Beyond the Laws: Parental Monitoring, Perceived Acceptability of Underage Drinking and Alcohol Use Among Belgian Youth.

Parental monitoring behaviors are negatively associated with adolescent substance use. Yet, the processes explaining these associations are still unclear. The current study examined adolescents' knowledge of minimum legal drinking age laws and their perceived acceptability of underage drinking as potential mediators of the links between parental monitoring behaviors and youth alcohol use. The sample included 1154 Belgian adolescents (Mage = 16.34, SD = 1.33; 71% girls), who were recruited in Wallonia (54.9%) and in Flanders (45.1%). Path analyses revealed that higher parental rule setting, but not solicitation, was related to lower alcohol use. Acceptability of underage drinking mediated this link, but not knowledge of the laws. Results suggest that beyond laws regulating the minimum legal drinking age, alcohol use prevention programs should consider the importance of parental rule setting and youth's perceived acceptability of underage drinking.

Pulmonary Rehabilitation with and without a Cognitive Behavioral Intervention for Breathlessness in People Living with Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial.

(1) Background: Most controlled trials of cognitive behavior therapy (CBT) in people living with chronic obstructive pulmonary disease (COPD) have targeted anxiety and depression. (2) Methods: This pragmatic randomized controlled trial explored whether a comprehensive pulmonary rehabilitation program (CPRP) with CBT for breathlessness or social group control (CPRP + SC) significantly improved health outcomes. (3) Results: People with moderate-to-severe COPD were block randomized (CPRP + CBT n = 52 or CPRP + SC n = 49). Primary outcomes (Hospital Anxiety and Depression scale (HADs), six-minute walk distance (6MWD)) and secondary outcomes (breathlessness, quality of life and habitual physical activity) were assessed before and 1, 6 and 12 months post intervention. Between-group differences were calculated with mixed models for each time point to baseline (intention to treat (ITT)). Participants (n = 101, mean ± SD age 70 ± 8.5 years, 54 (53%) males, FEV1% pred 47.7 ± 16.3) were similar between groups. Post intervention, primary outcomes did not differ significantly between groups at 1 (6MWD mean difference -7.5 [95% CI -34.3 to 19.4], HADs-A -0.3 [-1.4 to 0.9], HADs-D 0.2 [-0.8 to 1.3]), 6 (6MWD -11.5 [-38.1 to 15.1], HADs-A 1.1 [0.0 to 2.2], HADs-D 0.2 [-0.9 to 1.3]), or 12 months (6MWD -3.8 [-27.2 to 19.6], HADS-A -0.4 [-1.5 to 0.6], HADs-D -0.7 [-1.7 to 0.4]). (4) Conclusions: In this cohort, combining CBT with a CPRP did not provide additional health benefits beyond those achieved by a standard CPRP.

A More Supportive Social Environment May Protect Against Nutritional Risk: A Cross-Sectional Analysis Using Data From the Canadian Longitudinal Study on Aging.

BACKGROUND: Nutritional risk has been linked to individual social factors, but the relationship with the overall social environment has not been assessed. OBJECTIVES: To evaluate associations between different support profiles of the social environment and nutritional risk using cross-sectional data from the Canadian Longitudinal Study on Aging (n = 20,206). Subgroup analyses were performed among middle-aged (range, 45-64 y; n = 12,726) and older-aged (≥65 y, n = 7480) adults. Consumption of major food groups [whole grains, proteins, dairy products, and fruits and vegetables (FV)] by social environment profile was a secondary outcome. METHODS: Latent structure analysis (LSA) classified participants into social environment profiles according to data on network size, social participation, social support, social cohesion, and social isolation. Nutritional risk and food group consumption were assessed with the SCREEN-II-AB and Short Dietary questionnaires, respectively. ANCOVA was conducted to compare SCREEN-II-AB mean scores by social environment profile, adjusted for sociodemographic and lifestyle factors. Models were repeated to compare mean food group consumption (times/day) by social environment profile. RESULTS: LSA identified 3 social environment profiles classified as low, medium, and high support (17%, 40%, and 42% of the sample, respectively). Adjusted mean SCREEN-II-AB scores significantly increased with increasing social environment support, with the low support score indicating high nutritional risk status [low, medium, high support, respectively: 37.1 (99% CI: 36.9, 37.4), 39.3 (39.2, 39.5), 40.3 (40.2, 40.5), all comparisons P < 0.0001]. Results were consistent among age subgroups. The low support social environment profile had lower consumption of protein [low, medium, high support, respectively (mean ± SD): 2.17 ± 0.09, 2.21 ± 0.07, 2.23 ± 0.08, P = 0.004], dairy (2.32 ± 0.23, 2.40 ± 0.20, 2.38 ± 0.21, P = 0.009), and FV (3.65 ± 0.23, 3.94 ± 0.20, 4.08 ± 0.21, P < 0.0001), with some variation among age subgroups. CONCLUSIONS: The low support social environment profile had the poorest nutritional outcomes. Therefore, a more supportive social environment may protect against nutritional risk among middle- and older-aged adults.

