Search

This study explored the association between socioecological factors and outdoor physical activity (PA) and play in children with disabilities during the COVID-19 pandemic. Parents (N = 133) completed a survey to report changes in their child's outdoor PA and play during the pandemic (from prepandemic levels), and child, household, and neighborhood environment factors. Children with a PA-supporting parent and from multichild and White households had lower odds of reporting decreased outdoor PA. Children from multichild, higher income, married couple households and a PA-supporting parent had lower odds of decreased outdoor play. Living in neighborhoods with higher urbanization (i.e., high dwelling density, street intersections, and land-use mix) was associated with greater odds of decreased outdoor PA and play. Future research that uses larger and more representative samples of children with disabilities is needed to test for the multivariate effects of socioecological variables on outdoor PA and play. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of the current study were to identify risk profiles for nonadherence among children and youth (5–17 y) at the 6-month mark of the COVID-19 pandemic and to discuss similarities and differences between risk profiles identified in the current study and those identified at the 1-month mark of the pandemic. Methods: Data were part of a nationally representative sample of 1143 parents (Mage = 43.07 y, SD = 8.16) of children and youth (5–17 y) living in Canada. Survey data were collected in October 2020. Results: Results showed that 3.8% met all movement behavior recommendations, 16.2% met the physical activity recommendation, 27% met the screen time recommendation, and 63.8% met the sleep recommendation. Characteristics associated with nonadherence to all movement behaviors included low parental perceived capability to restrict screen time and decreased overall time spent outdoors. Characteristics associated with nonadherence to the physical activity and screen time recommendations included youth (12–17 y), low parental perceived capability to restrict screen time, decreased time spent outdoors, and increased screen time. Conclusion: Results emphasized the importance of parental perceived capability to restrict screen time and children's and youth's outdoor time and showed that pandemic-related factors have impacted children and youth differently. [ABSTRACT FROM AUTHOR]

Background/Purpose: Despite widespread use of Electronic Health Records (EHR), the promise of benefits has not been clearly realised due, in part, to inadequate physician training. Training for EHR use is a highly complex intervention that occurs in a dynamic socio‐technical health system. The purpose of this study was to describe and critically assess the interplay between educational activities and organisational factors that influenced EHR training and implementation across two different hospitals. Methods: Based in a socio‐technical framework, a comparative qualitative case study was undertaken as well suited to real‐world processes. Semi‐structured interviews were completed (n = 43), representing administrative leaders, staff physicians, residents and EHR trainers from two Canadian academic hospitals. Thematic analysis was employed for analysis. Results: Similar findings were noted at both hospitals despite different implementation strategies. Despite mandatory training, physicians described limited transferability of training to the workplace. Factors contributing to this included standardised vendor modules (lacking specificity for their clinical context); variable EHR trainer expertise; limited post‐launch training; and insufficient preparation for changes to workflow. They described learning while caring for patients and using workarounds. Strong emotional responses were described, including anger, frustration, anxiety and fear of harming patients. Conclusions: Training physicians for effective EHR utilisation requires organisational culture transformation as EHRs impacts all aspects of clinical workflows. Analytic thinking to consider workflows, ongoing post‐launch training and the recognition of the interdependency of multiple factors are critical to preparing physicians to provide effective clinical care, and potentially reducing burnout. A list of key considerations is provided for educational leaders. Physicians and residents report that feeling inadequately prepared for the profound changes electronic health record implementation has on workflow manifests as anxiety, frustration and fear of harming patients. [ABSTRACT FROM AUTHOR]

Summary: Objective: To assess stakeholder ratings of health indicators and subgroup analyses in systematic reviews used to update the Canadian Clinical Practice Guideline for Managing Paediatric Obesity. Methods: Stakeholders (caregivers of children with obesity and Clinical Practice Guideline Steering Committee members) completed an online survey between April 2020 and March 2021. Participants rated importance of health indicators and subgroup analyses for behavioural and psychological, pharmacotherapeutic, and surgical interventions for managing paediatric obesity from not important to critically important using Grading, Recommendations, Assessment, Development and Evaluation criteria. Results: No health indicators or subgroup analyses were rated not important by the 30 caregivers and 17 Steering Committee members. Across intervention types, stakeholders rated anxiety, depression, health‐related quality of life, serious adverse events, plus age and weight status subgroups as critically important. Conclusion: Stakeholder ratings will inform data reporting and interpretation to update Canada's Clinical Practice Guideline for Managing Paediatric Obesity. [ABSTRACT FROM AUTHOR]

