Here’s why you’re craving the outdoors so much during the coronavirus lockdown

Written by Deena Shaffer, Ryerson University. Photo credit: AP Photo/Noah Berger. Originally published in The Conversation.

Circles painted on the grass in San Francisco’s Dolores Park encourage social distancing and help prevent the spread of coronavirus.

When the long-awaited warm sunny weather arrived in Toronto over the weekend, hundreds flocked to Trinity Bellwoods Park in the city’s west end. Ontario Premier Doug Ford said it looked like a “rock concert,” but added that he understood people wanted to be outside and enjoy the outdoors.

These days, with social distancing rules still in place, it can be difficult to get outdoors, and to know whether or not to. High-rise apartment buildings have elevator limits. Neighbourhoods may have more parking lots than parkland. Or it could be that you are caring for someone with a high risk of developing severe illness from a COVID-19 infection.

Hikes, picnics or bike rides along a tree-lined path feel a long way off when you’re quarantined in a low-light basement apartment or a balcony-less condo, and you’re screen-saturated from work, school and social gatherings.

This sense of disconnection from the natural world is not surprising. Even prior to coronavirus lockdowns, most of us were spending 90 per cent of our time indoors.

Marika Chandler, Ontario director of Outward Bound Canada, says those of us living in urban environments were already experiencing the ill effects of high-density living and limited green space. Now, those green spaces are “taped off, locked, under the threat of financial punishment if you use them,” or packed full. And yet, “the positive impacts on our mental health from time spent in nature is essential — for all ages, all genders, all abilities, all people,” she says.

Getting our green in right now, however we can, can help us repair the nature deficit we might be feeling, honour our biophilic urge, nourish our mental well-being and harness the awe-inducing restorative and resiliency benefits of the outdoors.

Hardwired for nature

The desire for more green time might be the result of a “nature deficit.” Author and nature advocate Richard Louv describes nature-deficit disorder as a phenomenon — not a true diagnosis — that shows up as challenges with focus, clear thinking, physical health and mental well-being.

As co-creator of Ryerson University’s Thriving in Action program, resilience lecturer, co-ordinator of the campus nature-walking and paddling programs and president of Canada’s Learning Specialists Association, I teach and conduct research on the intersection of learning, well-being, equity and nature.

Spending time outdoors can ease some of the symptoms of depression. Photo credit Shutterstock.

Our lust for nature is real. The concept of biophilia, popularized by E.O. Wilson, professor emeritus of biology at Harvard University, holds that humans have an inherent love of and desire to be near and in nature.

Given this tension between our attraction to the natural world and our current indoor isolation, it’s not surprising that “our connection with nature can feel like it’s slipping away right now,” says Barbara McKean, head of education at the Royal Botanical Gardens in Hamilton, Ont., and the driving force behind the Back to Nature Network, a web of organizations that aim to restore children’s relationship with the outdoors.

This disconnection might feel additionally poignant given the time of year. “To not have contact with other humans, and with the outdoor world, in springtime no less, is a true deficit,” says Jeffrey McGarry, an outdoor educator and researcher.

Nature as a stress reducer

Prior to the coronavirus, many of us commuted to workplaces by foot or bike, enjoyed outdoor excursions and had our sights set on summertime camping and cottaging. Now, COVID cabin fever might be setting in.

A cyclist rides the dirt jumps at the Sunnyside Bike Park during the COVID-19 pandemic in Toronto on May 21, 2020. Photo credit THE CANADIAN PRESS/Nathan Denette.

“As we move to an ever-more virtual world, feeling trapped in our living quarters, we are craving a return to nature and its benefits,” says Marija Padjen, director of the Centre for Innovation in Campus Mental Health, a partnership that supports mental health capacity-building and resource-sharing on post-secondary campuses.

Alongside daily reports about COVID-19’s spread, so too are there growing concerns about the strain of lockdown, isolation, fear and grief on our mental well-being, especially for youth. Yet just as this time of uncertainty can amplify stress, anxiety and overwhelm, so too can we mobilize our individual and collective resilience.

Time in nature can play a key role in fostering this resiliency. Abundant research makes clear that spending time outdoors can ease some symptoms of depression, enhance memory and cognitive function, reduce stress and improve creative thinking and problem solving.

For those who cannot get out, studies also make clear that views of nature, caring for plants and even digital images of nature can have positive impacts on stress. Roger Ulrich, health-care design researcher, has shown that people recover from surgery faster when they could see green space due to increased positive feelings, reduced fear and eased pain.

Inviting the outdoors in

“We also know that nature inspires awe,” encourages Linda Graham, the author of Resilience: Powerful Practices to Bounce Back from Disappointment, Difficulty, and Even Disaster. “ … the measurable impact of awe in nature is resilience, the capacity to face and deal skillfully with the difficulties of life.”

There may be no better time to intentionally bask in the wonder of seedlings emerging in an indoor garden, the sound of early morning birdsong sitting by a screen door, or if accessible and spacious enough, the experience of walking along a favourite ravine or trail.

By walk or by window, safely harvest the restorative benefits of the available nature — budding trees, spring’s changeable weather and the sky’s clouds and colours. Much of it might have passed by unnoticed prior to the pandemic.

Coronavirus crisis shows ableism shapes Canada’s long-term care for people with disabilities

Written by Gillian Parekh, York University, and Kathryn Underwood, Ryerson University. Photo credit: THE CANADIAN PRESS/Chris Young. Originally published in The Conversation.

Nationwide, long-term care facilities, primarily occupied by residents who are elderly or live with disabilities, are in deteriorating condition. But little has been done to actually address the organizational decisions that lead to these dangerous conditions. COVID-19 has exposed many inequities within Canada’s care systems.

When we look at who is disproportionately affected by this pandemic, we can’t help but ask how ableism shapes notions of whose lives are valued and whose are not. As governments plan for a “return to normal” while serious systemic issues remain in long-term living facilities, is normal really what we want to return to?

Localized, facility-based outbreaks of the coronavirus have led to high numbers of residents and staff contracting COVID-19. More than 40 per cent of the residents of Pinecrest Nursing Home in Bobcaygeon, Ont., have lost their lives to COVID-19. Similar patterns have surfaced in British Columbia, other communities in Ontario, Alberta, Québec (most severely) and Nova Scotia.

