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BACKGROUND For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. OBJECTIVE The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. METHODS We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. RESULTS We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration. CONCLUSIONS The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions.

Given the challenges with nutrition research, the Canadian Nutrition Society and Intertek Health Sciences Inc held an expert consultation in late 2019 to discuss the development and implementation of best practices for clinical trials on whole foods. Key challenges in the design, interpretation, and reporting of clinical efficacy studies on whole foods and opportunities for the future development of best practices are reported. Novelty: Outlines existing tools, resources, and checklists for clinical nutrition trials and provides clear and tangible steps to develop best practices for studies on whole foods.

Background: Although nutrition interventions may reverse frailty, it is unclear which interventions are optimal. We conducted a systematic review and meta-analysis to identify effective nutrition interventions that improve outcomes related to frailty. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and CINAHL (inception to July 2019) for English-language trials of nutrition and combined-approach (nutrition and exercise) interventions (with a control group) involving prefrail or frail adults aged 65 years or more. Outcomes of interest were frailty, mobility, health (body weight, body mass index), physical function (e.g., activities of daily living, muscle strength, appendicular lean mass), use of health care services (e.g., hospital admissions), quality of life, diet quality, mortality, and caregiver and social support. After data extraction, we assessed the risk of bias using the Cochrane Collaboration risk of bias tool for randomized controlled trials, rated the certainty of evidence with the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) approach, and assessed statistical and methodologic heterogeneity. In addition, we conducted subgroup analyses of studies based on the primary intervention of protein supplementation. Results: We identified 15 studies involving 1825 prefrail or frail older participants: 7 were nutrition trials, 7 were combined-approach trials, and 1 trial had both a nutrition arm and a combined-approach arm. Seven studies had low risk of bias, 2 studies had high risk of bias, and for 6 studies the risk of bias was unclear. Nutrition interventions had small but significant effects on measures of physical function (standardized mean difference [SMD] 0.16, 95% confidence interval [CI] 0.02 to 0.29), mobility (SMD 0.15, 95% CI 0.00 to 0.30) and frailty (SMD −0.22, 95% CI −0.44 to −0.01) outcomes. Nutrition interventions combined with physical activity also had small but significant effects on physical function (SMD 0.19, 95% CI 0.06 to 0.32), mobility (SMD 0.25, 95% CI 0.02 to 0.48) and frailty (SMD −0.41, 95% CI −0.68 to −0.14; risk ratio 0.72, 95% CI 0.52 to 1.00) measures. Protein supplementation (5 studies) had small but significant effects on physical function measures (SMD 0.16, 95% CI 0.01 to 0.31) and mobility measures (SMD 0.20, 95% CI 0.02 to 0.39), with moderate certainty of evidence. Interpretation: There is moderate evidence that nutrition (including protein supplementation) and combined interventions are beneficial for prefrail or frail older adults. Trials with clear definitions of frailty and outcomes that reflect frailty identification and diagnosis are needed. PROSPERO registration: CRD42020144819

Given the focus on developing Dietary Reference Intakes (DRIs) based on chronic disease risk reduction and recent research for omega-3 long chain PUFA since the last DRI review, the Canadian Nutrition Society convened a panel of stakeholders for a 1-day workshop in late 2019. Attendees discussed the new NASEM guidelines for establishing DRI values based on chronic disease risk endpoints and the strength of current evidence for EPA and DHA as it relates to the new guidelines. Novelty: Summarizes evidence and expert opinions regarding the potential for reviewing DRI values for EPA and DHA and cardiovascular disease risk and early development.

The Canadian population is aging. With aging, biological and social changes occur increasing the risk of developing chronic conditions and functional loss leading to frailty. Older adults living with frailty are more vulnerable to minor stressors, take longer to recover from illness, and have difficulty participating in daily activities. The Canadian Frailty Network’s (CFN) mis-sion is to improve the lives of older adults living with frailty. In September 2019, CFN launched the Activity & Exercise, Vaccination, Optimization of medications, Interaction & Socialization, and Diet & Nutrition (AVOID) Frailty public health campaign to promote assessing and reducing risk fac-tors leading to the development of frailty. As part of the cam-paign, CFN held an Enabling Healthy Aging Symposium with 36 stakeholders from across Canada. Stakeholders identified individual and community-level opportunities and challenges for the enablement of healthy aging and frailty mitigation, as part of a focused consultative process. Stakeholders ranked the three most important challenges and opportunities at the individual and community levels for implementing AVOID Frailty recommendations. Concrete actions, further research areas, policy changes, and existing resources/programs to enhance the AVOID Frailty campaign were identified. The results will help inform future priorities and behaviour change strategies for healthy aging in Canada.