Otolith-inferred patterns of marine migration frequency in Nunavik Arctic charr.

Alternative migratory tactics in salmonids reflect the large observed interindividual variation in spatial behaviour which may range from strict freshwater residency to uninterrupted anadromy. In Salvelinus, sea migrations are performed during the ice-free period as freshwater overwintering is thought to be obligatory due to physiological constraints. As a result, individuals can either migrate the next spring or remain in freshwater, as anadromy is generally considered facultative. In Arctic charr (Salvelinus alpinus), skipped migrations are known to occur, but limited data are available regarding their frequencies within and among populations. Here, the authors used an otolith microchemistry approach relying on strontium (88 Sr) to infer movements between freshwater and marine habitats, and annual oscillations in zinc (64 Zn) to help with age identification. They determined the age-at-first-migration and the occurrence of subsequent annual migrations in two Nunavik Arctic charr populations sampled in Deception Bay (Salluit) and river systems linked to Hopes Advance Bay (Aupaluk), northern Québec, Canada. The mode for age-at-first-migration was 4+ for both populations, although it exhibited large variation (range: 0+ to 8+). Skipped migrations constituted a rare event, as 97.7% and 95.6% of the examined Arctic charr at Salluit (n = 43, mean age = 10.3 ± 2.0 years) and Aupaluk (n = 45, mean age = 6.0 ± 1.9 years), respectively, were found to have performed uninterrupted annual migrations after initiation of the behaviour. The consistency of the annual migrations suggests that the tactic is sufficiently fitness rewarding to be maintained under current environmental conditions. From a fisheries management perspective, these repeated migrations combined with low site fidelity in this species may lead to large interannual variations in abundance at the local scale, which may represent a challenge for monitoring Arctic charr demographics on a river-by-river basis.

Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources.

BACKGROUND: Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community. OBJECTIVE: This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults. METHODS: A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources. RESULTS: The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services. CONCLUSIONS: A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.

Visual abilities and exploration behaviors as predictors of intelligence in autistic children from preschool to school age.

LAY ABSTRACT: At the time of diagnosis, parents of autistic children frequently wonder what the future holds for their children in terms of intellectual development. It remains however difficult to answer this question at such a young age. Indeed, while early precursors of intelligence are well known for children following a typical development, these precursors remain to be identified for autistic children. Some theoretical models of intelligence suggest that perceptual abilities or behaviors, as seen early in autistic cognitive development, could be early indicators of intelligence. However, research examining the relation between early perceptual predictors and autistic intelligence over time is needed. This article is the first to consider a variety of early perceptual abilities and behaviors as precursors/predictors of intelligence at school age in autistic children. We showed that better performance in perceptual tasks at preschool age predicted better intellectual abilities measured later in autistic children. Importantly, our sample of autistic children represented the whole spectrum, including children with few to no spoken words, who are an important proportion of autistic preschoolers. While early perceptual abilities and behaviors may not substitute for a formal intellectual assessment, our results support that these indices may help estimate later intellectual level in autistic children. Perceptual abilities have the advantage to be easy to observe at preschool age and seem to fit the cognitive style of autistic children. Assessment methods could probably gain from including and focusing more on the perceptual strengths of autistic children.

