Facility In Ontario Research Articles

Association between long-term exposure to ambient air pollution and COVID-19 severity: a prospective cohort study.

Background:The tremendous global health burden related to COVID-19 means that identifying determinants of COVID-19 severity is important for prevention and intervention. We aimed to explore long-term exposure to ambient air pollution as a potential contributor to COVID-19 severity, given its known impact on the respiratory system.Methods:We used a cohort of all people with confirmed SARS-CoV-2 infection, aged 20 years and older and not residing in a long-term care facility in Ontario, Canada, during 2020. We evaluated the association between long-term exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ground-level ozone (O3), and risk of COVID-19-related hospital admission, intensive care unit (ICU) admission and death. We ascertained individuals’ long-term exposures to each air pollutant based on their residence from 2015 to 2019. We used logistic regression and adjusted for confounders and selection bias using various individual and contextual covariates obtained through data linkage.Results:Among the 151 105 people with confirmed SARS-CoV-2 infection in Ontario in 2020, we observed 8630 hospital admissions, 1912 ICU admissions and 2137 deaths related to COVID-19. For each interquartile range increase in exposure to PM2.5 (1.70 μg/m3), we estimated odds ratios of 1.06 (95% confidence interval [CI] 1.01–1.12), 1.09 (95% CI 0.98–1.21) and 1.00 (95% CI 0.90–1.11) for hospital admission, ICU admission and death, respectively. Estimates were smaller for NO2. We also estimated odds ratios of 1.15 (95% CI 1.06–1.23), 1.30 (95% CI 1.12–1.50) and 1.18 (95% CI 1.02–1.36) per interquartile range increase of 5.14 ppb in O3 for hospital admission, ICU admission and death, respectively.Interpretation:Chronic exposure to air pollution may contribute to severe outcomes after SARS-CoV-2 infection, particularly exposure to O3.

Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study

ObjectivesWe examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs).DesignMulti-site cross-sectional.Setting and participantsWe extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who received at minimum, an admission and first-quarterly assessment with the Resident Assessment Instrument Minimum Data Set (MDS) 2.0 between November 1, 2009, and October 31, 2017.MethodsWe conducted a secondary analysis of routinely collected MDS 2.0 data. The provision of a recent medical care visit by a physician (or authorized clinician) was assessed in the 14-day period preceding a resident’s first-quarterly MDS 2.0 assessment. We utilized best-subset multivariable logistic regression to model the adjusted associations between resident-level clinical factors and a recent medical care visit.ResultsTwo thousand eight hundred fifty nine (80.4%) NH residents had one or more medical care visits prior to their first-quarterly MDS 2.0 assessment. Six clinically relevant factors were identified to be associated with recent medical care visits in the final model: exhibiting wandering behaviours (OR = 1.34, 95% CI 1.09 – 1.63), presence of a pressure ulcer (OR = 1.37, 95% CI 1.05 – 1.78), a urinary tract infection (UTI) (OR = 1.52, 95% CI 1.06 – 2.18), end-stage disease (OR = 9.70, 95% CI 1.32 – 71.02), new medication use (OR = 1.31, 95% CI 1.09 – 1.57), and analgesic use (OR = 1.24, 95% CI 1.03 – 1.49).Conclusions and implicationsOur findings suggest that resident-level clinical factors drive the provision of medical care visits following NH admission. Clinical factors associated with medical care visits align with the minimum competencies expected of physicians in NH practice, including managing safety risks, infections, medications, and death. Ensuring that NH physicians have opportunities to acquire and strengthen these competencies may be transformative to meet the ongoing needs of NH residents.