Background Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2–3 times more than cognitively healthy older adults and 60–80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. Methods We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings. Results Five hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [− 1.10, − 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [− 0.94, − 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls. Conclusion The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.

Background: Cognitive impairment (CI) is a risk factor for falls due to environmental or living settings, balance, gait and vision impairments, as well as medications. While previous systematic reviews have focused on the effectiveness of fall prevention programs in adults with cognitive impairment (1-4), but very limited information is available on their implementation. This review examines what aspects of fall prevention interventions for community-dwelling adults with CI have been reported using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to support successful implementation.Methods: We examined the included studies from our systematic review, which searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations and extracted data for study characteristics and the 5 dimensions (62 criteria) of the RE-AIM framework.Results: 12 randomized controlled trials (RCTs) consisting of 8 exercise interventions, 3 multifactorial interventions, and 1 medication treatment were included in the review. Only 4 of 62 criteria were reported by all 12 included studies and 29 criteria were not reported by any of the studies. Five of the included studies reported on 20 or more of the 62 possible RE-AIM criteria and three of these studies were ones that self-identified as “feasibility” studies. While Reach was the best-reported construct by the included studies, followed by Effectiveness and Implementation, the criteria within the Adoption and Maintenance constructs were rarely mentioned by these studies. In general, there was also wide variation in how each of the criteria were reported on by study authorsConclusion: Based on the reporting of RE-AIM components in this review, we are unable to make connections to successful intervention components and thus practice-based recommendations for fall prevention in those with CI. The lack of detail regarding implementation approaches greatly limits the interpretation and comparisons across studies to fully understand inform future research efforts.

Background:Despite the known health benefits of dairy products, their daily consumption continues to decline in many populations, particularly in pre-adolescents and adolescents.Objective:The primary objective of the cluster randomized controlled trial was to assess whether a school-based intervention enhanced with a web-based component, known as WhyDairy? was more effective than a standardized dairy education program at changing: (i) knowledge of dairy products, (ii) intentions to consume dairy products, and (iii) dietary intake of dairy products.Methods:Grade 7 students (n=175) in 10 Southwestern Ontario schools were randomized by the school, into intervention or control. Intervention schools received the WhyDairy? intervention with a website component while control schools received a DFO education program. Intervention schools were further randomized to receive follow-up contact, through monthly emails, or no follow-up contact. A questionnaire, consisting of three surveys (knowledge, FFQ, and intention), was delivered at baseline, post-intervention, and follow-up.Results:All groups significantly increased their knowledge post-intervention but only intervention schools with follow-up email contact maintained this positive change in knowledge. No groups saw significant changes in dietary behaviour. The email campaign was successful in reaching parents but did not result in high engagement or changes in student outcomes.Conclusion:The results of this study demonstrate the effectiveness of a school-based intervention enhanced with a web-based component in changing student knowledge regarding dairy products and the engagement of the website during the intervention period. Future work should consider longer durations to see changes in dietary behaviour and more targeted approaches during follow-up periods.

Background Measurement of nutrition knowledge is common in interventions targeting dietary modifications in a school-based setting. Previous research has noted a general lack of disclosure regarding the details and psychometric properties of nutrition knowledge tools, which makes uptake of previously used instruments extremely difficult. Methods Our systematic literature review sought to identify interventions measuring nutrition knowledge in school settings to students aged 9 to 18. Studies were categorized according to content subject and relevant descriptive characteristics and psychometric properties were extracted. Results Following the initial screening of 16,868 articles, 308 papers were evaluated for eligibility. Sixty-seven studies consistent with the inclusion criteria were included in the review. A minority of studies reported analysis of validity (31.3%) and/or reliability (40.3%), and 73.1% of studies had at least one unknown relevant descriptive characteristic. The majority (68.7%) of studies were custom developed, of which only 13 reproduced the tool in the publication. Conclusion Overall, there was an alarming lack of reporting across studies, both in terms of the description of knowledge tools as well as their psychometric properties. These omissions make the selection of appropriate instruments for use in novel contexts difficult, and highlight the need for greater disclosure and pre-intervention testing.

Background: Despite the known health benefits of dairy products, their daily consumption continues to decline, particularly in pre-adolescents and adolescents. It is therefore of interest to develop effective strategies to increase dairy intake and education in this population. Objective: The objective of this study was to evaluate the use of the web-based component of a school-based dairy nutrition intervention called WhyDairy?. Through analysis of popular website content, traversal paths and timing of website access, we aimed to investigate how students used this website and to identify areas of improvement for future research. Method: Grade 7 students (n=115) in 10 Southwestern Ontario schools received the WhyDairy? intervention, which included three classroom visits and a website that could be voluntarily accessed. Website use data was collected using Google Analytics. The intervention delivered to control schools did not have a website component and is therefore not described in this report. Results: The website was voluntarily accessed by 33.6% of students participating in the intervention. Almost 70% of website visits occurred within two days following a classroom visit. Popular content included games and interactive pages. While there was moderate engagement with the website during the intervention period, there was poor engagement during the follow-up period. Conclusion: The utilization of the WhyDairy? website represents students’ interest in independently furthering their knowledge and student engagement with a web-based component of a dairy nutrition intervention. Future work should investigate students’ motivations for accessing the website and how to encourage prolonged website use.