Children’s active transportation (AT) and independent mobility (IM) can provide benefits for health and social development. Using data from two national surveys, we assessed parent-perceived changes in AT and IM among 5- to 17-year-olds in Canada since the outbreak of COVID-19. About half of parents reported no changes, but two to three times more parents reported declines compared to increases in AT and IM. We explored many potential correlates of changes in AT and IM. Changes in IM were the strongest correlate of changes in AT. Strategies to minimize unintended negative impacts on children’s physical activity from policies to prevent infectious disease transmission should be developed. [ABSTRACT FROM AUTHOR]

Objectives This study examined the acute and longer-term impacts of the COVID-19 pandemic on the movement behaviours and health of children and youth with disabilities (CYD) in Canada. Methods Eighty-six parents of CYD completed an online survey twice (May 2020 and November 2020). Interviews were completed with seven families in March 2021. Results At both time points, <20% of CYD met the physical activity and sedentary behaviour guidelines, and >50% of CYD met the sleep guideline. No CYD met all three movement guidelines. Nearly one-quarter of CYD reported declines in health from pre-pandemic levels. Interview themes revealed that shifting of routines, unoccupied time, reduced physiotherapy opportunities, parental capacity, and the social and built environment all impacted the movement behaviours of CYD. Conclusions Movement behaviours and health of CYD must be prioritized in COVID-19 recovery efforts through quality programming, highly trained instructors, accessible and inclusive infrastructure, and family-centred health. [ABSTRACT FROM AUTHOR]

Background: Healthy childhood development is fostered through sufficient physical activity (PA; including time outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours. Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what extent related restrictions may compromise the ability to play and meet movement behaviour recommendations. This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play behaviours in children and youth. Methods: A national sample of Canadian parents (n = 1472) of children (5–11 years) or youth (12–17 years) (54% girls) completed an online survey that assessed immediate changes in child movement and play behaviours during the COVID-19 outbreak. Behaviours included PA and play, SB, and sleep. Family demographics and parental factors that may influence movement behaviours were assessed. Correlations between behaviours and demographic and parental factors were determined. For open-ended questions, word frequency distributions were reported. Results: Only 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined movement behaviour guidelines during COVID-19 restrictions. Children and youth had lower PA levels, less outside time, higher SB (including leisure screen time), and more sleep during the outbreak. Parental encouragement and support, parental engagement in PA, and family dog ownership were positively associated with healthy movement behaviours. Although families spent less time in PA and more time in SB, several parents reported adopting new hobbies or accessing new resources. Conclusions: This study provides evidence of immediate collateral consequences of the COVID-19 outbreak, demonstrating an adverse impact on the movement and play behaviours of Canadian children and youth. These findings can guide efforts to preserve and promote child health during the COVID-19 outbreak and crisis recovery period, and to inform strategies to mitigate potential harm during future pandemics. [ABSTRACT FROM AUTHOR]

Background: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke. Methods: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses. Results: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of >30 and >60 min (p = 0.001 and p = 0.004, respectively). Regression models explained 11–19% of the variance in total sedentary time and time in prolonged sedentary bouts. Conclusion: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke. [ABSTRACT FROM AUTHOR]

