The Physician Anesthesia Workforce in Canada From 1996 to 2018: A Longitudinal Analysis of Health Administrative Data.

BACKGROUND: A robust anesthesia workforce is essential to the provision of safe surgical, obstetrical, and critical care but information describing the physician anesthesia workforce and volume of clinical services delivered in Canada is limited. This study examines the Canadian physician anesthesia workforce, exploring trends in physician characteristics and activity levels over time. Practice patterns of specialist anesthesiologists and family physician anesthetists (FPAs) working in urban and rural communities were of particular interest. METHODS: Physicians who provided anesthesia care between 1996 and 2018 were identified using health administrative data from the Canadian Institute of Health Information (CIHI). In addition, data from the Canadian Post-MD Education Registry (CAPER) were used to characterize physicians pursuing postgraduate anesthesia training (1996-2019). Descriptive analyses of physician demographics, training, location, specialty designations, and volume of clinical services were undertaken. RESULTS: Between 1996 and 2018, the anesthesia workforce grew 1.8-fold to 3681 physicians, including 536 FPAs. Over the same time, nerve block services increased 7-fold, and payments for other anesthesia services increased 5-fold. The average age of the anesthesiology workforce increased by 2.3 years and the annual retirement rate was 3%. The workforce has become more gender balanced but remains predominantly male (73% in 2018). The proportion of physicians who were trained internationally (about 30%; 38% in rural areas) remained stable (and higher than that in the overall physician workforce). FPAs provided most anesthesia care in rural Canada and their attrition rate was generally 2- to 3-fold higher than specialists. Physicians in the rural anesthesia workforce provided anesthesia services more intensively over time. Relatively few FPAs who left the anesthesia workforce entered full retirement and they instead contributed other medical services to their communities. CONCLUSIONS: This study provides foundational information regarding anesthesia workforce capacity over a 22-year period, including insights into demographics, locations of practice, and clinical volumes. The results do not quantify the gap between service capacity and need; however, they support the need for a national workforce strategy to achieve equitable access to sustainable anesthesia services in Canada, particularly for rural communities.

Associations between screen time and cognitive development in preschoolers.

Objectives: To examine the cross-sectional associations between screen time and cognitive development in preschoolers. Methods: Participants were 97 preschoolers (36 to 60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or portable device was assessed using a parental questionnaire. Television time and video game time were summed to calculate total screen time. Adherence to the screen time recommendation (≤1 hour/day) of the Canadian 24-Hour Movement Guidelines was calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution of working memory, it was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory). Results: Screen time was not associated with expressive vocabulary. Preschoolers who had higher total screen time were less likely to have better working memory (OR=0.52; 95%CI:0.31, 0.88), despite the null associations for television time (P=0.155) and video game time (P=0.079). Preschoolers who met the screen time recommendation were more likely to have higher working memory capacity (OR=3.48; 95%CI:1.06, 11.47), compared to those who did not meet the recommendation. Conclusion: Limiting total screen time to no more than one hour per day may facilitate working memory development in preschoolers. Screen time may be unrelated to expressive language development in this age group.

The impact of new government childcare accreditation standards on children's in-care physical activity and sedentary time.

BACKGROUND: A new physical activity and sedentary behaviour accreditation standard criterion for childcare settings was introduced by the provincial government in Alberta, Canada. The primary objective of this study was to examine if changes for in-care physical activity and sedentary time (ST) differed between centres in and around Edmonton, Alberta after implementing the new accreditation standards and non-accredited control centres in and around Ottawa, Ontario. Secondary objectives were to examine whether baseline age group (toddler, preschooler) or the childcare environment moderated any group differences in change of the primary outcomes. Furthermore, accreditation and control group differences in change of children's body mass index (BMI) Z-scores or cognitive development as well as educators' perceptions of the primary outcomes were explored. METHODS: Participants were 252 toddlers (19-35 months) and preschoolers (36-60 months) in childcare centres from Alberta (n = 11) and Ontario (n = 8) in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care ST, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived before and 6 months after the implementation of the new standards. At both time points, cognitive development (working memory, expressive vocabulary), heights, and weights were measured, and BMI Z-scores were calculated. Additionally, the childcare environment was observed using the Environment and Policy Assessment and Observation (EPAO) and Movement Environment Rating Scale (MOVERS) tools. Demographic characteristics were parent-reported and weather variables were derived from Environment Canada data. Mixed models were conducted. RESULTS: In adjusted models (n = 241), change in children's in-care ST (B = -0.07, 95%CI: - 1.43,1.29), LPA (B = 0.08, 95%CI: - 0.89,1.05), and log-transformed MVPA (B = 0.01, 95%CI: - 0.09,0.11) were not significantly different between accreditation and control groups. Age group and the childcare environment were not moderators. Significant increases in BMI Z-score (B = 0.19, 95%CI: 0.03,0.35) and high working memory (OR = 3.24, 95%CI: 1.32,7.97) were observed in the accreditation group and significant increases in expressive vocabulary (B = 3.18, 95%CI: 0.05,6.30) were observed in the control group. CONCLUSIONS: The new accreditation criterion may not significantly change physical activity or ST in childcare settings and therefore may not explain findings for BMI Z-scores and cognitive development. Additional training and resources may be needed.

