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Article ; Online: Healthcare utilization in Canadian children and young adults with asthma during the COVID-19 pandemic.

To, Teresa / Zhang, Kimball / Terebessy, Emilie / Zhu, Jingqin / Licskai, Christopher

2023 Volume 18, Issue 1, Page(s) e0280362

Abstract: Literature is limited regarding the COVID-19 pandemic's impact on health services use in younger Canadian populations with asthma. We utilized health administrative databases from January 2019-December 2021 for a population-based cross-sectional study to ...

Abstract	Literature is limited regarding the COVID-19 pandemic's impact on health services use in younger Canadian populations with asthma. We utilized health administrative databases from January 2019-December 2021 for a population-based cross-sectional study to identify Ontario residents 0-25 years old with physician-diagnosed asthma and calculate rates of healthcare use. Multivariable negative binomial regression analysis was used to adjust for confounders. We included 716,690 children and young adults ≤25 years. There was a sharp increase of ICS and SABA prescription rates at the start of the pandemic (March 2020) of 61.7% and 54.6%, respectively. Monthly virtual physician visit rates increased from zero to 0.23 per 100 asthma population during the pandemic. After adjusting for potential confounders, rate ratios (RR) with 95% confidence intervals (CI) showed that the pandemic was associated with significant decrease in hospital admissions (RR = 0.21, 95% CI: 0.18-0.24), emergency department visits (RR = 0.35, 95% CI: 0.34-0.37), and physician visits (RR = 0.61, 95% CI: 0.60-0.61). ICS and SABA prescriptions filled also significantly decreased during the pandemic (RR = 0.58, 95% CI: 0.57-0.60 and RR = 0.47, 95% CI: 0.46-0.48, respectively). This Canadian population-based asthma study demonstrated a dramatic decline in physician and emergency department visits, hospitalizations, and medication prescriptions filled during the COVID-19 pandemic. An extensive evaluation of the factors contributing to an 80% reduction in the risk of hospitalization may inform post-pandemic asthma management.
MeSH term(s)	Humans ; Child ; Young Adult ; Infant, Newborn ; Infant ; Child, Preschool ; Adolescent ; Adult ; Pandemics ; Cross-Sectional Studies ; COVID-19/epidemiology ; Asthma/drug therapy ; Asthma/epidemiology ; Hospitalization ; Emergency Service, Hospital ; Patient Acceptance of Health Care ; Ontario/epidemiology
Language	English
Publishing date	2023-01-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0280362
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Article: Is overreliance on short-acting β

To, Teresa / Zhu, Jingqin / Terebessy, Emilie / Zhang, Kimball / Gershon, Andrea S / Licskai, Christopher

ERJ open research

2022 Volume 8, Issue 1

Abstract: Recent Global Initiative for Asthma (GINA) recommendations reduce the role of short-acting ... ...

Abstract	Recent Global Initiative for Asthma (GINA) recommendations reduce the role of short-acting β
Language	English
Publishing date	2022-03-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2827830-6
ISSN	2312-0541
ISSN	2312-0541
DOI	10.1183/23120541.00032-2022
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Article ; Online: Mode of delivery and birth outcomes before and during COVID-19 -A population-based study in Ontario, Canada.

To, Teresa / Zhu, Jingqin / Terebessy, Emilie / Borkhoff, Cornelia M / Gershon, Andrea S / Kendzerska, Tetyana / Pakhale, Smita S / Vozoris, Nicholas T / Zhang, Kimball / Licskai, Christopher

PloS one

2024 Volume 19, Issue 5, Page(s) e0303175

Abstract: There is lack of clarity on whether pregnancies during COVID-19 resulted in poorer mode of delivery and birth outcomes in Ontario, Canada. We aimed to compare mode of delivery (C-section), birth (low birthweight, preterm birth, NICU admission), and ... ...