From early birds to night owls: a longitudinal study of actigraphy-assessed sleep trajectories during the transition from pre- to early adolescence.

STUDY OBJECTIVES: Pre- and early adolescence are believed to constitute periods of important age-related changes in sleep. However, much of the research on these presumed developmental changes has used cross-sectional data or subjective measures of sleep, limiting the quality of the evidence. In addition, little is known about the development of certain features of the sleep-wake cycle pertaining to regularity (e.g. weekend-weekday differences and intra-individual variability) or circadian rhythms (e.g. sleep midpoint). METHODS: This study examined the sleep trajectories of 128 typically developing youth (69 girls) from ages 8 to 12 years on four sleep characteristics: sleep onset, sleep offset, total sleep time (TST), and sleep midpoint. For each of these characteristics, actigraphy-derived estimates of typical (i.e. mean) sleep and sleep regularity were obtained at each time point. Multilevel growth curves were modeled. RESULTS: Overall, the sleep-wake cycle significantly changed between 8 and 12 years. Mean sleep onset, offset and midpoint exhibited an ascending curvilinear growth pattern that shifted later with age, while mean TST decreased linearly. Weekend-weekday differences (social jetlag) for sleep offset and midpoint became more pronounced each year. Weekday TST was longer than weekend TST, though this difference became smaller over time. Finally, intra-individual variability increased over time for all sleep characteristics, with variability in TST ascending curvilinearly. Important between-person and sex differences were also observed. CONCLUSION: This study reveals the marked changes that occur in the sleep of typically developing pre- and early adolescents. We discuss the potential implications of these trajectories.

Branched-chain amino acids and sleep: a population-derived study of Australian children aged 11-12 years and their parents.

Micronutrients, particularly amino acids, are thought to play an important role in sleep regulation and maintenance. While tryptophan is a known predictor of sleep, less is known about branched-chain amino acids (BCAAs), which compete with tryptophan for transport across the blood-brain barrier. The aim of this study was to determine the association between BCAAs and actigraphy-derived sleep duration, timing and efficiency, and self-reported trouble sleeping. This study examined data on children and adults collected as part of the Child Health CheckPoint study. Linear mixed models, adjusted for geographic clustering, were used to determine the association between BCAAs and sleep characteristics. Complete-case analysis was conducted for 741 children aged 11-12 years old (51% females) and 941parents (87% mothers). While BCAAs were significantly associated with children's sleep duration, timing and self-reported trouble sleeping, no associations were observed in adults, in fully adjusted models. In children, higher levels of BCAAs are associated with shorter sleep duration, delayed sleep timing, and more frequent reports of trouble sleeping.

Food Values, Food Purchasing, and Eating-Related Outcomes Among a Sample of Quebec Adults During the COVID-19 Pandemic.

Purpose: This investigation evaluated food values, food purchasing, and other food and eating-related outcomes during the COVID-19 pandemic in Quebec, Canada. The role of stress in eating outcomes was also examined.Methods: An online household survey was conducted among Quebec adults aged ≥18 years (n = 658). Changes in outcomes during, as compared to before, the pandemic were evaluated using descriptive statistics and thematic analysis of free text responses. Eating outcomes by daily stress level (low, some, high) were assessed using Cochran-Armitage test for trend.Results: Most respondents reported increased importance and purchasing of local food products (77% and 68%, respectively) and 60% reported increased grocery spending (mean ± standard deviation: 28% ± 23%). Respondents with a higher daily stress level had a higher frequency of reporting eating more than usual compared to before the pandemic (low stress 21%, some stress 34%, high stress 39%, p-trend <0.0001). Free text responses described more time spent at home as a reason for eating more than usual.Conclusions: To support healthy eating during and post-pandemic, dietitians should consider patients' mental/emotional well-being and time spent at home. Moreover, support of local food products may provide opportunities to promote healthy eating, sustainability, and post-pandemic resiliency of food systems.

Multidimensional Sleep and Cardiometabolic Risk Factors for Type 2 Diabetes: Examining Self-Report and Objective Dimensions of Sleep.

