Contribution of environmental determinants to the risk of developing type 2 diabetes mellitus in a life-course perspective: a systematic review protocol.

BACKGROUND: Prevention policies against type 2 diabetes mellitus (T2DM) focus solely on individual healthy lifestyle behaviours, while an increasing body of research recognises the involvement of environmental determinants (ED) (cultural norms of land management and planning, local foodscape, built environment, pollution, and neighbourhood deprivation). Precise knowledge of this relationship is essential to proposing a prevention strategy integrating public health and spatial planning. Unfortunately, issues related to the consistency and synthesis of methods, and results in this field of research limit the development of preventive strategies. This systematic review aims to improve knowledge about the relationship between the risk of developing T2DM in adulthood and long-term exposure to its ED during childhood or teenage years. METHODS: This protocol is presented according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) tools. PubMed, Embase, CINAHL, Web of Science, EBSCO, and grey literature from the Laval University Libraries databases will be used for data collection on main concepts such as 'type 2 diabetes mellitus', 'zoning' or 'regional, urban, or rural areas land uses', 'local food landscape', 'built environment', 'pollution', and 'deprivation'. The Covidence application will store the collected data for selection and extraction based on the Population Exposure Comparator Outcome and Study design approach (PECOS). Studies published until December 31, 2023, in English or French, used quantitative data about individuals aged 18 and over that report on T2DM, ED (cultural norms of land management and planning, local foodscape, built environment, and neighbourhood deprivation), and their association (involving only risk estimators) will be included. Then, study quality and risk of bias will be conducted according to the combined criteria and ratings from the ROBINS-E (Risk of Bias in Non-randomised Studies-of Exposures) tools and the 'Effective Public Health Practice Project' (EPHPP). Finally, the analytical synthesis will be produced using the 'Synthesis Without Meta-analysis' (SWiM) guidelines. DISCUSSION: This systematic review will summarise available evidence on ED associated with T2DM. The results will contribute to improving current knowledge and developing more efficient cross-sectoral interventions in land management and public health in this field of research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023392073.

Life-course socioeconomic status and obesity: a scoping review protocol.

OBJECTIVE: We aim to explore the literature that studies the links between life-course socioeconomic status and weight status and characterize the life-course approach used. INTRODUCTION: Obesogenic environments are increasing rapidly in deprived environments, and cross-sectional studies have shown limitations in explaining the links between these environments and obesity. The life-course approach has been proposed recently to better understand the links between socioeconomic status and weight status. INCLUSION CRITERIA: Studies that identify life-course socioeconomic status and longitudinal built environment indicators and associate them with body weight indicators between January 2000 and January 2023. METHODS: Studies in French or English were searched in Medline (PubMed), Web of Science and GeoBase (Embase) according to the strategies formulated for each database. The selected studies were exported to Covidence for evaluation according to the inclusion/exclusion criteria. RESULTS: The main results retained are the association between longitudinal socioeconomic indicators and weight measures; longitudinal built environment indicators and the measures of weight.

Chemical and Visual Cues as Modulators of the Stress Response to Social Isolation in the Marine Medaka, Oryzias melastigma.

The marine medaka is emerging as a potential behavioral model organism for ocean studies, namely on marine ecotoxicology. However, not much is known on the behavior of the species and behavioral assays lack standardization. This study assesses the marine medaka as a potential model for chemical communication. We investigated how short exposure to visual and chemical cues mediated the stress response to social isolation with the light/dark preference test (LDPT) and the open field test (OFT). After a 5-day isolation period, and 1 h before testing, isolated fish were randomly assigned to one of four groups: (1) placed in visual contact with conspecifics; (2) exposed to a flow of holding water from a group of conspecifics; (3) exposed to both visual and chemical cues from conspecifics; or (4) not exposed to any stimuli (controls). During the LDPT, the distance traveled and transitions between zones were more pronounced in animals exposed to the conspecific's chemical stimuli. The time spent in each area did not differ between the groups, but a clear preference for the bright area in all animals indicates robust phototaxis. During the OFT, animals exposed only to chemical cues initially traveled more than those exposed to visual or both stimuli, and displayed lower thigmotaxis. Taken together, results show that chemical cues play a significant role in exploratory behavior in this species and confirm the LDPT and OFT as suitable tests for investigating chemical communication in this species.