This is also true in facilities dedicated to people with disabilities. A Markham, Ont., facility reported that 40 of 42 residents and 38 health-care workers tested positive for COVID-19 towards the end of April.

According to the Toronto Star, deaths of residents in long-term care facilities made up 82 per cent of the country’s total number of fatalities due to COVID-19 as of May 7, 2020. Despite the continuing threat of COVID-19 to residents in care facilities and warnings of a resurgence, many jurisdictions are now making plans to lighten travel and social restrictions.

Long-term care, long-term problems

Even before the pandemic, long-term care facilities had disturbing incidences of abuse, neglect and even murder. Yet the conditions that allow such atrocities to occur continue.

Long-term care facilities often experience severe deficits in funding and staff. Typically, there is far greater demand for beds than there are beds available, leaving no opportunity for choice of facility.

For many Canadians, the choice to move into residential care is not really a choice at all. There are limited options for many people who require around-the-clock care. Independent living centres are not broadly available and many have extensive waiting lists. Self-directed care options may be available, however, there are limitations for those who require full-time support.

These services are also vulnerable to staffing shortages, lack of training and funding cuts. While personal support workers (PSWs) provide a critical service and support many personal care activities for daily living, their work is often undervalued. Many are overworked, underpaid and precariously employed.

In addition, care work is often fulfilled through the labour of poor, racialized and/or immigrant women who may face additional barriers in drawing attention to exploitative working conditions. During the pandemic, it has been revealed that PSWs are not always provided with adequate personal protective equipment to keep themselves or the residents safe.

But none of this is new or, at least, unexpected. For generations, the dangers that arise when we organize populations into institutional settings have been abundantly clear. COVID-19 may have shone a spotlight on these issues, but the inequities were always there.

An indifference towards people with disabilities

At a March 23 news conference, Dr. Deborah Birx, the White House coronavirus response co-ordinator, spoke on the global mortality rates of COVID-19. She assured the public that the majority of people who do and will perish from the virus are largely elderly and those with pre-existing conditions.

“Still 99 per cent of all the mortality coming out of Europe, in general, is over 50 and pre-existing conditions. The pre-existing condition piece still holds in Italy with the majority of the mortality having three or more pre-existing conditions. I think this is reassuring to all of us, but it doesn’t change the need to continue to protect the elderly….”

Birx’s statement echoes a dangerous discourse that people with disabilities as well as disability activists and allies have been challenging for some time — an insidious indifference towards the lives of persons who are disabled or elderly.

To whom would this be reassuring? This casual and callous indifference has come further into focus as jurisdictions weigh the economic implications of returning to normal despite the continued, and possibly heightened, risk for persons in residential care.

Nirmala Erevelles, a critical disability studies scholar, explores the role capitalism and capitalist principles play in producing bodies that matter and bodies that do not. Ableism is keenly expressed by attempting to justify human value through the lens of economic productivity and perceived expense. As disability justice activist Mia Mingus writes: “Ableism is connected to all of our struggles because it undergirds notions of whose bodies are considered valuable, desirable and disposable.”

This crisis exposes how ableism has long shaped how we think about care and those who receive care. Ableism shapes how we organize long-term care funding, staffing and crisis management as well as day-to-day care.

As governments and organizations re-imagine how care can be more effectively delivered, there are lessons to be learned from people who have navigated care and service systems before the global crisis began. People with disabilities and those who have experienced life in long-term care need to be at the forefront, leading and advising on systemic change.

Conspiracy theorists are falsely claiming that the coronavirus pandemic is an elaborate hoax

Written by Anatoliy Gruzd & Philip Mai, Ryerson University. Photo credit The Canadian Press/Darryl Dyck. Originally published in The Conversation.

A sign outside Lions Gate Hospital in North Vancouver, B.C., explains visitor restrictions to limit the spread of the novel coronavirus COVID-19.

In the midst of a global pandemic, conspiracy theorists have found yet another way to spread dangerous disinformation and misinformation about COVID-19, sowing seeds of doubts about its severity and denying the very existence of the pandemic.

Since March 28, conspiracy theorists — “coronavirus deniers” — have been using the hashtag #FilmYourHospital to encourage people to visit local hospitals to take pictures and videos to prove that the COVID-19 pandemic is an elaborate hoax.

The premise for this conspiracy theory rests on the baseless assumption that if hospital parking lots and waiting rooms are empty then the pandemic must not be real or is not as severe as reported by health authorities and the media.

Necessary precautions

Of course, there is a simple explanation for why some hospital parking lots and waiting rooms might have been empty. As part of pandemic planning, many hospitals have banned visitors and doctors have had to postpone or cancel elective and non-urgent procedures to free up medical staff and resources. This is in keeping with expert advice from the Centers for Disease Control and Prevention (CDC) and other health authorities.

In addition, to slow the spread of the virus and prevent cross infections with non-COVID-19 patients, the CDC also recommended that health-care facilities create separate intake and waiting areas for coronavirus patients and reserve emergency areas for emergencies such as heart attacks and broken arms. Furthermore, with the lockdown, fewer people are exerting and hurting themselves, which has resulted in fewer visits to the emergency department for heart attacks and strokes.

This empty-hospital conspiracy theory joins a parade of false, unproven and misleading claims about the virus that have been making the rounds on social media including allegations that 5G wireless technology somehow plays a role in the spread of the COVID-19 virus, or consuming silver particles or drinking water with lemon prevents or cures you of the virus. None of these are true.

Hashtag theories

At the Ryerson University Social Media Lab, some of our research investigates how misinformation propagates across different social media platforms. One of the first steps when examining trending topics on social media is to look for signs of social bots — social media accounts designed to act on Twitter and other platforms with some level of autonomy — and coordinated inauthentic behaviour that may include coordinated activities that attempt to artificially manipulate conversations to make them appear more popular than they are.

These two forms of social manipulation, when left unchecked, can skew the conversation, manufacture anger where there is none, suppress opposition or dampen debate. These tactics may undermine our ability as citizens to make decisions and reach consensus as a society.

This new conspiracy campaign against the media and public health officials, with hospitals and medical staff caught in the middle, started on March 28 with a simple tweet by a Twitter user posing a question: “#FilmYourHospital Can this become a thing?”