An analysis of health and safety audits of aquatic facilities in Ontario: 2002–2020

The risk of drowning in swimming pools is a concern for bathers in Canada. The Aquatic Safety Audit (ASA) is a service provided by the Lifesaving Society (LSS) to assess operations of aquatic facilities in Canada. However, the results of these ASA reports have never been analyzed systematically. We compiled and analyzed ASA reports from 2002 to 2020, received from LSS Ontario, to ascertain the most frequently identified recommendations (i.e., safety deficiencies) and identify trends in the data. A total of 59 ASA reports of aquatic facilities that contained swimming pools (i.e., indoor, outdoor, or both) were examined. The study identified a total of 4,589 recommendations. The general audit category of “Aquatic Facility” (n = 4,000 deficiencies) was more problematic than “Emergency and Operating Procedures” (n = 244), “Personnel” (n = 211), and “Communication” (n = 143). The “deck” subcategory of “Aquatic Facility” had the most deficiencies (n = 1,050). The topmost identified deficiencies were “no medical signs at the entrance points” (n = 37, priority concern) and “inadequate lighting levels” (n = 35, primary recommendation). In our comparative analysis, facilities with at least one outdoor pool and municipally owned facilities were more likely to be associated with safety deficiencies, compared to facilities with indoor pools and nonmunicipally owned facilities (e.g., university, military, private sector). Our study noted that noncompliance and violations of legal requirements were common in aquatic facilities in Ontario. Future studies are suggested to further investigate the poor safety performance of facilities, especially those with outdoor pools or are municipally owned.

Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use.

BackgroundAlcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused.ObjectiveThe aim of this survey study is to explore the beliefs that determine the intention to use AUDRA.MethodsWe conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020.ResultsThe final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA.ConclusionsThis study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA.

Predictors of diarrhea, mortality, and weight gain in male dairy calves

The objective of this prospective cohort study was to determine the effect of an abnormal fecal consistency score on weight gain and mortality in male Holstein calves and to identify risk factors associated with the occurrence of an abnormal fecal consistency score. This study enrolled 2,616 calves entering a calf-raising facility in Ontario, Canada, between January 2018 and December 2020. Fecal consistency scores were assigned twice daily for the first 28 d following arrival, where a score of 2, indicating runny consistency, and 3, indicating watery consistency, were classified as diarrhea. Severe diarrhea was classified by a score of 3. Serum total protein was measured upon arrival and the source of the calf (i.e., whether the calf came from a drover, local farm, or auction) was recorded. Body weight measurements were also collected at arrival and at 14, 56, and 77 d after arrival. Calf mortality and disease treatment during the first 77 d were recorded. On average, calves had diarrhea for 16% (4.51 d) of the first 28 d under observation, and severe diarrhea for 7% (1.87 d) of the 28 d under observation. Using a repeated measures linear regression model, we found the proportion of days with diarrhea significantly decreased weight gain at 14, 56, and 77 d following arrival. An increased proportion of days with diarrhea increased the risk of mortality, which was determined using a Cox proportional hazards model. We also found, using 2 Cox proportional hazards models, that a higher proportion of days with an abnormal fecal score increased the hazard of antibiotic treatment. With respect to factors associated with the occurrence of abnormal fecal consistency, we found that arrival weight and the source of calves were statistically significant predictors. Specifically, for every additional kilogram of body weight at arrival, the proportion of days with diarrhea decreased by 7%. With respect to source, calves from drovers had a higher proportion of days with diarrhea compared with those sourced directly from local dairy farms. Our results highlight the substantial influence the presence of abnormal fecal consistency has on short-term weight gain, mortality risk, and morbidity risk. We also demonstrate that diarrhea occurrence can be predicted using body weight at arrival and calf source. Further research should evaluate longer-term effects of diarrhea and better understand the effect of arrival weight on neonatal calf disease risk.

Intellectual/developmental disabilities among people incarcerated in federal correctional facilities in Ontario, Canada: Examining prevalence, health and correctional characteristics.

There is little research with people who experience intellectual/developmental disabilities and imprisonment. The study linked health and correctional data to examine prevalence of intellectual/developmental disabilities and health and correctional characteristics among adults experiencing their first federal incarceration between 1 January 2002 and 31 December 2011 (n= 9278) and two non-incarcerated groups (n= 10,086,802). The prevalence of intellectual/developmental disabilities was 2.1% in the incarcerated group and 0.9% in the non-incarcerated group. Before incarceration, those with, versus without, intellectual/developmental disabilities were at greater risk of traumatic brain injury, mental illness, and substance use disorders. While incarcerated, those with intellectual/developmental disabilities were more likely to incur serious institutional disciplinary charges. Post-incarceration, persons with intellectual/developmental disabilities were at greater risk of emergency department visits, and psychiatric and acute hospitalizations, than the non-incarcerated groups. People with intellectual/developmental disabilities are overrepresented in Canadian federal correctional institutions. The authors offer strategies to support people prior to, during, and post-incarceration.

