Time to diagnosis in systemic lupus erythematosus: Associated factors and its impact on damage accrual and mortality. Data from a multi-ethnic, multinational Latin American lupus cohort.

BACKGROUND: Systemic lupus erythematosus (SLE) often mimics symptoms of other diseases, and the interval between symptom onset and diagnosis may be long in some of these patients. Aims: To describe the characteristics associated with the time to SLE diagnosis and its impact on damage accrual and mortality in patients with SLE from a Latin American inception cohort. METHODS: Patients were from a multi-ethnic, multi-national Latin-American SLE inception cohort. All participating centers had specialized lupus clinics. Socio-demographic, clinical/laboratory, disease activity, damage, and mortality between those with a longer and a shorter time to diagnosis were compared using descriptive statistical tests. Multivariable Cox regression models with damage accrual and mortality as the end points were performed, adjusting for age at SLE diagnosis, gender, ethnicity, level of education, and highest dose of prednisone for damage accrual, plus highest dose of prednisone, baseline SLEDAI, and baseline SDI for mortality. RESULTS: Of the 1437 included in these analyses, the median time to diagnosis was 6.0 months (Q1-Q3 2.4-16.2); in 721 (50.2%) the time to diagnosis was longer than 6 months. Patients whose diagnosis took longer than 6 months were more frequently female, older at diagnosis, of Mestizo ethnicity, not having medical insurance, and having "non-classic" SLE symptoms. Longer time to diagnosis had no impact on either damage accrual (HR 1.09, 95% CI 0.93-1.28, p = 0.300) or mortality (HR 1.37, 95% CI 0.88-2.12, p = 0.200). CONCLUSIONS: In this inception cohort, a maximum time of 24 months with a median of 6 months to SLE diagnosis had no apparent negative impact on disease outcomes (damage accrual and mortality).

Telework and 24-hour movement behaviours among adults living in Canada during the COVID-19 pandemic.

OBJECTIVE: To assess the association between work location and movement behaviours (physical activity [PA], screen time, sleep) and adherence to the Canadian 24-Hour Movement Guidelines (24-H Guidelines) among Canadian workers during the COVID-19 pandemic. METHODS: Using cross-sectional data from the 2021 Canadian Community Health Survey (n = 10,913 working adults 18-75 years), primary work location was categorized as: worked outside the home at a fixed location (fixed workplace), worked at home (telework), and worked outside the home at no fixed location (non-fixed workplace). Recreational, transportation and occupational/household PA, as well as leisure screen time and sleep duration were self-reported. Logistic regression assessed associations between work location and adherence to movement behaviour recommendations, adjusting for covariates. RESULTS: Compared to a fixed workplace, those teleworking reported more recreational PA (21.1 vs 17.0 min/day, p < 0.0001) and sleep (7.2 vs 7.1 h/night, p = 0.026) and were more likely to meet sleep duration recommendations (adjusted odds ratio [aOR] = 1.28, 95% CI: 1.08-1.51) and the 24-H Guidelines (aOR = 1.25, 95% CI: 1.04-1.51). Compared to fixed workplaces, those at non-fixed workplaces reported more occupational PA (62.7 vs 32.8 min/day, p < 0.0001) and less leisure screen time (2.5 vs 2.7 h/day, p = 0.021), and were more likely to meet the PA recommendation (aOR = 1.46, 95% CI: 1.15-1.85) and the 24-H Guidelines (aOR = 1.38, 95% CI: 1.09-1.75). CONCLUSIONS: Results suggest that adherence to the 24-H Guidelines varies by work location, and work location should be considered when developing strategies to promote healthy movement behaviours. Future studies could explore hybrid work arrangements, and longitudinal study designs.

Sociodemographic differences in recreational screen time before and during the COVID-19 pandemic in Canada.

