A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline.

This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists' Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.

RéSUMé: Ces Lignes directrices de pratique clinique 2023 Lignes directrices de pratique clinique dicale du décès basée sur l'arrêt permanent de la fonction cérébrale qui s'applique à toute personne, ainsi que des recommandations pour la détermination du décès par des critères circulatoires pour des donneurs d'organes potentiels et des recommandations pour la détermination du décès par des critères neurologiques pour tous les patients sous ventilation mécanique, indépendamment de leur potentiel de donneur d'organes. Les présentes Lignes directrices sont approuvées par la Société canadienne de soins intensifs, l'Association médicale canadienne, l'Association canadienne des infirmiers/infirmières en soins intensifs, la Société canadienne des anesthésiologistes, la Fédération des sciences neurologiques du Canada (représentant la Société canadienne de neurologie, la Société canadienne de neurochirurgie, la Société canadienne de neurophysiologie clinique, l'Association canadienne de neurologie pédiatrique, la Société canadienne de neuroradiologie et le Consortium neurovasculaire canadien), la Société canadienne du sang, le Programme de recherche en don et transplantation du Canada, l'Association canadienne des médecins d'urgence, l'Association des infirmières et infirmiers praticiens du Canada, et la Société canadienne de soins intensifs cardiovasculaires (CANCARE) et la Société canadienne de pédiatrie.

Organ Donation at the End of Life: Experiences From the 3 Wishes Project.

PURPOSE: The 3 Wishes Project (3WP) promotes holistic end-of-life care in the intensive care unit (ICU) to honor dying patients, support families, and encourage clinician compassion. Organ donation is a wish that is sometimes made by, or on behalf of, critically ill patients. Our objective was to describe the interface between the 3WP and organ donation as experienced by families, clinicians, and organ donation coordinators. METHODS: In a multicenter evaluation of the 3WP in 4 Canadian ICUs, we conducted a thematic analysis of transcripts from interviews and focus groups with clinicians, organ donation coordinators, and families of dying or died patients for whom donation was considered. RESULTS: We analyzed transcripts from 26 interviews and 2 focus groups with 18 family members, 17 clinicians, and 6 organ donation coordinators. The central theme describes the mutual goals of the 3WP and organ donation-emphasizing personhood and agency across the temporal continuum of care. During family decision-making, conversations encouraged by the 3WP can facilitate preliminary discussions about donation. During preparation for donation, memory-making activities supported by the 3WP redirect focus toward personhood. During postmortem family care, the 3WP supports families, including when donation is unsuccessful, and highlights aspirational pursuits of donation while encouraging reflections on other fulfilled wishes. CONCLUSIONS: Organ donation and the 3WP provide complementary opportunities to engage in value-based conversations during the dying process. The shared values of these programs may help to incorporate organ donation and death into a person's life narrative and incorporate new life into a person's death narrative.

Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project.

Background: The 3 Wishes Project (3WP) is an end-of-life program that aims to honor the dignity of dying patients by creating meaningful patient- and family-centered memories while promoting humanistic interprofessional care. Objective: To determine whether this palliative intervention could be successfully implemented-defined as demonstrating value, transferability, affordability, and sustainability-beyond the intensive care unit in which it was created. Design: Mixed-methods formative program evaluation. (ClinicalTrials.gov: NCT04147169). Setting: 4 North American intensive care units. Participants: Dying patients, their families, clinicians, hospital managers, and administrators. Intervention: Wishes from dying patients, family members, and clinicians were elicited and implemented. Measurements: Patient characteristics and processes of care; the number, type, and cost of each wish; and semistructured interviews and focus groups with family members, clinicians, and managers. Results: A total of 730 patients were enrolled, and 3407 wishes were elicited. Qualitative data were gathered from 75 family members, 72 clinicians, and 20 managers or hospital administrators. Value included intentional comforting of families as they honored the lives and legacies of their loved ones while inspiring compassionate clinical care. Factors promoting transferability included family appreciation and a collaborative intensive care unit culture committed to dignity-conserving end-of-life care. Staff participation evolved from passive support to professional agency. Program initiation required minimal investment for reusable materials; thereafter, the mean cost was $5.19 (SD, $17.14) per wish. Sustainability was demonstrated by the continuation of 3WP at each site after study completion. Limitation: This descriptive formative evaluation describes tertiary care center-specific experiences rather than aiming for generalizability to all jurisdictions. Conclusion: The 3WP is a transferrable, affordable, and sustainable program that provides value to dying patients, their families, clinicians, and institutions. Primary Funding Source: Greenwall Foundation.