Social media analysis

For our analysis, we collected a sample dataset consisting of nearly 100,000 #FilmYourHospital public tweets and retweets posted by 43,000 public accounts on Twitter from March 28, the beginning of this campaign, until April 9.

Our analysis suggests that while the #FilmYourHospital campaign on Twitter is full of misleading and false COVID-19 claims, most of the active and influential accounts behind it don’t appear to be automated. However, we did find signs of ad hoc co-ordination among conservative internet personalities and far-right groups attempting to take a baseless conspiracy theory and turn it into a weapon against their political opponents.

Importantly, we found that while much of the content came from users with limited reach, the oxygen that fuelled this conspiracy in its early days came from just a handful of prominent conservative politicians and far right political activists like @DeAnna4Congress, @realcandaceo and @DonnaWR8. These power users employed the #FilmYourHospital hashtag to build awareness about the campaign and to encourage their followers to film what’s happening in their local hospitals. After the initial boost by a few prominent accounts, the campaign was mostly sustained by pro-Trump supporters, followed by a secondary wave of propagation outside the U.S.

Communication network comprising Twitter accounts (displayed as dots) that used the #FilmYourHospital hashtag March 28-30, 2020. Connections between accounts represent interactions (reply, retweet or mention). Notably, one of the most influential users who triggered the viral spread of this campaign was @DeAnna4Congress, a verified account for DeAnna Lorraine, a former Republican congressional candidate who recently ran unsuccessfully against Nancy Pelosi for Congress.
Communication network comprising Twitter accounts (displayed as dots) that used the #FilmYourHospital hashtag March 28-30, 2020. Connections between accounts represent interactions (reply, retweet or mention). Notably, one of the most influential users who triggered the viral spread of this campaign was @DeAnna4Congress, a verified account for DeAnna Lorraine, a former Republican congressional candidate who recently ran unsuccessfully against Nancy Pelosi for Congress. Author provided.

As part of our ongoing research on COVID-19 misinformation, we developed the COVID-19 Misinformation Portal that features a range of resources to inform and inoculate Canadians against false and misleading claims about the pandemic. This includes documenting coronavirus claims debunked by professional fact checkers, and a Twitter dashboard tracking the presence of possible bot accounts.

Heightened awareness

In normal times, outlandish conspiracies like this might make us shake our heads, but as COVID-19 cases continue to stalk the hallways of nursing homes in Canada and fill beds in New York hospitals, it is harder to ignore such upsetting conspiracies from the dark recesses of the internet.

The rise of this conspiracy from a single tweet reminds us that while the spread of misinformation can be mitigated by fact-checking and directing people to credible sources of information from public health agencies, false and misleading claims that are driven by politics and supported by strong convictions and not science are much harder to root out.

During coronavirus hospital surge, a midwife recommends home birth

Written by Manavi Handa, Ryerson University. Photo credit Shutterstock. Originally published in The Conversation.

A woman holds her newborn son right after giving birth; they are still in the birthing pool after labour at home

For many health-care providers who worked through the 2003 SARS epidemic, especially in epicentres, like Toronto, the COVID-19 pandemic is a reminder of the many lessons health-care providers learned at that time. Social distancing measures are the most effective way to “flatten the curve” and minimize the spread of the epidemic.

However, as a midwife working in Toronto for over 20 years, I can also speak about another important lesson learned during SARS that is often forgotten or overlooked: the importance of home birth and the role of midwives during an epidemic.

There is ample evidence from high-income countries like Canada, the United States and the United Kingdom to demonstrate the safety of home births for healthy people who have a trained midwife. In fact, research shows that home birth may even be beneficial in terms of rates of unnecessary interventions, complications and associated cost to the system.

The evidence is so compelling that in 2014, U.K.’s NICE, the National Institute for Health and Care Excellence — the main body responsible for setting guidelines for health care in the U.K. — recommended home births for all low-risk healthy pregnant people. Since the selection criteria for home birth is vitally important to safety, being a low-risk pregnant person is an important factor. For people with high blood pressure, diabetes, preterm labour and other health issues, home birth would not be the safest option.

However, despite these recommendations, mainstream perception has not greatly changed regarding hospital as the preferred place of birth for the large majority. The reasons for this are numerous and complicated, and highly related to social norms, preferences and perceptions of risk.

A husband and a midwife both congratulate a new mother, moments after birth, placing their hands on her shoulder and the back of the newborn’s head. Photo credit Shutterstock.

I have seen many news articles, targeted campaigns, TV shows and even movies supporting home births. But in all my 20 years as a regulated midwife, nothing in my recollection came close to changing people’s minds about place of birth than SARS.

For midwives, this was not necessarily surprising, as we know the safety of a home birth. But it was one of the first times mainstream public perception was greatly altered.

Home births during a pandemic

During a pandemic, people quickly remember that hospitals are, and should be, for sick people; that is, those needing medical care. Ironically, however, in Canada and the U.S., health-care systems the No. 1 reason people are admitted to hospital is for childbirth.

During a pandemic it soon becomes apparent what a bad idea it is to have healthy women and newborns in the same places and spaces as those who are unwell, and increasingly so as more get infected.

Suddenly — our high tech, bells and whistles “for the normal” starts to seem like a really poor idea. In fact, research shows all those bells and whistles lead to more intervention — more episiotomies, more use of forceps and vacuum, and more severe vaginal tearing — with no better outcomes for either the pregnant woman or newborn.

As soon as that babe is here, it becomes even more apparent what a bad idea it is to have a vulnerable new human in a place with lots of sick people.

Home birth starts looking better every second.

A woman being examined at home by her midwife. Photo credit Shutterstock.

I fully appreciate all the bells and whistles — when they are needed. But, like many of my colleagues, I personally prefer a home birth for low-risk births with a healthy uncomplicated pregnancy and normal labour. Not just because it can be very beautiful — quiet, intimate, family oriented — but also because it is actually safer for healthy people — at least during a pandemic.

Although I could talk about the great benefits of home births in general, I’m specifically advocating for home births, or out-of-hospital births, during a pandemic. So, as our health resources and hospital beds become more scarce, I hope we remember the importance of home birth.