Background: Over the last several years, recreational screen time has been increasing. During the COVID-19 pandemic, recreational screen time rose among Canadian youth and adults, and those who increased screen time had poorer self-reported mental health compared with those who decreased or maintained their recreational screen time levels. Data and methods: Using data from the 2017, 2018, and 2021 Canadian Community Health Survey, the prevalence of meeting the recreational screen time recommendation from the Canadian 24-Hour Movement Guidelines was compared before and during the pandemic across sociodemographic groups. Logistic regression was used to identify sociodemographic groups that were more likely to meet the recreational screen time recommendation before and during the pandemic. Results: The amount of time Canadians spent engaging in daily recreational screen time increased from 2018 to 2021, leading to fewer youth and adults meeting the recreational screen time recommendation during the pandemic compared with before. The prevalence of meeting the recommendation was lower during the pandemic compared with before the pandemic among almost all sociodemographic groups. Among youth, living in a rural area was associated with a greater likelihood of meeting the recommendation before and during the pandemic. Among adults, the following characteristics were all associated with a greater likelihood of meeting the recommendation during the pandemic: being female; living in a rural area or a small population centre; identifying as South Asian; being an immigrant to Canada; living in a two-parent household; being married or in a common-law relationship or widowed, separated, or divorced; working full time; and being a health care worker. Interpretation: The prevalence of meeting the recreational screen time recommendation during the pandemic was lower overall compared with before the pandemic. Several sociodemographic groups were more likely to meet the recommendation during the pandemic. Continued surveillance of recreational screen time is necessary to monitor the indirect effects of the pandemic and to identify population subgroups that would benefit from tailored interventions in the pandemic recovery period.

Sustaining an Aboriginal wellbeing program: Informing health promotion practice and policy.

ISSUE ADDRESSED: Aboriginal and Torres Strait Islander Peoples' holistic concepts of wellbeing are inadequately represented in the health promotion discourse. The aim of this article was to explore what sustains an Aboriginal wellbeing program, to inform critical reflection and reorientation to empower Aboriginal wellbeing approaches in health promotion practice and policy. METHODS: Aboriginal and non-Indigenous researchers collaboratively designed a critically framed, strengths-based research approach with Aboriginal Community Controlled Health Service staff and wellbeing program participants. Data from Individual Yarning (n = 15) with program participants and staff inspired co-researchers to co-develop interpretations over two half-day Collaborative Yarning sessions (n = 9). RESULTS: Co-researchers depicted five lifeworld qualities that sustain an Aboriginal wellbeing program: love, connection, respect, culture and belonging. The lifeworld qualities are relational, communicative and involve the dynamics of identity, power and self-determination. CONCLUSIONS: The five qualities support a lifeworld approach to an Aboriginal wellbeing program, opening communicative and relational opportunities to mediate culturally responsive interactions. The qualities mediated interactions between people in the lifeworld including program participants and coordinators, and systems representatives including health service providers. A lifeworld approach provides a way to empower Aboriginal self-determination and leadership through embedment of cultural determinants of health in wellbeing programs. SO WHAT?: Health service providers and policy makers can use lifeworld approaches to guide critical reflection and reorient practice and policy related to Aboriginal health. The lifeworld qualities that encompass this approach in wellbeing programs are communicative and relational, centred on local community voices and co-produced with community for Aboriginal identity, empowerment and self-determination.

Identifying Risk Profiles for Nonadherence to the 24-Hour Movement Guidelines for Children and Youth 6 Months Into the COVID-19 Pandemic.

PURPOSE: The purposes of the current study were to identify risk profiles for nonadherence among children and youth (5-17 y) at the 6-month mark of the COVID-19 pandemic and to discuss similarities and differences between risk profiles identified in the current study and those identified at the 1-month mark of the pandemic. METHODS: Data were part of a nationally representative sample of 1143 parents (Mage = 43.07 y, SD = 8.16) of children and youth (5-17 y) living in Canada. Survey data were collected in October 2020. RESULTS: Results showed that 3.8% met all movement behavior recommendations, 16.2% met the physical activity recommendation, 27% met the screen time recommendation, and 63.8% met the sleep recommendation. Characteristics associated with nonadherence to all movement behaviors included low parental perceived capability to restrict screen time and decreased overall time spent outdoors. Characteristics associated with nonadherence to the physical activity and screen time recommendations included youth (12-17 y), low parental perceived capability to restrict screen time, decreased time spent outdoors, and increased screen time. CONCLUSION: Results emphasized the importance of parental perceived capability to restrict screen time and children's and youth's outdoor time and showed that pandemic-related factors have impacted children and youth differently.