Building organizational compassion among teams delivering end-of-life care in the intensive care unit: The 3 Wishes Project.

BACKGROUND: The 3 Wishes Project is a semistructured program that improves the quality of care for patients dying in the intensive care unit by eliciting and implementing wishes. This simple intervention honors the legacy of patients and eases family grief, forging human connections between family members and clinicians. AIM: To examine how the 3 Wishes Project enables collective patterns of compassion between patients, families, clinicians, and managerial leaders in the intensive care unit. DESIGN: Using a qualitative descriptive approach, interviews and focus groups were used to collect data from family members of dying patients, clinicians, and institutional leaders. Unconstrained directed qualitative content analysis was performed using Organizational Compassion as the analytic framework. SETTING/PARTICIPANTS: Four North American intensive care units, participants were 74 family members of dying patients, 72 frontline clinicians, and 20 managerial leaders. RESULTS: The policies and processes of the 3 Wishes Project exemplify organizational compassion by supporting individuals in the intensive care unit to collectively notice, feel, and respond to suffering. As an intervention that enables and empowers clinicians to engage in acts of kindness to enhance end-of-life care, the 3 Wishes Project is particularly well situated to encourage collective responses to suffering and promote compassion between patients, family members, and clinicians. CONCLUSIONS: Examining the 3 Wishes Project through the lens of organizational compassion reveals the potential of this program to cultivate the capacity for people to collectively notice, feel, and respond to suffering. Our data document multidirectional demonstrations of compassion between clinicians and family members, forging the type of human connections that may foster resilience.

Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations.

BACKGROUND: The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The purpose of the current study is to describe the variation in implementation of 3WP across sites, in order to ascertain which factors facilitated multicenter implementation, which factors remain consistent across sites, and which may be adapted to suit local needs. METHODS: Using the methodology of qualitative description, we collected interview and focus group data from 85 clinicians who participated in the successful initiation and sustainment of 3WP in 9 ICUs. We describe the transition between different models of 3WP implementation, from core clinical program to the incorporation of various research activities. We describe various sources of financial and in-kind resources accessed to support the program. RESULTS: Beyond sharing a common goal of improving end-of-life care, sites varied considerably in organizational context, staff complement, and resources. Despite these differences, the program was successfully implemented at each site and eventually evolved from a clinical or research intervention to a general approach to end-of-life care. Key to this success was flexibility and the empowerment of frontline staff to tailor the program to address identified needs with available resources. This adaptability was fueled by cross-pollination of ideas within and outside of each site, resulting in the establishment of a network of like-minded individuals with a shared purpose. CONCLUSIONS: The successful initiation and sustainment of 3WP relied on local adaptations to suit organizational needs and resources. The semi-structured nature of the program facilitated these adaptations, encouraged creative and important ways of relating within local clinical cultures, and reinforced the main tenet of the program: meaningful human connection at the end of life. Local adaptations also encouraged a team approach to care, supplementing the typical patient-clinician dyad by explicitly empowering the healthcare team to collectively recognize and respond to the needs of dying patients, families, and each other. TRIAL REGISTRATION: NCT04147169 , retrospectively registered with clinicaltrials.gov on October 31, 2019.

Automated Telephone Follow-up for Smoking Cessation in Smokers With Coronary Heart Disease: A Randomized Controlled Trial.

