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Objective: Fruits and vegetables (FV) distribution interventions have been implemented as a public health strategy to increase children's intake of FV at school settings. The purpose of this review was to examine whether snack-based FV distribution interventions can improve school-aged children's consumption of FV.Design: Systematic review and meta-analysis of articles published in English, in a peer-reviewed journals, were identified by searching six databases up to August 2020. Standardised mean differences (SMD) and 95 % CI were calculated using a random effects model. Heterogeneity was quantified using I2 statistics.Setting: Population-based studies of interventions where the main focus was the effectiveness of distributed FV as snacks to schoolchildren in North America, Europe and Pacific were included.Results: Forty-seven studies, reporting on fifteen different interventions, were identified; ten studies were included in the meta-analysis. All interventions were effective in increasing children's consumption of FV, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children's consumption of FV, particularly for multi-component interventions at post-intervention (SMD 0·20, 95 % CI 0·13, 0·27) and free distribution interventions at follow-up (SMD 0·19, 95 % CI 0·12, 0·27).Conclusions: Findings suggest that FV distribution interventions provide a promising avenue by which children's consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration and follow-up evaluation are needed to improve comparability across studies. [ABSTRACT FROM AUTHOR]

Abstract Background Trends in food retailing associated with the consolidation of smaller-format retailers into fewer, larger-format supercentres have left some rural areas with fewer sources of nutritious, affordable food. Access to nutritious, affordable food is essential for good dietary habits and combating health issues such as type-2 diabetes, obesity, and cardiovascular disease. Many studies on food environments use inaccurate or incomplete methods for locating food retailers, which may be responsible for mischaracterising food deserts. This study uses databases of every residence in and every food retailer in and around Middlesex County, Ontario, Canada. Residences were geocoded to their precise address, and network analysis techniques were performed in a geographic information system (GIS) to determine distances between every residence and different types of food retailers (grocery stores, fast food, fruit and vegetable sources, grocery stores plus fruit and vegetable sources, variety stores), both when considering and neglecting facilities outside the area of study, to account for a deficiency in analysis termed the 'edge effect'. Results Analysis of household accessibility to food outlets by neighbourhood socioeconomic distress level indicated that residents in the most distressed neighbourhoods tended to have better accessibility to all types of food retailers. In the most distressed neighbourhoods, 79 percent of residences were within walking distance of a grocery store, compared to only 10 percent in the least distressed neighbourhoods. When the edge effect was neglected, 37 percent of distance estimates proved inaccurate. Average accessibility to all food retailer types improved dramatically when food outlets adjacent to the study area were considered, thereby controlling for the edge effect. Conclusion By neglecting to consider food retailers just outside study area boundaries, previous studies may significantly over-report the actual distance necessary to travel for food. Research on food access spanning large rural regions requires methods that accurately geocode residents and their food sources. By implementing methods akin to those in this paper, future research will be better able to identify areas with poor food accessibility. Improving identification of food desert communities is a first step in facilitating more effective deployment of food policies and programs in those communities.

Abstract Background Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. Methods Patients of 50 years and older, with a diagnosis of hip fracture, discharged from two local acute care hospitals over a 5 year period (n = 2150) were analyzed as a function of age and gender to explore the relative proportions of intertrochanteric and subcapital fractures, and the change in relative proportion in the two genders with age. Results Overall, for the genders combined, the proportion of intertrochanteric fractures increases with age (p = .007). In women this increase is significant (p < .001), but in men the opposite pattern is observed, with the proportion of intertrochanteric fractures falling significantly with age (p = .025). Conclusions The pattern of hip fractures is different in men and women with aging. It is likely that the pattern difference reflects differences in type and rate of bone loss in the genders, but it is conjectured that the changing rate and pattern of falling with increasing age may also be important. The two main hip fracture types should be considered distinct and different and be studied separately in studies of cause and prevention.

Urban areas have complex thermal distribution. We examined the association between extreme temperature and mortality in urban Ontario, using two temperature data sources: high-resolution and weather station data. We used distributed lag non-linear Poisson models to examine census division-specific temperature–mortality associations between May and September 2005–2012. We used random-effect multivariate meta-analysis to pool results, adjusted for air pollution and temporal trends, and presented risks at the 99th percentile compared to minimum mortality temperature. As additional analyses, we varied knots, examined associations using different temperature metrics (humidex and minimum temperature), and explored relationships using different referent values (most frequent temperature, 75th percentile of temperature distribution). Weather stations yielded lower temperatures across study months. U-shaped associations between temperature and mortality were observed using both high-resolution and weather station data. Temperature–mortality relationships were not statistically significant; however, weather stations yielded estimates with wider confidence intervals. Similar findings were noted in additional analyses. In urban environmental health studies, high-resolution temperature data is ideal where station observations do not fully capture population exposure or where the magnitude of exposure at a local level is important. If focused upon temperature–mortality associations using time series, either source produces similar temperature–mortality relationships. [ABSTRACT FROM AUTHOR]