Cognitive impairment increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and there is a lack of evidence for effective fall prevention interventions for community-dwelling cognitively impaired adults. We conducted a systematic review and meta-analysis to investigate the effectiveness of fall prevention interventions in improving falls, perceived risk of falls, gait, balance, and functional mobility. We searched 7 databases for interventions involving community-dwelling adults ≥50 years with mild to moderate cognitive impairment. Reviewers screened citations, extracted data, assessed risk of bias and certainty of evidence (GRADE). We performed a meta-analysis of 509 community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate cognitive impairment from 12 randomized controlled trails (8 exercise interventions, 3 multifactorial, and 1 providing medication). Interventions had medium significant effects on perceived risk of falls (SMD -0.73 [-1.10, -0.36]), balance (SMD 0.66 [0.19, 1.12]), and timed up and go test (SMD -0.56 [-0.94, -0.17]) and small significant effects on gait speed and control (SMD 0.26 [0.08, 0.43]) with moderate certainty of evidence. There were no significant effects for falls. Sub-analysis showed that exercise and studies at low risk of bias remained significant for balance and perceived risk of falls. The effect of fall prevention interventions on falls remains unclear; exercise interventions are effective at addressing fall risk factors. However, high quality and longer studies with adequate sample sizes are needed to determine their effectiveness on falls.

BACKGROUND Owing to the associations between diet and health, it is important that effective health promotion strategies establish healthful eating behaviors from an early age. We reviewed the intensity of school-based interventions aimed to modify dietary behavior in preadolescent and adolescents and related intervention characteristics to effectiveness. METHODS Our systematic literature search of 8 databases sought to identify interventions measuring dietary intake in school settings to students aged 9 to 18. We evaluated these studies for effectiveness, intensity, intervention category, and follow-up measures. RESULTS Of the 105 interventions 81 were found to be effective immediately postintervention, irrespective of intensity. Studies that were 6 weeks to 5 months in duration, targeted students' environment or group (alone or in combination), and reached students only in schools were more effective. Only one-fifth of interventions conducted a follow-up measure, and a majority showed a loss of effectiveness from postintervention to follow-up. CONCLUSIONS We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.

Objective. Effective interventions are needed to address the reported inadequacies of dairy product and calcium (Ca) intakes among adolescents. The present review investigated interventions aimed at increasing adolescent dairy and/or Ca intakes and determined the characteristics associated with successful interventions. Design. A PRISMA systematic review search identified 17 interventions, described in 16 publications, between 1993 and 2015 (February). Studies were evaluated for population, delivery, dietary targets and outcomes measures, measure of intervention intensity, use of behavior change techniques, intervention effectiveness, and effect size and quality. Setting. Interventions targeting an increase in dairy food or Ca intake, either exclusively or in combination with other dietary modifications. Subjects. Adolescents, aged 12 to 18 years. Results. Twelve of the 17 interventions were found to be effective. Effective interventions tended to be higher in overall intensity (mean intensity: negative interventions 12.2, positive interventions 14.25), with the most notable difference in the duration category, such that effective interventions tended to be longer in duration. The number of behavior change techniques applied did not differentiate effective and ineffective interventions, but prompting the review of behavioral goals and including interviews or brief counseling appeared to be important for effective interventions. Effective interventions tended to have higher methodological quality, while the majority of ineffective interventions were qualitatively assessed as weak. Conclusions. The current review has identified characteristics of effective interventions that offer insight into promising strategies likely to increase dairy consumption and Ca intakes in countries where adolescent intake is insufficient. These findings may have important implications for future intervention design.

This review focuses on evidence-informed strategies to enhance learning in undergraduate nutrition education. Here, we describe the general shift in undergraduate education from a teacher-centered model of teaching to a student-centered model and present approaches that have been proposed to address the challenges associated with this shift. We further discuss case-based, project-based, and community-based learning, patient simulation, and virtual clinical trials as educational strategies to improve students’ critical thinking and problem-solving skills; these strategies are well suited to the teaching of undergraduate nutrition. The strategies are defined, and we discuss the potential benefits to students and how they can be applied specifically to the teaching of undergraduate nutrition. Finally, we provide a critical analysis of the limitations associated with these techniques and propose several directions for future research, including research methodologies that may best evaluate teaching strategies in terms of both teaching and learning outcomes. Consideration of these evidence-informed strategies is warranted, given their ability to encourage students to develop relevant skills that will facilitate their transition beyond the university classroom.