Abstract	There is lack of clarity on whether pregnancies during COVID-19 resulted in poorer mode of delivery and birth outcomes in Ontario, Canada. We aimed to compare mode of delivery (C-section), birth (low birthweight, preterm birth, NICU admission), and health services use (HSU, hospitalizations, ED visits, physician visits) outcomes in pregnant Ontario women before and during COVID-19 (pandemic periods). We further stratified for pre-existing chronic diseases (asthma, eczema, allergic rhinitis, diabetes, hypertension). Deliveries before (Jun 2018-Feb 2020) and during (Jul 2020-Mar 2022) pandemic were from health administrative data. We used multivariable logistic regression analyses to estimate adjusted odds ratios (aOR) of delivery and birth outcomes, and negative binomial regression for adjusted rate ratios (aRR) of HSU. We compared outcomes between pre-pandemic and pandemic periods. Possible interactions between study periods and covariates were also examined. 323,359 deliveries were included (50% during pandemic). One in 5 (18.3%) women who delivered during the pandemic had not received any COVID-19 vaccine, while one in 20 women (5.2%) lab-tested positive for COVID-19. The odds of C-section delivery during the pandemic was 9% higher (aOR = 1.09, 95% CI: 1.08-1.11) than pre-pandemic. The odds of preterm birth and NICU admission were 15% (aOR = 0.85, 95% CI: 0.82-0.87) and 10% lower (aOR = 0.90, 95% CI: 0.88-0.92), respectively, during COVID-19. There was a 17% reduction in ED visits but a 16% increase in physician visits during the pandemic (aRR = 0.83, 95% CI: 0.81-0.84 and aRR = 1.16, 95% CI: 1.16-1.17, respectively). These aORs and aRRs were significantly higher in women with pre-existing chronic conditions. During the pandemic, healthcare utilization, especially ED visits (aRR = 0.83), in pregnant women was lower compared to before. Ensuring ongoing prenatal care during the pandemic may reduce risks of adverse mode of delivery and the need for acute care during pregnancy.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Female ; Pregnancy ; Ontario/epidemiology ; Adult ; Infant, Newborn ; Pregnancy Outcome/epidemiology ; Delivery, Obstetric/statistics & numerical data ; Premature Birth/epidemiology ; Cesarean Section/statistics & numerical data ; Young Adult ; SARS-CoV-2/isolation & purification ; Pandemics ; Hospitalization/statistics & numerical data
Language	English
Publishing date	2024-05-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0303175
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Article ; Online: Association of ever use of e-cigarettes with health and lifestyle variables among young adults: a Canadian health measure survey study.

To, Teresa / Borkhoff, Cornelia M / Chow, Chung-Wai / Moraes, Theo J / Schwartz, Robert / Vozoris, Nick / Lal, Avtar / Yen, Wendy / Zhang, Kimball / Terebessy, Emilie / Zhu, Jingqin

European journal of pediatrics

2024 Volume 183, Issue 6, Page(s) 2521–2526

Abstract: Research suggests that vaping raises oxidative stress levels and has been implicated in poor mental health. The objective of this study is to assess cross-sectional associations between quality of life (QOL) indicators and e-cigarette (EC) use in young ... ...