Introduction: This qualitative study investigates children's perceptions of the influences of a Centrally Procured School Food Program on their dietary behaviours and their recommendations on how to improve the program. Methods: The observations of 208 students aged 9 to 14 years (Grades 5- 8) at 21 elementary schools were collected through focus groups in 2017/18. The larger intervention consisted of a 10-week program offering daily snacks (i.e. fruit, vegetables, whole grains, dairy, meat alternatives) for elementary school children in southwestern Ontario, Canada. Results: The participants' overall impressions of the program were positive. They noted reduced hunger, increased energy and improved nutrition. Many children felt that the program changed their dietary patterns at home as well as at school, particularly in terms of eating more fruit and vegetables. The snack program also enabled children to try healthy foods. Conclusion: Most participants considered the program to be beneficial in promoting healthy eating. Participants recommended adding educational activities, expanding the variety of foods and increasing child involvement in selecting and preparing foods. [ABSTRACT FROM AUTHOR]

An intervention, which used elements of the theory of planned behavior, was developed and tested in a randomized control trial (RCT) involving households in the city of London, Ontario, Canada. A bespoke methodology involving the direct collection and measurement of food waste within curbside garbage samples of control (n = 58) and treatment households (n = 54) was used to evaluate the effectiveness of the intervention. A comparison of garbage samples before and after the intervention revealed that total food waste in treatment households decreased by 31% after the intervention and the decrease was significantly greater (p =.02) than for control households. Similarly, avoidable food waste decreased by 30% in treatment households and was also significantly greater (p =.05) than for control households. Key determinants of treatment household avoidable food waste reduction included personal attitudes, perceived behavioral control, the number of people in a household, and the amount of garbage set out. [ABSTRACT FROM AUTHOR]

Abstract Background A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit. Results The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist. Conclusion Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes.

This systematic review explores experiences of household food insecurity in rural areas of developed countries. A search of 5 databases resulted in 32 peer-reviewed articles for inclusion. Data were analyzed using directed content analysis to broaden the understanding of rural household food insecurity. Elements of food security (ie, availability, accessibility, acceptability, adequacy, and agency) were exemplified across the literature. In addition, 4 key themes were found: exercising human capital, realizing social capital, coping with compounding stressors, and navigating complex systems. This review demonstrates the need for interventions that improve social connectedness, individual coping skills, and system navigation. [ABSTRACT FROM AUTHOR]

Introduction: Low levels of physical activity among children are a significant public health concern in several industrialized nations. The current research body has failed to gather adequate information on various geographic regions. Understanding barriers and facilitators in different rural regions is imperative for creating successful physical activity interventions for children in rural areas. The purpose of this study is to explore rural children’s perspectives on physical activity and to discuss barriers or facilitators to physical activity participation in rural Northwestern Ontario, Canada. Methods: Children (n=84) in Grades 4–8 (ages 8–14 years) in rural Northwestern Ontario participated in focus groups to discuss barriers and facilitators to physical activity. Twenty focus groups were conducted in schools. The focus groups were audio-recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis. Subthemes were created based on the explicit content of the data and grouped to form broader themes. Results: Three key themes were identified: environment, social environment, and perceptions of safety. Environmental features include weather and the built environment. Social environment includes the role of friends and adults to either facilitate or restrict children’s play. The fear of wildlife was pervasive across all focus groups and resulted in restricted independent mobility and physical activity. Conclusion: Rural children are typically under-represented in physical activity research. The findings of this study reveal that rural children experience some barriers to physical activity that are distinct from those of urban children. The findings suggest that researchers need to understand contextual nuances of the rural environment. Specific to the setting of Northwestern Ontario, these rural children could benefit from the addition of a skate park, indoor places to play, and more wildlife education. [ABSTRACT FROM AUTHOR]

Objective: In this meta-analysis, we sought to compare accelerometry-measured physical activity and sedentary time (ST) among elementary school students during physical education (PE) lessons taught by generalist and specialist teachers. Methods: We searched 7 databases for peer-reviewed, English-language, original research that met the inclusion criteria. The percentage of PE lesson spent in moderate-to vigorous-intensity physical activity (MVPA) and ST was synthesized across the 2 types of teachers. Studies that provided percentage of PE class spent in MVPA/ST, a standard deviation, and sample size were pooled for meta-analysis. Results: Overall, 42 studies were included in this review. On average, children engaged in MVPA for 33.0% of their PE classes, and were sedentary for 35.9% of their PE classes. Subgroup analyses found that children spent an average of 33.8% of their PE class time in MVPA when taught by a specialist, and 29.9% of their PE class time in MVPA when a generalist was responsible for instruction. Similarly, children spent 34.2% of PE class time in ST under the instruction of a specialist, and 40.9% of PE class time when taught by a generalist teacher. Conclusion: Regardless of teacher specialization, physical activity levels during PE class at the elementary school level are low. [ABSTRACT FROM AUTHOR]