Does the Use of Immunosuppressive Drugs Impact on SARS-CoV-2 Infection Outcome? Data From A National Cohort of Patients With Immune-Mediated Inflammatory Diseases (SAR-COVID Registry).

BACKGROUND/OBJECTIVE: This study describes the impact of immunomodulatory and/or immunosuppressive (IM/IS) drugs in the outcomes of COVID-19 infection in a cohort of patients with immune-mediated inflammatory diseases (IMIDs). METHODS: Adult patients with IMIDs with a confirmed SARS-CoV-2 infection were included. Data were reported by the treating physician between August 13, 2020 and July 31, 2021. Sociodemographic data, comorbidities, and DMARDs, as well as clinical characteristics, complications, and treatment of the SARS-CoV-2 infection, were recorded. Descriptive analysis and multivariable logistic regression models were carried out. RESULTS: A total of 1672 patients with IMIDs were included, of whom 1402 were treated with IM/IS drugs. The most frequent diseases were rheumatoid arthritis (47.7%) and systemic lupus erythematosus (18.4%). COVID-19 symptoms were present in 95.2% of the patients. A total of 461 (27.6%) patients were hospitalized, 8.2% were admitted to the intensive care unit, and 4.4% died due to COVID-19.Patients without IM/IS treatment used glucocorticoids less frequently but at higher doses, had higher levels of disease activity, were significantly older, were more frequently hospitalized, admitted to the intensive care unit, and died due to COVID-19. After adjusting for these factors, treatment with IM/IS drugs was not associated with a worse COVID-19 outcome (World Health Organization-Ordinal Scale ≥5) (odds ratio, 1.24; 95% confidence interval, 0.73-2.06). CONCLUSIONS: SAR-COVID is the first multicenter Argentine registry collecting data from patients with rheumatic diseases and SARS-CoV-2 infection. After adjusting for relevant covariates, treatment with IM/IS drugs was not associated with severe COVID-19 in patients with IMIDs. STUDY REGISTRATION: This study has been registered in ClinicalTrials.gov under the number NCT04568421.

Sleep behaviours among Canadian adults: Findings from the 2020 Canadian Community Health Survey healthy living rapid response module.

INTRODUCTION: The Canadian 24-Hour Movement Guidelines for Adults, released in October 2020, recommend 7 to 9 hours of good-quality sleep for adults aged 18 to 64 and 7 to 8 hours for adults aged 65 and older, on a regular basis, with consistent sleep and wake times for health benefits. This study assesses the sleep behaviours of Canadian adults and how these behaviours align with the recommendations. DATA AND METHODS: This cross-sectional study uses nationally representative data from the 2020 Canadian Community Health Survey healthy living rapid response module (N = 9,248), collected from January to March 2020. Sleep behaviours were self-reported by respondents, and descriptive statistics were used to calculate means or percentages for sleep duration, guideline adherence, physical activity and screen time, sleep timing, and sleep variability in the full sample. This was done by age, sex, household education, household income adequacy and employment status. RESULTS: Mean sleep duration was 7.9 hours for adults aged 18 to 64, with 77% meeting sleep duration recommendations, and 8.1 hours for adults aged 65 and older, with 55% meeting sleep duration recommendations. Among adults aged 18 to 64, 61% reported high sleep quality, compared with 71% among adults aged 65 and older. High sleep variability (≥30-minute difference between work and free days) and poor sleep-facilitating behaviours were prevalent. Adults who reported high sleep quality and high sleep variability were more likely to meet sleep duration recommendations. INTERPRETATION: To maximize health benefits, continued efforts are needed to promote good sleep behaviours among Canadian adults. Device-based measures of sleep could improve surveillance and research.