INTRODUCTION: Smokers with coronary heart disease (CHD) benefit from in-hospital cessation treatment, but relapse is common without ongoing support postdischarge. The purpose of this study was to determine if smoking abstinence would be higher after hospital discharge in smokers who received automated telephone follow-up (ATF) and nurse-counseling, compared with a standard care (SC) control group. METHODS: A total of 440 smokers hospitalized with CHD were randomly assigned to the ATF group (n = 216) or to the SC group (n = 224). Participants in the ATF group received automated phone calls 3, 14, 30, 60, 90, 120, 150, and 180 days after hospital discharge. The ATF system posed questions concerning smoking status, confidence in staying smoke-free, and need for assistance. If flagged by the ATF system, a nurse-counselor provided additional counseling by phone. Self-reported continuous smoking abstinence was assessed 26 and 52 weeks postdischarge using intention-to-treat analysis. The main outcome measure was continuous abstinence for weeks 1-26 postdischarge. RESULTS: Participants in the ATF group achieved higher abstinence rates for weeks 1-26 than those in the SC group (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.01 to 2.33). There was no significant difference between groups in abstinence rates for weeks 27-52 (OR = 1.37; 95% CI = 0.89 to 2.09). CONCLUSIONS: ATF-mediated follow-up helped smokers with CHD achieve abstinence during the intervention period. There was a trend toward clinically important improvements for weeks 27-52; but between-group differences for this time point did not achieve statistical significance. CLINICAL TRIAL NUMBER: NCT00449852. IMPLICATIONS: Automated telephone follow-up exerts its effect by reinforcing participants' efforts to be smoke-free and by proactively linking people requiring assistance to individualized support (eg, telephone counseling). This study shows that automated telephone follow-up can assist smokers with CHD in remaining smoke-free; however, the success of automated telephone follow-up is limited to the treatment period and abstinence rates after the treatment period were not statistically different from among those receiving standard care. Extended treatment via automated telephone follow-up may provide a solution to extend cessation assistance beyond hospital discharge.

Recent trends in prostate cancer in Canada.

BACKGROUND: Prostate cancer is the most common type of cancer in Canadian men. Screening recommendations have changed substantially over the last 25 years. Since 2011 (United States) and 2014 (Canada), taskforce guidelines have recommended against screening using the prostate-specific antigen (PSA) test in low-risk men of all ages. This work reports on trends in prostate cancer incidence, mortality, and stage at diagnosis in Canada from 1992 to 2015. DATA AND METHODS: Prostate cancer incidence, mortality, and stage at diagnosis were retrieved from Statistics Canada's Canadian Cancer Registry and Canadian Vital Statistics - Death Database. Joinpoint analysis was used to examine trends over time. RESULTS: The age-standardized incidence rate (ASIR) of prostate cancer peaked in 1993 and 2001, and declined thereafter. From 2011 to 2015, the ASIR declined by 9.3% per year. The age-standardized mortality rate (ASMR) decreased continuously from 1992 to 2015, but fell most rapidly (2.9% per year) after 2001. Data from two provinces show that, from 2005 to 2015, the rate of Stage I and Stage II cancers decreased by 3.2% per year, while the rate of Stage III and Stage IV cancers remained relatively stable. DISCUSSION: Incidence of prostate cancer has declined substantially in recent years. Most of the decline seems to be in localized cases (Stage I and Stage II). Changes in incidence have mirrored changes to PSA screening recommendations. Future work should continue to monitor trends over time at the national level, especially as they relate to screening recommendations.

Outdoor time and dietary patterns in children around the world.

Background: Whether outdoor time is linked to dietary patterns of children has yet to be empirically tested. The objective of this study was to examine the association between outdoor time and dietary patterns of children from 12 countries around the world. Methods: This multinational, cross-sectional study included 6229 children 9-11 years of age. Children self-reported the time that they spent outside before school, after school and on weekends. A composite score was calculated to reflect overall daily outdoor time. Dietary patterns were assessed using a food frequency questionnaire, and two components were used for analysis: healthy and unhealthy dietary pattern scores. Results: On average, children spent 2.5 h outside per day. After adjusting for age, sex, parental education, moderate-to-vigorous physical activity, screen time and body mass index z-score, greater time spent outdoors was associated with healthier dietary pattern scores. No association was found between outdoor time and unhealthy dietary pattern scores. Similar associations between outdoor time and dietary patterns were observed for boys and girls and across study sites. Conclusions: Greater time spent outside was associated with a healthier dietary pattern in this international sample of children. Future research should aim to elucidate the mechanisms behind this association.