Public health restrictions caused by the COVID-19 pandemic have dramatically impacted children and youth's ability to engage in the recommended amount of physical activity (PA), sedentary behaviour (SB), and sleep ('movement behaviours') for optimal health. There is heightened concern of the impact of this sudden 'time out' of active play for our most vulnerable children and youth including those living with disabilities who have a higher prevalence of multiple chronic conditions and less access to PA. PURPOSE: To assess the acute and longer-term impact of COVID-19 restrictions on the movement behaviours and guideline adherence in Canadian children and youth with disabilities. METHODS: Parents of school-aged children and youth with disabilities completed an online survey to assess their child's previous 7-day PA, SB, and sleep. Parents' perceived changes in their child's movement behaviours between pre-COVID-19 and (a) April-May 2020 (time 1; N = 151) and (b) April-November 2020 (time 2; N = 87) were also assessed. Descriptive statistics were used to analyze child behavioural patterns and guideline adherence. RESULTS: At time 1, 5.3%, 13.2%, and 66.2% of children and youth met the individual guidelines for PA, SB, and sleep, respectively. Only 1.3% of children and youth met all three movement guidelines. Similarly, at time 2, 7.2%, 20.7%, and 66.3% of children and youth met the individual guidelines for PA, SB and sleep, respectively; none met all three movement guidelines. Parents reported their child to spend less time in both outdoor (60% vs. 62.1%) and indoor (46% vs. 60.9%) PA, and more time in recreational screen time (83.5% vs. 77%) across time 1 and 2, respectively. The majority of parents reported their child's sleep quantity and quality to be the same as pre-pandemic levels for both time 1 (53.1% and 57.3%) and time 2 (77.6% and 64.4%). CONCLUSIONS: These results show very concerning PA and SB profiles of children and youth with disabilities over the early and subsequent periods of the COVID-19 pandemic compared to pre-COVID-19. Immediate action at the programmatic and policy levels is need for more accessible and inclusive strategies to increase PA and reduce SB in this vulnerable population of children and youth. Supported by Canadian Tire Jumpstart Charities [ABSTRACT FROM AUTHOR]

Presents a case study on the Great Big Sea band as an example of Newfoundland and Labrador's popular music and cultural identity. Reasons for the success of the band; Features of popular music in Newfoundland which are reflected in the music of the Great Big Sea; Musical identity of the band.

Introduction: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not., Methods and Analysis: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities., Ethics and Dissemination: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

To examine the (i) relationships between various body mass index (BMI)-derived metrics for measuring severe obesity (SO) over time based the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) references and (ii) ability of these metrics to discriminate children and adolescents based on the presence of cardiometabolic risk factors. In this cohort study completed from 2013 to 2021, we examined data from 3- to 18-year-olds enrolled in the CANadian Pediatric Weight management Registry. Anthropometric data were used to create nine BMI-derived metrics based on the CDC and WHO references. Cardiometabolic risk factors were examined, including dysglycemia, dyslipidemia, and elevated blood pressure. Analyses included Pearson correlations, intraclass correlation