The influence of removing the 10-minute bout requirement on the demographic, behaviour and health profiles of Canadian adults who meet the physical activity recommendations.

Background: Recently, the Canadian 24-Hour Movement Guidelines for Adults were released, and included a revised physical activity (PA) recommendation. The recommendation of 150 minutes per week of moderate-to-vigorous intensity PA (MVPA) was revised, from requiring that MVPA be accrued in bouts of 10 minutes or more (bouted) to having no bout requirement (non-bouted). The objective of this study was to assess whether there were differences in sociodemographic, health and fitness characteristics of Canadians who met the bouted and non-bouted PA recommendations. Data and methods: Using adult (aged 18 to 79 years) accelerometer data from three combined cycles of the nationally representative Canadian Health Measures Survey (N = 7,102), this study compared adherence to the bouted and non-bouted recommendations. Differences in sociodemographic, health and fitness measures were assessed using independent t-tests and chi-squares. Multivariate linear and logistic regressions controlling for age, sex, household education and smoking examined associations with health and fitness measures. Results: More adults met the PA recommendation using the non-bouted versus bouted (45.3% vs. 18.5%) requirement. Characteristics of those who met the bouted and only the non-bouted recommendations were similar. Exceptions among those who met only the non-bouted recommendation compared with meeting the bouted recommendation included fewer adults aged 65 years and older; lower MVPA, recreation PA and transport PA; and higher sedentary time, light PA and grip strength. Interpretation: Although the removal of the 10-minute bout requirement increased the proportion of Canadian adults who met the PA recommendation, there were no substantial differences in the sociodemographic and health characteristics of the populations captured by the bouted and non-bouted definitions. Results help to inform the transition in reporting for PA surveillance.

Health associations with meeting the Canadian 24-hour movement guidelines for adults: Results from the Canadian Health Measures Survey.

BACKGROUND: The Canadian 24-Hour Movement Guidelines for Adults (18-64 years and 65 years or older) were launched in October 2020 and provide evidence-based recommendations for physical activity, sedentary behaviour and sleep. The purpose of this study was to examine whether meeting the 24-Hour Movement Guidelines overall, and different combinations of recommendations within the guidelines, was associated with health indicators in a representative sample of Canadian adults. DATA AND METHODS: Participants were 8,297 adults aged 18 to 79 from cycles 1 to 3 of the Canadian Health Measures Survey. They were classified as meeting or not meeting each of the recommendations required for overall guideline adherence: moderate-to-vigorous physical activity (150 minutes or more per week), sedentary behaviour (8 hours or less per day or 9 hours or less per day of sedentary time, including 3 hours or less per day of recreational screen time) and sleep duration (7 to 9 hours per day for adults 18 to 64 years old, 7 to 8 hours per day for adults aged 65 years or older). A combination of self-reported and device-based measures were used. Indicators of adiposity (n=2), aerobic fitness (n=1) and cardiometabolic health (n=7) were measured. RESULTS: A total of 19.1% of the sample met none of the recommendations, 43.9% met one of them, 29.8% met two and 7.1% met all three. Compared with meeting no recommendations, meeting one, two and all three recommendations was associated with better health for one, six and seven health indicators, respectively (p < 0.05). Compared with adults meeting two or fewer recommendations, those who met all three recommendations had more favourable body mass index; waist circumference; aerobic fitness scores; and triglyceride, insulin, C-reactive protein and serum glucose levels (p < 0.05). INTERPRETATION: These findings provide support for the 24-Hour Movement Guidelines and show that less than 1 in 10 Canadian adults are meeting all three of the healthy movement behaviour guidelines.

How sedentary are Canadian adults? It depends on the measure.

