Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada.

BACKGROUND: Primary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model. METHODS: A one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement. RESULTS: Experts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken. CONCLUSIONS: This study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.

Clinical and organisational quality indicators for the optimal management of acute ischaemic stroke in the era of thrombectomy: a scoping review and expert consensus study.

OBJECTIVE: The purpose of this study is to identify clinical and organisational quality indicators conducive to the optimal interdisciplinary management of acute-phase ischaemic stroke. METHOD: A scoping review based on the six-step methodological framework of Arksey and O'Malley (2005) was conducted including a Delphi process with an experts committee. DATA SOURCES: MEDLINE, CINAHL, Academic search complete, Cochrane Library databases, in addition to Google Scholar and Google were searched through January 2015 to February 2023. ELIGIBILITY CRITERIA: French and English references, dealing with clinical and organisational indicators for the management and optimal care of adults with acute ischaemic stroke. DATA EXTRACTION AND SYNTHESIS: After duplicate removal, all publications were checked for title and abstract. The full text of articles meeting the inclusion criteria was reviewed. Two independent reviewers performed 10% of the study selection and data extraction. Data collected underwent descriptive statistics. RESULTS: Of the 4343 references identified, 31 were included in the scoping review. About 360 indicators were identified and preliminary screened by two stroke experts. Fifty-four indicators were evaluated for validity, relevance and feasibility by a committee of experts including a partner patient using a Delphi method. A total of 34 indicators were selected and classified based on dimensions of care performance such as accessibility of services, quality of care and resource optimisation. Safety accounted for about one-third of the indicators, while there were few indicators for sustainability, equity of access and responsiveness. CONCLUSION: This scoping review shows there are many clinical and organisational indicators in the literature that are relevant, valid and feasible for improving the quality of care in the acute phase of ischaemic stroke. Future research is essential to highlight clinical and organisational practices in the acute phase. REGISTRATION DETAILS: https://osf.io/qc4mk/.

Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews.

AIM: To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). MATERIALS AND METHODS: A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. RESULTS: Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. DISCUSSION: Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. CONCLUSION: This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO REGISTRATION NUMBER: CRD42020198182.

Physical Activity, Occupational Stress, and Cardiovascular Risk Factors in Law Enforcement Officers: A Cross-sectional Study.

OBJECTIVE: This cross-sectional study aimed to assess the interrelationship between leisure-time physical activity (LTPA), occupational stress, and cardiovascular disease (CVD) risk factors in law enforcement officers (LEOs). METHODS: A total of 229 LEOs completed a survey assessing their LTPA level, occupational stress, and CVD risk factors. RESULTS: After adjusting for age and sex, physically inactive LEOs are more likely to have one or more CVD risk factors. While high occupational stress was associated with greater odds of CVD risk factors in physically inactive LEOs, stress was not significantly associated with the prevalence of CVD risk factors in active LEOs. CONCLUSIONS: Our results suggest that occupational stress is associated with the prevalence of CVD risk factors in LEOs. Nevertheless, LTPA might have the potential to mitigate the impact of occupational stress on CVD risk factors.

Health, Safety, and Wellness Concerns Among Law Enforcement Officers: An Inductive Approach.

Background: Although studies have assessed the impact of occupational risk factors on the health of law enforcement officers (LEO's), few have involved (LEO's) as informants in ways that allow their points of view to be heard directly. Thus, the objective of this study is to explore the occupational health, safety, and wellness (OHSW) concerns of (LEO's). Methods: (LEO's) working in Quebec, Canada were invited to answer an open-ended question regarding their OHSW concerns. Using a multi-stage content analysis, the collected answers were analyzed and coded by two members of the research team to identify the most recurrent concerns of (LEO's). Findings: Five themes relating to the OHSW concerns of (LEO's) were identified, namely, the work schedule, occupational stress, work equipment, workplace health promotion, and operational risks. Furthermore, our analyses highlighted differences in the concerns of (LEO's) based on their level of experience and sex. Conclusions/Application to Practice: This study addresses a gap in the literature on the OHSW concerns from the perspective of (LEO's). Overall, our results support that the work schedule and occupational stress associated with law enforcement are the two most recurrent concerns of (LEO's). Thus, the results of this study further stress the need for police organizations to implement strategies and policies, which could mitigate the deleterious effects of these hazards on the overall wellness of (LEO's).

