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.

Do schools in Quebec foster healthy eating? An overview of associations between school food environment and socio-economic characteristics.

OBJECTIVE: A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The present study explored the associations between the socio-economic characteristics of the school environment and the school food environment. DESIGN: A cross-sectional survey was conducted in 2008-2009. Descriptive and bivariate analyses were performed on data from public primary and secondary schools. SETTING: Quebec, Canada. The school food offering was observed directly and systematically by trained research assistants. Interviews were conducted to fully describe food offerings in the schools and schools' child-care services. SUBJECTS: A two-stage stratified sampling was used to build a representative sample of 143 French-speaking public schools. The response rate was 66.2%. RESULTS: The primary and secondary schools in low-density areas were more likely to be located near diners (primary: P=0.018; secondary: P=0.007). The secondary schools in deprived areas were less likely to have a regular food committee (P=0.004), to seek student input on menu choices (P=0.001) or to have a long lunch period (P=0.010). The primary schools in deprived areas were less likely to have a food service (P=0.025) and their meal periods were shorter (P=0.033). CONCLUSIONS: The schools in areas with lower socio-economic status provided an environment less favourable for a healthy diet. From a public health perspective, the results of this analysis could assist policy makers and managers to identify actions to support the creation of favourable school environments.

A budget impact analysis comparing a Hydrofiber® ; dressing to an alginate dressing in managing exuding venous leg ulcers in France.

An Excel model was developed to compare total costs (including primary and secondary dressings only) of Hydrofiber(®) ; dressing (2010 branded price) versus an alginate dressing (generic or branded price) in managing exuding venous leg ulcers considering mean wear time and mean duration of exudate management phase, from the French Social Security perspective over 5 years (2011-2015). Budget impact (based on prevalence of venous leg ulcers in France) was estimated as the difference between scenario 1 (Hydrofiber(®) ; versus alginate dressing usage proportion increasing slightly per year) and Scenario2 (proportion remaining at 2010 levels). Annual costs and net savings per patient for the dressings were calculated in analyses 1 and 2. Analysis 1 (28-day mean exudate management phase for both Hydrofiber(®) ; and alginate dressing groups): total costs 66·82€ Hydrofiber(®) ;, 70·08€ generic alginate, 77·0€ branded alginate; net savings 3·26€ and 10·18€ for Hydrofiber(®) ; versus generic and branded alginate. Analysis 2 (mean exudate management phase of 22·2 versus 28 days for Hydrofiber(®) ; versus alginate): total costs 52·92€, 70·08€ and 77·0€, and net savings 17·10€ and 24·02€, accordingly. Total cost savings (budget impact scenario 1 minus scenario 2): Analysis 1 - 223 107€ and 696 304€ for Hydrofiber(®) ; versus generic and branded alginate dressings, respectively; Analysis 2 - 1 169 845€ and 1 643 042€ accordingly. Sensitivity analyses indicated that results are reliable. This conservative analysis shows that effective exudate management using Hydrofiber(®) ; dressing can produce sizeable cost savings.

Association between perceived self-efficacy related to meal management and food coping strategies among working parents with preschool children.

OBJECTIVE: This study assessed the associations between the perception of self-efficacy related to meal management and food coping strategies among working parents with preschool children. METHODS: In this cross-sectional study, 417 working parents with at least one child between the ages of 2 and 5 years completed a self-administered questionnaire. The association between perceived self-efficacy related to meal management and food coping strategies referred to as home-based or "away from home" food strategies, and was verified with logistic regression analysis. RESULTS: High self-efficacy among working parents was associated with planning a menu for the upcoming week (OR=1.171-1.959), preparation of healthy meals with only few ingredients on hand (OR=1.152-1.495), and preparation of meals in advance (OR=1.131-1.364), which are home-based food strategies. Low self-efficacy was linked to adoption of «away from home¼ food strategies such as eating in fast-food restaurants (OR=0.713-0.898). CONCLUSION: self-efficacy related to meal management stands out as one of the priority consideration in planning nutrition interventions targeting working parents. Actions related to acquiring cooking skills, planning menus, and drawing up grocery lists would also be of value.

Perceptions of employed parents about early childhood obesity and the need for prevention strategies.

