Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Qualitative Study (Preprint)

BACKGROUND Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be employed to meet the needs of geriatric care professionals in providing care to frail older patients and their caregivers, and families. OBJECTIVE This study aimed to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and families, and how to maximize the benefits of this method of providing care. METHODS We conducted a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine and participate in a semi-structured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS We obtained quantitative and qualitative data from 30 practicing geriatric care professionals (22 geriatricians, 5 geriatric psychiatrists, and 3 geriatric specialist nurses) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (Complexity, Design quality and packaging, Patient needs and resources, Readiness for implementation, and Culture) and 13 CFIR contextual facilitators (Relative Advantage, Adaptability, Tension for Change, Available Resources, Access to Knowledge, Network and Communications, Compatibility, Knowledge and Beliefs, Self-Efficacy, Champions, External Agents, Executing, and Reflecting and Evaluating). The CFIR concept of External Policy and Incentives was found to be a neutral construct. CONCLUSIONS This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person, but is less useful in providing specific aspects of geriatric care to frail older patients and their caregivers, and families.

Individual animal geographies for the more-than-human city: Storying synanthropy and cynanthropy with urban coyotes

Recent efforts within geography to deconstruct anthropocentric readings of the urban and explore the city as ‘multispecies’ or ‘more-than-human’ face substantial methodological challenges. This paper contributes an empirical case study of human-coyote urban cohabitations in the Greater Toronto Area, Canada, using a ‘hybrid’ methodological approach to individual animal geographies. It builds on dialogues surrounding animals’ geographies that centre individual animal lifeworlds and experiences, exploring coyotes as subjects and actors who participate in the co-creation of shared urban worlds. A methodological approach based on collaboration and storying recounts the tales of two coyotes – Urban10 and Blondie – and their kin whose stories are gleaned by weaving together diverse social and ecological research tools, including: participant observation with Coyote Watch Canada, document review, semi-structured interviews, GPS collar data, field investigations, ethological observations, and trail cameras. The discussion details implications in terms of cynanthropy – ‘becoming-canid’ as methodology, delving into coyote lifeworlds using hybrid tools – as well as synanthropy – coyote synurbization and more-than-human urban belongings. Dwelling with Urban10 and Blondie in cynanthropic exploration makes visible opportunities for multispecies researchers to generate knowledge collaboratively with other-than-humans. Findings surrounding synanthropy highlight the practices involved in adapting to and participating, ecologically and socially, in life in the multispecies city. Overall, this paper advances efforts aimed at developing innovative and experimental hybrid methodologies for animal geographies, and theoretical discussions around re-storying the more-than-human city towards livable multispecies futures.

Contextualizing the Experiences of Black Women Arrested for Intimate Partner Violence in Canada

This qualitative study was informed by critical race feminism and explored Black women’s experiences with the police with a particular focus on how issues of race, racism, oppression, and subordination inform their experiences. It sought to answer three research questions: (1) What is known about Black women’s experiences with the police in the context of intimate partner violence? (2) Given their experiences with the police, what is their perception of the police? and (3) To what extent do women construct counter-narratives of their experiences with the police and what does that involve? The sample was comprised of 25 participants, 15 of whom were arrested. The women were over the age of 18 and lived in the Greater Toronto Area and surrounding areas. Most women expressed that they had negative encounters with the police, which was influenced by the police’s negative perceptions of them. Black women who called the police to intervene in an intimate partner violence incident were subjected to great scrutiny and vulnerable to racialized and gendered police violence. Consequently, women were fearful and distrustful of the police and were less likely to seek help from them in the future. The study answers the call for research that examines Black women’s experiences with the police from their perspective. It has implications for social service providers and provides strategies to improve future police interactions with Black communities.

HOW IMMIGRANT AND REFUGEE PARENTS’ EXPERIENCES RELATED TO THEIR CHILD’S SCHOOL SYSTEM DIFFERENT IN CANADA

The purpose of this qualitative research study was to determine the experiences of a group of immigrant and refugee parents related to their child’s school system and interactions with the school personnel, including the teachers, administrators, and school counselors in Canada. Twelve parents who immigrated from Turkey and living in the Greater Toronto Area participated in semi-structured interviews. Results showed that these parents’ experiences were surprisingly much more positive compared to the experiences of immigrant parents in many other parts of the world, including in the U.S. These parents felt welcome and accepted by their child’s school personnel. They also reported not experiencing any discrimination due to their cultural, ethnic, and/or racial backgrounds. The reasons for this difference, and recommendations in relation to how to make immigrant and refugee parents’ experiences related to their child’s school system positive, are discussed.