Abstract	Research suggests that vaping raises oxidative stress levels and has been implicated in poor mental health. The objective of this study is to assess cross-sectional associations between quality of life (QOL) indicators and e-cigarette (EC) use in young Canadian adults. We used data from the 2016-2017 Canadian Health Measures Survey. We compared physical activity (daily steps), physiological measurements (high-density lipoprotein for cholesterol level), self-perceived life stress, mental health, and QOL between ever-use EC users and non-users. Multivariable binary or ordinal logistic regressions were used to calculate odds ratios (OR) with 95% confidence intervals (CI). Analyses included 905 participants (15-30 years) with 115 (12.7%) reporting EC use and 790 non-users. After adjusting for confounders, compared to non-users, EC users had significantly higher odds of being physically active (OR = 2.19, 95%CI: 1.14-4.20) but also with self-reported extreme life stress (OR = 2.68, 95%CI: 1.45-4.92). Albeit statistically non-significant, EC users also had higher odds of poorer QOL (OR = 1.12, 95%CI: 0.64-1.95). No statistically significant interactions between EC use, cigarette smoking, cannabis consumption and health outcomes were observed. Conclusion: Our study found that EC use was independently and significantly associated with increased odds of life stress and an indication of poorer QOL. Ongoing surveillance on young EC users is important to measure the long-term impact of vaping on their physical, mental health and quality of life to target for interventions. What is known: • E-cigarette use has been associated with high-risk behaviours and adverse mental health outcomes, such as depression and anxiety. What is new: • E-cigarette users had significantly higher odds of being physically active and higher amounts of life stress.
MeSH term(s)	Humans ; Canada/epidemiology ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Cross-Sectional Studies ; Vaping/epidemiology ; Quality of Life ; Health Surveys ; Life Style ; Exercise ; Electronic Nicotine Delivery Systems/statistics & numerical data ; Stress, Psychological/epidemiology ; Mental Health ; Health Status
Language	English
Publishing date	2024-03-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	194196-3
ISSN	1432-1076 ; 0340-6199 ; 0943-9676
ISSN (online)	1432-1076
ISSN	0340-6199 ; 0943-9676
DOI	10.1007/s00431-024-05499-2
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Article ; Online: Effect of smoke-free legislation on respiratory health services use in children with asthma: a population-based open cohort study in Ontario, Canada.

To, Teresa / Fong, Ivy / Zhu, Jingqin / McGihon, Rachel / Zhang, Kimball / Terebessy, Emilie

BMJ open

2021 Volume 11, Issue 8, Page(s) e048137

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Asthma/epidemiology ; Asthma/therapy ; Child ; Cohort Studies ; Emergency Service, Hospital ; Hospitalization ; Humans ; Infant ; Ontario/epidemiology
Language	English
Publishing date	2021-08-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-048137
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Article: UV, ozone, and COVID-19 transmission in Ontario, Canada using generalised linear models

To, Teresa / Zhang, Kimball / Maguire, Bryan / Terebessy, Emilie / Fong, Ivy / Parikh, Supriya / Zhu, Jingqin / Su, Yushan

Environmental research. 2021 Mar., v. 194

2021

Abstract: Quantifying the impact of environmental factors on COVID-19 transmission is crucial in preventing more cases. Ultraviolet (UV) radiation and ozone (O₃) have reported antimicrobial properties but few studies have examined associations with community ... ...

Abstract	Quantifying the impact of environmental factors on COVID-19 transmission is crucial in preventing more cases. Ultraviolet (UV) radiation and ozone (O₃) have reported antimicrobial properties but few studies have examined associations with community infectivity of COVID-19. Research suggests UV light can be preventative while the effect of O₃ is contested. We sought to determine the relationship between UV, O₃, and COVID-19 incidence in Ontario, Canada.In our time series analyses, we calculated daily incidence rates and reproductive number (Rₜ) from 34,975 cases between January and June 2020 across 34 Ontario Public Health Units. We used generalised linear models, adjusting for potential confounders, to calculate point estimates (PE) and 95% confidence intervals (CI) for UV and O₃. Analyses were further stratified by age groups and outbreaks at institutions versus community.We found that 1-week averaged UV was significantly associated with a 13% decrease (95% CI: 0.80–0.96) in overall COVID-19 Rₜ, per unit increase. A negative association with UV was also significant among community outbreaks (PE: 0.88, 95% CI: 0.81–0.96) but not institutional outbreaks (PE: 0.94, 95% CI: 0.85–1.03). A positive association of O₃ with COVID-19 incidence is strongly suggested among institutional outbreak cases (PE: 1.06, 95% CI: 1.00–1.13).Our study found evidence to support the hypothesis that higher UV reduced transmission of COVID-19 and some evidence that ground-level O₃ positively influenced COVID-19 transmission. Setting of infection should be strongly considered as a factor in future research. UV and O₃ may explain some of COVID-19's seasonal behaviour.
Keywords	COVID-19 infection ; ozone ; pathogenicity ; public health ; research ; time series analysis ; ultraviolet radiation ; Ontario
Language	English
Dates of publication	2021-03
Publishing place	Elsevier Inc.
Document type	Article
Note	NAL-AP-2-clean
ZDB-ID	205699-9
ISSN	1096-0953 ; 0013-9351
ISSN (online)	1096-0953
ISSN	0013-9351
DOI	10.1016/j.envres.2020.110645
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Association of factors with childhood asthma and allergic diseases using latent class analysis.