Watching television or listening to music while exercising failed to affect post-exercise food intake or energy expenditure in male adolescents.

Watching television or listening to music while exercising can serve as motivating factors, making it more pleasant to exercise for some people. However, it is unknown whether these stimuli influence food intake and/or physical activity energy expenditure (PAEE) for the remainder of the day, potentially impacting energy balance and weight control. We examined the effects of watching television or listening to music while exercising on post-exercise energy intake and expenditure. Our study was a randomized crossover design, in which 24 male adolescents (mean age: 14.9 ±â€¯1.1 years) completed three 30-min experimental conditions consisting of walking/jogging on a treadmill at 60% of heart rate reserve while (1) watching television; (2) listening to music; or (3) exercising with no other stimulus (control). An ad libitum lunch was offered immediately after the experimental conditions, and a dietary record was used to assess food intake for the remainder of the day. An Actical accelerometer was used to estimate PAEE until bedtime. The primary outcome measure was post-exercise energy intake and expenditure (kJ). We found that exercising while watching television or listening to music did not significantly affect post-exercise energy intake or energy expenditure. Exercising on a treadmill was found to be significantly more enjoyable while watching television than with no stimulus present. Ratings of perceived exertion were not significantly different between conditions. Overall, our results suggest that watching television or listening to music while exercising does not impact post-exercise energy intake or expenditure in male adolescents, which may have positive implications for adolescents who may need additional motivation to participate in physical activity.

Pokémon Go: A game changer for the physical inactivity crisis?

There is an urgent need to find novel strategies aimed at motivating people to go outside and move more. Pokémon Go blends a fun smartphone game with real-life, outdoor physical activity. Initial reports suggest it is a successful population level strategy to increase physical activity levels. Further research is needed to understand the long-term risks and benefits of this new game. Free-to-play location-based augmented reality mobile games are likely to be a new model for promoting healthy active living in the future.

International normative 20†m shuttle run values from 1†142†026 children and youth representing 50 countries.

OBJECTIVE: To develop sex-specific and age-specific international norms for the 20 m shuttle run test (20mSRT) in children and youth (aged 9-17 years), and to estimate the prevalence meeting the FITNESSGRAM criterion-referenced standards for healthy cardiorespiratory endurance (CRE). METHODS: A systematic review was undertaken to identify papers explicitly reporting descriptive 20mSRT (with 1 min stages) data on children and youth since 1981. Data were included on apparently healthy (free from known disease/injury) 9-17 years old. Following standardisation to a common metric and for protocol differences, pseudo data were generated using Monte Carlo simulation, with population-weighted sex-specific and age-specific normative centiles generated using the Lambda Mu and Sigma (LMS) method. Sex-related and age-related differences were expressed as per cent and standardised differences in means. The prevalence with healthy CRE was estimated using the sex-specific and age-specific FITNESSGRAM criterion-referenced standards for [Formula: see text]. RESULTS: Norms were displayed as tabulated centiles and as smoothed centile curves for the 20mSRT using 4 common metrics (speed at the last completed stage, completed stages/minutes, laps and relative [Formula: see text]). The final data set included 1 142 026 children and youth from 50 countries, extracted from 177 studies. Boys consistently outperformed girls at each age group (mean difference±95% CI: 0.86±0.28 km/h or 0.79±0.20 standardised units), with the magnitude of age-related increase larger for boys than for girls. A higher proportion of boys (mean±95% CI: 67±14%) had healthy CRE than girls (mean±95% CI: 54±17%), with the prevalence of healthy CRE decreasing systematically with age. CONCLUSIONS: This study provides the most comprehensive and up-to-date set of international sex-specific and age-specific 20mSRT norms for children and youth, which have utility for health and fitness screening, profiling, monitoring and surveillance.

Objectively-measured sleep and its association with adiposity and physical activity in a sample of Canadian children.