Introduction: The new Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years and older recommend that adults limit daily sedentary time to eight hours or less, including three hours or less of recreational screen time. The eight-hour recommendation was centred between the evidence from research using self-reported sitting time (threshold: seven hours or less per day) and accelerometer-measured sedentary time (threshold: nine hours or less per day). The purpose of this study is to compare the percentages of Canadians meeting three different sedentary thresholds (three hours or less per day of screen time, seven hours or less per day of self-reported sitting time and nine hours or less per day of accelerometer-measured sedentary time). Methods: This analysis is based on 2,511 adults (aged 18 to 79 years) from Cycle 3 of the Canadian Health Measures Survey, in 2012 and 2013. Screen time and sitting time were assessed via self-report, and average daily sedentary time was assessed using a hip-worn Actical accelerometer. Results: Adults self-reported an average daily screen time of 3.2 hours (95% confidence interval [CI]: 3.0 to 3.5) and an average daily sitting time of 5.7 hours (95% CI: 5.4 to 6.0). According to accelerometry data, adults accumulated an average of 9.8 hours per day (95% CI: 9.7 to 9.9) of sedentary time. Adherence varied, with 57.7% meeting the self-reported recreational screen time threshold of three hours or less per day, 71.7% meeting the self-reported sitting time threshold of seven hours or less per day and 26.5% meeting the accelerometer-measured sedentary time threshold of nine hours or less per day. Interpretation: The percentage of Canadian adults meeting the three different sedentary behaviour thresholds varied widely. The findings in this article highlight the difference in sedentary time between what Canadians report versus what is measured by an accelerometer.

Assessment of the Sources of Information by Patients With Rheumatic Diseases.

OBJECTIVE: The aim of this study was to ascertain the frequency of use, search intent (SI), level of accessibility, and degree of reliability of sources of information (SOIs) in rheumatology. METHODS: A survey among adult outpatients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritis was conducted. They were asked if they had procured information from 12 selected SOIs during the past year. Search intent was defined as the source they would like to consult. Accessibility and reliability were assessed through 0-to-10 scales (minimum and maximum, respectively). RESULTS: Four hundred two patients were surveyed. They had consulted a median of 3 SOIs (interquartile range, 2-6) but described a higher SI: median of 5 SOIs (interquartile range 3-8); p = 0.001.The most consulted SOIs were the physician (83%), other patients (45%), and Facebook (36%). The main differences between SI and the searches actually performed were observed in community lectures by health care professionals (49%), scientific societies (48%), and associations of patients (27%); p < 0.001. These 3 sources showed low level of accessibility. Facebook, press, radio, and YouTube were the least reliable sources. CONCLUSIONS: Patients consulted a median of 3 SOIs but reported a significantly higher SI. Although patients demand more information, the request is leveled at SOIs with difficult accessibility but high reliability.

Physician associates in the UK: Development, status, and future.

ABSTRACT: Physician associates (PAs) have been part of the UK health workforce for almost 20 years. The profession is growing rapidly with statutory regulation, protection of the title, and career progression supported by a national-level framework all in the pipeline for the near future. This article provides a brief history of the profession in the United Kingdom and prospects for its future.

Clinical features, damage accrual, and survival in patients with familial systemic lupus erythematosus: data from a multi-ethnic, multinational Latin American lupus cohort.

OBJECTIVES: This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE). METHODS: A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality. RESULTS: A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08-3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00-2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14-0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%; p = 0.04) and musculoskeletal (6.1% vs. 1.9%; p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30-1.55) or mortality (HR = 1.23; 95% CI 0.26-4.81). CONCLUSION: Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.

Sedentary behaviour surveillance in Canada: trends, challenges and lessons learned.

