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Abstract Chronic obstructive pulmonary disease (COPD) exacerbations contribute significantly to morbidity and mortality. COPD is also associated with high levels of psychological distress, which has been linked with higher exacerbation rates. At a recent American Thoracic Society conference symposium titled “Depression and Obstructive Lung Disease: State of the Science and Future Directions” held in 2010 in New Orleans, clinicians and researchers identified a number of important research priorities related to psychiatric comorbidities, including the need to better understand their impact on COPD outcomes, such as exacerbations. This article reviews the current literature and quantifies the prospective impact of anxiety and depression on exacerbation risk in patients with COPD. The limitations of the existing literature and the perspectives for future research are addressed.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with poorer mental well-being (e.g., anxiety, depressive symptoms and infection worry) and unfavorable changes in health behaviours (e.g., physical activity, healthy eating, and alcohol intake). Notably, trends in changes appear to differ between adult males and females (>18 years). To investigate these sex-based differences, we explored the impact of sex as a moderator on changes in health behaviours attributed to changes in mental well-being during SARS-CoV-2. Data from Canada, Columbia and Ireland collected through the International COVID-19 Awareness and Responses Evaluation (iCARE) Study was used. Participants (n = 17,880; 52.3% female) self-reported changes in their mental well-being and health behaviours attributed to SARS-CoV-2. Associations were explored using multi-variable logistic regression models stratified by country. Significance was determined by p < .01. In Canada and Ireland, increased psychological distress was significantly associated with ≥50% increase in the odds of an unfavourable change in healthy eating, physical activity and alcohol intake (minimum odds ratios (ORs)=1.50). In Columbia, increased psychological distress was significantly associated with unfavourable changes in only alcohol intake (OR=1.63). Increased infection worry was associated with unfavourable changes in physical activity (OR=1.21) in Columbia. Sex was found to significantly moderator associations in Columbia; Females experienced more unfavourable changes in their odds of healthy eating compared to males with increased psychological distress (p < .01). Given the lack of consistent sex-based trends across countries, geographic and cultural context are likely more salient to tailored future behavioural interventions intended to support adults’ practice of health-protective behaviours during a pandemic than biological sex (e.g., public health campaign promoting culturally relevant physical activity in response to greater perceived psychological distress).

IntroductionIn the context of a highly contagious virus with only recently approved vaccines and no cure, the key to slowing the spread of the COVID-19 disease and successfully transitioning through the phases of the pandemic, including vaccine uptake, is public adherence to rapidly evolving behaviour-based public health policies. The overall objective of the iCARE Study is to assess public awareness, attitudes, concerns and behavioural responses to COVID-19 public health policies, and their impacts, on people around the world and to link behavioural survey data with policy, mobility and case data to provide behavioural science, data-driven recommendations to governments on how to optimise current policy strategies to reduce the impact of the COVID-19 pandemic.Methods and analysesThe iCARE study (www.icarestudy.com) uses a multiple cross-sectional survey design to capture self-reported information on a variety of COVID-19 related variables from individuals around the globe. Survey data are captured using two data capture methods: convenience and representative sampling. These data are then linked to open access data for policies, cases and population movement.Ethics and disseminationThe primary ethical approval was obtained from the coordinating site, the Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal (REB#: 2020–2099/03–25–2020). This study will provide high-quality, accelerated and real-time evidence to help us understand the effectiveness of evolving country-level policies and communication strategies to reduce the spread of the COVID-19. Due to the urgency of the pandemic, results will be disseminated in a variety of ways, including policy briefs, social media posts, press releases and through regular scientific methods.

ObjectiveGiven the role of sociocultural gender in shaping human behaviours, the main objective of this study was to examine whether sex and gender-related factors were associated with the public’s adherence to COVID-19-recommended protective health behaviours.DesignThis was a retrospective analysis of the survey that captured data on people’s awareness, attitudes and behaviours as they relate to the COVID-19 policies.SettingData from the International COVID-19 Awareness and Responses Evaluation survey collected between March 2020 and February 2021 from 175 countries.ParticipantsConvenience sample around the world.Main outcome measuresWe examined the role of sex and gender-related factors in relation to non-adherence of protective health behaviours including: (1) hand washing; (2) mask wearing; and (3) physical distancing. Multivariable logistic regression was conducted to determine the factors associated with non-adherence to behaviours.ResultsAmong 48 668 respondents (mean age: 43 years; 71% female), 98.3% adopted hand washing, 68.5% mask wearing and 76.9% physical distancing. Compared with males, females were more likely to adopt hand washing (OR=1.97, 95% CI: 1.71 to 2.28) and maintain physical distancing (OR=1.28, 95% CI: 1.22 to 1.34). However, in multivariable sex-stratified models, females in countries with higher Gender Inequality Indexes (GII) were less likely to report hand washing (adjusted OR (aOR)=0.47, 95% CI: 0.21 to 1.05). Females who reported being employed (aOR=0.22, 95% CI: 0.10 to 0.48) and in countries with low/medium GIIs (aOR=0.18, 95% CI 0.06 to 0.51) were less likely to report mask wearing. Females who reported being employed were less likely to report physical distancing (aOR=0.39, 95% CI: 0.32 to 0.49).ConclusionWhile females showed greater adherence to COVID-19 protective health behaviours, gender-related factors, including employment status and high country-wide gender inequality, were independently associated with non-adherence. These findings may inform public health and vaccination policies in current as well as future pandemics.