Lessons from SARS

SARS was one of the rare times in my career that I had both obstetrical and pediatric colleagues openly supporting the idea of home births and encouraging people to stay out of hospital. At that time, we understood hospital care should be saved for those who were high risk. This was even more clear as the situation worsened during the SARS epidemic.

There were many other important lessons learned during SARS, particularly for Canadian midwifery — although there is almost no academic literature on this subject. However, I do have some anecdotal experience to share as a front-line care provider during that time.

If there is one essential service that we know must continue during a pandemic, it is the business of birthing.

Midwives are an important part of the health force that is often overlooked. Our speciality is low-risk normal birth: this is where we have the most expertise and where we can be most effective.

This is a time when other birth attendants — mainly obstetricians — will be called on for their clinical and surgical speciality skills to manage those pregnant people who have complications, have COVID-19 or are unwell for other reasons.

Midwives can be divided into those who work within the hospital setting and those that work outside within the community. This would help prevent movement in and out of people’s homes and health-care settings.

Midwives have a lot of crossover skills between nurses and physicians. We can stitch and prescribe, like a physician, but also start an IV and take blood, like a nurse. There are many things we can use our skills for beyond birthing.

Some midwives have more advanced skills such as being able to assist during surgery, perform bedside ultrasounds and conduct vacuum deliveries. These skills could be important as the health force declines.

Birth centres, or other out-of-hospital birth locations, should be considered and opened as places for low-risk people to give birth and for healthy newborns to stay.

Finally, the needs of those who are pregnant are often overlooked. Home birth has many potential benefits, but most importantly in a pandemic, we need healthy people to give birth with the best chances of staying healthy — which doesn’t always mean hospital.

Coronavirus: For the sake of athletes, it’s too soon to cancel the Olympics

Written by Nicole W. Forrester, Ryerson University & Lianne Foti, University of Guelph. Photo credit AP Photo/Jae C. Hong. Originally published in The Conversation.

A man walks past a large display promoting the Tokyo 2020 Olympics. Organizers have resisted calls to postpone or cancel the Games, which are scheduled to start July 24.

For many people, the COVID-19 pandemic became real when professional sports leagues around the world suspended their seasons. Amateur competitions followed suit, with many international sports federations cancelling their championships. But what about the Tokyo 2020 Olympic Games?

The International Olympic Committee continues to support Tokyo 2020’s preparation and encourage athletes to train for the Games scheduled to be held July 24 to Aug. 9.

The IOC’s approach should not come as a surprise. Since the start of the modern Olympics in 1896, only the 1916, 1940 and 1944 Games have been cancelled — and that was because of the First and Second World Wars. The 1920 Olympic Games went ahead after the 1918 Spanish flu pandemic, a deadly strain of influenza that infected close to 500 million people globally and claimed the lives of approximately 50 million people.

Now, 100 years later, the IOC and Tokyo 2020 are faced with an eerily similar pandemic, raising questions about whether the Games should be cancelled for the fourth time in history.

Since the beginning of the COVID-19 outbreak, there have been concerns raised about the perceived health risks of holding the Olympics. As Japan experienced rising numbers of cases in February, IOC member Dick Pound suggested organizers had until May to make a final decision.

Decision rests with IOC

Amid these fears, Japan’s Prime Minister Shinzo Aby stated: “We will overcome the spread of the infection and host the Olympics without problem, as planned.” IOC president Thomas Bach has made similar statements; ultimately, the decision lies with the IOC.

The financial costs of hosting such a massive global event also weigh heavily on any decisions. The official budget for hosting the Tokyo Games is $US12.6 billion, with $7 billion to be covered by the Government of Japan and the Tokyo Metropolitan Government and $5.9 billion from IOC contributions, sponsorship, licensing and ticket sales. However, a 2019 report from the Board of Audit of Japan shows the actual costs are closer to $26 billion.

There would be a substantial revenue hit for organizers if the Games went ahead without spectators. A loss of ticket sales alone would decrease the projected revenue by 13.5 per cent. Broadcasters are also concerned that television viewers would find empty stands off-putting. This will be a significant point for the IOC to consider because broadcasters contribute billions to the IOC coffers — NBC paid $4.38 billion to have the U.S. broadcast rights for all of the Olympic Games from 2012 to 2020.

Then there’s the additional positive bump to the local economy that all Olympic host cities experience during the Games.

One thing for certain is that the cost of cancelling increases the longer organizers wait to make a decision.

The athletes’ perspective

The perspective of athletes is often lost amid all these billion-dollar debates about the cost of cancelling the Games.

The months leading up to an Olympics is the time many athletes need to qualify for the Games. The IOC and the athlete’s National Olympic Committee set specific criteria that must be achieved — for example, the Olympic qualifying time for swimmers in the 100 metres is 48.57 seconds for men and 54.38 seconds for women. Additionally, some athletes must then compete and qualify at their country’s Olympic trials.

Great performances are the culmination of a perfectly timed program, designed to allow athletes to qualify while staving off peak performance results for the Olympic Games. It is an intricate science of balancing volume and intensity of training, while sharpening one’s mental skills.

It’s not unusual for an elite athlete to travel to several different countries across the globe in a span of one month to achieve a qualifying result. But national sport organizations like Athletics Canada are now instructing their athletes travelling and training abroad to return home.

With competitions being cancelled and countries rapidly closing their borders to international travel, the opportunity to qualify for the Olympic Games increasingly narrows.

Limited opportunities

That means even if the Olympics go ahead, athletes who have not yet met the Olympic qualifying standard may have a limited opportunity to qualify to represent their country, if at all.

However, even for the athletes who have already qualified, the uncertainty of the Olympic Games is still stressful. Regardless of the IOC’s decision, some athletes may weigh the risk and rewards and choose to not participate in Tokyo 2020.

Fans at a women’s soccer match at the 2016 Summer Olympics in Brazil hold up a sign that refers to the zika virus, a mosquito-borne virus that was a concern to some athletes four years ago. (AP Photo/Eraldo Peres)

In 2016, the threat of the Zika virus resulted in many top athletes electing to sit out the Rio Olympic Games. At the 2010 Commonwealth Games held in Delhi, India, Canadian swimmer and former world-record holder Annamay Pierse contracted dengue fever and never recovered, ending her athletic career. And during the Spanish flu, professional baseball games continued as normal, resulting in many players contracting the virus.