PURPOSE: The purpose of the study was to determine the association between objective and self-report measures of sleep and cardiometabolic risk factors for type 2 diabetes. METHODS: This study examines data on Australian adults, collected as part of the Child Health CheckPoint study. Sleep was examined in terms of actigraphy-derived sleep duration, timing, efficiency and variability; and self-report trouble sleeping. Cardiometabolic risk factors for type 2 diabetes were examined in terms of body mass index and biomarkers of inflammation and dyslipidemia. Generalized estimating equations, adjusted for geographic clustering, were used to determine the association between measures of sleep and cardiometabolic risk factors. RESULTS: Complete case analysis was conducted for 1017 parents (87% mothers). Both objective and self-report measures of sleep were significantly but weakly associated with cardiometabolic risk factors. CONCLUSION: Both objective and self-report measures of sleep are significantly associated with cardiometabolic risk factors for type 2 diabetes. Self-report troubled sleep is associated with poorer cardiometabolic health, independent of actigraphy-derived sleep parameters.

Providing guideline-recommended preventive cardiovascular care to Aboriginal and Torres Strait Islander women: exploring gender differences with a medical record review in primary health care.

BACKGROUND: For Aboriginal and Torres Strait Islander women, the premature burden of cardiovascular disease is affecting their capacity to fulfil roles in society, and promote the health and wellbeing of future generations. In Australia, there is limited understanding of the difference in primary preventive cardiovascular care experienced by women, despite knowledge of sex and gender differentials in health profile and receipt of guideline-based acute care. This paper sought to explore the health profile and receipt of assessment and management of cardiovascular risk for Aboriginal and Torres Strait Islander women accessing preventive primary health care, and investigate gender differentials. METHOD: Records of 1200 current clients, 50% women, aged 18-74years from three Aboriginal Health Services in central and South Australia for the period 7/2018-6/2020 were reviewed. RESULTS: Twelve percent had documented cardiovascular disease. Compared with men, women with no recorded cardiovascular disease had a greater likelihood of being overweight or obese, a waist circumference indicative of risk, diabetes, and depression. Women were less likely to report being physically active. CONCLUSIONS: The research concluded that gaps exist in the provision and recording of guideline-recommended primary preventive care regardless of sex. These are stark, given the evident burden.

Collaborative writing applications in support of knowledge translation and management during pandemics: A scoping review.

OBJECTIVES: This study aimed to: (1) Map existing evidence about the use of collaborative writing applications (CWAs) during pandemics; (2) Describe CWAs' positive and negative effects on knowledge translation (KT) and knowledge management (KM) during pandemics; and (3) Inventory the barriers and facilitators that affect CWAs' use to support KT and KM during pandemics. MATERIALS AND METHODS: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews, we conducted a scoping review of the literature reporting the use of CWAs during pandemics published between 2001 and 2021. Two reviewers undertook the screening, study selection and qualitative thematic analysis. RESULTS: We identified a total of 46 studies. CWAs were used for the following two purposes: KT and KM (23 of 46) anddisease surveillance and infodemiology (20 of 46). Three studies addressed both purposes. Influenza was the focus of most studies (15 of 46), followed by COVID-19 (10 of 46).We identified and classified 24 barriers and 66 facilitators into four categories (factors related to the CWAs, users' knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 74 positive and 7 negative effects that were classified into processes and outcomes. CONCLUSION: CWAs offer the potential to accelerate KT and KM during pandemics. Their scalability and adaptability to different contexts makes them well suited to support the urgent KT and KM needed in the context of rapidly changing knowledge during pandemics. While their speed and cost as disease surveillance systems compare favorably with existing surveillance systems, the primary challenge is to ensure the accuracy of information shared.

Benefits and limitations of business process model notation in modelling patient healthcare trajectory: a scoping review protocol.