Responses to the increased prevalence of childhood obesity are merging, and employed parents will become targets for strategies designed to prevent childhood obesity. This study aimed at describing their perceptions of employed parents about childhood obesity and determining which prevention strategies they would need the most. In this cross-sectional study, 504 employed parents were recruited from 33 child care centers in Sherbrooke (Quebec, Canada) who completed a self-administered questionnaire on their perceptions about childhood obesity and the need for prevention strategies. Logistic regression was used to explore differences in needs for prevention strategies according to participant characteristics. Most participants were female, aged 32.9 ± 4.9 years, and perceived childhood obesity was an important problem. The prevention strategies that seemed most needed were the implementation of (a) physical and nutrition education programs in child care settings and (b) measures that give employed parents more time to cook for and be physically active with their children. Support for specific strategies differed across genders and education levels. Moreover, they depended on the perceived relationship between work and meal preparation. Policy makers should be aware of the needs of employed parents to develop policies that would have the greatest likelihood of success in this population.

Why and how can we improve patient and caregiver information for the proper use of their medical devices throughout the care pathway?

Information is generally a major pillar in the relationship of trust between the patient and their healthcare team. In the case of medical devices, which are operator-dependent and for which the proper "handling" of the device will directly affect its performance, information on the proper use becomes a major therapeutic issue. To do this, patients must have access to quality information about health products. Twenty years after the Kouchner Act introduced a right to information for patients, our panel questioned the quality of information provided to patients about the medical devices they use during their care pathway. We mapped off the information process throughout the life of the medical device (manufacturer, prescription, dispensing, use and monitoring) to identify deficiencies and potential corrective solutions. Thus, the device could respond to the 5B as for the drug (right device, right patient, right indication, right time, and right use). Seven recommendations have emerged and are proposed in this article.

[Food environment in childcare settings in Quebec: results from a descriptive study]. / L'environnement alimentaire dans les milieux de garde au Québec : résultats d'une étude descriptive.

PURPOSE: The goal of this study was to describe different components of the food environment in childcare settings. METHODS: Visits were made to 33 early childcare centres (CPEs) in the Estrie region of Quebec, Canada. Data were collected between March and July 2008 using a questionnaire based on the Cohen model. The goal of the questionnaire was to collect information about meal organization, menu composition and food preparation methods. RESULTS: Although few CPEs had adopted a food policy, descriptive analyses showed that the food environment in these settings was generally adequate. In 97% of the CPEs, menu planning was performed by the food technician. The meals offered as well as the food preparation methods employed were consistent with the general guidelines of Canada's Food Guide (CFG). However, a lack of professional training was observed. Furthermore, only 25% of the CPEs offered a snack made up of two food groups. CONCLUSIONS: Certain improvements must be made to the food environment in Quebec childcare settings, which underscoresthe need to create and implement a food policy for childcare centres.

The Impact of the COVID-19 Pandemic on the Anxiety of Adolescents in Québec.

Background: Several studies conducted since the beginning of the COVID-19 pandemic have shown its harmful effects on young people's mental health. In Québec and Canada, few studies have focussed on adolescents, and even fewer of these studies have examined this subject using a methodology that involved comparisons of data obtained before and during the pandemic, which is the purpose of this study. Objective: The objective of this study is to determine the impact of the COVID-19 pandemic on the anxiety of secondary 1 and 2 students in Québec, using data obtained before and during the pandemic. Method: Participants were 2990 French Canadian students in secondary 1 (grade 7) and secondary 2 (grade 8) in Québec. Two independent samples completed the questionnaires, one sample before the pandemic (fall 2019) and one sample during the pandemic (fall 2020). Their answers were subjected to descriptive analysis and multivariate analysis of variance. Results: Results show that the pandemic has had variable impacts on the student's mental health, with some of them reporting negative effects on their lives, others reporting no effect, and some reporting positive effect. However, the students surveyed during the pandemic generally reported more symptoms of generalized anxiety, and higher levels of test anxiety, fear of judgment and perfectionism than the ones surveyed before the pandemic. Conclusions: The discussion puts forward possible explanations for the results obtained, which contribute to a better understanding of young adolescents' experience during the COVID-19 pandemic. It also discusses the importance of developing interventions for adolescents affected by this pandemic.

Empowerment interventions, knowledge translation and exchange: perspectives of home care professionals, clients and caregivers.

