.

This open access book discusses the socio-political context of the COVID-19 crisis and questions the management of the pandemic emergency with special reference to how this affected the governance of migration and asylum. The book offers critical insights on the impact of the pandemic on migrant workers in different world regions including North America, Europe and Asia.

The book addresses several categories of migrants including medical staff, farm labourers, construction workers, care and domestic workers and international students. It looks at border closures for non-citizens, disruption for temporary migrants as well as at special arrangements made for essential (migrant) workers such as doctors or nurses as well as farmworkers, ‘shipped’ to destination with special flights to make sure emergency wards are staffed, and harvests are picked up and the food processing chain continues to function.

The book illustrates how the pandemic forces us to rethink notions like membership, citizenship, belonging, but also solidarity, human rights, community, essential services or ‘essential’ workers alongside an intersectional perspective including ethnicity, gender and race.

Open Access

COVID-19 and other public health threats have contributed to more than six million deaths globally in a short amount of time. As such, there is an urgent need to respond to these threats in a way that improves global health and wellbeing. Written by a diverse group of exemplary scientists, the thirteen chapters in this volume provide unique, comprehensive, and science-based approaches to respond to macro-structural, human process, and micro issues affecting public health threats.

Objectives: To assess potential nosocomial coronavirus disease-2019 (COVID-19) transmission in patients who underwent robot-assisted laparoscopic procedures during the pandemic.

Material and methods: Prospective study in patients undergoing robot-assisted laparoscopy in urology or gynaecology within 2 academic hospitals. Patients underwent local preoperative COVID-19 screening using a symptoms questionnaire. Patients with suspicious screening underwent coronavirus real time-polymerase chain reaction (RT-PCR) and were excluded from robotic surgery if positive. Patients with symptoms postsurgery were systematically tested for coronavirus by RT-PCR. One-month postsurgery, all patients had a telephone consultation to evaluate COVID-19 symptoms.

Results: Sixty-eight patients underwent robotic surgery during the study period (median age: 63-years [IQR: 53-70], 1.8 male: female ratio). Oncology was the main indication for robotic surgery (n = 62, 91.2%) and 26 patients (38.2%) received a chest CT-scan prior to surgery. Eleven patients (16.2%) were symptomatic after surgery of whom only 1 tested positive for coronavirus by RT-PCR (1.5%) and was transferred to COVID-19 unit with no life-threatening condition. No attending surgeon was diagnosed with COVID-19 during the study.

Conclusions: Robot-assisted laparoscopic surgery seemed safe in the era of COVID-19 as long as all recommended precautions are followed. The rate of nosocomial COVID-19 transmission was extremely low despite the fact that we only used RT-PCR testing in symptomatic patients during the preoperative work-up. Larger cohort is needed to validate these results.

Purpose of review: The ability to effectively prepare for and respond to the psychological fallout from large-scale disasters is a core competency of military mental health providers, as well as civilian emergency response teams. Disaster planning should be situation specific and data driven; vague, broad-spectrum planning can contribute to unprepared mental health teams and underserved patient populations. Herein, we review data on mental health sequelae from the twenty-first century pandemics, including SARS-CoV2 (COVID-19), and offer explanations for observed trends, insights regarding anticipated needs, and recommendations for preliminary planning on how to best allocate limited mental health resources.

Recent findings: Anxiety and distress, often attributed to isolation, were the most prominent mental health complaints during previous pandemics and with COVID-19. Additionally, post-traumatic stress was surprisingly common and possibly more enduring than depression, insomnia, and alcohol misuse. Predictions regarding COVID-19's economic impact suggest that depression and suicide rates may increase over time. Available data suggest that the mental health sequelae of COVID-19 will mirror those of previous pandemics. Clinicians and mental health leaders should focus planning efforts on the negative effects of isolation, particularly anxiety and distress, as well as post-traumatic stress symptoms.

A health care crisis such as the coronavirus disease 2019 (COVID-19) pandemic requires allocation of hospital staff and resources on short notice. Thus, new and sometimes less experienced team members might join the team to fill in the gaps. This scenario can be particularly challenging in endovascular stroke treatment, which is a highly specialized task that requires seamless cooperation of numerous health care workers across various specialties and professions. This document is intended for stroke teams who face the challenge of integrating new team members into endovascular stroke-treatment workflows during the COVID-19 pandemic or any other global health care emergency. It discusses the key strategies for smooth integration of new stroke-team members in a crisis situation: 1) transfer of key knowledge (simple take-home messages), 2) open communication and a nonjudgmental atmosphere, 3) strategic task assignment, and 4) graded learning and responsibility. While these 4 key principles should generally be followed in endovascular stroke treatment, they become even more important during health care emergencies such as the COVID-19 pandemic, when health care professionals have to take on new and additional roles and responsibilities in challenging working environments for which they were not specifically trained.