Cardiorespiratory Fitness of Police Recruits: Normative Reference Values and Temporal Trend.

ABSTRACT: Poirier, S, Houle, J, Lajoie, C, and Trudeau, F. Cardiorespiratory fitness of police recruits: normative reference values and temporal trend. J Strength Cond Res 37(1): 207-212, 2023-Several studies have highlighted the increased risk of cardiovascular diseases (CVDs) among police officers. Given the longitudinal association between cardiorespiratory fitness (CRF) in early adulthood and later appearance of CVD, the identification of police recruits exhibiting lower CRF could allow the implementation of targeted CVD prevention strategies. Unfortunately, norm-referenced values for the CRF of Canadian police recruits are not yet available. Thus, this research aimed to provide norm-referenced values for the CRF of police recruits in the province of Quebec (Canada) and to evaluate the temporal trend in the CRF of police recruits over a 14-year period. First, a model was developed to estimate maximal oxygen consumption (V̇O2max) based on the results of the physical ability test (PAT) used for the recruitment of police officers in Quebec. Based on the previously developed model, the CRF of police recruits who completed the PAT from 2004 to 2017 was retrospectively assessed using administrative records. The analysis of 7,234 PAT results including 2,150 females (29.7%) and 5,084 males (70.3%) suggests that police recruits generally present high levels of CRF with an average estimated V̇O2max of 53.3 ml·min-1·kg-1 for males and 43.8 ml·min-1·kg-1 for females. Furthermore, our analyses showed significant but small positive correlations between estimated V̇O2max and time periods of PAT performance for male (rs = 0.105, p < 0.001) and female recruits (rs = 0.125, p < 0.001). Overall, our results suggest that the CRF of police recruits in Quebec is considerably higher than that of their North American peers.

Change in heart rate variability during two firefighting work cycles.

This study aimed to determine whether the change in heart rate variability from pre to post firefighting is modulated by different work cycles. Thirteen male firefighters underwent two firefighting simulations that comprised two identical 25-min work bouts intercalated by a passive recovery period of either 20 min (T20) or 5 min (T5). The square root of the mean squared differences of successive R-R intervals (RMSSD) and aural temperature were measured at rest before (PRE) and after (POST) firefighting simulations. The decrease in RMSSD was different between firefighting simulations (T20: -10 ± 21.2 ms, T5: -19.9 ± 20.9 ms, interaction, p = 0.02). Post-firefighting aural temperature was greater (p = 0.05) in T5 (37.18 ± 0.53 °C) than in T20 (36.88 ± 0.49 °C). In conclusion, a shorter recovery period of 5 min between firefighting work bouts decreases post-firefighting heart rate variability, possibly attributed to a lower parasympathetic reactivation and a higher absolute value of body temperature.

Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials.

BACKGROUND: Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. OBJECTIVE: This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. METHODS: We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI. RESULTS: Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient -668, 95% CI -1157 to -180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient -517, 95% CI -1188 to -11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. CONCLUSIONS: In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. TRIAL REGISTRATION: PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143012.

Physical Activity Participation in People With an Active Diabetic Foot Ulceration: A Scoping Review.