BACKGROUND: Few studies have examined empowerment interventions as they actually unfold in home care in the context of chronic health problems. This study aims to document the empowerment process as it plays out in interventions with adults receiving home care services. METHODS/DESIGN: The qualitative design chosen is a fourth generation evaluation combined with case studies. A home care team of a health and social services center situated in the Eastern Townships (Québec, Canada) will be involved at every step in the study. A sample will be formed of 15 health care professionals and 30 of their home care clients and caregiver. Semi-structured interviews, observations of home care interventions and socio-demographic questionnaires will be used to collect the data. Nine instruments used by the team in prior studies will be adapted and reviewed. A personal log will document the observers' perspectives in order to foster objectivity and the focus on the intervention. The in-depth qualitative analysis of the data will illustrate profiles of enabling interventions and individual empowerment. DISCUSSION: The ongoing process to transform the health care and social services network creates a growing need to examine intervention practices of health care professionals working with clients receiving home care services. This study will provide the opportunity to examine how the intervention process plays out in real-life situations and how health care professionals, clients and caregivers experience it. The intervention process and individual empowerment examined in this study will enhance the growing body of knowledge about empowerment.

[Multivitamin supplement for primary prevention of birth defects: application of a preventive clinical practice]. / Prise de suppléments multivitaminiques pour la prévention primaire des anomalies congénitalies: application d'une pratique clinique préventive.

OBJECTIVE: To determine whether the recommendations health care professionals make to women of childbearing age on the importance of taking folic acid encourage these women to take folic acid supplements. DESIGN: Survey. SETTING: The Centre de santé et de services sociaux at the Institut universitaire de gériatrie de Sherbrooke in Sherbrooke, Que. PARTICIPANTS: A total of 323 Francophone women 18 to 45 years old. MAIN OUTCOME MEASURES: Whether or not women had consumed vitamin and mineral supplements during the past year. Descriptive, bivariate statistical analyses and logistic regression modeling were carried out to determine whether the association between health care professionals' recommendations and the consumption of vitamin and mineral supplements persisted after controlling for certain variables (consulting documentation, knowledge, sources of information, perception, age, education, income, marital status, and plans to become pregnant). RESULTS: About 41% of the women reported that their physicians had recommended that they take vitamin and mineral supplements. After adjusting for all the variables in the model, it became clear that there was a significant association between the recommendations of healthcare professionals and the consumption of vitamins and minerals by women of childbearing age. CONCLUSION: Health care professionals can improve the health of the population through preventive clinical practices. It is important that we support them in their efforts to integrate and apply scientific knowledge in their practice.

Food Reluctance of Preschool Children Attending Daycare Centers Is Associated with a Lower Body Mass Index.

BACKGROUND: Food reluctance can present as fussiness, picky eating, slowness in eating, and high satiety responsiveness. It can be associated with inadequate weight gain during early childhood. Although a majority of preschoolers attend daycare centers, associations between their eating behaviors at daycare and their body composition have not been studied. OBJECTIVE: Our aim was to develop an estimate of food reluctance and to assess the relationship between food reluctance at daycare and body mass index (BMI) and waist circumference of preschoolers. DESIGN: We conducted a cross-sectional secondary analyses. Food reluctance was estimated using weighted digital plate waste analysis. Intra-rater, inter-rater, and test-retest reliability and convergent validity of the food reluctance score were tested. The food reluctance score was then compared to preschool children's BMI and waist circumference. PARTICIPANTS/SETTING: Participants included 309 children aged 3 to 5 years in 24 daycare centers across the Canadian province of New Brunswick. MAIN OUTCOME MEASURES: Preschool children's waist circumference and age-adjusted BMI derived from objectively measured height and weight were analyzed. STATISTICAL ANALYSES PERFORMED: Intraclass correlations were used to determine the reliability of the new estimate. Spearman correlation was used to compare the estimate with parental report of food reluctance. Multivariate linear regressions were used to examine the relationship between food reluctance and waist circumference and age-adjusted BMI. RESULTS: The estimated food reluctance score demonstrated excellent inter- and intra-rater reliability (intraclass correlation>0.97; P<0.0001) and good test-retest reliability (intraclass correlation=0.72; P<0.0001). It also provided evidence of convergent validity through correlation with reluctance-related subscales of the Child Eating Behavior Questionnaire (ρ=.53, P<0.0001). Greater demonstration of food reluctance at the daycare center was associated with a lower age-adjusted BMI (adjusted ß -1.41; 95% CI -.15 to -2.67), but was not associated with children's waist circumference (adjusted ß -.60; 95% CI -2.06 to .86). CONCLUSIONS: Signs of food reluctance can be observed in daycare and relate to lower BMI among preschoolers.

Socioeconomic Factors Influence Physical Activity and Sport in Quebec Schools.