INTRODUCTION: The adoption of business process model notation (BPMN) in modelling healthcare trajectory can enhance the efficiency and efficacy of healthcare organisations, improve patient outcomes while restraining costs. Existing systematic reviews have been inconclusive regarding the effectiveness of BPMN in modelling healthcare trajectory. The aims of this scoping review are to map and aggregate existing evidence on the benefits and limitations associated with BPMN in healthcare trajectory, highlighting areas of improvement on BPMN and its extensions in healthcare. We will assess BPMN's ability to model key dimensions or concepts of the healthcare process and to meet the needs of stakeholders. The review will highlight the advantages of this approach to support clinical activities and decision-making processes associated with the healthcare trajectory, proposing a conceptual framework for improving the use of BPMN in healthcare. METHODS AND ANALYSIS: This study will be performed in accordance with the methodological framework suggested by Arksey and O'Malley. A wide range of electronic databases and grey literature sources will be systematically searched using predefined keywords. The review will include any study design focusing on the application of the BPMN approach for optimising healthcare trajectories, published in either English or French from 1 January 2004 to 9 December 2021. Two reviewers will independently screen titles, abstracts and full-text articles and select articles meeting the inclusion criteria. A customised data extraction form will be used to extract data. The results will be presented using descriptive statistics and thematic analysis on qualitative data. ETHICS AND DISSEMINATION: Research ethics approval is not required. Review findings will be used to advance understanding about BPMN, its extensions and application in healthcare trajectory optimisation. The review will develop recommendations on tailoring BPMN strategies for optimising care pathways and decision-making processes. Findings will be disseminated in peer-reviewed journals, conferences and discussions with relevant organisations and stakeholders.

Mother-child interactions and child anger proneness as antecedents of changes in sleep during the preschool period.

Age-related developments in sleep during the preschool years are normative and consequential. Yet, very few studies have examined the antecedents of individual differences in such developments, and most have used parental reports of child sleep. This study aimed to investigate the roles of mutual responsiveness in mother-child interactions and child temperamental anger proneness in the prediction of changes in sleep during the preschool period. The sample was comprised of 94 children (44 girls, 50 boys) of mostly White (93%) and college-educated (85%) mothers. Mother-child mutual responsiveness and child anger proneness were assessed at 2 years, and sleep was assessed using actigraphy at the ages of 2, 3, and 4 years. Multilevel growth models revealed that higher temperamental anger proneness was concurrently associated with lower sleep efficiency and shorter nighttime sleep duration at 2 years. In regard to changes in sleep, nighttime sleep duration decreased between 2 and 4 years among children exposed to lower mutual responsiveness in interactions with their mothers. High anger proneness was related to an increase in sleep efficiency from 2 to 4 years, whereas low anger proneness was associated with a decrease in nighttime duration during the same period. No interactive effect was found between anger proneness and mother-child mutual responsiveness. These results suggest that mother-child relationships and child temperament may play different roles, not only in children's concurrent sleep patterns but also in changes in sleep across the preschool period. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A systematic review on assessment and management of preventive cardiovascular care in primary health for Aboriginal and Torres Strait Islander women and men.

In promoting positive cardiovascular health for Aboriginal and Torres Strait Islander peoples, there is a need to ensure provision of high-quality risk assessment and management in primary healthcare settings. There is some evidence of gender gaps for Australian women in the provision of cardiovascular risk assessment and management; however, there is little understanding of whether these gaps are also present for Aboriginal and Torres Strait Islander women. A mixed-method systematic review was utilised to synthesise existing evidence on the provision of assessment and management against guideline-recommended care for Aboriginal and Torres Strait Islander women, and determine whether gender disparities in provision of care exist for this population. Sixteen studies that report gender-specific data indicate there are significant gaps in the provision of assessment and management for Aboriginal and Torres Strait Islander women and men alike. There is no evidence of incorporation of social and emotional wellbeing into cardiovascular care and limited studies outlining the assessment and management of behaviours and factors that may be protective of cardiovascular health. Furthermore, little is known about the provision of care in mainstream primary health services for Aboriginal and Torres Strait Islander peoples.

Dyspnoea-12 and Multidimensional Dyspnea Profile: Systematic Review of Use and Properties.