Rewards may outweigh the risks

Despite this, many athletes may deem the rewards outweigh the risks. Athletes are well aware of the controversial Goldman’s dilemma, a research study that found 52 per cent of elite athletes surveyed said they would take a drug that would guarantee an Olympic gold medal even if it meant they would die five years later. While some researchers have challenged these results over the years, Goldman’s results highlight the value of the Olympic Games to world-class athletes.

The Summer Olympic Games occur once every four years, and for the athletes, it is a culmination of perhaps a decade of training and preparation for a single moment. So it is reasonable to assume there are many athletes willing to take the risk to become an Olympian and have a chance at winning a gold medal.

While the Olympic Games are significant to the athletes, they are equally important to the world. The Olympic Charter states:

The goal of Olympism is to place sport at the service of the harmonious development of humankind, with a view to promoting a peaceful society concerned with the preservation of human dignity.

If COVID-19 recedes in the coming months, the Olympic Games may be able to deliver some sense of healing — uniting nations in celebration. If the disease continues to grow exponentially, its trajectory will force the IOC to cancel or suspend the Games.

Ultimately, when it comes to COVID-19, we don’t know what we don’t know, and perhaps the IOC’s delay for a final decision may just be prudent at this time.

MDMA-assisted couples therapy: How a psychedelic is enhancing intimacy and healing PTSD

Written by Anne Wagner, Ryerson University. Photo credit Shuttershock. Originally published in The Conversation.

Research over the last decade has shown MDMA-assisted psychotherapy to be effective in treating PTSD from military combat, sexual assault and childhood abuse. Now researchers are trialing MDMA with couples and finding promising results.

Post-traumatic stress disorder (PTSD) is a mental health condition, triggered by experiencing or witnessing a terrifying or threatening event. Symptoms can include re-experiencing the trauma, avoidance, nightmares and severe anxiety. Living with PTSD can feel devastating, permanent and life-defining.

The path to relieving suffering can also feel overwhelming — diving into past pain, memories and experience to understand and move through them can be horrifying, especially when your system is screaming for you to avoid them. People’s defence systems can be so strong, their narratives about the world so stuck, that the best treatments we have available do not work for everyone.

That’s where the synthetic psychoactive drug MDMA (3,4 methylenedioxymethamphetamine) comes in — as a supportive catalyst to a therapeutic process.

MDMA has been showing excellent effect for the treatment of PTSD from many different causes — including military combat, sexual assault and childhood abuse — over the past decade, coupled with an inner-directed, supportive model of psychotherapy.

This therapy combination has received “breakthrough therapy designation” from the Food and Drug Administration (FDA) in the United States. It is currently being tested in a large, multi-site randomized controlled trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS).

How MDMA works in the brain

MDMA is a drug that alters mood and perception. In non-clinical settings, it is a common recreational drug — known as Ecstasy (E) or Molly.

MDMA can produce blissful experiences, but also can be used to revisit traumatic memories. Photo credit Shutterstock.

MDMA works on numerous neural structures (especially the amygdala and pre-frontal cortex) and enhances the secretion of hormones and neurotransmitters — namely serotonin, dopamine, norepinephrine and oxytocin, among others.

The drug can produce joyful, blissful experiences and, in the context of PTSD treatment, can allow for a revisiting of traumatic memories, emotions and context with greater ease and less avoidance than would be possible without the drug.

MDMA-facilitated psychotherapy embeds the use of MDMA within a psychotherapy treatment for PTSD, therefore providing a deeply evocative template to be able to work from — to move the seemingly immovable presence of the trauma.

Revisiting traumatic memories

As a clinical psychologist and researcher, I’ve focused my work on trauma and relationships for the past decade. As the founder of Remedy, a mental health innovation community, and an adjunct professor in psychology at Ryerson University, my goal has been to illuminate treatments for trauma that can have deep, profound and lasting effects. This is what inspired me to work with MDMA.

Our team recently conducted a pilot trial of cognitive behavioural conjoint therapy (CBCT) for PTSD in combination with MDMA, with six couples in Charleston, S.C. The therapy was successful in reducing PTSD symptoms in the majority of couples and improved their relationship satisfaction.

We are now preparing to run a pilot trial of cognitive processing therapy (CPT) with MDMA and a larger randomized controlled trial of CBCT with MDMA that will take place in Toronto, pending government and regulatory approvals.

MDMA-assisted psychotherapy could offer hope to those in the military who serve in conflict zones, and veterans who struggle with PTSD. Photo credit Shutterstock.

Preparation and integration

Cognitive behavioural conjoint therapy, a treatment for couples, has demonstrated excellent effect in reducing symptoms for people with PTSD, and also for their intimate relationships and their loved ones.

Cognitive processing therapy, a treatment that focuses on meaning-making about a trauma in order to unravel thoughts and feelings that are stuck, is one of the approaches that has received the strongest recommendation in international treatment guidelines. It was also recently featured on NPR’s This American Life.

We test these highly effective trauma-focused treatments alongside the catalyst of MDMA, to see if it offers an additive or potentiating effect.

Sessions with MDMA are daylong, occurring two or three times over the course of several weeks or months, depending on the study. Research participants are accompanied by two therapists.

If MDMA-assisted psychotherapy becomes legal, it may be life-saving for people living with PTSD. Photo credit Shutterstock.

The therapeutic work done before the MDMA sessions prepares clients for the experience. The work afterwards integrates the experience, using the template of the MDMA session to scaffold new learnings and new ways of potentially understanding their traumatic experiences.

A life-saving legal medicine?

The large randomized controlled trial sponsored by MAPS is designed to collect enough evidence on the safety and efficacy of MDMA in treatment to make it a legal medicine.

As evidence accumulates for MDMA’s effectiveness, there is the possibility that MDMA will become legal — a medicine to be used in psychotherapy and prescribed for PTSD.

The ability to use it in practice will be potentially life-altering and life-saving for people living with PTSD.

Good governance is the missing ingredient for effective digital health care

Written by Linying Dong, Ryerson University. Photo credit Shutterstock. Originally published in The Conversation.

Despite massive investments, Canada’s health-care system has not reaped the benefits of digital technology like banking and retail sectors have.

Recently Ontario released its Digital First for Health strategy — aiming to further digitize health care and end the problem of overcrowded hospitals and “hallway medicine.”