Cross-sectional associations between objectively-measured sleep duration, sleep efficiency and sleep timing with adiposity and physical activity were examined in a cohort of 567 children from Ottawa, Canada. Five-hundred and fifteen children (58.8% female; age: 10.0 ± 0.4 years) had valid sleep measurements and were included in the present analyses. Physical activity, sedentary time and sleep parameters were assessed over 7 days (actigraphy). Height, weight and waist circumference were measured according to standardized procedures. Percentage body fat was assessed using bioelectric impedance analysis. Light physical activity and sedentary time were greater in children with the shortest sleep durations (P < 0.0001), whereas children with the highest sleep efficiencies had lower light physical activity and more sedentary time across tertiles (P < 0.0001). In multivariable linear regression analyses, and after adjusting for a number of covariates, sleep efficiency was inversely related to all adiposity indices (P < 0.05). However, sleep duration and sleep timing were not associated with adiposity indices after controlling for covariates. Inverse associations were noted between sleep duration and light physical activity and sedentary time (P < 0.0001). Sleep efficiency (P < 0.0001), wake time and sleep timing midpoint (P < 0.05) were negatively associated with light physical activity, but positively associated with sedentary time. In conclusion, only sleep efficiency was independently correlated with adiposity in this sample of children. Participants with the shortest sleep durations or highest sleep efficiencies had greater sedentary time. More research is needed to develop better sleep recommendations in children that are based on objective measures of sleep duration, sleep efficiency and sleep timing alike.

Mediating role of television time, diet patterns, physical activity and sleep duration in the association between television in the bedroom and adiposity in 10 year-old children.

BACKGROUND: Having a TV in the bedroom is associated with adiposity in children. It is not known how lifestyle behaviours (television viewing time, diet patterns, physical activity, and sleep duration) mediate this association. The objective of this study was to examine the mediating role of these lifestyle behaviours in the association between TV in the bedroom and percent body fat (% BF). METHODS: Cross-sectional data from 1 201 children (57.3% female; mean age = 9.8 years) from Ottawa, Canada and Baton Rouge, USA were examined. % BF was directly measured. Accelerometers were used to determine physical activity and sleep duration (24-h, 7-day protocol). Questionnaires were used to assess TV viewing time and healthy/unhealthy diet patterns (derived using factor analysis from food frequency questionnaire data). RESULTS: Canadian boys and girls with a TV in their bedroom had a higher % BF, watched more TV and had unhealthier diets. American boys and girls with a TV in their bedroom watched more TV, while boys had a higher % BF and a more unhealthy diet, and girls had less MVPA. In Canadian girls, TV viewing time mediated the association between having a TV in the bedroom and adiposity, independent of diet patterns, MVPA, and sleep duration. Other lifestyle mediators were not significant in Canadian boys or in US children. CONCLUSION: TV viewing is a mediating lifestyle behaviour in the association between TV in the bedroom and adiposity in Canadian girls. Future research is needed to identify lifestyle behaviours as intermediate mediators.

Correlates of objectively measured sedentary time and self-reported screen time in Canadian children.

BACKGROUND: Demographic, family, and home characteristics play an important role in determining childhood sedentary behaviour. The objective of this paper was to identify correlates of total sedentary time (SED) and correlates of self-reported screen time (ST) in Canadian children. METHODS: Child- and parent-reported household, socio-demographic, behavioural, and diet related data were collected; directly measured anthropometric and accelerometer data were also collected for each child. Participants with complete demographic, anthropometric, and either SED (n=524, 41% boys) or ST (n=567, 42% boys) data from the Canadian site of the International Study of Childhood Obesity Lifestyle and the Environment (ISCOLE) were included in analysis. Sixteen potential correlates of SED and ST were examined using multilevel general linear models, adjusting for sex, ethnicity, number of siblings, and socio-economic status. All explanatory variables moderately associated (p<0.10) with SED and/or ST in univariate analyses were included in the final, fully-adjusted models. Variables that remained significant in the final models (p<0.05) were considered correlates of SED and/or ST. RESULTS: Children averaged 8.5 hours of daily SED; no differences in total SED, or total ST were seen between girls and boys, but boys reported significantly more video game/computer usage than girls. Boys also had higher waist circumference and BMI z-scores than girls. In the final models, waist circumference and number of TVs in the home were the only common correlates of both SED and ST. SED was also negatively associated with sleep duration. ST was also positively associated with mother's weight status, father's education, and unhealthy eating pattern score and negatively associated with healthy eating pattern score, and weekend breakfast consumption. Few common correlates existed between boys and girls. CONCLUSION: Several factors were identified as correlates of SED and/or of ST in Canadian children; however, few correlates were common for both SED and ST, and for both boys and girls. This suggests that a single strategy to reduce SED and ST is unlikely to be effective. Future work should examine a variety of other, non-screen based sedentary behaviours and their potential correlates in the hopes of creating tailored public health messages to reduce SED and ST in both boys, and girls.