coefficients (ICC), and receiver operator characteristic area-under-the-curve (ROC AUC). Our sample included 1,288 participants (n = 666 [52%] girls; n = 874 [68%] white). The prevalence of SO varied from 60-67%, depending on the definition. Most BMI-derived metrics were positively and significantly related to one another (r = 0.45-1.00); ICCs revealed high tracking (0.90-0.94). ROC AUC analyses showed CDC and WHO metrics had a modest ability to discriminate the presence of cardiometabolic risk factors, which improved slightly with increasing numbers of risk factors. Overall, most BMI-derived metrics rated poorly in identifying presence of cardiometabolic risk factors.    Conclusion: CDC BMI percent of the 95 th percentile and WHO BMIz performed similarly as measures of SO, although neither showed particularly impressive discrimination. They appear to be interchangeable in clinical care and research in pediatrics, but there is a need for a universal standard. WHO BMIz may be useful for clinicians and researchers from countries that recommend using the WHO growth reference. What is Known: • Severe obesity in pediatrics is a global health issue. • Few reports have evaluated body mass index (BMI)-derived metrics based on the World Health Organization growth reference. What is New: • Our analyses showed that the Centers for Disease Control and Prevention BMI percent of the 95 th percentile and World Health Organization (WHO) BMI z-score (BMIz) performed similarly as measures of severe obesity in pediatrics. • WHO BMIz should be a useful metric to measure severe obesity for clinicians and researchers from countries that recommend using the WHO growth reference., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Public health restrictions varied by region during the COVID-19 pandemic and reduced opportunities for children to be physically active. The purpose of this study was to assess regional differences in movement behaviours of Canadian children and youth during the second wave of the COVID-19 pandemic., Methods: A national sample of Canadian parents (n=1568; 58% women) of children and youth (5-17 years of age) completed an online survey. Participants were classified based on region of residence (British Columbia, Prairies, Ontario, Quebec, or Atlantic Canada). Differences in movement and play behaviours (physical activity, outdoor play, sleep, screen time) between children and youth living in different regions were examined., Results: Compared to children and youth in Quebec (the region with the highest COVID-19 prevalence), children and youth in the Prairies (F (1,1563) =9.0, p=0.01) and Atlantic Canada (F (1,1563) =17.1, p<0.001) participated in more moderate-to-vigorous physical activity (MVPA). Compared to Quebec, living in Atlantic Canada increased the odds of meeting the MVPA guideline (odds ratio (OR)=2.1, p=0.02), living in Ontario decreased the odds of meeting the sleep guideline (OR=0.6, p=0.01), and living in Ontario (OR=0.7, p=0.04) or Atlantic Canada (OR=0.6, p=0.049) decreased the odds of meeting the screen time guideline. Children and youth in Atlantic Canada demonstrated smaller declines in outdoor play than their counterparts in Quebec., Conclusion: Movement and play behaviours varied between regions of Canada where the highest COVID-19 prevalence corresponded to lower odds of meeting the physical activity guidelines. Low compliance with 24-hour movement guidelines suggests that regional pandemic recovery plans need to prioritize opportunities for healthy movement., (© 2022. The Author(s) under exclusive license to The Canadian Public Health Association.)