While applauding the government’s continuous effort to improve quality health care through digital health, one can’t help wonder about the bumpy journey this has been to date.

It has been a journey involving large financial investments — from the launch of Canada Health Infoway in 2001 to use technology for more efficient delivery of services, to the billion-dollar project eHealth Ontario in 2008 to create electronic health records.

However, despite being the most expensive universal-access health-care system in the Organization for Economic Co-operation and Development (OECD), the Canadian health-care system continues to grapple with chronic challenges. These include skyrocketing health-care costs, unbearable wait times and an aging population.

It is puzzling that one of our most cherished Canadian institutions — our public health-care system — struggles to reap the benefits of the digital revolution, while other industries such as banking and retail have already harnessed advanced technologies to deliver fast and convenient services.

The reason: our health-care system lacks good governance.

Software systems must work together

For example, one key contributor to the hallway medicine issue is the lack of system interoperability.

In other words, multiple software systems are needed to support the transition of a patient from hospital care to community care. In Ontario, the Client Health and Related Information System (CHRIS) helps this process and is available province-wide.

Unfortunately, some EMR systems are not interoperable with CHRIS and as a result, care plans are faxed, duplicated and not always synchronized when updated. The result: a long waiting time to transition a patient, which results in hallway medicine.

A piecemeal approach to digitization will not prepare our health-care system for the aging population. Photo credit Shutterstock.

There are other painful effects of our fragmented health-care systems: hospital readmissions and excessive wait times for medical diagnoses and treatments, to name just two.

What is more, the current piecemeal approach to digitization will not prepare our health-care system for the aging population. This will result in an increase in elderly patients who have multiple chronic conditions and require care from multiple service providers.

A change of mindset is needed

Granted, significant improvements have been made in different provinces. According to the Canadian Medical Association 2017 Physician Workforce Survey, more than 82 per cent of primary care doctors used an electronic medical record system across provinces and 85 per cent of primary care doctors accessed lab results and notes electronically.

Hospitals and health-care agencies have also allocated significant resources to modernize their IT systems and embrace IT into their daily operations.

However, the key issue here is to change the mindset that more technologies will cure our health-care system. While it always sounds exciting to introduce new technologies in hope that they will do wonders, more systems would not fundamentally address the painful issues Canadians have been experiencing.

Transparency and accountability

Instead, we need a governance structure in place — to fund only IT investment initiatives that are interoperable with existing backbone systems. Better data access should be achieved not through fax machines, phone calls, post mails, printouts and emails, but through seamless integration of technologies that allow data to be communicated without losing its accuracy, completeness and timeliness.

Good governance stresses transparent funding policies and accountability that links investments to outcomes. Private organizations rely on governance to reduce costs and make businesses agile and scalable. The number one component of the national e-health strategy recommended by the World Health Organization (WHO) is governance.

However, governance has not yet been paid much attention to by either government officials or health-care service providers. It explains the bumpy road we have experienced in our path of health-care digitalization.

As technologies are deeply ingrained in our health-care system, it is critical to have better governance — in order for Canadians to enjoy world-class digital health care.

Why do we keep having debates about video-game violence?

Written by Richard Lachman, Ryerson University. Photo credit AP Photo/Evan Vucci. Originally published in The Conversation.

President Donald Trump visits the El Paso Regional Communications Center after meeting with people affected by the El Paso mass shooting, Aug. 7, 2019.

After the series of tragic mass shootings in El Paso, Tex., and Dayton, Ohio, and shocking murders in Ontario and British Columbia, all on the heels of the horrific events in Christchurch, New Zealand, we once again are having debates about the effects of video-game violence on society. We need to stop.

For police investigators, the presence of video games in the online habits of perpetrators may be one relevant piece of information. But for the rest of us, it’s another example of our emotional reaction trumping (and I don’t use that word lightly) evidence-based research.

I study emerging technologies and digital culture. In our field it’s well-established: major studies show no link between violent criminal action and violent video games.

There is some evidence for a possible increase in aggressive tendencies after playing games for a period of time. Surveys of children find similar short-term aggressive play when kids watch any violent media (like a Marvel action film) — yet all of this falls radically short of criminal behaviour and violence.

I don’t want to be an apologist for popular-culture media. We can and should make space to talk about the representations of gender-based violence and the representation of people of colour in video games (and in movies and on television). We should have a conversation about the online misogyny of Gamergate, and game voice-chats, as experienced by anyone who spends time in those online spaces.

But our conversations and our actions should be based on the real needs of society for representation and inclusion. They should be based on actual evidence, rather then a scapegoat used to score quick political points.

Trying to make sense of a violent world

When we hear about mass shootings in public spaces, we want something tangible to blame, so that we can feel that the world isn’t unpredictable and unsafe. We want to feel like there’s something we can do (as long as that “something” doesn’t seem complicated).

We don’t want to blame systems or cultures of violence, or talk about public health. Those seem unimaginably complicated, intractable and therefore won’t make us feel better.

In the United States, it’s hard to get funding to say anything real. Congress bans the Centers for Disease Control and Prevention from conducting research into gun violence. This type of control leaves scholars worried that researching the wrong topic may destroy their careers.

And so journalists, politicians and pundits are left with a demonization of sub-cultures — in this case video-gaming — instead of talking about systemic issues.

Call of Duty, a long-running video game military shooter series. Photo credit Activision.

I collect stories about media panics. In the 1800s, some demonized the novel, fearing it would drive women to ruin. And, going way back, Plato critiqued the invention of writing itself, fearing it would injure our memory. The earliest crusade against video-game violence I know of dates from the ‘70s, for the game Death Race. If your stomach is strong, go online to see the game as archived at the Museum of Play.

But now video games are mainstream. Three-quarters of U.S. households have at least one gamer resident. This is no longer a fringe activity. Pay attention, politicians: those kids who played Death Race? They grew up to be parents and voters. And many still play games.

So if we can’t blame video games, what’s next?

Looking for solutions

We have to look deeper and with more focus. Rather than stigmatizing the mentally ill, researchers at The Violence Project are studying what we do know about mass shooters, looking at actual data from people and events. They identified four commonalities on the part of the shooters: previous trauma (abuse, neglect, bullying), a recent crisis (loss of a job or a relationship), social contagion (studying the actions of other shooters) and access to weaponry.