Food environment trajectories: a sequence analysis from the CARTaGENE cohort.

OBJECTIVE: The purpose of this study was to create a typology of longitudinal exposure to food environment based on socio-economic context. DESIGN: Food environment trajectories were modelled using a sequence analysis method, followed by a logistic regression to describe those trajectories. SETTING: The study took place in Quebec, Canada, using food environment data from 2009, 2011 and 2018 merged with participants' demographic and socio-economic characteristics. PARTICIPANT: At recruitment, 38 627 participants between the ages of 40 and 69 years from six urban areas in Quebec were included in the CARTaGENE cohort study. The cohort was representative of the Quebec urban population within this age range. RESULTS: Our study revealed five trajectories of food access over time: (1) limited access to food stores throughout the study period, (2) limited access improving, (3) good access diminishing, (4) good access throughout the period and (5) low access throughout the period. Logistic regression analysis showed that participants who were unable to work (OR = 1·42, CI = 1·08-1·86), lived in households with five or more persons (OR = 1·69, CI = 1·17-2·42) and those living in low-income households (OR = 1·32, CI = 1·03-1·71) had higher odds of experiencing a disadvantaged food environment trajectory. Additionally, the level of education and age of participants were associated with the odds of experiencing a disadvantaged food environment trajectory. CONCLUSIONS: The study demonstrates that people facing socio-economic disadvantage are more likely to experience a disadvantaged food environment trajectory over time.

Neighborhood deprivation and obesity: Sex-specific effects of cross-sectional, cumulative and residential trajectory indicators.

Obesity is a long-term health issue that is becoming increasingly prevalent. Very few studies have considered the life course effects of neighborhood characteristics on obesity. In a sample of 35,856 adult participants (representative of the population of the Province of Quebec in Canada), we measured the association between neighborhood deprivation and obesity using logistic modelling on indicators of cross-sectional neighborhood deprivation, cumulative neighborhood deprivation and trajectories of neighborhood deprivation. For cross-sectional exposure, we found that females in our sample had higher odds of being affected by obesity when living in high-deprivation (OR 1.73, CI 1.41-2.13) or medium-deprivation neighborhoods (OR 1.27, CI 1.07-1.51) compared to females living in low-deprivation neighborhoods. Males also had higher odds of being affected by obesity when living in medium or high deprivation. For cumulative exposure to neighborhood deprivation, only females in the second highest category for longitudinal exposure to deprived neighborhoods had significantly higher odds of living with obesity (OR 1.89 CI 1.12-3.19) compared to females in the low cumulative exposure category. Using sequence analysis to determine neighborhood deprivation trajectories for up to 17 years, we found that females with a Deprived upward (OR 1.75 CI 1.10-2.78), an Average downward (OR 1.75 CI 1.08-2.84) or a Deprived trajectory (OR 1.81 CI 1.45-2.86) had higher odds of living with obesity compared to the Privileged trajectory. For males, there were no significant associations. Using trajectory indicators was beneficial to our analyses because this method shows that not only are individuals in low socioeconomic status neighborhoods at the end of their trajectory more susceptible to living with obesity, but so are those exposed to neighborhood deprivation at the beginning of their trajectory. These results could help to more precisely identify individuals at higher risk of developing obesity-related health issues.

Benchmarking missing-values approaches for predictive models on health databases.