Evaluation of Afterschool Activity Programs' (ASAP) Effect on Children's Physical Activity, Physical Health, and Fundamental Movement Skills.

BACKGROUND: Physical literacy-focused afterschool activity programs (ASAPs) can be an effective strategy to improve children's health-related parameters. We sought to compare physical activity, body composition, aerobic capacity, and fundamental movement skills between physical literacy-focused ASAP and a standard recreational ASAP. METHOD: A pre-post (6 months) comparison study was conducted in 5- to 12-year-old children in a physical literacy-focused ASAP (physical literacy group, n = 14) and children attending a standard recreational ASAP (comparison group, n = 15). Physical activity guideline adherence was assessed using accelerometry, body composition was analyzed using bioelectrical impedance, aerobic capacity was estimated using the Progressive Aerobic Cardiovascular Endurance Run test, and fundamental movement skills were evaluated using the Test of Gross Motor Development-2. RESULTS: There were no significant differences between groups at baseline. After 6 months, the physical literacy group exhibited a significant improvement in their total raw score for the Test of Gross Motor Development-2 (p = .016), which was likely due to improvements in object control skills (p = .024). The comparison group significantly increased body mass index (p = .001) and body fat (p = .009) over time. No significant between-group differences were found; however, there was a trend for improved aerobic capacity in the physical literacy group (d = 0.58). CONCLUSIONS: Engagement in the physical literacy-focused ASAP contributed to an attenuated increase in adiposity and an improvement in object control skills.

Longitudinal Physiological and Fitness Evaluations in Elite Ice Hockey: A Systematic Review.

ABSTRACT: Chiarlitti, NA, Crozier, M, Insogna, JA, Reid, RER, and Delisle-Houde, P. Longitudinal physiological and fitness evaluations in elite ice hockey: A systematic review. J Strength Cond Res 35(10): 2963-2979, 2021-Ice hockey has greatly evolved since the last review article was published more than 25 years ago. Although players still combine anaerobic and aerobic conditioning, the pace of the game has greatly increased. Players are faster, stronger, and more agile than their predecessors; however, an important emphasis is now placed on maximizing player performance for the play-offs. For the coaching staff, strength and conditioning coaches, and players, an emphasis on mitigating fitness and physiologic losses throughout the season would be beneficial, given the intimate relationship they share with on-ice performance. This systematic review of the literature outlines the current knowledge concerning longitudinal changes in relation to fitness, body composition, and physiologic parameters across an elite hockey season. The search of 4 large scientific databases (i.e., Embase, PubMed, SPORTDiscus, and Web of Science) yielded 4,049 items, which, after removing duplicates and applying inclusion and exclusion criteria, resulted in 23 published scientific articles to be included in this review. The wide span of literature (1956-2020) made inferences difficult giving the degree to which the game of ice hockey has changed; however, more recent research points to an aerobic deconditioning pattern and increased fatigue throughout the season in a specific group of elite hockey players (i.e., university athletes) while showing that ice hockey can lead to many possible histological adaptations. Ultimately, tracking, identifying, and developing methods to mitigate potential negative longitudinal changes will be imperative to influencing individual and team performance in the later parts of the season.

Associations between sleep duration, adiposity indicators, and cognitive development in young children.

OBJECTIVE: This study aimed to examine the associations between sleep duration, adiposity indicators, and cognitive development in young children. METHODS: Participants were 217 children aged 19-60 months in Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. Nap duration and nighttime sleep duration were assessed using a parent questionnaire and were summed up as total sleep duration. Body mass index (BMI) z-scores and weight status were determined using the World Health Organization growth standards. Expressive vocabulary and working memory were assessed using the Early Years Toolbox in preschoolers only (36-60 months; n = 101). Mixed models (BMI z-score, expressive vocabulary) and generalized mixed models (weight status, working memory) were conducted. RESULTS: A linear association between total sleep duration and BMI z-score (B = -0.12; 95% CI: -0.23, -0.01) were observed. Compared to children having nighttime sleep within ±1SD (9.13-11.13 h/d) of the mean, those having shorter nighttime sleep had higher BMI z-scores (B = 0.39; 95% CI: 0.06, 0.73) and an increased risk of being overweight (OR = 4.54; 95% CI: 1.39, 14.81). Nap duration was not associated with adiposity indicators. In preschoolers, sleep duration was not associated with expressive vocabulary. Total sleep duration and nap duration were not associated with working memory. However, non-nappers were more likely to have greater working memory (OR = 4.04; 95% CI: 1.09, 14.92) compared to those having nap duration within ±1SD (0.46-2.18 h/d) of the mean. CONCLUSION: Promoting longer total sleep, including more than nine hours of nighttime sleep, appears important for maintaining healthy adiposity levels in young children. Cessation of napping may be associated with better working memory in preschoolers.

Longitudinal correlates of sleep duration in young children.