To fight the problem, The Violence Project suggests we should:

  • End the practice of media-attention/notoriety (discourage press coverage; don’t share or view videos or manifestos from the scene of a violent act).
  • Prevent the normalization of this behaviour (perhaps rethinking bulletproof backpacks).
  • Reduce access to the type of guns used in these tragedies.

Finally, the team found that most mass public shooters telegraphed their intentions in some way — perhaps on a message board, probably via social media. This seems like an area we can actively work to improve. If someone discloses violent action, people online might be uncertain about how dangerous the disclosure is. They may treat it as a joke or worry about damaging their social standing if they speak out.

A woman leans over to write a message on a cross at a makeshift memorial at the scene of a mass shooting at a shopping complex, Aug. 6, 2019, in El Paso, Texas. Photo credit AP Photo/John Locher.

We need more ways to refer people to help without punishment. Users could flag an online post for follow-up by moderators without thinking it will immediately result in a SWAT team being called. A paid trained expert, able to approach people without criminalizing them until deemed necessary could make that determination.

If we start with a community-based public-health approach to people in need, as expensive as that may be, we can perhaps help a wealth of issues at the same time.

Invest in mental health supports

While not easy, these are findings we can act on. We can change the way we cover mass-shootings stories in the press. We can name and combat racist, gender-based and anti-immigrant rhetoric where we find it. We can critique, not ban, a culture that supports violence, with our kids, friends and co-workers.

And finally, we can provide long-term interventions across a variety of contexts (in-person, online, international) to connect people with the mental and social resources they need.

Ultimately, a path ahead doesn’t exist solely in the realm of criminalization (red flag laws) and restriction (video-game bans), but rather, includes pro-social actions like public health policies and affordable, accessible, community-based mental health supports.

I’m one of the wrong set of experts to call when investigators discover that a mass-shooter played video-games. Bring in those studying mass violence or public health, and let’s put this red herring to rest.

Study hard and you might lower your chances of dementia

Written by David Chandross, Ryerson University. Photo credit Shutterstock. This article is republished from The Conversation.
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A new study funded by the Centre for Aging and Brain Health Innovation will investigate the use of learning technologies such as streaming media for people with dementia and those at risk.

Every year hundreds of elderly students gather in Toronto for convocation, in-person and online, anxiously awaiting their diplomas. Some are in their nineties; some have dementia.

One graduate, who completed 15 courses taught by Ryerson University faculty, was a former entertainment manager for Madonna. She argued in class that Prussian philosopher Immanuel Kant’s view of art was better than that of David Hume, the Scottish philosopher. Kant said art was based on intention, Hume said it was skill.

During the class, this student could well maintain her rational argument. What she remembered the next week was little. But in the moment, which is where dementia patients find themselves, as we all do, existentially, she was present.

And the benefits go beyond presence. Participation in higher learning can also temper the loss of cognitive function associated with aging and Alzheimer’s disease.

Gill Livingston and his team who lead the Lancet Commission on Dementia have shown that resilience can help slow the progression of dementia or delay its onset. The idea underlying resilience is a concept called cognitive reserve. Lifestyle factors such as diet and fitness — and also learning — increase cognitive reserve. Higher cognitive reserve means fighting against loss of memory.

From philosophy to neuropsychology

Over the past four years, Ryerson University, in partnership with Baycrest Health Sciences, has been offering up to 20 courses a year to seniors. Some have dementia, some don’t — they sit side by side in the classroom.

The courses are thick, eight-week intensive, two-hour sessions. Titles include: The Philosophy of Socrates, Astronomy, Neuropsychology, Romanticism and the Great Artists, Classical Music, The Great Directors, French Literature and Archeology.

Harvard-trained archeologist, David Lipovitch, conducts courses on Middle Eastern dig sites he is working on. Top writers for the Globe and Mail and experts in Broadway history present to classes of up to 30 students.

Research shows that education improves seniors’ well-being. Photo credit Shutterstock.

The key is engagement — optimizing learning to reduce social isolation and increase self-esteem. These offerings are not “edutainment,” but rival the content of real university undergraduate offerings.

What is different is that the students do not complete assignments. They are recognized for making the effort to attend. One student with advanced dementia, but still coherent, said “I have trouble remembering things and this is the highlight of my week, so don’t YOU forget to bring me here next week!”

This kind of comment is frequent. And the very idea that organized learning led this patient to perform a “metacognitive act” — knowing she had dementia and needing to compensate — is impressive in itself.

Social connectedness and mental stimulation

The Lancet Commission report also explored the role of early childhood education in the development of dementia. The data suggests that lack of education leads to higher incidence of dementia due to decreased cognitive reserve.

This points to the value of educating seniors over long periods of time — not only for those with dementia, but for those who are healthy and at risk for dementia.

George Rebok’s 2014 landmark study on the effect of education for seniors tracked participants for a 10-year period, exploring many aspects of cognitive function. Small effects were seen in increased ability to think and more impressive effects with respect to personal hygiene, self-efficacy and other measures of well-being.

Learning seems to provide both social connectedness and mental stimulation, possibly leading to resilience through increasing cognitive reserve. Reasoning and speed of thinking improved in Rebok’s outcomes, but not memory.

It is projected that at least half of the human population will be over the age of 50 by 2050. Photo credit Baycrest Health Sciences, Author provided.

We still do not understand whether focused mental rehearsal through learning can prevent or improve dementia. Studies by Julia Spaniol at Ryerson University show that increasing engagement and motivation in seniors helps unlock memory. But until recently there had been no focused research on the role of deeper learning, such as these intensive university-led courses, in dementia outcomes or quality of life.

‘Eudamonia’ for an aging society

However, this is about to change. This summer, the Centre for Aging and Brain Health Innovation (CABHI) awarded a grant to our team — to investigate the use of learning technologies such as streaming media compared to face-to-face sessions in people with dementia and those at risk of developing it.

The goal of the program is to create greater access to lifelong learning opportunities for older adults irrespective of their place of residence — be it long-term care or in the community. The clinical studies begin in September 2018 and we will report on our data in the late spring of 2019.

Life expectancy is increasing and it is projected that at least half of the human population will be over the age of 50 by the year 2050. We will need to keep our minds alive and our senses keen to really enjoy those treasured elder years.