A cross-sectional examination of socio-demographic and school-level correlates of children's school travel mode in Ottawa, Canada.

BACKGROUND: Active school transport (AST) is an important source of children's daily physical activity (PA). However, decreasing rates of AST have been reported in multiple countries during the last decades. The purpose of the present study was to examine the socio-demographic and school-level correlates of AST. METHODS: A stratified sample of children (N = 567, mean age = 10.0 years; 57.8% female) was recruited in the Ottawa area. Four sources of data were used for analyses: 1) child questionnaire including questions on school travel mode and time; 2) parent questionnaire providing information on household socio-demographic characteristics; 3) school administrator survey assessing school policies and practices pertaining to PA; and 4) school site audit performed by the study team. Generalized linear mixed models were used to identify socio-demographic and school-level correlates of AST while controlling for school clustering. RESULTS: Individual factors associated with higher odds of AST were male gender (OR = 1.99; 95% CI = 1.30-3.03), journey time <5 minutes vs. >15 minutes (OR = 2.26; 95% CI = 1.17-4.37), and 5-15 minutes vs. >15 minutes (OR = 2.27; 95% CI = 1.27-4.03). Children were more likely to engage in AST if school administrators reported that crossing guards were employed (OR = 2.29; 95% CI = 1.22-4.30), or if they expressed major or moderate concerns about crime in the school neighbourhood (OR = 3.34; 95% CI = 1.34-8.32). In schools that identified safe routes to school and where traffic calming measures were observed, children were much more likely to engage in AST compared to schools without these features (OR = 7.87; 95% CI = 2.85-21.76). Moreover, if only one of these features was present, this was not associated with an increased likelihood of AST. CONCLUSION: These findings suggest that providing crossing guards may facilitate AST. Additionally, there was a synergy between the identification of safe routes to school and the presence of traffic calming measures, suggesting that these strategies should be used in combination.

Active Healthy Kids Canada's Position on Active Video Games for Children and Youth.

The effect of active video games (AVGs) on acute energy expenditure has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear. To address this knowledge gap, Active Healthy Kids Canada (AHKC) convened an international group of researchers to conduct a systematic review to understand whether AVGs should be promoted to increase physical activity and improve health indicators in children and youth (zero to 17 years of age). The present article outlines the process and outcomes of the development of the AHKC's position on active video games for children and youth. In light of the available evidence, AHKC does not recommend AVGs as a strategy to help children be more physically active. However, AVGs may exchange some sedentary time for light- to moderate-intensity physical activity, and there may be specific situations in which AVGs provide benefit (eg, motor skill development in special populations and rehabilitation).

On a déjà rendu compte de l'effet des jeux vidéo actifs (JVA) sur la dépense énergétique aiguë, mais on ne connaît pas leur influence sur d'autres indicateurs du mode de vie liés à la santé. Pour corriger cette lacune, Jeunes en forme Canada (JEFC) a réuni un groupe international de chercheurs afin qu'ils effectuent une analyse systématique pour établir s'il faut promouvoir les JVA pour accroître l'activité physique et améliorer les indicateurs de la santé chez les enfants et les adolescents (de zéro à 17 ans). Le présent article expose le processus et les résultats de l'élaboration de la position des JEFC sur les JVA pour les enfants et les adolescents. À la lumière des données disponibles, JEFC ne recommande pas les JVA comme stratégie pour aider les enfants à faire plus d'activité physique. Cependant, les JVA peuvent transformer un comportement sédentaire en une activité physique d'intensité légère à modérée, et dans certaines situations, les JVA peuvent se révéler bénéfiques (p. ex., développement de la motricité dans des populations ayant des besoins particuliers et dans un cadre de réadaptation).

