The usability and reliability of a smartphone application for monitoring future dementia risk in ageing UK adults.

BACKGROUND: The rising number of dementia diagnoses and imminent adoption of disease-modifying treatments necessitate innovative approaches to identify individuals at risk, monitor disease course and intervene non-pharmacologically earlier in the disease course. Digital assessments of dementia risk and cognitive function have the potential to outperform traditional in-person assessments in terms of their affordability, accuracy and longitudinal tracking abilities. However, their accessibility and reliability in older adults is unclear. AIMS: To evaluate the usability and reliability of a smartphone assessment of lifestyle and cognitive factors relevant to dementia risk in a group of UK-based older adults. METHOD: Cognitively healthy adults (n = 756) recruited through the Dementias Platform UK Great Minds volunteer register completed three assessments of cognitive function and dementia risk over a 3-month period and provided usability feedback on the Five Lives smartphone application (app). We evaluated cognitive test scores for age, gender and higher education effects, normality distributions, test-retest reliability and their relationship with participants' lifestyle dementia risk factors. RESULTS: Participants found the app 'easy to use', 'quick to complete' and 'enjoyable'. The cognitive tests showed normal or near-to-normal distributions, variable test-retest reliabilities and age-related effects. Only tests of verbal ability showed gender and education effects. The cognitive tests did not correlate with lifestyle dementia risk scores. CONCLUSIONS: The Five Lives assessment demonstrates high usability and reliability among older adults. These findings highlight the potential of digital assessments in dementia research and clinical practice, enabling improved accessibility and better monitoring of cognitive health on a larger scale than traditional in-person assessments.

Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging.

OBJECTIVES: Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited. METHODS: We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex. RESULTS: Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex. CONCLUSIONS: Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

Early nap cessation in young children as a correlate of language and psychosocial outcomes: Evidence from a large Canadian sample.

OBJECTIVES: Most children stop napping between 2 and 5years old. We tested the association of early nap cessation (ie, children who stopped before their third birthday) and language, cognition functioning and psychosocial outcomes. METHODS: Data were from a national, longitudinal sample of Canadian children, with three timepoints. Children were 0-to-1 year old at T1, 2-to-3 years old at T2, and 4-to-5 years old at T3. Early nap cessation was tested as a correlate of children's psychosocial functioning (cross-sectionally and longitudinally), cognitive function (longitudinally), and language skills (longitudinally). There were 4923 children (50.9% male; 90.0% White) and their parents in this study who were included in the main analyses. Parents reported on demographics, perinatal and developmental variables, child functioning, and child sleep. Children completed direct assessments of receptive language and cognitive ability. Nap cessation, demographic, and developmental-control variables were tested as correlates of cross-sectional and longitudinal outcomes using linear regression (with a model-building approach). RESULTS: Early nap cessation correlated with higher receptive language ability (ß = 0.059 ± 0.028) and lower anxiety (ß = -0.039 ± 0.028) at T3, after controlling for known correlates of nap cessation, nighttime sleep, and other sociodemographic correlates of the outcomes. Cognitive ability, hyperactivity-inattention, and aggression were not correlated with nap cessation. CONCLUSIONS: Early nap cessation is related to specific benefits (ie, better receptive language and lower anxiety symptoms). These findings align with previous research. Future research should investigate differences associated with late nap cessation and in nap-encouraging cultures, and by ethnicity.

Accessing and re-accessing mental health walk-in clinics for children and families.

Background: Many child and youth mental health (CYMH) agencies across Canada and in Ontario are using mental health walk-in clinics (MHWCs). Objectives: (1) Explore how MHWCs are used by families (e.g. mean, mode, and median number of visits), and (2) document how often and how soon families returned for a second MHWC visit and identify correlates of time to a second MHWC visit. Design: Administrative data from two CYMH agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods: In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared to MHWC use exclusively. Results: About a third of children and families using MHWCs had two or more visits. Child age, guardianship, and disposition at discharge emerged as correlates of time to a second MHWC visit. Conclusion: MHWCs can save families' time, and both agencies' time and money by eliminating the need to complete a detailed assessment prior to treatment for cases that would go on to have a single visit within this service.

An eHealth Program for Insomnia in Children With Neurodevelopmental Disorders (Better Nights, Better Days): Protocol for an Economic Evaluation of a Randomized Controlled Trial.

BACKGROUND: Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. OBJECTIVE: This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care. METHODS: The BNBD-NDD RCT evaluates the impacts of the intervention on children's sleep and quality of life, as well as parents' daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children's insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. RESULTS: Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. CONCLUSIONS: To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. TRIAL REGISTRATION: ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46735.

Accessing mental health walk-in clinics and other services for children and families.

Background: Mental health walk-in clinics (MHWCs) are a model of service delivery that has gained increasing interest and traction. The aim of the study was to better understand how MHWC use is related to use of other services provided by agencies. Objectives: (1) Explore if and how MHWCs are used alongside other services, including the different time points (e.g. MHWCs used exclusively, MHWCs used before other agency services); (2) identify correlates of MHWC use alongside other agency services. Design: Administrative data from two child and youth mental health agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods: In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared with MHWC use exclusively. Results: More than half of families used MHWCs and other agency services before or concurrently with other agency services. Child age, guardianship, and disposition at discharge emerged as correlates of MHWC use before other agency services. Conclusions: MHWCs are sufficient for some families, easing the pressure on other agency services. For the remaining families, MHWCs can help support them at the beginning of their service use journey.

Insulin resistance, age and depression's impact on cognition in middle-aged adults from the PREVENT cohort.