To, Teresa / Borkhoff, Cornelia M / Anderson, Laura N / Birken, Catherine S / Dell, Sharon D / Janus, Magdalena / Maguire, Jonathon L / Moraes, Theo J / Parkin, Patricia C / Subbarao, Padmaja / Van Dam, Anne / Guttman, Beverly / Terebessy, Emilie / Zhang, Kimball / Zhu, Jingqin

Scientific reports

2024 Volume 14, Issue 1, Page(s) 6874

Abstract: We hypothesize that children characterized by deprived factors have poorer health outcomes. We aim to identify clustering of determinants and estimate risk of early childhood diseases. This 1993-2019 longitudinal cohort study combines three Canadian ... ...

Abstract	We hypothesize that children characterized by deprived factors have poorer health outcomes. We aim to identify clustering of determinants and estimate risk of early childhood diseases. This 1993-2019 longitudinal cohort study combines three Canadian pediatric cohorts and their families. Mothers and children are clustered using latent class analysis (LCA) by 16 indicators in three domains (maternal and newborn; socioeconomic status [SES] and neighbourhood; environmental exposures). Hazard ratios (HR) of childhood asthma, allergic rhinitis (AR), and eczema are quantified with Cox proportional hazard (PH) regression. Rate ratios (RR) of children's health services use (HSU) are estimated with Poisson regression. Here we report the inclusion of 15,724 mother-child pairs; our LCA identifies four mother-clusters. Classes 1 and 2 mothers are older (30-40 s), non-immigrants with university education, living in high SES neighbourhoods; Class 2 mothers have poorer air quality and less greenspace. Classes 3 and 4 mothers are younger (20-30 s), likely an immigrant/refugee, with high school-to-college education, living in lower SES neighborhoods with poorer air quality and less greenspace. Children's outcomes differ by Class, in comparison to Class 1. Classes 3 and 4 children have higher risks of asthma (HR 1.24, 95% CI 1.11-1.37 and HR 1.39, 95% CI 1.22-1.59, respectively), and similar higher risks of AR and eczema. Children with AR in Class 3 have 20% higher all-cause physician visits (RR = 1.20, 95% CI 1.10-1.30) and those with eczema have 18% higher all-cause emergency department visits (RR = 1.18, 95% CI 1.09-1.28) and 14% higher all-cause physician visits (RR = 1.14, 95% CI 1.09-1.19). Multifactorial-LCA mother-clusters may characterize associations of children's health outcomes and care, adjusting for interrelationships.
MeSH term(s)	Infant, Newborn ; Female ; Humans ; Child ; Child, Preschool ; Longitudinal Studies ; Latent Class Analysis ; Canada ; Asthma/epidemiology ; Asthma/etiology ; Eczema/epidemiology ; Rhinitis, Allergic/epidemiology
Language	English
Publishing date	2024-03-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-56805-9
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Article ; Online: Correlation of ambient temperature and COVID-19 incidence in Canada.

To, Teresa / Zhang, Kimball / Maguire, Bryan / Terebessy, Emilie / Fong, Ivy / Parikh, Supriya / Zhu, Jingqin

The Science of the total environment

2020 Volume 750, Page(s) 141484

Abstract: The SARS-CoV-2 is a novel coronavirus identified as the cause of COVID-19 and, as the pandemic evolves, many have made parallels to previous epidemics such as SARS-CoV (the cause of an outbreak of severe acute respiratory syndrome [SARS]) in 2003. Many ... ...