Background: Since the first national guideline for managing obesity in adults and children in Canada was published in 2007, new evidence has emerged and guideline standards have evolved. Our purpose is to describe the protocol used to update the Canadian clinical practice guideline for managing pediatric obesity., Methods: This guideline will update the pediatric components of the 2007 Canadian clinical practice guideline for the management of obesity. In partnership with Obesity Canada, we began preliminary work in 2019; activities are scheduled for completion in 2022. The guideline will follow standards developed by the National Academy of Medicine and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Guideline development will be informed by 5 complementary literature reviews: a scoping review that focuses on clinical assessment in pediatric obesity management and 4 systematic reviews to synthesize evidence regarding families' values and preferences as well as the safety and effectiveness of interventions (psychological and behavioural; pharmacotherapeutic; and surgical). We will use standard systematic review methodology, including summarizing and assessing the certainty of evidence and determining the strength of recommendations. Competing interests will be managed proactively according to recommendations from the Guidelines International Network. Diverse stakeholders, including families and clinicians, will be engaged throughout guideline development., Interpretation: The guideline will support Canadian families and clinicians to make informed, value-sensitive and evidence-based clinical decisions related to managing pediatric obesity. The guideline and accompanying resources for end-users will be published in English and French, and we will partner with Obesity Canada to optimize dissemination using integrated and end-of-project knowledge translation., Competing Interests: Competing interests: Bradley Johnston is a GRADE working group member and has received a grant from Texas A&M AgriLife Research to fund investigator-initiated research related to saturated and polyunsaturated fats. The grant was from Texas A&M AgriLife institutional funds from interest and investment earnings, not a sponsoring organization, industry or company. Diana Sherifali has worked as a consultant for Obesity Canada and received travel support to attend a meeting with the World Heart Federation. Catherine Birken has received research funding from the Canadian Institutes of Health Research; the Heart and Stroke Foundation of Canada; Physician Services, Inc.; the Leong Centre, University of Toronto and Hospital for Sick Children; the Centre for Addiction and Mental Health; and a Walmart community grant through the SickKids Foundation. Jill Hamilton has received research funding from Mead Johnson, Levo Therapeutics and the Heart and Stroke Foundation of Canada. She received an honorarium from Pfizer Canada for a sponsored lecture on Prader–Willi Syndrome and participated as a member of the Novo Nordisk Canada national advisory board on pediatric obesity. Dawn Hatanaka is employed by Obesity Canada, which contributed in-kind resources to support this project. Mélanie Henderson holds a Fonds de la recherche du Québec — Santé (FRQS) Junior 2 Clinical Research Scholar Award. She is a member of Canada’s Children’s Hospitals Foundations (CCHF) and the Sun Life Child and Youth Type 2 Diabetes Prevention initiative. She also sits on the Comité scientifique sur la prévention de l’obésité of the Institut national de santé publique du Québec and the Groupe de consultation de la prise en charge de l’obésité chez l’enfant et l’adolescent and Comité consultatif québécois en médecine bariatrique of the Quebec Ministry of Health (no financial support). She holds research funding from the Canadian Institutes of Health Research, the Quebec Cardiometabolic Health, Diabetes and Obesity Research Network and the Quebec Network on Nursing Intervention Research, Diabète Québec, as well as through the CCHF–Sun Life initiative. Sarah Moore has received research funding from the Michael Smith Foundation for Health Research, the Natural Sciences and Engineering Research Council of Canada and the Kids Brain Health Network. She currently holds startup research funding from the Faculty of Health at Dalhousie University. Katherine Morrison has received consulting fees from Novo Nordisk Canada and research funding from the Canadian Institutes of Health Research. Ximena Ramos Salas has received consulting fees from Obesity Canada, the European Association for the Study of Obesity and the World Health Organization Regional Office for Europe. She has also received research funding from the Canadian Institutes of Health Research. Ian Zenlea has received an honorarium from Novo Nordisk Canada for participating as a member of the pediatric obesity national advisory board and for participating in a meeting to discuss diagnostic approaches to short stature in Canada, as well as an honorarium from Abbott Diabetes Care for participating as a member of a national advisory board. He has also received speaker fees from the Ontario Association of Social Workers. He has received research funding from the Canadian Institutes of Health Research, the University of Toronto, the Social Sciences and Humanities Research Council of Canada, the Medical Psychiatry Alliance and the Regional Municipality of Peel. He is co-chair of the Ontario Paediatric Bariatric Network. Geoff Ball has received support from Novo Nordisk Canada for participating as a member of the pediatric obesity national advisory board, in-kind resources from Obesity Canada, research and administrative support from Alberta Health Services (AHS; AHS Chair in Obesity Research) and research funding from the Canadian Institutes of Health Research, Alberta Innovates, the AHS Strategic Clinical Network (Maternal, Newborn, Child & Youth), the Public Health Agency of Canada and the Women and Children’s Health Research Institute of the University of Alberta. No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.)