BACKGROUND: Being physically active on a regular basis has a favourable impact on diabetes-related complications. With the exception of evidence advising individuals with an active diabetic foot ulceration (DFU) to avoid weight-bearing activity, no physical activity (PA) recommendations are currently provided for this population. OBJECTIVE: The aim of this scoping review was to examine and map the existing research evidence of PA participation for individuals with an active DFU. DESIGN: A scoping review using the Arksey and O'Malley framework was conducted in electronic databases and grey literature from inception to June 2020 to identify publications that investigated individuals with type 1 or type 2 diabetes and an active DFU at enrolment in relation to a PA intervention. Reported outcomes had to inform on effects of PA on any health or wound parameters. RESULTS: Nineteen articles from 17 distinct studies met inclusion criteria. Fourteen of the included studies were published in the last 10 years. Types of exercises and materials used, duration of studies, offloading considerations and provision of wound care varied greatly between studies. Included studies are heterogenous in methodological designs and aims, and reporting was often lacking important components of wound care and PA interventions. A discussion based on descriptive statistics and narrative analysis is provided. CONCLUSIONS: It is not possible from this scoping review to determine what would be the ideal components of a PA program for this specific population. Conclusions are limited by the quality and design of the included studies. No articles evaluated quality of life, mortality or cardiorespiratory capacity, nor were adverse effects routinely reported.

Psychological distress, depression symptoms and fatigue among Quebec nursing staff during the COVID-19 pandemic: A cross-sectional study.

AIM: To describe the state of health of Quebec nursing staff during the pandemic according to their exposure to COVID-19, work-related characteristics and sociodemographic factors (gender, generational age group). State of health was captured essentially by assessing psychological distress, depression symptoms and fatigue. DESIGN AND METHODS: A large-scale cross-sectional study was conducted with 1,708 nurses and licenced practical nurses in Quebec (87% women, mean age of 41 ± 11 years). The survey included several questionnaires and validated health-related scales (psychological distress, depression symptoms and fatigue). The STROBE guidelines were followed in reporting the study's findings. RESULTS: Results showed that the prevalence of psychological distress and depression symptoms was moderate to severe. Women, generation Xers and Yers, nurses who cared for COVID-19 patients and those with a colleague who was infected with COVID-19 at work scored higher for fatigue, psychological distress and depression.

Postexercise hypotensive response in stroke patients following acute moderate or high intensity cycling session.

BACKGROUND: Hypertension is highly prevalent in stroke patients and reducing blood pressure is a priority. Aerobic exercise is known to induce postexercise hypotensive responses, but limited studies have documented this concept in stroke patients. The purpose was to investigate the effect of a single bout of moderate intensity continuous training (MICT) and high-intensity interval training (HIIT) on postexercise ambulatory blood pressure with patients with prior ischemic stroke or transient ischemic attack (TIA). METHODS: Ten hypertensive adults (mean age: 70±9 years) with prior ischemic stroke or TIA participated using a randomized crossover design. Ambulatory blood pressure was monitored for up to 8 hours after either ergocycle MICT or HIIT of respectively 50% and 95% of peak power output. Blood pressure was compared to pre-exercise resting measure. RESULTS: HIIT and MICT induced a decrease of systolic blood pressure of -11.0±9.2 mmHg and -4.7±4.5 mmHg respectively (P=0.03) immediately after the exercise. Ambulatory systolic blood pressure showed a steady linear increase (R2=0.90; P<0.001) of ~1.2 mmHg/hour and returned to pre-exercise measure after 8 hours. Effect of the two exercise conditions over time did not significantly differ (P=0.278). Diastolic blood pressure was not affected by both exercises. CONCLUSIONS: Those results suggest that HIIT induce a systolic blood pressure reduction of greater magnitude than MICT immediately after cycling exercise among patients with prior ischemic stroke or TIA. For both exercises, effects on ambulatory blood pressure are similar and persist up to 8 hours.

Addition of high-intensity interval training to a moderate intensity continuous training cardiovascular rehabilitation program after ischemic cerebrovascular disease: A randomized controlled trial.