BACKGROUND: As databases grow larger, it becomes harder to fully control their collection, and they frequently come with missing values. These large databases are well suited to train machine learning models, e.g., for forecasting or to extract biomarkers in biomedical settings. Such predictive approaches can use discriminative-rather than generative-modeling and thus open the door to new missing-values strategies. Yet existing empirical evaluations of strategies to handle missing values have focused on inferential statistics. RESULTS: Here we conduct a systematic benchmark of missing-values strategies in predictive models with a focus on large health databases: 4 electronic health record datasets, 1 population brain imaging database, 1 health survey, and 2 intensive care surveys. Using gradient-boosted trees, we compare native support for missing values with simple and state-of-the-art imputation prior to learning. We investigate prediction accuracy and computational time. For prediction after imputation, we find that adding an indicator to express which values have been imputed is important, suggesting that the data are missing not at random. Elaborate missing-values imputation can improve prediction compared to simple strategies but requires longer computational time on large data. Learning trees that model missing values-with missing incorporated attribute-leads to robust, fast, and well-performing predictive modeling. CONCLUSIONS: Native support for missing values in supervised machine learning predicts better than state-of-the-art imputation with much less computational cost. When using imputation, it is important to add indicator columns expressing which values have been imputed.

Exploring social inequalities in healthcare trajectories following diagnosis of diabetes: a state sequence analysis of linked survey and administrative data.

BACKGROUND: Social inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories. METHODS: We used the TorSaDe (The Care Trajectories-Enriched Data) cohort, which links Canadian Community Health Survey respondents to health administrative data. Care trajectories were mapped over a two-year period following a new diagnosis and analysed using state sequence and clustering methods. Associations between individual and geographic characteristics with trajectory types were assessed with multinomial logistic regression. RESULTS: Three trajectories were identified: Regular Family Physician (FP) Predominant, Specialist Physician Predominant, and Few Services. With Regular FP as the reference, males had higher odds of experiencing the Few Services trajectory, higher education was associated with higher odds of both the Few Services and the Specialist trajectories, and immigrants had higher odds of the Specialist trajectory. Diagnoses in a physician's office, as opposed to in hospital, were associated with higher odds of the Regular FP trajectory. CONCLUSIONS: The Regular FP trajectory most closely aligns with the management principles of the PCSC approach. We did not find strong evidence of social status privileging access to this trajectory. However, the association with location of diagnosis suggests that efforts to ensure patients diagnosed in hospital are well linked to a regular family physician for follow up may help to reduce unnecessary specialist use and meet PCSC goals.

Self-perceived health status among adults with obesity in Quebec: a cluster analysis.

PURPOSE: People with obesity are a highly heterogeneous group. Characterizing this heterogeneity may help to improve public health by offering adapted interventions and treatments to more homogeneous sub-groups among obese patients. This research aims to (1) identify distinct clusters of people with obesity based on demographic, behavioural, and clinical factors in the province of Quebec (Canada) and (2) assess the association of these clusters with selfperceived health. METHODS: We conducted a sex specific cluster analysis (multiple correspondence analysis and hierarchical clustering) of adults with body mass index (BMI) ≥ 30 kg/m2 from the 2015-2016 Canadian Community Health Survey in Quebec. Clusters were based on demographic, clinical, and behavioural characteristics. The clusters were tested for association with poor selfperceived health using logistic regression. RESULTS: Three clusters of individuals with obesity were identified. These were (1) young individuals, (2) people with higher levels of depression and anxiety, and (3) older adults with high comorbidity. Those with high levels of depression and anxiety (9% of men vs. 13% of women) were associated with the poorest selfperceived health. CONCLUSIONS: People with obesity in Quebec can be categorized into three clusters based on demographic, clinical, and behavioural characteristics. The findings of this study draw attention to the need to examine the coexistence of obesity with depression and anxiety, particularly as it relates to selfperceived health.

Association between Neighbourhood Deprivation Trajectories and Self-Perceived Health: Analysis of a Linked Survey and Health Administrative Data.