Objectives: The goal of this quality initiative was to develop consensus standards for glycemic management of patients with diabetes who undergo surgical procedures in Canada., Methods: A modified Delphi method was used to gather broad stakeholder input and arrive at a consensus for perioperative/periprocedure diabetes management., Results: Glycemic management standards were developed for the following categories: Organization of Care; Preoperative Assessment; Immediate Preoperative and Intraoperative; Postanesthesia Care Unit or Recovery Room; Postoperative Period; and Transition to Outpatient Care., Conclusions: It is anticipated these standards will serve as a basis to develop clinical tools to support the recommendations., (Copyright © 2021 Canadian Diabetes Association. All rights reserved.)

All children and youth require ample physical activity (PA), low levels of sedentary behaviour (SB), and adequate sleep to stay healthy. Children and youth living with disabilities (CYWD) tend to have fewer opportunities for participation in PA and outdoor play compared with their typically developing peers. In turn, CYWD are typically less active and more sedentary, on average, compared with their peers. The COVID-19 pandemic reduced opportunities for many children and youth to participate in PA and outdoor play. The purpose of this study was to assess parent-perceived changes in PA (including outdoor play), SB (including screen time), and sleep quality and quantity, due to COVID-19 and related restrictions, in a national cohort of Canadian CYWD. We recruited parents of school-aged CYWD ( N = 151) in May 2020. In an online survey, parents reported their child's previous 7-day PA, SB, and sleep, as well as perceived changes in their child's movement and play behaviours due to COVID-19 and related restrictions. Parent-perceived parental support for their child's movement and play behaviours during the pandemic was also assessed. We used descriptive statistics to describe the child's movement behaviours and assessed the association between movement behaviours and parental factors using Pearson and point-biserial correlations. Few (5.3%) CYWD met PA recommendations and 13.2% met screen time recommendations during the acute period of the COVID-19 pandemic. More CYWD (66.2%) were meeting sleep recommendations. Overall, only 1.3% of CYWD were meeting the combined movement guidelines. Parent encouragement was positively associated with the child's outdoor PA (0.23), wheeling, walking, and biking (0.19), indoor PA (0.16), and family-based PA (0.26). Parental co-play was similarly positively associated with the child's outdoor PA (0.26), wheeling, walking, and biking (0.39), indoor PA (0.16), and family-based PA (0.26). Parents perceived their CYWD to be less active and more sedentary as a result of COVID-19 and the related restrictions. Parents of CYWD have an important role in encouraging healthy movement behaviours. Return to movement and play post-COVID guidelines should include tailored strategies for CYWD and their families to mitigate the negative impacts of the pandemic.

Daily life has changed for families due to the COVID-19 pandemic. The aim of this repeated cross-sectional study was to describe movement behaviours in Canadian children and youth 6 months into the pandemic (T2; October 2020) compared with the start of the pandemic (T1, April 2020). An online survey was distributed to parents ( N = 1568) of children and/or youth (5-17 years; 58% girls) in October 2020. The survey assessed changes in movement behaviours (physical activity and play, sedentary behaviours, and sleep) from before the pandemic to October 2020 (T2). We compared these data with spring data (T1; April 2020; Moore et al. 2020; Int. J. Behav. Nutr. Phys. Act, 17:85) collected using identical methodology ( N = 1472; 54% girls). We report correlations between movement behaviours and relevant parental factors and provide word frequency distributions for open-ended responses. During the second wave, 4.5% of children (4.6% girls; 4.3% boys) and 1.9% of youth (1.3% girls, 2.4% boys) met the movement guidelines (3.1% overall). Whereas, during the first wave, 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined guidelines (2.6% overall). Parental support was correlated with their child's movement behaviours (T1 and T2). Our study demonstrates the ongoing challenges for children and youth to engage in healthy movement during the pandemic. Novelty: Our large-scale national study demonstrates that children and youth were not meeting the 24-hour movement guidelines during the second wave of the pandemic. Our findings illustrate the need to protect children and youth from the collateral consequences of the pandemic.

Objective: As part of a larger project to develop quality standards in perioperative diabetes management, the goal of this project was to assess self-reported management of surgical patients with diabetes across healthcare institutions and specialties in Canada., Methods: Current practice of perioperative management of patients with diabetes was assessed using multiple-choice questions based on commonly encountered clinical scenarios involving patients with type 1 and type 2 diabetes. The survey was sent to a broad stakeholder group of individuals involved in perioperative medicine in academic and community settings across Canada., Results: Responses to clinical case scenarios demonstrated more consistent approaches for patients with type 1 diabetes undergoing cardiac surgery, possibly reflecting more robust evidence. There was more variability in the management of noninsulin antihyperglycemic agents and hyperglycemia in patients with type 2 diabetes undergoing noncardiac surgery., Conclusions: Given the variability in clinical practice, standards and clinical tools are required for perioperative and periprocedural glycemic management in Canada to inform practice, improve the experience and outcomes for people with diabetes and provide a foundation for quality improvement initiatives and benchmarking., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Objectives: In this study, we examined the prevalence and clinical characteristics of sodium-glucose cotransporter-2 inhibitor (SGLT2i)-associated diabetes ketoacidosis (DKA)., Methods: A retrospective chart review of patients admitted for DKA over 4 years. Patients with SGLT2i-associated DKA were invited for pancreatic autoantibody testing. A subset of patients were invited for an interview to identify clinical characteristics suggestive of undiagnosed latent autoimmune diabetes in adults (LADA)., Results: Of 647 DKA admissions, 6.6% were associated with SGLT2i use. Time from SGLT2i initiation and DKA ranged from 2 weeks to 3.25 years; 69.8% had euglycemic DKA. Pancreatic autoantibody testing on 20 patients identified 5 originally diagnosed with type 2 as having LADA. Four were interviewed and had a LADA clinical risk score predictive of this diagnosis., Conclusions: A larger study is needed to qualify the role of the LADA clinical risk score with confirmatory pancreatic autoantibody testing before SGLT2i initiation to reduce DKA risk., (Copyright © 2020 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