Introduction: Moderate intensity continuous training (MICT) is usually recommended for stroke or transient ischemic attack (TIA) patients. High intensity interval training (HIIT) has emerged as a potentially effective method for increasing cardiorespiratory fitness (CRF) among clinical populations. Its effectiveness remains to be demonstrated after stroke. A combined program of HIIT and MICT was designed to create a realistic exercise program implemented for a clinical setting to help patients become more active. Purpose: This study aimed to compare the effects of a 6-month exercise program with either MICT only or a combination of HIIT and MICT and a control group in terms of CRF, cardiovascular risk factors, functionality, cognitive function (Montreal Cognitive Assessment) and depression markers (Hospital Anxiety and Depression Scale). Methods: This randomized controlled trial started with 52 participants (33 men and 19 women, mean age: 69.2 ± 10.7) divided into three groups: HIIT + MICT combined, MICT, and control. Both exercise groups consisted of 4 weekly sessions including supervised and at-home exercise. Outcomes were assessed at T0 (baseline measure), T6 (end of exercise protocols), and T12 (follow-up), 40 participants having completed the 12-month follow-up. Results: At T6, both HIIT+MICT and MICT programs provided a similar increase of CRF (3 ml·min-1·kg-1) from baseline (p < 0.01), while the control group showed a global slight decrease. Despite some decrease of CRF at T12 compared to T6, improvement persisted 6 months post-intervention (HIIT + MICT: p < 0.01 and MICT: p < 0.05). The control group decreased compared with baseline (p < 0.05). The two exercise programs induced a comparable increase in self-reported physical activity and a decrease in anxiety and depression markers. Participants in HIIT + MICT and MICT programs declared a good degree of acceptability assessed by the Acceptability and Preferences Questionnaire. Conclusion: A 6-month HIIT + MICT combined program and a standard MICT program induced similar improvements in CRF, self-reported physical activity and anxiety and depression markers among patients with prior ischemic stroke or TIA compared with a control group. These effects appear to persist over time. Addition of HIIT was safe and considered acceptable by participants. Our results do not support any superiority of the combination HIIT + MICT nor disadvantage vs. MICT in this population.

Determinants of pain assessment documentation in intensive care units.

PURPOSE: The underassessment of pain is a major barrier to effective pain management, and the lack of pain assessment documentation has been associated with negative patient outcomes. This study aimed to 1) describe the contextual factors related to pain assessment and management in five Québec intensive care units (ICUs); 2) describe their pain assessment documentation practices; and 3) identify sociodemographic and clinical determinants related to pain assessment documentation. METHODS: A descriptive-correlational retrospective design was used. Sociodemographic data (i.e., age, sex), clinical data (i.e., diagnosis, mechanical ventilation, level of consciousness, severity of illness, opioids, sedatives), and pain assessments were extracted from 345 medical charts of ICU admissions from five teaching hospitals between 2017 and 2019. Descriptive statistics and multiple linear regression were performed. RESULTS: All sites reported using the 0-10 numeric rating scale, but the implementation of a behavioural pain scale was variable across sites. A median of three documented pain assessments were performed per 24 hr, which is below the minimal recommendation of eight to 12 pain assessments per 24 hr. Overall, pain assessment was present in 70% of charts, but only 20% of opioid doses were followed by documented pain reassessment within one hour post-administration. Higher level of consciousness (ß = 0.37), using only breakthrough doses (ß = 0.24), and lower opioid doses (ß = -0.21) were significant determinants of pain assessment documentation (adjusted R2 = 0.25). CONCLUSION: Pain assessment documentation is suboptimal in ICUs, especially for patients unable to self-report or those receiving higher opioid doses. Study findings highlight the need to implement tools to optimize pain assessment and documentation.