Jain et al discuss the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline. C-CHANGE produces a guideline that is a subset of recommendations chosen from guidelines developed by Canada's cardiovascular-focused guideline groups. It is designed to help clinicians formulate comprehensive treatment plans for use by all members of the health care team to address multimorbidity, as recommended by the Canadian Heart Health Strategy and Action Plan. C-CHANGE specifically chooses implementable or actionable recommendations for primary care and helpful tools to organize how patient care is approached in clinic during periodic health and episodic visits. The recommendations are organized to address and individualize the management of patients with multiple comorbidities.

Recommandations: Nous avons formule 11 recommandations sur la prise en charge de diverses maladies creurcerveau concomitantes. Les principales recommandations comprennent le depistage du declin cognitif en cas de fibrillation auriculaire et de la depression en cas de coronaropathie; le traitement de la depression en cas de coronaropathie, de troubles cognitifs en cas d'hypertension et de la dyslipidemie en cas d'accident vasculaire cerebral (AVC); ainsi que la vaccination pour prevenir l'AVC, l'infarctus du myocarde et la demence. Nous recommandons egalement la prise de decision partagee, ce qui comprend le recours a des outils d'aide a la decision fondes sur des donnees probantes, afin de soutenir la patientele aux prises avec des maladies creur-cerveau.

Background The COVID-19 pandemic and its prevention policies have taken a toll on Canadians, and certain subgroups may have been disproportionately affected, including those with non-communicable diseases (NCDs; e.g., heart and lung disease) due to their risk of COVID-19 complications and women due to excess domestic workload associated with traditional caregiver roles during the pandemic. Aims/Objectives We investigated the impacts of COVID-19 on mental health, lifestyle habits, and access to healthcare among Canadians with NCDs compared to those without, and the extent to which women with NCDs were disproportionately affected. Methods As part of the iCARE study ( www.icarestudy.com ), data from eight cross-sectional Canadian representative samples (total n = 24,028) was collected via online surveys between June 4, 2020 to February 2, 2022 and analyzed using general linear models. Results A total of 45.6% (n = 10,570) of survey respondents indicated having at least one physician-diagnosed NCD, the most common of which were hypertension (24.3%), chronic lung disease (13.3%) and diabetes (12.0%). In fully adjusted models, those with NCDs were 1.18–1.24 times more likely to report feeling lonely, irritable/frustrated, and angry ‘to a great extent’ compared to those without (p’s < 0.001). Similarly, those with NCDs were 1.22–1.24 times more likely to report worse eating and drinking habits and cancelling medical appointments/avoiding the emergency department compared to those without (p’s < 0.001). Moreover, although there were no sex differences in access to medical care, women with NCDs were more likely to report feeling anxious and depressed, and report drinking less alcohol, compared to men with NCDs (p’s < 0.01). Conclusion Results suggest that people with NCDs in general and women in general have been disproportionately more impacted by the pandemic, and that women with NCDs have suffered greater psychological distress (i.e., feeling anxious, depressed) compared to men, and men with NCDs reported having increased their alcohol consumption more since the start of COVID-19 compared to women. Findings point to potential intervention targets among people with NCDs (e.g., prioritizing access to medical care during a pandemic, increasing social support for this population and mental health support).

Objectives: To determine the prevalence and correlates of COVID-19 vaccine hesitancy among Canadian health care workers (HCWs) and identify motivators for COVID-19 vaccination, compared with the general population (GPop).Methods: As part of the iCARE study, 4 cross-sectional age-, sex-, and province-weighted population-based samples of 12 009 Canadians aged 18+ years were recruited between May 2021 and February 2022. Participants self-reported HCW and vaccine status.Results: A total of 738 participants identified as HCWs, with 8.5% being vaccine hesitant, versus 12.6% of the GPop (P = .005). In multivariate analyses, those with a chronic disease were less likely (HCW odds ratio [OR] = 0.34; GPop OR = 0.77) and parents with children <18 years of age in the household were more likely (HCW OR = 2.29; GPop OR = 1.39) to be vaccine hesitant. Needing only a single-dose vaccine (86%; 82.6%), and vaccine safety (46%; 42%) and effectiveness (38%; 37%) were most likely to motivate hesitant HCWs and GPop to get vaccinated.Conclusions: Our findings highlight less vaccine hesitancy in HCWs compared with the GPop, despite demographic and motivator correlates being similar. In terms of policy implications, shared interventions emphasizing vaccine safety, reduced illness severity, shorter disease duration, and the advantages of single-dose options may benefit all groups.