BACKGROUND: Historical changes in the nature of sedentary activities have been observed in other countries, but it is not clear if similar trends exist in Canada. It is also unclear how changes in the measurement of sedentary behaviour affects national estimates. Our objective is to document all sources and measures of sedentary behaviour from Canadian, nationally representative surveys, and report on selected estimates of time spent in sedentary activities. Lessons learned can benefit the wider international surveillance community. METHODS: We describe and document all data sources of sedentary behaviour at the national level in Canada, and report on selected prevalence data from repeated cross-sectional surveys. We summarize amounts of total device-assessed sedentary time and self-reported sedentary activities (e.g., passive travel, leisure television, computer, video games, screen, and reading) by age group over time. RESULTS: Nineteen national surveys were identified. Changes in questions and/or response categories precluded direct assessment of trends over time for some measures; however, certain trends were observed. Accelerometer-measured sedentary time, leisure reading (among those < 50 years) and television/video viewing in younger age groups have remained relatively stable (with a possible slight decline in television/video viewing). Time spent in passive travel and leisure computer and electronic device use appears to have increased. Television and video viewing appears to have increased in older adults while their leisure reading appears to have fallen. CONCLUSIONS: Changes in measurement of sedentary behaviour can affect estimates and reduce comparability over time. Total leisure screen use appears to have increased over time, reflecting the ways in which Canadians spend their free time and technological advances. The main public health message is the need for continued efforts to reduce leisure screen use, especially among youth and older adults.

Screening for sexual health concerns in survivors of gynecological cancer.

OBJECTIVE: To assess the impact of a screening tool, the Brief Sexual Symptom Checklist for Women, on referral rates to physiotherapists, sexual counselors, and psychologists for sexual issues among patients attending the practices of two gynecological oncologists. METHODS: A prospective observational cohort study. A retrospective cohort of consecutive patients matched for age, diagnosis, and stage was used as a control group. RESULTS: Seventy-eight women were recruited to the intervention group. Diagnoses were endometrial carcinoma (38%), ovarian carcinoma (33%), and cervical carcinoma (24%). Sixty percent had completed adjuvant treatment, and 89% were married or in a de facto relationship. More than half of participants reported at least one sexual difficulty and were not satisfied with their sexual function. The most commonly reported sexual issue was decreased sexual desire. Twelve of 77 (15%) women screened in the intervention group were referred to a sexual counselor and/or a physiotherapist for a sexual issue. Twelve percent of women in the intervention group were referred to a sexual counselor, compared with 5% in the control group (p = 0.072). There was no difference in the proportion of women referred to a pelvic floor physiotherapist between the two groups (8% of women in the intervention group vs. 8% in the control group; p = 1.000). CONCLUSIONS: In the current study, the Brief Sexual Symptom Checklist for Women identified sexual health concerns in over half of gynecological cancer survivors and resulted in a non-significant trend to more referrals for sexual counseling.

Gender and education differences in sedentary behaviour in Canada: an analysis of national cross-sectional surveys.

BACKGROUND: Canadians spend the majority of their days sedentary. Gender and education are important social determinants of health that impact health behaviours. There is evidence that gender and educational differences in sedentary behaviour exist. In Canada, while general trends suggest that leisure sedentary activities have changed; there has been no comprehensive assessment examining whether historical changes in sedentary behaviour differ by gender and education level. Our objective was to examine whether gender and educational differences in accelerometer-measured sedentary time and self-reported sedentary behaviours exist among Canadians and if differences are consistent across age groups, over time and across multiple survey sources. METHODS: We summarize amounts of total accelerometer-measured sedentary time and self-reported sedentary activities (e.g., passive travel, television, computer, video games, screen, reading) by age (i.e. children: 6-11 years, youth: 12-17 years, adults: 18-34 years, 45-49 years, 50-64 years, and older adults: ≥ 65 years), gender (girls/women, boys/men) and household education level (< post-secondary vs. ≥ post-secondary) over time in the Canadian Community Health Survey, Canadian Health Measures Survey, General Social Survey, and the Health Behaviour in School-Aged Children study. Gender and education level differences are examined using independent sample t-tests or chi-square analyses. RESULTS: While few differences were found for total accelerometer-measured sedentary time, gender and education differences in self-reported, type-specific sedentary behaviour were identified. Among youth, data from all surveys consistently identified that boys engaged in more video/computer game play (e.g., boys: 0.35-2.68 vs. girls: 0.09-2.15 h/day), while girls engaged in more leisure reading (e.g., boys: 0.45-0.65 vs. girls: 0.71-0.99 h/day). Those with a higher education or household education often reported more leisure reading and passive travel. Education level differences in screen time were often age dependent, with leisure computer use greater in higher education groups in adults only and leisure television watching generally higher in lower education groups in children and adults, but not youth. CONCLUSIONS: This information is valuable as it helps to identify segments of the population which may be at greater risk for engaging in higher volumes of sedentary behaviour. In turn, this information can identify target audiences and behaviours for policies and interventions. Future work is needed to further understand factors contributing to these differences (e.g., preferences, occupation, family structure).