COVID-19 Cases Among Facility-Staff by Neighbourhood of Residence and Social and Structural Determinants: An Observational Study (Preprint)

BACKGROUND Disproportionate risks of COVID-19 in congregate settings including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility-staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there remain limited data on how COVID-19 among facility-staff reflect urban neighbourhood disparities, particularly stratified by the social and structural determinants of community-level transmission. OBJECTIVE To compare the concentration of cumulative cases by geography and social/structural determinants across three mutually exclusive subgroups in the Greater Toronto Area (population 7.1 million): community, facility-staff, and healthcare workers (HCW) in other settings. METHODS We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination roll-out). We derived neighbourhood-level social/structural determinants from census data, and generated Lorenz curves and Gini coefficients to visualize and quantify inequalities in cases. RESULTS The hardest-hit neighbourhoods (comprising 20% of the population) accounted for 53.4% of community cases, 48.6% of facility-staff cases, and 42.3% of other HCW cases. Compared with other HCW, cases in facility-staff more closely reflected the distribution of community cases. Cases in facility-staff reflected greater social and structural inequalities (larger Gini coefficients) than other HCW across all determinants. Facility-staff cases were also more likely than community cases to be concentrated in lower income neighbourhoods (Gini 0.24[0.15-0.38] vs 0.14[0.08-0.21] with lower household density (Gini 0.23[0.17-0.29] vs 0.17[0.12-0.22]) and with a greater proportion working in other essential services (Gini 0.29 [0.21-0.40], 0.22[0.17-0.28]). CONCLUSIONS COVID-19 cases among facility-staff largely reflects neighbourhood-level heterogeneity and disparities; even more so than cases in other HCW. Findings signal the importance of interventions prioritized and tailored to home geographies of facility-staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighbourhood-level) and at work.

The evolution of choice set formation in dwelling and location with rising prices: A decadal panel analysis in the Greater Toronto Area

Home location choice is based on both the characteristics of the dwelling (e.g., size, style, number of bedrooms) and the location (e.g., proximity to work, quality of schools, accessibility). Recent years have seen a steep increase in the price of housing in many major cities. In this research, we examine how these price increases are affecting the types of dwelling and locations considered by households. A large sample of real estate listings from 2006 and 2016 from the Greater Toronto Area is used to develop the empirical models. Two recently developed discrete choice models are used in the study: a nested logit model with latent class feedback (LCF) and a semi-compensatory independent availability logit (SCIAL) model. A method of alternative aggregation is proposed to overcome the computational hurdle that often impedes the estimation of choice set models. We find a significant increase in the probability of larger households considering townhouses and apartments over detached single-family dwellings between 2006 and 2016.

Surviving SARS and living through COVID-19: Healthcare worker mental health outcomes and insights for coping

Objective Explore how previous work during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak affects the psychological response of clinical and non-clinical healthcare workers (HCWs) to the current COVID-19 pandemic. Methods A cross-sectional, multi-centered hospital online survey of HCWs in the Greater Toronto Area, Canada. Mental health outcomes of HCWs who worked during the COVID-19 pandemic and the SARS outbreak were assessed using Impact of Events—Revised scale (IES-R), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Results Among 3852 participants, moderate/severe scores for symptoms of post- traumatic stress disorder (PTSD) (50.2%), anxiety (24.6%), and depression (31.5%) were observed among HCWs. Work during the 2003 SARS outbreak was reported by 1116 respondents (29.1%), who had lower scores for symptoms of PTSD (P = .002), anxiety (P < .001), and depression (P < .001) compared to those who had not worked during the SARS outbreak. Multivariable logistic regression analysis showed non-clinical HCWs during this pandemic were at higher risk of anxiety (OR, 1.68; 95% CI, 1.19–2.15, P = .01) and depressive symptoms (OR, 2.03; 95% CI, 1.34–3.07, P < .001). HCWs using sedatives (OR, 2.55; 95% CI, 1.61–4.03, P < .001), those who cared for only 2–5 patients with COVID-19 (OR, 1.59; 95% CI, 1.06–2.38, P = .01), and those who had been in isolation for COVID-19 (OR, 1.36; 95% CI, 0.96–1.93, P = .05), were at higher risk of moderate/severe symptoms of PTSD. In addition, deterioration in sleep was associated with symptoms of PTSD (OR, 4.68, 95% CI, 3.74–6.30, P < .001), anxiety (OR, 3.09, 95% CI, 2.11–4.53, P < .001), and depression (OR 5.07, 95% CI, 3.48–7.39, P < .001). Conclusion Psychological distress was observed in both clinical and non-clinical HCWs, with no impact from previous SARS work experience. As the pandemic continues, increasing psychological and team support may decrease the mental health impacts.