Scientific sinkhole: estimating the cost of peer review based on survey data with snowball sampling.

BACKGROUND: There are a variety of costs associated with publication of scientific findings. The purpose of this work was to estimate the cost of peer review in scientific publishing per reviewer, per year and for the entire scientific community. METHODS: Internet-based self-report, cross-sectional survey, live between June 28, 2021 and August 2, 2021 was used. Participants were recruited via snowball sampling. No restrictions were placed on geographic location or field of study. Respondents who were asked to act as a peer-reviewer for at least one manuscript submitted to a scientific journal in 2020 were eligible. The primary outcome measure was the cost of peer review per person, per year (calculated as wage-cost x number of initial reviews and number of re-reviews per year). The secondary outcome was the cost of peer review globally (calculated as the number of peer-reviewed papers in Scopus x median wage-cost of initial review and re-review). RESULTS: A total of 354 participants completed at least one question of the survey, and information necessary to calculate the cost of peer-review was available for 308 participants from 33 countries (44% from Canada). The cost of peer review was estimated at $US1,272 per person, per year ($US1,015 for initial review and $US256 for re-review), or US$1.1-1.7 billion for the scientific community per year. The global cost of peer-review was estimated at US$6 billion in 2020 when relying on the Dimensions database and taking into account reviewed-but-rejected manuscripts. CONCLUSIONS: Peer review represents an important financial piece of scientific publishing. Our results may not represent all countries or fields of study, but are consistent with previous estimates and provide additional context from peer reviewers themselves. Researchers and scientists have long provided peer review as a contribution to the scientific community. Recognizing the importance of peer-review, institutions should acknowledge these costs in job descriptions, performance measurement, promotion packages, and funding applications. Journals should develop methods to compensate reviewers for their time and improve transparency while maintaining the integrity of the peer-review process.

Screening for prostate cancer: protocol for updating multiple systematic reviews to inform a Canadian Task Force on Preventive Health Care guideline update.

PURPOSE: To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening for prostate cancer in adults aged 18 years and older in primary care. This protocol outlines the planned scope and methods for a series of systematic reviews. METHODS: Updates of two systematic reviews and a de novo review will be conducted to synthesize the evidence on the benefits and harms of screening for prostate cancer with a prostate-specific antigen (PSA) and/or digital rectal examination (DRE) (with or without additional information) and patient values and preferences. Outcomes for the benefits of screening include reduced prostate cancer mortality, all-cause mortality, and incidence of metastatic prostate cancer. Outcomes for the harms of screening include false-positive screening tests, overdiagnosis, complications due to biopsy, and complications of treatment including incontinence (urinary or bowel), and erectile dysfunction. The quality of life or functioning (overall and disease-specific) and psychological effects outcomes are considered as a possible benefit or harm. Outcomes for the values and preferences review include quantitative or qualitative information regarding the choice to screen or intention to undergo screening. For the reviews on benefits or harms, we will search for randomized controlled trials, quasi-randomized, and controlled studies in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. For the review on values and preferences, we will search for experimental or observational studies in MEDLINE, Embase, and PsycInfo. For all reviews, we will also search websites of relevant organizations, gray literature, and reference lists of included studies. Title and abstract screening, full-text review, data extraction, and risk of bias assessments will be completed independently by pairs of reviewers with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of the evidence for each outcome. DISCUSSION: The series of systematic reviews will be used by the Canadian Task Force on Preventive Health Care to update their 2014 guideline on screening for prostate cancer in adults aged 18 years and older. Systematic review registration This review has been registered with PROSPERO (CRD42022314407) and is available on the Open Science Framework (osf.io/dm32k).

Systematic review of sedentary behaviour and health indicators in school-aged children and youth.

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

Building capacity for implementation-the KT Challenge.

BACKGROUND: The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change. METHODS: The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams' final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics. RESULTS: Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. CONCLUSIONS: The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.