To reduce the spread of COVID-19, public health authorities across the country have recommended that Canadians keep their distance, wash their hands, and stay home. To enforce these measures, restrictions on outdoor behaviour have been implemented, limiting access to parks and recreational outdoor spaces. New evidence shows that COVID-19 restrictions are associated with an overall lower amount of time spent in outdoor play among Canadian children and youth. This is concerning, as outdoor play is important for children's physical and mental health and helps provide them with a sense of control during times of uncertainty and stress. As policies on access to the outdoors during the COVID-19 outbreak vary by province, it is possible that policy differences have led to regional differences in changes in outdoor play among children and youth. In this commentary, we examine regional differences in outdoor play among children and youth across Canada, and the association between provincial policies related to COVID-19 and outdoor play. We argue that through the recovery process, in the event of a second wave of infections, and in preparing for future public health challenges, policy decisions should consider ways to preserve outdoor play for Canadian children and youth.

This paper explores patterns of increased/ decreased physical activity, sedentary and sleep behaviours among Canadian children and youth aged 5-17 years during the COVID-19 pandemic, and examines how these changes are associated with the built environment near residential locations. A cluster analysis identified two groups who were primarily distinguished by the changes in outdoor activities. Compliance to 24-hour movement guidelines was low among both groups. For children, houses (versus apartments) was correlated with increased outdoor activities; proximity to major roads was a barrier. For youth, low dwelling density, and access to parks in high-density neighbourhoods, increased the odds of increased outdoor activities during the pandemic. Our findings can inform future urban and health crisis planning practices by providing new insights into the desirable public health messaging and characteristics of healthy and resilient communities., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to use decision tree modeling to generate profiles of children and youth who were more or less likely to meet the Canadian 24-h movement guidelines during the coronavirus disease-19 (COVID-19) outbreak., Methods: Data for this study were from a nationally representative sample of 1472 Canadian parents (Mean age  = 45.12, SD = 7.55) of children (5-11 years old) or youth (12-17 years old). Data were collected in April 2020 via an online survey. Survey items assessed demographic, behavioral, social, micro-environmental, and macro-environmental characteristics. Four decision trees of adherence and non-adherence to all movement recommendations combined and each individual movement recommendation (physical activity [PA], screen time, and sleep) were generated., Results: Results revealed specific combinations of adherence and non-adherence characteristics. Characteristics associated with adherence to the recommendation(s) included high parental perceived capability to restrict screen time, annual household income of ≥ $100,000, increases in children's and youth's outdoor PA/sport since the COVID-19 outbreak began, being a boy, having parents younger than 43 years old, and small increases in children's and youth's sleep duration since the COVID-19 outbreak began. Characteristics associated with non-adherence to the recommendation(s) included low parental perceived capability to restrict screen time, youth aged 12-17 years, decreases in children's and youth's outdoor PA/sport since the COVID-19 outbreak began, primary residences located in all provinces except Quebec, low parental perceived capability to support children's and youth's sleep and PA, and annual household income of ≤ $99,999., Conclusion: Our results show that specific characteristics interact to contribute to (non)adherence to the movement behavior recommendations. Results highlight the importance of targeting parents' perceived capability for the promotion of children's and youth's movement behaviors during challenging times of the COVID-19 pandemic, paying particular attention to enhancing parental perceived capability to restrict screen time., (Copyright © 2020. Production and hosting by Elsevier B.V.)