Life course exposure to neighbourhood deprivation may have a previously unstudied relationship with health disparities. This study examined the association between neighbourhood deprivation trajectories (NDTs) and poor reported self-perceived health (SPH) among Quebec's adult population. Data of 45,990 adults with complete residential address histories from the Care-Trajectories-Enriched Data cohort, which links Canadian Community Health Survey respondents to health administrative data, were used. Accordingly, participants were categorised into nine NDTs (T1 (Privileged Stable)-T9 (Deprived Stable)). Using multivariate logistic regression, the association between trajectory groups and poor SPH was estimated. Of the participants, 10.3% (95% confidence interval [CI]: 9.9-10.8) had poor SPH status. This proportion varied considerably across NDTs: From 6.4% (95% CI: 5.7-7.2) for Privileged Stable (most advantaged) to 16.4% (95% CI: 15.0-17.8) for Deprived Stable (most disadvantaged) trajectories. After adjustment, the likelihood of reporting poor SPH was significantly higher among participants assigned to a Deprived Upward (odds ratio [OR]: 1.77; 95% CI: 1.48-2.12), Average Downward (OR: 1.75; CI: 1.08-2.84) or Deprived trajectory (OR: 1.81; CI: 1.45-2.86), compared to the Privileged trajectory. Long-term exposure to neighbourhood deprivation may be a risk factor for poor SPH. Thus, NDT measures should be considered when selecting a target population for public-health-related interventions.

Sediments in the mangrove areas contribute to the removal of endocrine disrupting chemicals in coastal sediments of Macau SAR, China, and harbour microbial communities capable of degrading E2, EE2, BPA and BPS.

The occurrence of endocrine disrupting chemicals (EDCs) is a major issue for marine and coastal environments in the proximity of urban areas. The occurrence of EDCs in the Pearl River Delta region is well documented but specific data related to Macao is unavailable. The levels of bisphenol-A (BPA), estrone (E1), 17α-estradiol (αE2), 17ß-estradiol (E2), estriol (E3), and 17α-ethynylestradiol (EE2) were measured in sediment samples collected along the coastline of Macao. BPA was found in all 45 collected samples with lower BPA concentrations associated to the presence of mangrove trees. Biodegradation assays were performed to evaluate the capacity of the microbial communities of the surveyed ecosystems to degrade BPA and its analogue BPS. Using sediments collected at a WWTP discharge point as inoculum, at a concentration of 2 mg l-1 complete removal of BPA was observed within 6 days, whereas for the same concentration BPS removal was of 95% after 10 days, which is particularly interesting since this compound is considered recalcitrant to biodegradation and likely to accumulate in the environment. Supplementation with BPA improved the degradation of bisphenol-S (BPS). Aiming at the isolation of EDCs-degrading bacteria, enrichments were established with sediments supplied with BPA, BPS, E2 and EE2, which led to the isolation of a bacterial strain, identified as Rhodoccoccus sp. ED55, able to degrade the four compounds at different extents. The isolated strain represents a valuable candidate for bioremediation of contaminated soils and waters.

School food offer at lunchtime: assessing the validity and reliability of a web-based questionnaire.

OBJECTIVES: To develop and validate a web-based self-diagnostic questionnaire on school food service offer aimed at food service managers (FSM) by: (i) identifying relevant indicators of school food offer, developing a questionnaire and validating the concept using an expert panel; (ii) validating the questions by comparing the FSM's responses with observations by dietitians and (iii) undergoing a qualitative evaluation of the tool through direct observation and short interviews. DESIGN: Mixed methods. SETTING: Quebec, Canada. PARTICIPANTS: Nine experts validated the theoretical constructs and indicators on which the questionnaire was based. Inter-rater reliability tests were conducted with thirty-nine FSM, who then participated in interviews about platform functionality satisfaction. Twenty school stakeholders participated in the survey pertaining to their use of the personalised report. RESULTS: The questionnaire focused on the main school food service's lunchtime offer and comprised twenty-six questions. The overall strength of agreement was good, and all questions' strengths of agreement were fair to excellent except for one question. Qualitative data reached saturation and showed that navigation through the questionnaire was fluid. Improvements were suggested to increase user-friendliness and simplicity of both the platform and questionnaire. Results from the survey showed that all respondents were either satisfied or very satisfied with their personalised report. CONCLUSIONS: We successfully developed and validated a web-based self-diagnostic questionnaire. The final version facilitates knowledge mobilisation with school stakeholders and offers a new opportunity for the assessment and surveillance of school food offer.

Examining longitudinal patterns of individual neighborhood deprivation trajectories in the province of Quebec: A sequence analysis application.