Selected Geographical and Tourist Aspects in the Assessment of the Quality and Standard of Living of Polonia in the Greater Toronto Area

The quality of life is commonly referred to as a determinant of well-being, contentment, happiness or a sense of satisfaction with one’s own existence. Often used interchangeably with the level, conditions or standard of living. Quality of life is the satisfaction of meeting all human needs. The main aim of this research is to determine the level and quality of life in terms of tourism by the Polish community living in the Greater Toronto Area, which includes the city of Toronto and four regions: Halton, Peel, York and Durham.The article will present its own model of objective factors (standard of living) and subjective factors (life quality) interacting with each other with a particular emphasis on geographic and tourism aspects. The main aim of this article is to show how the Polish community living in the Greater Toronto Area assesses the aspects related to tourism management in the city. The results of the study will be presented on the basis of a survey questionnaire conducted on 583 respondents. The respondents assessed, among other things, whether they were satisfied with the conditions of rest and relaxation in this city, public transport and the environmental quality. Respondents were also asked to evaluate the activity of Polish travel agencies operating in the Greater Toronto Area. The study will also address matters related to improving the quality of life and tourism development in the city. As indicated by the respondents, such activities as supporting existing tourist activities, expansion of bicycle paths or increasing sports and recreational infrastructure (i.e. construction projects of swimming pools, tennis courts) are the main needs in the city, which could contribute to the higher rated aspects of Toronto related to tourism. Data will be presented showing that in the Polish community in the last twelve months their household had enough income to cover the costs related to leisure, vacations, holidays or school breaks.

737. Geographic Clustering of Travel-acquired Infections in Ontario, Canada, 2008-2020

Background As rates of international travel increase, more individuals are at risk of travel-acquired infections (TAIs). We aimed to review all microbiologically confirmed cases of malaria, dengue, chikungunya, and enteric fever (Salmonella enterica serovar Typhi/Paratyphi) in Ontario, Canada between 2008-2020 to identify high-resolution geographical clusters that could be targeted for pre-travel prevention. Methods Retrospective cohort study of over 174,000 unique tests for the four above TAIs from Public Health Ontario Laboratories. Test-level data were processed to calculate annual case counts and crude population-standardized incidence ratios (SIRs) at the forward sortation area (FSA) level. Moran’s I statistic was used to test for global spatial autocorrelation. Smoothed SIRs and 95% posterior credible intervals (CIs) were estimated using a spatial Bayesian hierarchical model, which accounts for statistical instability and uncertainty in small-area incidence. Posterior CIs were used to identify high- and low-risk areas, which were described using sociodemographic data from the 2016 Census. Finally, a second model was used to estimate the association between drivetime to the nearest travel clinic and risk of TAI within high-risk areas. Results There were 5962 cases of the four TAIs across Ontario over the study period. Smoothed FSA-level SIRs are shown in Figure 1a, with an inset for the Greater Toronto Area (GTA) in 1b. There was spatial clustering of TAIs (Moran’s I=0.61, p&lt; 2.2e-16). Identified high- and low-risk areas are shown in panels c and d. Compared to low-risk areas, high-risk areas were significantly more likely to have higher proportions of immigrants (p&lt; 0.0001), lower household after-tax income (p=0.04), more university education (p&lt; 0.0001), and were less knowledgeable of English/French (p&lt; 0.0001). In the high-risk GTA, each minute increase in drivetime to the closest travel clinic was associated with a 4% reduction in TAI risk (95% CI 2 - 6%). Bayesian hierarchical model (BHM) smoothed standardized incidence ratios (SIRs) for travel-acquired infections (TAIs) and estimated risk levels (a and c) with insets for the Greater Toronto Area (b and d). High-risk areas are defined as those with smoothed SIR 95% CIs greater than 2, and low-risk areas with smoothed SIR 95% CIs less than 0.25. Conclusion Urban neighbourhoods in the GTA had elevated risks of becoming ill with TAIs. However, geographic proximity to a travel clinic was not associated with an area-level risk reduction in TAI, suggesting other barriers to seeking and adhering to pre-travel advice. Disclosures Isaac Bogoch, MD, MSc, BlueDot (Consultant)National Hockey League Players' Association (Consultant) Andrea Boggild, MSc MD DTMH FRCPC, Nothing to disclose Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker's Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support)