Conducting research during the COVID-19 pandemic: the Op LASER study.

The Canadian Armed Forces (CAF) deployed 2595 regular and reserve force personnel on Operation (Op) LASER, the CAF's mission to provide support to civilian staff at longterm care facilities in Ontario and in the Centres d'hébergement de soins de longue durée in Quebec. An online longitudinal survey and in-depth virtual discussions were conducted by a multidisciplinary team of researchers with complementary expertise. This paper highlights the challenges encountered in conducting this research and their impact on the design and implementation of the study, and provides lessons learned that may be useful to researchers responding to similar public health crises in the future.

Modeling COVID-19 Outbreaks in Long-Term Care Facilities Using an Agent-Based Modeling and Simulation Approach.

The elderly, especially those individuals with pre-existing health problems, have been disproportionally at a higher risk during the COVID-19 pandemic. Residents of long-term care facilities have been gravely affected by the pandemic and resident death numbers have been far above those of the general population. To better understand how infectious diseases such as COVID-19 can spread through long-term care facilities, we developed an agent-based simulation tool that uses a contact matrix adapted from previous infection control research in these types of facilities. This matrix accounts for the average distinct daily contacts between seven different agent types that represent the roles of individuals in long-term care facilities. The simulation results were compared to actual COVID-19 outbreaks in some of the long-term care facilities in Ontario, Canada. Our analysis shows that this simulation tool is capable of predicting the number of resident deaths after 50 days with a less than 0.1 variation in death rate. We modeled and predicted the effectiveness of infection control measures by utilizing this simulation tool. We found that to reduce the number of resident deaths, the effectiveness of personal protective equipment must be above 50%. We also found that daily random COVID-19 tests for as low as less than 10% of a long-term care facility’s population will reduce the number of resident deaths by over 75%. The results further show that combining several infection control measures will lead to more effective outcomes.

Substance Use among Youth in Community and Residential Mental Health Care Facilities in Ontario, Canada.

There is a need to improve the integration of substance use and mental health care for children and youth. This study examines risk and protective factors for substance use among youth with mental health conditions who received community-based or residential care services between 2012–2020 in Ontario, Canada. In this study, a cross-sectional design was used to examine patterns and factors associated with substance use among youth (12–18 years) assessed in the community (n = 47,418) and residential (n = 700) mental health care facilities in Ontario, Canada. Youth were assessed with the interRAI Child and Youth Mental Health Assessment (ChYMH). Substance use is identified by any substance use (including alcohol) 14 to 30 days prior to assessment. Logistic regression with generalized estimating equations was used to examine clinical, psychosocial, and environmental factors associated with substance use. This study shows that 22.3% of youth reported the use of substances in the community settings and 37% in residential settings. Older age group (Youth older than 16 years), being a victim of abuse, having experienced self-injurious ideation/attempt, being at risk of disrupted education, and having a parent/caregiver with addiction or substance use disorder were significantly associated with substance use. Several factors reduced the risk of substance use, including being a female, having anxiety symptoms, and having cognition problems. In conclusion, the study found that individual and parental factors increase youth’s risk of substance use, highlighting the importance of a holistic approach that includes consideration of social and biological risk factors to prevention/risk reduction, risk assessment, management, and recovery.