Physical activity, screen time and sleep duration: Combined associations with psychosocial health among Canadian children and youth.

BACKGROUND: Canada recently adopted the 24-Hour Movement Guidelines for Children and Youth (24-Hour Guidelines) for young people aged 5 to 17 years-an international first, providing integrated recommendations for physical activity, sedentary time and sleep. Since the release of the guidelines, very few studies have examined the associations of adherence to the 24-Hour Guidelines with health outcomes-and none focus on psychosocial health. Therefore, the objective of this study was to assess the associations of meeting the 24-Hour Guidelines and their behaviour-specific recommendations with psychosocial health among Canadian children and youth. DATA AND METHODS: This cross-sectional study included 4,250 children and youth aged 5 to 17 years with valid accelerometer data. The study data were collected from 2009 to 2015 with the Canadian Health Measures Survey and pooled. Moderate-to-vigorous physical activity was measured using accelerometers; screen time, sleep duration and measures of psychosocial health were self- or proxy-reported. Multivariate logistic regression models were used to examine the associations of meeting individual or different combined recommendations from the 24-Hour Guidelines with psychosocial health. RESULTS: There was low overall adherence to all three 24-Hour Guidelines recommendations, especially among youth (children: 13.9%, youth: 4.8%). Meeting two or more of the recommendations was associated with higher odds of positive psychosocial health among youth (odds ratio [OR] = 3.10; 95% confidence interval [CI]: 1.17-8.19). Sleep duration and screen time were strongly associated with social behaviour and psychosocial health among Canadian youth. DISCUSSION: Adherence to the 24-Hour Guidelines was significantly associated with better psychosocial health among Canadian youth.

Daily physical activity and sedentary behaviour across occupational classifications in Canadian adults.

BACKGROUND: Adults spend a large proportion of their day at work. Physical activity (PA) and sedentary behaviour (SB) have been shown to vary considerably between occupations. The objective of this study is to describe occupational differences in accelerometer-measured and self-reported PA and SB for Canadian full-time workers. DATA AND METHODS: Using combined data from three cycles of the nationally representative Canadian Health Measures Survey (N = 4,080), three activity groups (high, intermediate, low) were created based on a composite ranking of accelerometer-derived steps, proportion of time spent sedentary (SED%) and moderate-to-vigorous intensity physical activity (MVPA) in bouts of ⋝10 minutes (MVPAbouted). Differences between groups were assessed for accelerometer-derived and self-reported PA and SB, and sociodemographic and clinical characteristics. RESULTS: On average, Canadians employed in full-time work were sedentary for 68.9% of their day (95% confidence interval [CI]: 68.3% to 69.6%), took 8,984 steps per day (95% CI: 8,719 to 9,249) and accumulated 79.5 minutes per week of MVPAbouted (95% CI: 71.1 to 87.9). Among Canadians employed in full-time work, 18.5% met the Canadian Physical Activity Guidelines. The high-activity group took significantly more steps and had a lower SED%, but spent a higher proportion of time in light-intensity PA compared with the intermediate- and low-activity groups. No differences were observed for MVPA. The low-activity group reported more recreational and active travel-related PA and leisure reading, while those in the high-activity group reported more work and domestic PA and leisure screen time. DISCUSSION: The majority of full-time working adults are not getting adequate MVPA and spend most of their day sedentary, regardless of occupation. Findings support workplace policies to improve MVPA levels among Canadian workers and to promote awareness for the potential benefit of occupation-specific messaging around PA and SB.