Background: Dairy products and alternatives can contribute to overall good health including positive body composition and decreased adiposity; however, these foods are grossly underconsumed by youth, and worldwide, almost 25% of children are overweight or obese. Objective: The study investigated the barriers and facilitators toward dairy consumption by Grade 7 youth. Methods: Thirty 50-minute, audio-recorded focus groups were conducted with 134 students in eight Grade 7 classes across 5 elementary schools. Focus groups were led by trained facilitators in the elementary schools and participants were separated based on dairy consumption and gender. Recorded data were transcribed and thematically analyzed using qualitative analysis software to identify themes related to barriers and facilitators to dairy product intake by each gender. Results: Factors considered important by males and females across different levels of habitual intake include personal knowledge about dairy products and misconceptions regarding dairy foods and their associated health benefits; food characteristics, including taste; personal behaviors such as habits or routines including dairy products; social environments including parental and peer influence; physical environments factors such as availability and skipping meals; and the convenience of dairy products. Interestingly, only males noted sports as a positive influence for dairy product intake. Also, there were differences in the way males and females perceived dining out as affecting their dairy intake. Conclusion: Results suggest several potential factors that nutrition education interventions aiming to increase dairy consumption could target.

Body Image, 14 (2015) 118-129. doi:10.1016/j.bodyim.2015.04.001 Nausikaa El-Mecky 0 0 2015-08-20T18:34:00Z 2015-08-20T18:34:00Z 1 308 1757 14 4 2061 14.0 Normal 0 false false false EN-CA JA X-NONE The goal of this Field Note is to outline our experiences developing and maintaining a Knowledge Translation and Transfer-Knowledge Mobilization (KTT-KMb) Learning Circle for graduate students at the University of Guelph. Since the fall of 2013, we have planned and held events and training opportunities for graduate students across the university’s colleges and maintained an online presence for our membership of 107 students. In this article, we reflect on the successes of the Learning Circle, including a sustained presence across an interdisciplinary group, securing funding, and engaging in successful collaborations. We also highlight our challenges, including attendance at events, staying relevant in a quickly evolving field, and striving toward sustainability. Our hope is that this article provides a non-prescriptive guideline for students wishing to develop similar “by student, for student” initiatives to scaffold graduate student learning and engagement in KTT-KMb. Resume : Dans ce field note, nous visons a surligner nos experiences en developpant et maintenir un cercle d’apprentissage pour la mobilization des connaissances pour les etudiants de deuxieme et troisieme cycle a Universite de Guelph. Depuis 2013, nous avons organise de nombreuses evenements et formations pour les etudiants de toutes les colleges a l’Universite; nous avons aussi maintenu un presence web pour nos 107 membres. Dans cet article, nous reflechissons au sujet des succes du cercle, ci inclus une presence soutenu au coeur d’un nombre de membres interdisciplinaires, du succes a obtenir les fonds, et les collaborations concus pour realiser nos buts. Nous surlignons aussi nos defis, en tant que les difficultes attirer les etudiants aux evenements, rester au courant dans une domaine en evolution, et viser a la durabilite. Nous esperons que l’article fournira une guide non-prescrit pour les etudiants qui veulent developper des initiatives “par etudiants, pour etudiants” qui visent a soutenir les connaissances et engagement dans la domaine de la mobilisation des connaissances. Mots cles : Mobilization des conaissances; Partage du savoir; Etudiants; Formation; Communaute de practique

Background: Understanding how adolescents acquire health knowledge and where they currently seek answers to health-related questions may facilitate the development of interventions that will be both engaging and effective, and may help to improve health over the short- and long-term. Objective: The present study sought to investigate the perception and use of sources of health knowledge by young adolescents as stratified by gender. Methods: Thirty 50-min long focus groups were conducted with 143 participants. Focus group questions were built around the following three main categories: sources of knowledge, including preferred sources, sources accessed for general health, and sources accessed for personal/sensitive health; health information and behaviour change, including characteristics of health knowledge presentation that have influenced behaviour change; and learning preferences to promote behaviour change. Content analysis of focus group transcripts was performed. Results: The use of sources of health knowledge was similar between genders, with some differences noted between sources accessed for general as compared to personal health questions. As well, motivation appeared to be the primary influence of health behaviour change, with knowledge being reported as both as positive and neutral influence, most notably in the areas of diet and exercise. Lastly, adolescents reported several characteristics of health knowledge presentation that they felt would motivate positive behaviour change, including engaging and participatory activities. Conclusion: These results should be considered in the development of interventions to improve health-related behaviour in adolescents, although future research to quantify the use of sources of health knowledge by this population is recommended.