Interactions of a temperate North American fish community with a very low head hydropower facility in Ontario, Canada

AbstractEfforts are underway to re‐evaluate the use of existing instream infrastructure (e.g., weirs, water control dams) for the purposes of hydroelectric generation, with new very low head turbine technology that is purportedly “fish friendly” making retrofitting a viable option. This is the case at Wasdell Falls on the Severn River, ON, Canada, where the first very low head (VLH) turbines in Canada were put into operation at a long‐standing low‐head dam site. There is little information regarding fish usage of areas upstream from these structures and how this may relate to entrainment risk. Therefore, we assessed the risk of entrainment based on fish use of the forebay areas upstream from the infrastructure, including the forebay of three operating VLH turbines. Acoustic telemetry was used to determine movements and entrainment events of eight north temperate fish species. Entrainment through the VLH turbines did not occur over the course of one year, however, several fish did move downstream via other paths (e.g., over the water control structure). Forebay use was exclusive to rock bass, smallmouth bass, northern pike and largemouth bass, whereas channel catfish, walleye, white sucker and pumpkinseed avoided the forebay. When near the dam, fish tended to select deeper areas located away from the VLH forebay. Fish use of the VLH forebay was limited to brief forays indicating exploratory movements rather than prolonged residence. The findings suggest that entrainment risk at this VLH turbine site is low for the species and life stages studied.

Determination of the baseline tritium concentrations (HTO, TFWT and OBT) in soil and plants in Ontario, Canada

Tritiated water (HTO), tissue free water tritium (TFWT) and organically bound tritium (OBT) activity concentrations in soil and plant leaves, collected at background areas in Ontario, were measured to quantify the current tritium baseline. Five representative background sites, based on their geological characteristics and residential populations, have been selected for this study.Undisturbed soils, plant leaves and surface water samples were collected at 5 sites (London, Kapuskasing, Thunder Bay, Elliot Lake and Cornwall areas) in 2015. Water sample HTO activity concentrations were measured using Liquid Scintillation Counting (LSC, ALOKA), and HTO activity concentrations for soil and TFWT for plant leaves were measured by LSC (Quantulus 1220) on water extracted from frozen samples using a freeze-drying vacuum system equipped with a liquid nitrogen trap. Plant leaf OBT levels were obtained by combustion of rinsed freeze-dried samples using a Parr combustion system, while soil OBT values were obtained using a tube furnace combustion system. Combustion water was distilled before being counted by LSC (Quantulus 1220).HTO activity concentrations were found to range between 1.4 and 2.0 Bq/L (MDA = 0.5 Bq/L) in surface water and soil samples. TFWT values were less than the minimum detectable activity (MDA = 3.5 Bq/L) in plant leaves. In contrast, OBT activity concentrations (MDA = 5 Bq/L) ranged from 5.7 to 17.1 Bq/L in plant leaves and 8.3–20.7 Bq/L in surface soil (0–5 cm depth). The overall OBT activity concentrations were higher in the London and the Cornwall areas. Lower levels were measured near Thunder Bay, Kapuskasing and Elliot Lake. There was no obvious relationship between soil OBT activity concentrations and soil types.The results provide the current tritium (HTO, TFWT and OBT) baseline values in Ontario. These values will be helpful for use as background locations for the evaluation of past and future environmental tritium inputs associated with nuclear facilities, and will be taken into account when evaluating the environmental impact of nuclear facilities in Ontario. Since samples in this study were primarily taken in wooded areas, some questions remain regarding the possibility that soil samples in open, non-wooded areas could show different HTO and OBT contents than those presented in this study.

Timing and Weather Offer Alternative Mitigation Strategies for Lowering Bat Mortality at Wind Energy Facilities in Ontario.