CONTEXT: The Dyspnoea-12 (D-12) and Multidimensional Dyspnea Profile (MDP) were specifically developed for assessment of multiple sensations of breathlessness. OBJECTIVES: This systematic review aimed to identify the use and measurement properties of the D-12 and MDP across populations, settings and languages. METHODS: Electronic databases were searched for primary studies (2008-2020) reporting use of the D-12 or MDP in adults. Two independent reviewers completed screening and data extraction. Study and participant characteristics, instrument use, reported scores and minimal clinical important differences (MCID) were evaluated. Data on internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient, ICC) were pooled using random effects models between settings and languages. RESULTS: A total 75 publications reported use of D-12 (n = 35), MDP (n = 37) or both (n = 3), reflecting 16 chronic conditions. Synthesis confirmed two factor structure, internal consistency (Cronbach's α mean, 95% CI: D-12 Total = 0.93, 0.91-0.94; MDP Immediate Perception [IP] = 0.88, 0.85-0.90; MDP Emotional Response [ER] = 0.86, 0.82-0.89) and 14 day test-rest reliability (ICC: D-12 Total = 0.91, 0.88-0.94; MDP IP = 0.85, 0.70-0.93; MDP ER = 0.84, 0.73-0.90) across settings and languages. MCID estimates for clinical interventions ranged between -3 and -6 points (D-12 Total) with small variability in scores over 2 weeks (D-12 Total 2.8 (95% CI: 2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1) and six months (D-12 Total 2.9 (2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1)). CONCLUSION: D-12 and MDP are widely used, reliable, valid and responsive across various chronic conditions, settings and languages, and could be considered standard instruments for measuring dimensions of breathlessness in international trials.

Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals.

BACKGROUND: Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals' use of wiki-based knowledge tools. OBJECTIVE: This study aims to measure emergency physicians' (EPs) and other acute care health professionals' (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. METHODS: In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. RESULTS: Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs' intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). CONCLUSIONS: The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.

Multiscale Risk Factors of Cardiovascular Disease: CLSA Analysis of Genetic and Psychosocial Factors.

Background: Cardiovascular disease (CVD) is a complex disease resulting from multiscale risk factors including genetics, age, and psychosocial factors (PSFs) such as depression and social isolation. However, previous research has lacked in operationalizing multiscale risk factors to determine individual and interactive associations over the life course. Therefore, this study aimed to evaluate individual and interactive associations of multiscale risk factors for CVD outcomes including genetics and PSFs at middle and older-aged stages of the life course. Methods: Baseline data from the Canadian Longitudinal Study on Aging (CLSA; n = 9,892 with genome-wide genotyping data) was used for this investigation. A 39 single nucleotide polymorphism polygenic risk score (PRS) for CVD was constructed. PSFs consisted of: (1) Depressive symptoms categorized into: "none" (Group 1, reference), "current" (Group 2), "clinical depression with no current symptoms" (Group 3), and "potential, recurrent depression" (Group 4); and (2) Social isolation index as a binary variable comprised of marital status, living arrangements, retirement status, contacts, and social participation. Heart-related disorders (HRD: myocardial infarction, angina and heart disease) was the primary outcome of interest and peripheral/vascular-related disorders (PVRD: stroke, peripheral vascular disease and hypertension) was the secondary outcome. Multivariable logistic regression models adjusted for socio-demographic factors were conducted stratified by age group (middle-aged: 45-69 years, older-aged: ≥70 years). Results: PRS was associated with HRD among middle- and older-aged participants [OR (95% confidence interval)] [1.06 (1.03-1.08), 1.06 (1.03-1.08), respectively]. Most depressive symptoms groups compared to the reference associated with HRD and PVRD, but only Group 4 associated with PVRD among older-aged [1.69 (1.08-2.64)]. Social isolation was associated with only PVRD among middle-aged [1.84 (1.04-3.26)]; however, socially isolated CLSA participants were underrepresented in the genotyped cohort (1.2%). No significant PRS*PSFs interactions were observed. Conclusions: Genetics and PSFs are independently associated with CVD. Varying observations across age groups underscores the need to advance research on multiscale risk factors operating both at a given point in time and over the life course. Future cohort studies may benefit from use of mobile assessment units to enable better reach to socially isolated participants for collection of biospecimens.