BACKGROUND: School environments providing a wide selection of physical activities and sufficient facilities are both essential and formative to ensure young people adopt active lifestyles. We describe the association between school opportunities for physical activity and socioeconomic factors measured by low-income cutoff index, school size (number of students), and neighborhood population density. METHODS: A cross-sectional survey using a 2-stage stratified sampling method built a representative sample of 143 French-speaking public schools in Quebec, Canada. Self-administered questionnaires collected data describing the physical activities offered and schools' sports facilities. Descriptive and bivariate analyses were performed separately for primary and secondary schools. RESULTS: In primary schools, school size was positively associated with more intramural and extracurricular activities, more diverse interior facilities, and activities promoting active transportation. Low-income primary schools were more likely to offer a single gym. Low-income secondary schools offered lower diversity of intramural activities and fewer exterior sporting facilities. High-income secondary schools with a large school size provided a greater number of opportunities, larger infrastructures, and a wider selection of physical activities than smaller low-income schools. CONCLUSIONS: Results reveal an overall positive association between school availability of physical and sport activity and socioeconomic factors.

Sugar Sweetened Beverage Consumption among Primary School Students: Influence of the Schools' Vicinity.

The purpose of the research was to explore the associations between the characteristics of schools' vicinity and the risk of sugar sweetened beverage (SSB) consumption in elementary students. Findings exposed an important variation in student's SSB consumption between schools. Schools with a lower socioeconomic status or in a densely built environment tend to have higher proportion of regular SSB drinkers. These characteristics of the school's vicinity partly explained the variation observed between them. We estimated that a student moving to a school with a higher proportion of SSB drinkers may increase his/her chances by 52% of becoming a daily consumer. Important changes in dietary preferences can occur when children are in contact with a new social environment. Findings also support the idea that dietary behaviors among children result from the complex interactions between biological, social, and environmental factors.

Pregnancy planning: a determinant of folic acid supplements use for the primary prevention of neural tube defects.

OBJECTIVE: Daily consumption of supplements containing 400 micrograms of folic acid in the periconception period may reduce the risk of neural tube defects (NTDs) by as much as 70%. However, despite explicit recommendations, folic acid consumption among women likely to become pregnant remains low. The objectives of this study were: to evaluate women's knowledge and beliefs with regard to folic acid; to estimate the frequency of vitamin supplement consumption; and to identify its determinants during the periconception period. METHODS: In 1999-2000, a questionnaire was completed by 1,240 pregnant women in 10 Quebec hospitals. RESULTS: Seventy percent of the respondents were aware of the preventive role of folic acid but only 25% had taken the recommended dose of supplements during the periconception period. Supplement consumption is associated with the pregnancy planning intensity score (OR: 1.06; 95% CI: 1.02-1.11), knowledge score (OR: 1.11; 95% CI: 1.07-1.16) and belief in the usefulness of supplements (OR: 1.56; 95% CI: 1.02-2.39). CONCLUSION: These results indicate that further efforts are needed to inform the population and promote the optimal use of folic acid supplements.

Relationship between eating behaviors and physical activity among primary and secondary school students: results of a cross-sectional study.

BACKGROUND: With a view toward developing concerted efforts in fostering healthy eating habits and a physically active lifestyle among young people, a study was carried out to explore associations between eating behavior and physical activity (PA). METHODS: In the school district, questionnaires were completed at home by parents of primary school children (N = 8612) and by secondary school youth (N = 5250) during a break in the schedule. The rates of response were 79% and 83%, respectively. Inferential and descriptive analyses were performed. RESULTS: The results indicate significant differences between the eating behaviors of young people who engage in 60 minutes of daily PA and those who are sedentary. The physically active children were generally more likely to eat fruit, vegetables, and whole-grain products and to have breakfast (p < .05 among high-school students). The lack of self-confidence (55%) and not enjoying PA (46%) stood out as the greatest obstacles facing adolescents trying to lose weight. CONCLUSION: There should be particular actions targeting students in the last half of primary school aimed at developing individual accountability and autonomy with respect to healthy eating and PA. These actions should also consider sex differences and those who have more sedentary lifestyles.

Foods offered in Quebec school cafeterias: do they promote healthy eating habits? Results of a provincial survey.