Simple SummaryWind farms represent one of the largest sources of anthropogenic mortality for bats. Wind proponents attempt to mitigate these effects via operational curtailment, such that wind energy is not produced on nights with low wind speeds during the late summer and fall. Our study modeled bat activity and mortality on two timescales (nightly and seasonally) and in response to a range of weather variables. We showed that bat mortality risks could be lowered and opportunities for wind energy production can be increased by focusing curtailment efforts to the periods of the night and year when bats are most active and by considering a wider range of weather variables, compared to standard curtailment strategies.Relatively high mortality of migratory bats at wind energy facilities has prompted research to understand the underlying spatial and temporal factors, with the goal of developing more effective mitigation approaches. We examined acoustic recordings of echolocation calls at 12 sites and post-construction carcass survey data collected at 10 wind energy facilities in Ontario, Canada, to quantify the degree to which timing and regional-scale weather predict bat activity and mortality. Rain and low temperatures consistently predicted low mortality and activity of big brown bats (Eptesicus fuscus) and three species of migratory tree bats: hoary bat (Lasiurus cinereus), eastern red bat (L. borealis), and silver-haired bat (Lasionycteris noctivagans). Bat activity occurred in waves with distinct peaks through the season; regardless of seasonal timing, most activities occurred in the first half of the night. We conclude that wind energy facilities could adopt a novel and more effective curtailment strategy based on weather and seasonal and nocturnal timing that would minimize mortality risks for bats while increasing the opportunities for power generation, relative to the mitigation strategy of increasing cut-in wind speed to 5.5 m/s.

Nurse Practitioners and The Use of Antipsychotic Medications in Long Term Care in Ontario, Canada

Introduction: Antipsychotic use in Long-Term Care (LTC) in Ontario, Canada continues to pose a challenge in the care of older adult patients living in these institutions. The dangers and patterns of inappropriate prescribing have been documented frequently. Most of the current literature focuses on dementia and behavioral and psychological symptoms of dementia, the role of prescribers, or on interprofessional interventions with person-centered care to address the behavior. Very little discussion has focused on the role of nurse practitioners and other frontline long-term care staff in the assessment and interactions with residents that may result in prescriptions of antipsychotics.
 Objectives: The purpose of this population based retrospective study of data from all LTC facilities in Ontario, Canada in 2019-2020 was to determine the extent to which antipsychotic medications were used in and the factors associated with this use. Reflections about the NP role are discussed.
 Results: The results demonstrate that over thirty percent of residents in LTC continue to receive antipsychotics and those with the responsive behaviours are significantly more likely to be prescribed antipsychotics. 
 Conclusions: The findings identify a potential link between over-burdened front-line staff and increased antipsychotic prescriptions, as well as continued use of antipsychotics in attempts to prevent harm to residents and staff at long-term care homes. Recommendations are made that include changes to legislation that will ensure optimal front-line care and time for care, increased training for front line staff and, in particular, how the role of the nurse practitioner in LTC can be utilized to optimize the appropriate use of antipsychotics, and the support of discontinuing or decreasing the dose of antipsychotics when required.

Diesel Engine Exhaust Exposure in the Ontario Civil Infrastructure Construction Industry.

Diesel engine exhaust (DEE) is a known lung carcinogen and a common occupational exposure in Canada. The use of diesel-powered equipment in the construction industry is particularly widespread, but little is known about DEE exposures in this work setting. The objective of this study was to determine exposure levels and identify and characterize key determinants of DEE exposure at construction sites in Ontario. Elemental carbon (EC, a surrogate of DEE exposure) measurements were collected at seven civil infrastructure construction worksites and one trades training facility in Ontario using NIOSH method 5040. Full-shift personal air samples were collected using a constant-flow pump and SKC aluminium cyclone with quartz fibre filters in a 37-mm cassette. Exposures were compared with published health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03 µg m-3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5 µg m-3 respirable EC). Mixed-effects linear regression was used to identify determinants of EC exposure. In total, 149 EC samples were collected, ranging from <0.25 to 52.58 µg m-3 with a geometric mean (GM) of 3.71 µg m-3 [geometric standard deviation (GSD) = 3.32]. Overall, 41.6% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 90.6% exceeded the DECOS limit. Underground workers (GM = 13.20 µg m-3, GSD = 1.83) had exposures approximately four times higher than below grade workers (GM = 3.56 µg m-3, GSD = 1.94) and nine times higher than above ground workers (GM = 1.49 µg m-3, GSD = 1.75). Training facility exposures were similar to above ground workers (GM = 1.86 µg m-3, GSD = 4.12); however, exposures were highly variable. Work setting and enclosed cabins were identified as the key determinants of exposure in the final model (adjusted R2 = 0.72, P < 0.001). The highest DEE exposures were observed in underground workplaces and when using unenclosed cabins. This study provides data on current DEE exposure in Canadian construction workers. Most exposures were above recommended health-based limits, albeit in other jurisdictions, signifying a need to further reduce DEE levels in construction. These results can inform a hazard reduction strategy including targeted intervention/control measures to reduce DEE exposure and the burden of occupational lung cancer.