Socrates spoke of an idea called “eudaimonia,” which means “flourishing in life.” Too much pleasure and we wilt. Too much purpose and we stress out. But when pleasure and purpose are both high, we achieve this “eudaimonia” state, according to Deborah Fels, one of Canada’s leading experts in aging and accessibility.

Learning is clearly what humans do best. We lack the agility of tigers or the longevity of sequoia trees, but we learn unceasingly and that makes us distinct. Learning about ourselves and the world might be the key to happiness and health into our golden years.

The secret formula for becoming an elite athlete

Written by Nicole W. Forrester, Ryerson University. Photo credit AP Photo/David Goldman. Originally published in The Conversation.

Specializing in a specific sport at an early age is not necessary to become an Olympic athlete. In fact, the opposite is true.

The next Olympics are less than two years away and for many athletes, the Games in Tokyo will be the pinnacle event in their career. Aspiring Olympians strive to compete on the world’s largest sporting stage, but only a few will ever realize that goal.

While anatomical and physiological factors clearly play a role in the development of a super-elite athlete, there are other critical components necessary to achieve success.

So, just how does somebody become an Olympian? As an Olympian and former world-class high jumper, I know that hard work and dedication are just part of the formula for success.

It is not uncommon for coaches, parents and athletes to believe that specializing in a sport at an early age is the secret ingredient to becoming a world-class athlete — especially when you consider the success of athletes like Tiger Woods and Rafael Nadal, who excelled in their sports at an early age. However, research exploring elite athlete development suggests their chosen path is less common than the typical case.

The 10,000-hour myth

In addition to the belief that starting early is a path to success, the popularity of the 10,000-hour rule has given rise to the belief that a certain numeric value of time must be acquired for an individual to become an expert.

The 10,000-hour rule is a fallacy that has been taken out of context, neglecting the most significant research findings by Swedish psychologist Anders Ericsson.

In that seminal study into the development of expertise in musicians, Ericsson and colleagues found talent to be the result of “deliberate practice” that occurred over a span of 10 years — or approximately 10,000 hours for some individuals. The study stated the concept of deliberate practice was more important than any magical number.

Deliberate practice is a highly structured activity requiring intense effort and is not inherently enjoyable. It is not about training and clocking in the hours of practice. Rather, it is about being immersed in the action at hand, with the end goal of improving one’s performance. In fact, the acquisition of expertise has been achieved with as few as 4,000 hours of deliberate practice.

The importance of play

Musicians, athletes and other people in other fields pursuing excellence appear to share the need for deliberate practice. However, sport also requires the unique element of deliberate play — arguably just as important as deliberate practice.

Deliberate play is intrinsically motivating unstructured play in sport, designed to provide a high degree of enjoyment. An example of deliberate play is a group of kids playing shinny instead of an organized hockey game. Ice time and positions are not structured by an adult, and kids of different ages and skills play against each other for the sake of fun.

On the surface, deliberate play may not appear to provide immediate benefits in the advancement of an athlete’s ability. The real benefits of deliberate play are actually realized later in an athlete’s development.

Deliberate play provides a breadth of cognitive and motor experiences while supporting an athlete’s later involvement in deliberate practice activities. Most importantly, it is fun and keeps children enjoying sports. The most common reason youths drop out of sport is that it is no longer fun. That means the best way to ensure your child drops out of sport is to force them to specialize at an early age.

In a study exploring the amount of training time elite hockey players acquired, researchers from Queen’s University found that by the age of 20, an equal amount of time was shared between deliberate play and deliberate practice.

Sport specific vs. multiple sports

There is also a myth that participating in many different sports is not advantageous in advancing an athletes’ ability. By engaging in various sports, athletes are able to develop a breadth of skills transferable to their eventual primary sport. In fact, researchers have found elite athletes spent less time training in their primary sport before the age of 15 compared to their less successful counterparts.

Sports researchers use something called the development model of sport participation to study elite athletes. The model shows that having a diverse sports background does not hinder the performance of elite athletes.

Athletes who develop skills in one sport are able to transfer those skills to another seemingly different sport and still reap the gains. For example, a child who has played soccer may have developed the skill of reading the field of play. This skill is also applicable and transferable to a sport like basketball, where that same athlete must learn to read plays on the court.

In the initial phase of the development model, termed the sampling years, athletes are introduced to various sports with a focus on having fun and deliberate play. In their teens, athletes enter the specializing years and begin to reduce their involvement in numerous sports. In this phase, the element of having fun is still important and coupled with the introduction of intentional effort.

As athletes advance in age (approximately 15 years and older), they enter the investment years and begin to focus on a primary sport. It is here where deliberate practice plays a larger role and the role of deliberate play lessons.

While this model is not intended to be the universal approach to developing sport expertise for all athletes, it certainly provides a framework for recognizing the integral role of deliberate play, deliberate practice and diversification in sport play.

It is worth noting that other factors. such as one’s (date of birth) and the size of their town (the size of their town), has also been associated with predicting elite athlete development. These cases highlight the role that environment plays in an athlete’s development.

Sometimes luck plays a role

And then there’s the element of luck, which was a factor in my own athletic career.

Author Nicole Forrester, seen here competing at the 2008 Summer Olympics in Beijing, didn’t start high jumping until she was 18 years old. Photo credit THE CANADIAN PRESS/Ryan Remiorz.

I was almost 18 when a track and field coach saw me and my tall, lean physique working at McDonald’s and gave me the phone number of a high jump coach at the University of Toronto. That fateful day led me to become a member of 20 national teams, an eight-time Canadian champion, an Olympian and a multi-medalist on various major Games, spanning a career more than 15 years.

I attribute my quick progression in the high jump to the various sports I played growing up. Had I started specializing in my sport at an earlier age, I doubt I would have lasted for as long as I did or had the same level of success.

The path to becoming an Olympian requires a mixture of important ingredients that may vary according to the sport and the individual athlete. Ultimately, for many, the path is navigated through deliberate play and involvement in various sports, developed through a commitment of deliberate practice, and reinforced by support, resources, motivation and effort.

Most importantly, in sports where peak performance occurs after maturation, early sport specialization is not the answer to becoming a super elite athlete.