Exposure to neighborhood deprivation has been associated with a number of health, behavioral and sociological outcomes. However, many negative outcomes associated with deprivation have a long latency and may be influenced by varying exposure to neighborhoods throughout time. Capturing the longitudinal exposure to neighborhood deprivation is methodologically complex when one wishes to include life course notions of order, duration and timing. In a sample of 60,555 participants, aged 12 years and older (representative of the population of the Province of Quebec in Canada) our objectives were to: 1) Create an indicator for neighborhood deprivation trajectories; 2) compare trajectories with cross-sectional and cumulative neighborhood deprivation; 3) identify individual socioeconomic determinants of membership to a trajectory cluster. Using sequence analysis based on optimal matching and clustering around theoretical types, we grouped sequences in nine neighborhood deprivation trajectory clusters. We found that half (50%) of the participants were in a stable trajectory and did not transition significantly from one deprivation tertile to another during their sequence. A comparison between a cross-sectional indicator of neighborhood deprivation and the trajectories showed that only 42.2% of the participants had a cross-sectional deprivation at the index date representative of their whole trajectory. We also found, using logistic regression (adjusted for age, sex, number of residential moves) that having no high school diploma, living in a rural area and being an immigrant was strongly associated with a deprived stable trajectory. Sequence analysis is an effective tool to describe neighborhood deprivation trajectories in a sample representative of the Quebec population. Trajectories are a useful addition to a better understanding of the distribution of health outcomes because they provide information about the order and accumulation of longitudinal exposures to neighborhood and seem to be associated with specific individual socioeconomic characteristics such as education, urbanity, and immigration status.

Single-shot observation of breathers from noise-induced modulation instability using heterodyne temporal imaging.

We report phase and amplitude measurements of large coherent structures originating from the noise-induced modulation instability in optical fibers. By using a specifically designed time-lens system (SEAHORSE) in which aberrations are compensated, the complex field is recorded in single-shot over long durations of 200 ps with sub-picosecond resolution. Signatures of Akhmediev breather-like patterns are identified in the ultrafast temporal dynamics in very good agreement with numerical predictions based on the nonlinear Schrödinger equation.

Validated methods for identifying individuals with obesity in health care administrative databases: A systematic review.

BACKGROUND: Health care administrative databases are increasingly used for health studies and public health surveillance. Cases of individuals with obesity are selected using case-identification methods. However, the validity of these methods is fragmentary and particularly challenging for obesity case identification. OBJECTIVE: The objectives of this systematic review are to (1) determine the case-identification methods used to identify individuals with obesity in health care administrative databases and (2) to summarize the validity of these case-identification methods when compared with a reference standard. METHODS: A systematic literature search was conducted in six bibliographic databases for the period January 1980 to June 2019 for all studies evaluating obesity case-identification methods compared with a reference standard. RESULTS: Seventeen articles met the inclusion criteria. International Classification of Diseases (ICD) codes were the only case-identification method utilized in selected articles. The performance of obesity-identification methods varied widely across studies, with positive predictive value ranging from 19% to 100% while sensitivity ranged from 3% to 92%. The sensitivity of these methods was usually low while the specificity was higher. CONCLUSION: When obesity is reported in health care administrative databases, it is usually correctly reported; however, obesity tends to be highly underreported in databases. Therefore, case-identification methods to monitor the prevalence and incidence of obesity within health care administrative databases are not reliable. In contrast, the use of these methods remains relevant for the selection of individuals with obesity for cohort studies, particularly when identifying cohorts of individuals with severe obesity or cohorts where obesity is associated with comorbidities.

The Elaboration of an Intersectoral Partnership to Perform Health Impact Assessment in Urban Planning: The Experience of Quebec City (Canada).

Health impact assessments (HIA) allow evaluation of urban interventions' potential effects on health and facilitate decision-making in the urban planning process. However, few municipalities have implemented this method in Canada. This paper presents the approach developed with partners, the process, and the outcomes of HIA implementation after seven years of interinstitutional collaborations in Quebec City (ten HIA). Using direct observation and meeting minutes, information includes: perceived role of each institution taking part in HIA beforehand, how the HIA process was implemented, if it was appreciated, and which outcomes were observed. The intersectoral interactions contributed to the development of a common language, which sped up the HIA process over time and fostered positive collaborations in unrelated projects. It was an effective tool to share concerns and responsibilities among independent institutions. This experience resulted in the creation of an informal group of stakeholders from four different institutions that perform HIA to this day in collaboration with researchers.