The Impact of COVID-19 on the Organization of Personal Support Work in Ontario, Canada

The COVID-19 pandemic has exposed fault-lines in the organization of personal support work, including low wages, part-time employment, and risky working condition, despite its essential nature in long-term care (LTC). This is, in part, because personal support work has long-existed on the fringes of what is considered health work, thereby precluding its status as a health profession. In this perspective paper, we explore how the pandemic may contribute to the semi-professionalization of personal support work based on the provision of LTC by personal support workers (PSWs) working in LTC facilities in Ontario, Canada. We first characterize personal support work to illustrate its current organization based on the logics of work control. We then speculate how the pandemic may shift control and map speculated changes onto existing checklists of professionalism and semi-professionalism in health work. We propose the pandemic will shift control away from existing market and hierarchical controls. At most, personal support work may undergo changes that are more characteristic of semi-professional control (semi-professionalism), characterized by the formation of a PSW registry that may improve role clarity, provide market shelter, and standardize wages. We do not believe this shift in control will solve all organizational problems that the pandemic has exposed, and continued market and hierarchical controls may be necessary. This perspective may provide insights for other high-income settings, where the pandemic has exposed similar fault-lines in the organization of personal support work in LTC.

Biogas from source separated organic waste within a circular and life cycle perspective. A case study in Ontario, Canada

The appropriate transformation and valorisation of biogas offers environmental and economic opportunities in a future with restrictions upon fossil-based fuels and materials. The LCA method was used to quantify and compare the potential environmental impacts of an AD plant incorporating biogas co-generation and upgrading options, namely AD-CHP and AD-RNG. Using an average Anaerobic Digestion facility in Ontario, Canada, modelled after real facilities, as a case study, electricity and steel were identified as potential hotspot input materials carrying a disproportionate environmental burden for biogas production. With a system expansion approach, the biogas was subsequently utilized to produce (1) both heat and electricity using a Combined Heat and Power (CHP) system, or (2) upgraded to renewable natural gas (also called biomethane) through chemical amine scrubbing, respectively.

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada.

BackgroundMany residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program.MethodsWe conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program.ResultsThere were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not.ConclusionsA dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities.

Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study

ObjectiveWe investigate whether older adults who were newly diagnosed with dementia (severity unspecified) and resided in an assisted living facility that offered a dementia care program had a lower rate of transition to a nursing home, compared to those who resided in an assisted living facility without such a program. DesignPopulation-based retrospective cohort study. Setting and ParticipantsLinked, person-level health system administrative data on older adults who were newly diagnosed with dementia and resided in an assisted living facility in Ontario, Canada, from 2014 to 2019 (n = 977). MethodsAccess to a dementia care program in an assisted living facility (n = 57) was examined. Multivariable Cox proportional hazards regression with robust standard errors clustered on the assisted living facility was used to model the time to transition to a nursing home from the new dementia diagnosis. ResultsThere were 11.8 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility with a dementia care program, compared with 20.5 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility without a dementia care program. After adjustment for relevant characteristics at baseline, older adults who resided in an assisted living facility with a dementia care program had a 40% lower rate of transition to a nursing home (hazard ratio 0.60, 95% confidence interval 0.44, 0.81), compared with those in an assisted living facility without such a program at any point during the follow-up period. Conclusions and ImplicationsThe rate of transition to a nursing home was significantly lower among older adults who resided in an assisted living facility that offered a dementia care program. These findings support the expansion of dementia care programs in assisted living facilities.