RéSUMé: OBJECTIF: La sous-évaluation de la douleur constitue un obstacle majeur à une gestion efficace de la douleur, et le manque de documentation de l'évaluation de la douleur a été associé à des conséquences défavorables pour les patients. Cette étude visait à : 1) décrire les facteurs contextuels liés à l'évaluation et à la gestion de la douleur dans cinq unités de soins intensifs (USI) du Québec; 2) décrire leurs pratiques de documentation de l'évaluation de la douleur; et 3) identifier les déterminants sociodémographiques et cliniques liés à la documentation de l'évaluation de la douleur. MéTHODE: Un devis de recherche rétrospectif descriptif-corrélationnel a été utilisé. Les données sociodémographiques (c.-à-d. l'âge, le sexe), les données cliniques (c.-à-d. le diagnostic, la ventilation mécanique, le niveau de conscience, la gravité de la maladie, les opioïdes, les sédatifs) et les évaluations de la douleur ont été extraites de 345 dossiers médicaux avec admissions à l'USI de cinq hôpitaux universitaires entre 2017 et 2019. Des statistiques descriptives et une régression linéaire multiple ont été effectuées. RéSULTATS: Tous les sites ont déclaré utiliser l'échelle d'évaluation numérique de 0 à 10, mais l'implantation d'une échelle de douleur comportementale variait d'un site à un autre. Une médiane de trois évaluations de douleur étaient documentées par 24 heures, ce qui est inférieur à la recommandation minimale de huit à 12 évaluations de douleur par 24 heures. Dans l'ensemble, l'évaluation de la douleur était présente dans 70 % des dossiers, mais seulement 20 % des doses d'opioïdes étaient suivies d'une réévaluation documentée de la douleur dans l'heure suivant leur'administration. Un niveau de conscience plus élevé (ß = 0,37), l'utilisation exclusive d'entredoses d'opioïdes pour les percées de douleur (ß = 0,24) et des doses d'opioïdes plus faibles (ß = -0,21) ont constitué les déterminants significatifs dans la documentation de l'évaluation de la douleur (R2 ajusté = 0,25). CONCLUSION: La documentation de l'évaluation de la douleur est sous-optimale dans les USI, en particulier pour les patients incapables de s'exprimer ou ceux qui reçoivent des doses plus élevées d'opioïdes. Les résultats de cette étude soulignent l'importance d'implanter des outils pour optimiser l'évaluation et la documentation de la douleur.

Individuals with self-determined motivation for eating have better overall diet quality: Results from the PREDISE study.

The study aimed at documenting motivational orientations for the regulation of eating as defined by self-determination theory and their association with sociodemographic characteristics and overall diet quality. As part of the PREDISE study, French-speaking women (n = 550) and men (n = 547), aged 18-65 years, living in the Province of Québec, Canada, completed online validated questionnaires. The Regulation of Eating Behavior Scale, based on the self-determination theory, assessed self-determined and non-self-determined motivation to regulate one's eating behavior. Three web-based 24-h food recalls were completed and used to compute the Canadian Healthy Eating Index 2007 (C-HEI), an indicator of the overall adherence to Canadian guidelines for healthy eating. Multiple linear regressions were performed to assess how regulation styles are associated with the C-HEI. Model 1 included no covariate, model 2 included sociodemographic covariates, and fully adjusted model 3 included as covariates sociodemographic variables as well as variables that were previously associated with diet quality, namely nutrition knowledge and social support for healthy eating. Women (p < 0.0001), older individuals (p = 0.0002), those with a higher education level (p < 0.0001), and non-smokers (p < 0.0001) reported higher self-determined motivation score than their counterparts. Self-determined motivation was positively (model 1: B = 4.67, p < 0.0001; model 2: B = 3.82, p < 0.0001; model 3: B = 3.61, p < 0.0001) and non-self-determined motivation was negatively (model 1: B = -1.62, p = 0.0009; model 2: B = -1.63, p = 0.0006; model 2: B = -1.49, p = 0.0022) associated with C-HEI. The present study suggests that some subgroups of the general adult population show more self-determined motivation for eating, which is associated with a better diet quality independently of individual characteristics and other individual and social determinants of healthy eating. Strategies to help individuals internalize the regulation of eating should be further investigated.

Identifying indicators sensitive to primary healthcare nurse practitioner practice: a review of systematic reviews protocol.