Neighbourhood effects on obesity: scoping review of time-varying outcomes and exposures in longitudinal designs.

CONTEXT AND OBJECTIVES: Neighbourhood effect research on obesity took off in the early 2000s and was composed of mostly cross-sectional observational studies interested in various characteristics of the built environment and the socioeconomic environment. To limit biases related to self-selection and life course exposures, many researchers apply longitudinal designs in their studies. Until now, no review has specifically and exclusively examined longitudinal studies and the specific designs of these studies. In this review, we intend to answer the following research question: how are the temporal measurements of contextual exposure and obesity outcomes integrated into longitudinal studies that explore how neighbourhood-level built and socioeconomic environments impact adult obesity? DESIGN: A systematic search strategy was designed to address the research question. The search was performed in Embase, Web of Science and PubMed, targeting scientific papers published before 1 January 2018. The eligible studies reported results on adults, included exposure that was limited to neighbourhood characteristics at the submunicipal level, included an outcome limited to obesity proxies, and reported a design with at least two exposure measurements or two outcome measurements. RESULTS: This scoping review identified 66 studies that fit the eligibility criteria. A wide variety of neighbourhood characteristics were also measured, making it difficult to draw general conclusions about associations between neighbourhood exposure and obesity. We applied a typology that classified studies by whether exposure and outcome were measured as varying or fixed. Using this typology, we found that 32 studies reported both neighbourhood exposure and obesity outcomes that were varying in time; 28 reported varying outcomes but fixed exposures; and 6 had fixed outcomes and varying exposures. CONCLUSION: Our typology illustrates the variety of longitudinal designs that were used in the selected studies. In the light of our results, we make recommendations on how to better report longitudinal designs and facilitate comparisons between studies.

Promoting meal planning through mass media: awareness of a nutrition campaign among Canadian parents.

OBJECTIVE: To evaluate awareness of the Eat Well Campaign (EWC) among parents and assess perceptions about its effectiveness. DESIGN: Post-campaign evaluation study with a cross-section of parents recruited through random digit dialling. Participants completed an online survey about EWC awareness, its perceived effectiveness among parents and their meal planning practices (attitudes, behaviours and self-efficacy). SETTING: A federal mass-media campaign disseminated by Health Canada (2013-2014) to promote meal planning to Canadian parents. PARTICIPANTS: Parents (n 964) of children aged 2-12 years from all Provinces and Territories. RESULTS: Of respondents, 41 % (390/964) were aware of the campaign; Quebec City and rural Quebec had the highest rates of awareness, whereas Vancouver, Winnipeg and Toronto had the lowest. Awareness was greater among parents with lower income, basic education and French-speakers. Campaign intensity was significantly associated with greater odds of reporting positive attitudes towards the EWC and meal planning (P < 0·05). Campaign awareness was significantly associated with greater odds of believing that meal planning helps maintain a healthy diet (OR = 1·68, 95 % CI 1·03, 2·74) and planning meals (OR = 1·66, 95 % CI 1·03, 2·54), but not self-efficacy, in adjusted models. CONCLUSIONS: The present study is the first to evaluate an initiative that promoted meal planning with mass media. The EWC demonstrated evidence of success in terms of equitable access to a nutrition initiative by reaching lower-income and less-educated parents. Understanding behavioural factors among different segments of the population will be important to target appropriate audiences and develop tailored interventions that support healthy eating practices.

Caractériser l'environnement alimentaire d'une municipalité régionale de comté pour identifier les zones prioritaires d'intervention en matière de sécurité alimentaire.