Risk of serious medical events in patients with depression treated with electroconvulsive therapy: a propensity score-matched, retrospective cohort study

Previous studies examining the risk of medical complications from electroconvulsive therapy have been confounded and this might contribute to its underuse. This study aimed to compare the risk of serious medical events, defined as those resulting in hospitalisation or death, among patients with depression who received electroconvulsive therapy versus patients who did not receive electroconvulsive therapy. This was a propensity score-matched, retrospective cohort study using linked population-based administrative health data for adults admitted to designated psychiatric facilities in Ontario, Canada, for more than 3 days with depression between April 1, 2007, to Feb 28, 2017. Electroconvulsive therapy exposure was defined as one or more physician billing procedure codes during hospitalisation. The unit of analysis was individual admissions and propensity score matching was used to match each exposed admission to an unexposed admission to estimate the average treatment effect of electroconvulsive therapy among those treated. The primary outcome was serious medical events, a composite of hospitalisation for medical (ie, non-psychiatric) reasons or non-suicide death within 30 days from electroconvulsive therapy exposure or matched date in the unexposed group. Effect modification was examined using tests of interaction for three clinically relevant prespecified subgroups (sex, presence of psychotic symptoms, and illness polarity). Secondary outcomes were medical hospitalisation and non-suicide death separately, suicide death, and specific serious medical events. In propensity score matched analyses, there were 10 016 psychiatric hospitalisation records (6628 women, 3388 men) with mean age 56·6 years (SD 16·3) and no ethnicity data available. 65 818 admissions were eligible for matching and 5008 were matched (1:1) in each exposure group. In the propensity score matched cohort, the incidence of serious medical events was 0·25 per person-year in the exposed group and 0·33 per person-year in the unexposed group (cause-specific hazard ratio 0·78 [95% CI 0·61-1·00]). Suicide death as a competing risk did not alter this finding. The risk of suicide death was significantly lower in the exposed (≤5 of 5008 admissions) versus the unexposed group (11 [0·2%] of 5008 admissions; p<0·03). Bipolar depression, compared with unipolar depression, was associated with a greater reduction in the risk of serious medical events with electroconvulsive therapy. Electroconvulsive therapy was not associated with medical hospitalisation or non-suicide death separately, nor with any specific serious medical event. Among individuals hospitalised with depression, we found no evidence for a clinically significant increased risk for serious medical events with exposure to electroconvulsive therapy, and the risk of suicide was found to be significantly reduced, suggesting the benefits of electroconvulsive therapy for depression outcomes might outweigh its risks in this population. Norris Scholars Award, Department of Psychiatry, University of Toronto; the Canadian Institutes for Health Research.

Several Pythium species cause crown and root rot on cannabis (Cannabis sativa L., marijuana) plants grown under commercial greenhouse conditions

Cannabis (Cannabis sativa L., marijuana) plants with symptoms of crown rot, root decay, wilting and plant death were sampled during 2018 and 2019 from seven production greenhouses. Affected tissues from 140 diseased plants were surface-sterilized and plated onto potato dextrose agar. Ninety-five isolates morphologically resembling Pythium species were subcultured and subjected to PCR of the ITS1-5.8-ITS2 region of ribosomal DNA. The following species were identified based on >99% sequence identity to reference isolates in GenBank: P. myriotylum (43 isolates), P. dissotocum (35 isolates), P. aphanidermatum (3 isolates) and Globisporangium ultimum (syn. P. ultimum) (2 isolates). A fifth species – P. catenulatum (12 isolates), was distinguished from P. rhizo-oryzae using the cytochrome oxidase c subunit I (COI) sequence. Cannabis licensed production facilities in British Columbia had all five species present, while P. dissotocum was found in two facilities in Ontario, and P. myriotylum was present in one facility in northern California. Isolates selected to represent each Pythium species were grown on potato dextrose agar at 25 oC and they all showed comparable colony growth after 6 days. The same isolates caused root browning, decay and stunting of cannabis plants grown in a coco: perlite potting medium. Plant mortality was similar after 21 days but rates of disease progression varied depending on the isolate tested. Wounding of roots and prolonged periods of saturation enhanced disease development. These results demonstrate for the first time that crown and root rot on greenhouse grown cannabis plants can be caused by up to five Pythium species.