INTRODUCTION: Primary healthcare nurse practitioners (PHCNPs) practice in a wide range of clinical settings and with diverse patient populations. Several systematic reviews have examined outcomes of PHCNP roles. However, there is a lack of consistency in the definitions used for the PHCNP role across the reviews. The identification of indicators sensitive to PHCNP practice from the perspective of patients, providers and the healthcare system will allow researchers, clinicians and decision-makers to understand how these providers contribute to outcomes of care. METHODS AND ANALYSIS: A review of systematic reviews is proposed to describe the current state of knowledge about indicators sensitive to PHCNP practice using recognised role definitions. Outcomes of interest include any outcome indicator measuring the effectiveness of PHCNPs. We will limit our search to 2010 onwards to capture the most up-to-date trends. The following electronic databases will be searched: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, EMBASE, Global Health, Health Economics Evaluation Database, Health Evidence, HealthStar, Health Systems Evidence, Joanna Briggs Institute, Medline, PDQ-Evidence, PubMed and Web of Science. The search strategies will be reviewed by an academic librarian. Reference lists of all relevant publications will be reviewed. Grey literature will be searched from 2010 onwards, and will include: CADTH Information Services, CADTH's Grey Matters tool, OpenGrey, Organisation for Economic Co-operation and Development, ProQuest Dissertation and Theses and WHO. The PROSPERO International Prospective Register of Systematic Reviews will be searched to identify registered review protocols. The review protocol was developed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A narrative synthesis will be used to summarise study findings. ETHICS AND DISSEMINATION: No ethical approval is required for the study. The data used in the study will be abstracted from published systematic reviews. Dissemination strategies will include peer-reviewed publication, conference presentations and presentations to key stakeholders. PROSPERO REGISTRATION NUMBER: CRD42020198182.

Associations Between Nutrition Knowledge and Overall Diet Quality: The Moderating Role of Sociodemographic Characteristics-Results From the PREDISE Study.

PURPOSE: To assess how nutrition knowledge is associated with global diet quality and to investigate whether sociodemographic characteristics (ie, sex, age, education, income, marital status, and living with children or not) moderate this association. DESIGN: Cross-sectional web-based study. PARTICIPANTS: The PREDISE study aims at identifying correlates of adherence to healthy eating guidelines in French-speaking adults from the Province of Quebec, Canada. SUBJECTS: A probability sample of 1092 participants (50% female). MEASURES: The Nutrition Knowledge Questionnaire and 24-hour food recalls from which the Canadian Healthy Eating Index (C-HEI) was calculated. ANALYSIS: Multiple linear regressions performed to assess how nutrition knowledge is associated with the C-HEI. Interaction terms tested to evaluate whether sociodemographic characteristics moderate the association between nutrition knowledge and the C-HEI. RESULTS: Nutrition knowledge (B = 0.141 [95% CI: 0.075-0.208], P < .0001) was identified as a significant correlate of the C-HEI. Education significantly moderated the association between nutrition knowledge and the C-HEI (P interaction = .0038), with a significative association among participants with a lower education level (B = 0.295 [95% CI: 0.170-0.421], P < .0001) but not among participants with a higher education level (B = 0.077 [95% CI: -0.004 to 0.157], P = .06). Whether participants lived with or without children also significantly moderated the association (P interaction = 0.0043); nutrition knowledge was associated with the C-HEI only in participants who were not living with children (B = 0.261 [95% CI: 0.167 to 0.355], P < .0001). CONCLUSION: This study suggests that the association between nutrition knowledge and adherence to healthy eating guidelines is not the same in different subgroups of the population. Interventions aiming at increasing nutrition knowledge may be a promising approach to improve diet quality, especially among individuals with a lower education.

Participants' Perspectives of a Primary Exercise-Based Prevention Program for Cardiac Patients: A Prepost Intervention Qualitative Case Study.

Perseverance in exercise-based, cardiovascular disease prevention programs is generally very low. The purpose of this case study is to understand the experience of participants enrolled in a 6-month primary and secondary exercise-focused, cardiovascular disease prevention out of hospital program. Ten participants were interviewed about their experiences at entry and after it ended 6 months later to understand the facilitators and difficulties encountered by participants in such exercise programs. Four out of ten participants completed the 6-month program. The six participants who left the program accepted to contribute to the postprogram interview. The results showed that the four participants who persevered in the program became aware of cardiac risk factors and their conditions were willing to make changes in their lifestyles to reach their objectives, felt a strong perception of self-efficacy, and felt like they belonged in the program. Both persevering and nonpersevering participants experienced many episodes of discouragement during the program and faced many barriers that interfered with their progress. Suggestions to help coping with these barriers while reinforcing self-efficacy and the sentiment of belonging are discussed.