Comparison of self-reported and accelerometer-measured physical activity among Canadian youth.

BACKGROUND: Generally, correlation and agreement between self-reported and accelerometer-measured physical activity are low. The objective of this study is to compare estimates of physical activity from a newly developed Canadian questionnaire with measurements by accelerometer among 12- to 17-year-olds. DATA AND METHODS: Physical activity was self-reported by domain (transportation, recreation, school, and occupational/household) as part of the new Physical Activity Youth Questionnaire (PAYQ) in the Canadian Health Measures Survey (CHMS; 2014-2017; n = 975) and the Canadian Community Health Survey (CCHS; 2015-2016; n=7,619). The CHMS also collected moderate-to-vigorous physical activity (MVPA) data using the Actical accelerometer. Descriptive statistics and correlation and agreement analyses were used to compare and contrast self-reported and accelerometer-measured physical activity variables. Linear regression was used to assess the association between physical activity and obesity. RESULTS: The average daily MVPA measured by accelerometry was 49.7 minutes per day. According to the PAYQ, Canadian youth reported an average of 78.2 minutes of physical activity per day from all domains, including recreation (31.3 minutes per day), transportation (15.5 minutes per day), school (25.8 minutes per day), and occupational/household (5.6 minutes per day). According to accelerometer-measured MVPA, 23.1% of youth met the physical activity guideline. The inclusion of all domains of self-reported physical activity resulted in a higher percentage of youth meeting the physical activity guideline (58.6%) than was the case for the recreation domain only (18.5%) or the sum of the recreation and school domains (34.0%). Overall, self-reported and accelerometer-measured physical activity estimates were poorly correlated (R ⟨ 0.2). DISCUSSION: Population-level estimates of physical activity and the percentage of youth meeting the physical activity guideline were well-aligned between the Actical and the PAYQ; however, large differences were evident at the individual level. Therefore, caution should be exercised in using data from these two methods since their values may not be interchangeable.

Comparison of self-reported and accelerometer-measured physical activity in Canadian adults.

BACKGROUND: Self-reported and accelerometer-measured physical activity levels generally exhibit low correlation and agreement. The objective of this study is to compare estimates of physical activity among adults from a newly developed Canadian questionnaire with those obtained objectively by accelerometry. DATA AND METHODS: Data for 18- to 79-year-olds (N = 2,372) were collected in 2014 and 2015 as part of the Canadian Health Measures Survey (CHMS). Moderate-to-vigorous physical activity (MVPA) was reported on the household questionnaire by domain (transportation, recreation, and occupational or household) as part of the new Physical Activity Adult Questionnaire (PAAQ) and measured objectively using the Actical accelerometer. Correlation and mean difference analyses were used to assess the relationships between measured and reported physical activity variables. Linear regression was used to test the association between measured and reported physical activity and measures of obesity. RESULTS: On average, Canadian adults reported more physical activity than they accumulated on an accelerometer (49 minutes versus 23 minutes per day). The highest correlation observed was between accelerometer-measured MVPA and the sum of self-reported recreation and transportation activity (R = 0.36, p ⟨ 0.0001). The sum of activity from all domains (recreation + transportation + occupational or household) exhibited a lower correlation with measured variables because the occupational or household domain was negatively correlated with MVPA (R = -0.04). The occupational or household domain was positively correlated with light-intensity physical activity (R = 0.20, p ⟨ 0.0001). Respondents in the least active quintile were more likely than those in the most active quintile to report more activity than was measured by the accelerometer. On average, the most active quintile reported less activity than was measured by the accelerometer. DISCUSSION: The newly developed Canadian physical activity questionnaire exhibited modest correlation and agreement with accelerometer-measured physical activity among adults. Accelerometers and questionnaires provide complementary information, about different aspects of physical activity (actual movement versus perceived time). Consequently, one should exercise caution in using estimates derived from these methods interchangeably.