Primary care is the level of a health system that provides first point of access to health care services for all health-related needs and problems, providing person-focused care over time in a continuous and coordinated fashion (Primary Healthcare Planning Group [48]; Aggarwal and Hutchison [1]; Health Canada [20]). This paper undertakes a comprehensive examination of how primary care services are distributed across Southwestern Ontario (SWO), with a particular focus on understanding how the distribution is meeting the primary care needs of the senior population (i.e., people aged 65 years and older) and populations living in different geographic settings (i.e., the urban-rural continuum). PCPs were included in our research database if they were physicians or NPs that have a comprehensive primary care practice and have a roster of enrolled patients for whom they provide ongoing primary care (as of July 2015). Despite the high PCP-to-population ratios, the number of PCPs actually providing care in these rural and small population centre communities away from metropolitan influence zones is overestimated, as many PCPs provide other health services (e.g., emergency room doctors, specialists, service to long-term care). [Extracted from the article]

Within research on ageing in neighbourhoods, older adults are often positioned as impacted by neighbourhood features; their impact on neighbourhoods is less often considered. Drawing on a study exploring how person and place transact to shape older adults' social connectedness, inclusion and engagement in neighbourhoods, this paper explores how older adults take action in efforts to create neighbourhoods that meet individual and collective needs and wants. We drew on ethnographic and community-based participatory approaches and employed qualitative and geospatial methods with 14 older adults in two neighbourhoods. Analysis identified three themes that described the ways that older adults enact agency at the neighbourhood level: being present and inviting casual social interaction , helping others and taking community action. The participants appeared to contribute to a collective sense of connectedness and creation of social spaces doing everyday neighbourhood activities and interacting with others. Shared territories in which others were present seemed to support such interactions. Participants also helped others in a variety of ways, often relating to gaps in services and support, becoming neighbourhood-based supports for other seniors. Finally, participants contributed to change at the community level, such as engaging politically, patronising local businesses and making improvements in public places. Study findings suggest the potential benefits of collaborating with older adults to create and maintain liveable neighbourhoods. [ABSTRACT FROM AUTHOR]

Background: Early experiences in physical activity (PA) are important to shape healthy movement behaviours long-term; as such, it is critical that PA is promoted from infancy, and that detrimental behaviours (e.g., prolonged sedentary time [ST]) are minimized. The purpose of this systematic review and meta-analysis was to examine infants' and toddlers' movement behaviours across daytime hours. Methods: Seven online databases were searched for terms related to infants (< 12 months), toddlers (12–35.9 months), PA, ST, and accelerometry. Two independent reviewers examined 4873 articles for peer-reviewed original research, published in English, that assessed infants' (counts/min) and/or toddlers' PA or ST (min/day) using accelerometry across daytime hours. Infants' mean PA level (counts/min) was averaged across studies, and ranges were produced. Estimates of toddlers' movement behaviours were aggregated meta-analytically to produce average daily rates, and accelerometer placement, cut-point validity, device type, and epoch length were tested as a moderating variables. Results: Twenty-four studies from 16 countries (published 2011–2019), representing 3699 participants, were included in the systematic review. Five studies reported on infants' PA, which ranged from 78.2 to 2580.5 cpm. Across 20 studies, toddlers' total PA, light PA, moderate-to vigorous-intensity PA, and ST ranged from 72.9 to 636.5, 48.5 to 582.4, 6.5 to 89.9, and 172.7 to 545.0 min/day, respectively. After taking into account accelerometer placement, cut-point validity, device type, and epoch length, we found that toddlers engaged in 246.19 min/day (SE = 28.50; 95% CI: 190.34, 302.04) of total PA, 194.10 min/day (SE = 28.76; 95% CI: 137.73, 250.47) of light PA, and 60.16 min/day (SE = 5.88; 95% CI: 48.64, 71.69) of moderate-to vigorous-intensity PA. Toddlers engaged in 337.04 min/day (SE = 32.67; 95% CI: 273.01, 401.07) of ST. Conclusions: With limited studies conducted in infants (n = 5), PA estimates are inconclusive and largely heterogeneous. Overall, toddlers tend to exceed the total PA recommendation of 180 min/day; however, very little of this time is spent at higher movement intensities. Even with high PA rates, toddlers still engage in substantial ST. More consistent and valid measurement protocols are needed to improve comparability across studies. [ABSTRACT FROM AUTHOR]

Nature exposure positively impacts children's physical, socio-emotional, and cognitive health and development. We know less about how children perceive their connection with nature and what nature means to them. This study uses focus groups to understand how rural Canadian children define, experience, and perceive benefits of nature. Using thematic analysis, we identified three primary themes. First, while children associate nature with specific activities, natural elements, and locations, they also conceptualize nature as 'a whole community.' Second, children experienced nature through doing, highlighting how activities connected them with nature while recognizing constraints on those engagements. Finally, children demonstrated agency in accessing nature to improve their emotional states. These findings indicate that from children's views, nature is more than just space with natural elements. Children are also knowledgeable about the health benefits of nature, and capitalize on this knowledge. These findings can inform interventions to increase children's interactions with outdoor environments. [ABSTRACT FROM AUTHOR]

In the original publication of this article [1], the institutional author's name needs to be revised from The Paediatric Chairs of Canada Mark Bernstein to The Paediatric Chairs of Canada. [ABSTRACT FROM AUTHOR]