Acceptability of a computer-tailored and pedometer-based socio-cognitive intervention in a secondary coronary heart disease prevention program: A qualitative study.

When developing an innovative intervention, its acceptability to patients, health care professionals and managers must be considered to ensure the implementation into practice. This study aims to identify factors influencing the acceptability of a computer-tailored and pedometer-based socio-cognitive intervention for patients with heart disease. Focus group interviews were conducted in two outlying regions of the province of Quebec (Canada). The Theory of Planned Behavior formed the theoretical basis of the interview guide. Two researchers performed verbatim analysis independently until consensus was achieved. The sample included 44 participants divided into six groups (patients n = 7 + 8, health care professionals n = 8 + 8, managers n = 6 + 7). Health care professionals and managers mentioned benefits concerning partners' opportunity to improve assessment and monitoring. Patients believed the intervention could be useful to improve adherence to physical activity. Additional benefits indicated were self-monitoring behavior and improved health-related outcomes. However, patients expressed concern about the online security, fearing possible data breach. Some clinicians felt the pedometer may not be able to evaluate physical activities other than walking. With regard to behavioral control, a web application and pedometer must be easy to use and compatible with services already in place. Further barriers include level of literacy, cost and the various difficulties associated with wearing a pedometer. Findings suggest that, to improve the acceptability of a computer-tailored and pedometer-based socio-cognitive intervention, users must be assured of a secure website, validated, affordable and easy-to-use pedometers, and an intervention adapted to their level of literacy.

Social Support, but Not Perceived Food Environment, Is Associated with Diet Quality in French-Speaking Canadians from the PREDISE Study.

The objectives were to assess whether social support for healthy eating and perceived food environment are associated with diet quality, and to investigate if sociodemographic characteristics moderate these associations. A probability sample of French-speaking adults from the Province of Québec, Canada, was recruited in the context of the PREDISE study. Participants reported their perceptions of supportive and non-supportive actions related to healthy eating from close others at home and outside of home (n = 952), and of the accessibility to healthy foods (n = 1035). The Canadian Healthy Eating Index (C-HEI) was calculated based on three Web-based 24 h food recalls. Multiple linear regression models showed that supportive (B = 1.50 (95% CI 0.46, 2.54)) and non-supportive (B = -3.06 (95% CI -4.94, -1.18)) actions related to healthy eating from close others at home were positively and negatively associated with C-HEI, respectively, whereas actions from close others outside of home were not. The negative association between non-supportive actions occurring at home and C-HEI was stronger among participants with lower (vs. higher) levels of education (p interaction = 0.03). Perceived accessibility to healthy foods was not associated with C-HEI (p > 0.05). These results suggest that the social environment may have a stronger influence on healthy eating than the perceived physical environment. This adds support for healthy eating promotion programs involving entire families, especially for more socioeconomically disadvantaged individuals, whose efforts to eat healthily may be more easily thwarted by non-supportive households.

Shortened Recovery Period Between Firefighting Work Bouts Increases Cardiac Response Disproportionately With Metabolic Rate.

OBJECTIVE: To compare physiological responses between two firefighting simulations with different recovery periods, one having work bouts intercalated by a shortened recovery period. METHODS: Thirteen male firefighters participated in two different simulations, which comprised two identical 25-minute effort bouts (E1 and E2) intercalated by a recovery period of either 20 (T20) or 5 (T5) minutes. RESULTS: From E1 to E2, the increase of mean heart rate (HR) (26 ±â€Š5 vs 14 ±â€Š5 bpm, P < 0.001) and mean VO2 (1.8 ±â€Š0.4 vs 1.3 ±â€Š0.4 mL kg min, P < 0.001) was higher in T5 than in T20. CONCLUSION: Results indicate that a shortened recovery time between firefighting work bouts intensifies cardiac strain disproportionately with metabolic rate, since mean HR increased by 19.3% and 10.8% while mean VO2 increased by only 7.2% and 5.0% in T5 and T20, respectively.