OBJECTIVES: Food security intervention is particularly complex in rural areas. The local stakeholders of the regional county municipality (RCM) of Portneuf wished to analyze the regional food supply in order to reduce food insecurity. The objective of this study was to characterize the RCM's food environment and to identify potential food deserts and priority intervention areas. METHOD: We measured the quality of the food supply in the RCM's food stores, using four indicators: freshness, diversity, economic accessibility and relative availability. We mapped the distance between residences and the nearest food store with a favourable result for all four indices to locate potential food deserts. We then presented the mapping of the food environment to a group of local stakeholders and compared it to their own perception. RESULTS: This study reveals three sectors that meet the criteria of a food desert in the RCM. Local actors did not perceive these sectors as food deserts, but thought they were at risk of becoming such in the future. We complemented the measures by taking into account the structuring impact of certain infrastructures as well as the temporal and seasonal accessibility of food stores in rural areas. Only one priority intervention area was suggested. CONCLUSION: Presenting geographical analyses to local stakeholders improved the characterization of the studied food environment. The use of a mixed methodology has enabled the particularities of the rural environment to be better accounted for and has facilitated intersectoral mobilization around food insecurity at the regional level.

Scoping review of the impacts of urban agriculture on the determinants of health.

BACKGROUND: There has been an increasing interest in urban agriculture (UA) practice and research in recent years. Scholars have already reported numerous beneficial and potential adverse impacts of UA on health-related outcomes. This scoping review aims to explore these impacts and identify knowledge gaps for future UA studies. METHODS: A systematic search was conducted in seven electronic bibliographic databases to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate, appraise the quality and make a narrative account of the findings. RESULTS: A total of 101 articles (51 quantitative, 29 qualitative, and 21 mixed methods studies) were included in our final analysis. Among these articles, 38 and 37% reported findings from North America and Sub-Saharan Africa respectively. Quantitative studies revealed evidence of positive impacts of UA on food security, nutrition outcomes, physical and mental health outcomes, and social capital. The qualitative studies reported a wide range of perceived benefits and motivations of UA. The most frequently reported benefits include contributions to social capital, food security, health and/or wellbeing. However, the evidence must be interpreted with caution since the quality of most of the studies was assessed as weak to moderate. While no definitive conclusions can be drawn about the adverse impacts of UA on health, paying particular attention to contamination of UA soil is recommended. CONCLUSION: More peer-reviewed studies are needed in areas where UA is practiced such as Latin America and Caribbean. The inconsistency and the lack of strong quality in the methodology of the included studies are proof that more rigorous studies are also needed in future research. Nevertheless, the substantial existing evidence from this review corroborate that UA can influence different determinants of health such as food security, social capital, health and well-being in a variety of contexts.

Individual Correlates of Sleep Among Childbearing Age Women in Canada.

Objective/Background: Women of childbearing age (WOCBA) may be at high risk for short or poor sleep. Yet few studies have focused on this population. The study objective was to identify individual correlates of sleep duration and quality among WOCBA. Participants: The sample consisted of 9,749 WOCBA aged 18-44 years from the Canadian Community Health Survey 2011-2014. Methods: All variables were self-reported. Sleep duration was dichotomized as insufficient (< 7 hr/night) or adequate (≥ 7 hr/night). A composite score of sleep quality was dichotomized as having sleeping problems none/little or some/most/all the time. Age, ethnicity, level of education, household income, mood disorders, parity, geographical location, fruit and vegetable (FV) intake, physical activity, smoking and alcohol consumption were tested as correlates of sleep duration or quality using hierarchical logistic regression. Results: Ethnicity, parity, geographical location and smoking were correlates of sleep duration; this model discriminated 56.9% of WOCBA. Ethnic minorities, WOCBA with many children, living in urban areas and smoking were associated with lower odds of having adequate sleep duration. Ethnicity, level of education, mood disorders, geographical location, FV intake, and alcohol consumption were correlates of sleep quality; this model discriminated 59.0% of WOCBA. Ethnic minorities, lower level of education, mood disorders, living in urban areas, low FV intake, and alcohol consumption were associated with lower odds of having quality sleep. Conclusions: Some WOCBA may be more at risk for short or poor sleep based on their demographics and health behaviors. This can be used to identify which WOCBA are most in need of sleep interventions.