OBJECTIVE: The primary aim of this study was to longitudinally examine potential demographic and screen time correlates of nap duration, nighttime sleep duration, and total sleep duration in young children over two time points. METHODS: Data from the supporting Healthy physical AcTive Childcare setting (HATCH) study were analyzed. Participants were 206 toddlers (19-35 months) and preschoolers (36-60 months) in Alberta and Ontario, Canada. Child age, screen time (television, video games), and sleep duration (nap, nighttime) were measured at baseline and six-month follow-up, while other demographic variables were assessed at baseline only using the HATCH parental questionnaire. Mixed models were performed to examine the associations between potential correlates and sleep duration over time. RESULTS: In the multiple regression models, significant correlates of total sleep duration (min/d) were child age (months; B = -3.03; 95%CI:-3.88,-2.19) and parental education (bachelor's degree vs. below bachelor level; B = 29.74, 95%CI:7.43,52.06). Significant correlates of nighttime sleep duration (min/d) included child age (B = -0.81; 95CI%:-1.53,-0.10), child race/ethnicity (Caucasian vs. non-Caucasian; B = 15.31; 95%CI:0.38,30.25), household income (>$150,000 vs. <$50,000; B = 32.93, 95%CI:9.80,56.06), television time (B = -0.19, 95%CI:-0.32,-0.05), video games time (B = -0.19, 95%CI: -0.38, -0.01) and total screen time (B = -0.19; 95%CI:-0.29,-0.08). Significant correlates of nap duration (min/d) were child age (B = -2.10; 95%CI:-2.68,-1.51) and race/ethnicity (Caucasian vs. non-Caucasian; B = -13.73; 95%CI:-25.78,-1.68). CONCLUSION: Young children who were non-Caucasian, from lower income families, who had less-educated parents, or who had more screen time tended to have shorter sleep duration. Targeting these demographic groups and screen time appears important for promoting adequate sleep duration in early childhood.

Associations Between the Child Care Environment and Children's In-Care Physical Activity and Sedentary Time.

BACKGROUND: Child care centers are important for children's behaviors. AIMS: To examine the cross-sectional associations between child care environmental characteristics and physical activity and sedentary time in children. METHODS: Participants were 124 toddlers and 118 preschoolers from 19 centers in Alberta and Ontario, Canada, in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care physical activity and sedentary time were assessed using Actigraph accelerometers. Child care environments, including structure (e.g., resources) and process (e.g., activities) quality, were measured using three instruments: (1) the Environment and Policy Assessment and Observation and (2) the Children's Physical Environments Rating Scale, and (iii) the Movement Environment Rating Scale. Mixed models were performed to examine the associations between environmental characteristics and children's sedentary time, light physical activity, and moderate-to-vigorous physical activity. RESULTS: A few structure quality characteristics related to child care policy and indoor environment were associated with higher physical activity and lower sedentary time in toddlers. The overall structure quality (B = 0.04; 95% CI [0.003, 0.08]) and process quality (B = 0.08; 95% CI [0.02, 0.15]) of the child care environment were associated with log moderate-to-vigorous physical activity in preschoolers. Specifically, structure quality characteristics of the outdoor environment and physical activity time, and process quality characteristics relevant to curriculum and pedagogy, were associated with higher physical activity and lower sedentary time in preschoolers. DISCUSSION AND CONCLUSION: The child care structure quality characteristics that are important for children' physical activity and sedentary behavior may vary by age group. Improving the overall process quality, in particular curriculum and pedagogy, of the child care environment, may promote more physical activity in preschoolers.

Sedentary Time and Physical Activity Associations Between Child Care Educators and Children.

INTRODUCTION: This study examines the associations between objectively measured sedentary time and physical activity among child care educators and children in their direct care and aims to determine if the associations differed between toddlers (aged 19-35 months) and preschoolers (aged 36-60 months). METHODS: The participants were educators and children from 19 child care centers in Edmonton and Ottawa, Canada, as part of the Supporting Healthy Active Child Care Settings study. Sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity during child care were measured with accelerometers in 2017-2018. Nap time data were removed for children and educators based on room schedules. Children were matched with the main educator in their room that had the highest total physical activity, resulting in 187 children and 38 educators. Multilevel linear regression models with interaction terms were conducted in 2019. RESULTS: Children engaged in 30.0, 23.1, and 6.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. Educators engaged in 33.5, 23.6, and 2.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. No significant interactions were observed, so age-stratified analyses were not conducted. Each additional 5 minutes per hour of educator sedentary time was significantly associated with 0.5 minutes per hour lower child moderate to vigorous-intensity physical activity. Each additional 5 minutes per hour of educator moderate to vigorous-intensity physical activity was significantly associated with 1.3 minutes per hour higher child moderate to vigorous-intensity physical activity. No other significant observations were observed. CONCLUSIONS: The educators' sedentary time and moderate to vigorous-intensity physical activity may have a small but potentially meaningful influence on children's moderate to vigorous-intensity physical activity because educators directly care for multiple children. Targeting these educator behaviors may be one strategy to increase children's moderate to vigorous-intensity physical activity during child care.