Abstract	The SARS-CoV-2 is a novel coronavirus identified as the cause of COVID-19 and, as the pandemic evolves, many have made parallels to previous epidemics such as SARS-CoV (the cause of an outbreak of severe acute respiratory syndrome [SARS]) in 2003. Many have speculated that, like SARS, the activity of SARS-CoV-2 will subside when the climate becomes warmer. We sought to determine the relationship between ambient temperature and COVID-19 incidence in Canada. We analyzed over 77,700 COVID-19 cases from four Canadian provinces (Alberta, British Columbia, Ontario, and Quebec) from January to May 2020. After adjusting for precipitation, wind gust speed, and province in multiple linear regression models, we found a positive, but not statistically significant, association between cumulative incidence and ambient temperature (14.2 per 100,000 people; 95%CI: -0.60-29.0). We also did not find a statistically significant association between total cases or effective reproductive number of COVID-19 and ambient temperature. Our findings do not support the hypothesis that higher temperatures will reduce transmission of COVID-19 and warns the public not to lose vigilance and to continue practicing safety measures such as hand washing, social distancing, and use of facial masks despite the warming climates.
MeSH term(s)	Alberta ; Betacoronavirus ; British Columbia/epidemiology ; COVID-19 ; Coronavirus Infections ; Humans ; Incidence ; Ontario ; Pandemics ; Pneumonia, Viral ; Quebec ; SARS-CoV-2 ; Temperature
Keywords	covid19
Language	English
Publishing date	2020-08-04
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	121506-1
ISSN	1879-1026 ; 0048-9697
ISSN (online)	1879-1026
ISSN	0048-9697
DOI	10.1016/j.scitotenv.2020.141484
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Article ; Online: Vaping and Health Service Use: A Canadian Health Survey and Health Administrative Data Study.

To, Teresa / Borkhoff, Cornelia M / Chow, Chung-Wai / Moraes, Theo J / Schwartz, Robert / Vozoris, Nick / Van Dam, Anne / Langlois, Chris / Zhang, Kimball / Terebessy, Emilie / Zhu, Jingqin

Annals of the American Thoracic Society

2023 Volume 20, Issue 6, Page(s) 815–824

Abstract: Rationale: ...

Abstract	Rationale:
MeSH term(s)	Young Adult ; Adolescent ; Humans ; Male ; Female ; Vaping/adverse effects ; Vaping/epidemiology ; Electronic Nicotine Delivery Systems ; Cohort Studies ; Routinely Collected Health Data ; Canada/epidemiology ; Asthma/epidemiology ; Health Surveys ; Health Services ; Patient Acceptance of Health Care ; Tobacco Products
Language	English
Publishing date	2023-03-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202207-578OC
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Article ; Online: UV, ozone, and COVID-19 transmission in Ontario, Canada using generalised linear models.

To, Teresa / Zhang, Kimball / Maguire, Bryan / Terebessy, Emilie / Fong, Ivy / Parikh, Supriya / Zhu, Jingqin / Su, Yushan

Environmental research

2021 Volume 194, Page(s) 110645

Abstract: Background: Quantifying the impact of environmental factors on COVID-19 transmission is crucial in preventing more cases. Ultraviolet (UV) radiation and ozone (O: Methods: In our time series analyses, we calculated daily incidence rates and ... ...

Abstract	Background: Quantifying the impact of environmental factors on COVID-19 transmission is crucial in preventing more cases. Ultraviolet (UV) radiation and ozone (O Methods: In our time series analyses, we calculated daily incidence rates and reproductive number (R Results: We found that 1-week averaged UV was significantly associated with a 13% decrease (95% CI: 0.80-0.96) in overall COVID-19 R Conclusion: Our study found evidence to support the hypothesis that higher UV reduced transmission of COVID-19 and some evidence that ground-level O
MeSH term(s)	COVID-19 ; Humans ; Linear Models ; Ontario/epidemiology ; Ozone/analysis ; SARS-CoV-2
Chemical Substances	Ozone (66H7ZZK23N)
Language	English
Publishing date	2021-01-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	205699-9
ISSN	1096-0953 ; 0013-9351
ISSN (online)	1096-0953
ISSN	0013-9351
DOI	10.1016/j.envres.2020.110645
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