OBJECTIVE: A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The aim of this paper is to describe the food offered for lunch in the cafeteria service lines in Quebec schools on regular school days. METHODS: A cross-sectional survey was conducted between November 2008 and June 2009 with a representative sample of 207 French-speaking schools in the province of Quebec. The response rate was 71%. The cafeteria food available from the service line was observed directly and systematically by research assistants trained in observational procedures. Bivariate and descriptive analyses were performed. RESULTS: While most schools offered a vegetable side dish, only 71% of primary schools, 71% of public secondary schools, and 54% of private secondary schools did not offer cold-cut dishes, stuffed pastry, or a fried food on their daily menus. The sandwiches available were rarely made with whole-grain bread. Public secondary schools had more cookies, biscuits, muffins, and chewing gum than private primary and secondary schools. Milk was available in 85% of the primary schools. Most of the schools had eliminated sodas but were still offering fruit cocktails instead of 100% fruit juice. CONCLUSION: The school eating environment changed significantly from 2002 to 2009, presumably as a result of the government action plan and the Framework Policy. Improvements must be made with respect to reducing added sugar in beverages and desserts and promoting baked rather than fried snacks. Vigilance is required since many new products are making their way into the market.

Trend in prevalence of neural tube defects in Quebec.

BACKGROUND: In Canada, the first recommendations on the use of folic acid (FA) supplements by women planning a pregnancy or capable of becoming pregnant were issued in 1993. In 1998, fortification of flour with FA became mandatory. The objective of this study was to assess the impact of these measures on the prevalence of neural tube defects (NTDs) in the province of Quebec. METHODS: The study population included stillbirths, live births, and elective terminations for fetal malformations that were reported in 1992-2000 for women residing in the province of Quebec. NTD cases were identified from stillbirth certificates and hospital discharge summaries. RESULTS: There was a marked decrease in the total NTD rate after 1997. The average NTD rate was 1.89 per 1000 total births during the period of 1992-1997, and 1.28 per 1000 in 1998-2000, a 32% reduction (p < 0.001). CONCLUSIONS: Fortification of flour, which began in early 1997 and gradually became widespread, is a very plausible explanation for the timing, shape, and magnitude of the decrease in NTD prevalence observed in Quebec and other Canadian provinces. An increase in FA supplement use may have played only a minor role. Birth Defects Research (Part A) 67:000-000, 2003.

Measuring the intensity of pregnancy planning effort.

This study validated a measure of pregnancy planning effort based on Miller's conceptual framework in two clinical settings. The questionnaire's main items deal with general behaviour with regard to pregnancy, timing and proception (proception being the reverse of contraception). Values for these three items are added to yield a continuous score ranging from 0 to 12. The study population comprised 448 women of different cultural backgrounds recruited in prenatal, fertility and family planning clinics in Quebec and North Carolina. The results indicate that the internal consistency between the three items pertaining to pregnancy planning was excellent (Cronbach's alpha of 0.83). Test-retest reliability after a 4-week interval was excellent, with an intraclass correlation coefficient of 0.86 for the planning score. The planning score median for women attending family planning clinics (1.00) was significantly lower than that for those recruited in fertility clinics (11.00), confirming the discriminant ability of the instrument. Path analysis shows that the conceptual model corroborates the observed data and explains 53% of the pregnancy planning variability. In conclusion, this is the first questionnaire specifically designed to assess the intensity of pregnancy planning effort, a potentially important variable in epidemiological studies and clinical practice.

Pregnancy planning and folic acid supplement use: results from a survey in Quebec.

BACKGROUND: To decrease the risk of neural tube defects, all women planning pregnancy or capable of becoming pregnant should take folic acid supplements. The aim of the study was to describe the association between pregnancy planning and vitamin supplement use. METHODS: A total of 1,858 pregnant women registered for a prenatal ultrasound examination in the Montérégie region, Province of Quebec, Canada, completed a questionnaire between November 1997 and May 1998. Pregnancy planning was described by six ordinal variables, which were included in a nonlinear principal component analysis. The main dimension representing the intensity of pregnancy planning was used as the dependent variable in a multivariate linear regression model, and as a basis for assessing vitamin use according to four levels of planning. RESULTS: A majority of women scored high for intensity of pregnancy planning. Planning intensity score increased with age and was higher among women who attended university, had a family income greater than CAD $30,000, and were married. Vitamin use in the period prior to conception occurred with a frequency of 27.5%, increasing moderately with planning intensity scores. Overall, only 13.5% of fetuses were exposed to adequate doses of folic acid. CONCLUSION: A promotion campaign selectively targeting women likely to plan a pregnancy could have a significant impact in reducing neural tube defect incidence.