BACKGROUND: Alzheimer's disease (AD), type 2 diabetes mellitus (characterised by insulin resistance) and depression are significant challenges facing public health. Research has demonstrated common comorbidities among these three conditions, typically focusing on two of them at a time. OBJECTIVE: The goal of this study, however, was to assess the inter-relationships between the three conditions, focusing on mid-life (defined as age 40-59) risk before the emergence of dementia caused by AD. METHODS: In the current study, we used cross-sectional data from 665 participants from the cohort study, PREVENT. FINDINGS: Using structural equation modelling, we showed that (1) insulin resistance predicts executive dysfunction in older but not younger adults in mid-life, that (2) insulin resistance predicts self-reported depression in both older and younger middle-aged adults and that (3) depression predicts deficits in visuospatial memory in older but not younger adults in mid-life. CONCLUSIONS: Together, we demonstrate the inter-relations between three common non-communicable diseases in middle-aged adults. CLINICAL IMPLICATIONS: We emphasise the need for combined interventions and the use of resources to help adults in mid-life to modify risk factors for cognitive impairment, such as depression and diabetes.

A systematic review of the association between dementia risk factors and cerebrovascular reactivity.

Cumulative evidence suggests that impaired cerebrovascular reactivity (CVR), a regulatory response critical for maintaining neuronal health, is amongst the earliest pathological changes in dementia. However, we know little about how CVR is affected by dementia risk, prior to disease onset. Understanding this relationship would improve our knowledge of disease pathways and help inform preventative interventions. This systematic review investigates 59 studies examining how CVR (measured by magnetic resonance imaging) is affected by modifiable, non-modifiable, and clinical risk factors for dementia. We report that non-modifiable risk (older age and apolipoprotein ε4), some modifiable factors (diabetes, traumatic brain injury, hypertension) and some clinical factors (stroke, carotid artery occlusion, stenosis) were consistently associated with reduced CVR. We also note a lack of conclusive evidence on how other behavioural factors such as physical inactivity, obesity, or depression, affect CVR. This review explores the biological mechanisms underpinning these brain-behaviour associations, highlights evident gaps in the literature, and identifies the risk factors that could be managed to preserve CVR in an effort to prevent dementia.

Regular, intermittent, and spontaneous: Patterns of preschool Children's nap behavior and their correlates.

BACKGROUND: Daytime sleep during the preschool years (i.e., 1-5-years-old) is characterized by high inter-child variability in several components of nap behavior, including nap duration, nap timing, and the proportion of sleep during daytime. We used an empirical approach to examine variations amongst children in these aspects of napping and investigated correlates of these components of nap behavior. METHODS: A large, nationally representative sample (N = 702) of Canadian parents completed an online survey, including a one-month retrospective report of their 1.5-5 year old's daytime and nighttime sleep behavior and other questionnaires. To understand patterns of children's nap behaviors we applied Latent Profile Analysis (LPA) to typical nap duration, typical timing of naps, frequency of naps, proportion of sleep during the daytime, and the proportion of naps which were spontaneous (i.e., child just fell asleep). Then, multinominal logistic regression was used to examine correlates of profile membership. RESULTS: Four profiles of children emerged: (1) regular nappers; (2) intermittent nappers; (3) spontaneous nappers; and (4) non-nappers. After controlling for demographic variables (e.g., child age, sex, ethnicity) and known correlates of napping behaviors (e.g., birthweight, nighttime sleep duration), profile membership was related to parents' beliefs about napping, parents' own nap behaviors, family functioning, and child nighttime sleep problems in a multinominal logistic regression. CONCLUSIONS: An empirical approach aided in understanding the inter-child variability in napping amongst preschool-age children. Parental beliefs about napping and the home environment were shown to be critical factors influencing this variability.

Trends in population characteristics associated with mental health service use among youth and emerging adults in Canada from 2011 to 2016.

OBJECTIVES: Despite the high prevalence of mental disorders among youth (age 12 to 17) and emerging adults (age 18 to 24), few receive mental health (MH) services. Using a cross-sectional study design, we examined population characteristics associated with MH service use in this age group from 2011 to 2016. METHODS: Data were from six cycles of the Canadian Community Health Survey (2011-2016). Population characteristics associated with service use were analyzed using logistic regression models for each year. Changes in odds ratios over time were used to examine trends. RESULTS: Presence of a mood or anxiety disorder had the largest magnitude of association on MH service use in every year. Trends suggested an increased association size between self-rated MH status and service use; lower self-rated MH was associated with a 62% increase in odds of service use in 2011 and an 83% increase in 2016. Being female was associated with increased odds of MH service use (range: 59-107%). Compared with white respondents, individuals who were East and Southeast Asian or South Asian had decreased odds of MH service use. While the association size varied for South Asians, there was a trend toward decreasing likelihood of accessing care (55% decreased odds in 2011, 74% in 2016) for East and Southeast Asians. CONCLUSION: Trends suggest changes in population characteristics associated with access to MH care (e.g., self-rated MH status) as well as persistent inequity in MH service use in Canada for males and individuals from Asian ethnic groups.

RéSUMé: OBJECTIFS: Les jeunes (12 à 17 ans) et les adultes émergents (18 à 24 ans) sont peu nombreux à recevoir des services de santé mentale (SSM) malgré la prévalence élevée des troubles mentaux dans ces deux groupes d'âge. À l'aide d'une étude transversale, nous avons examiné les caractéristiques démographiques associées à l'utilisation des SSM dans ces groupes d'âge entre 2011 et 2016. MéTHODE: Les données provenaient des six cycles de l'Enquête sur la santé dans les collectivités canadiennes (2011­2016). Les caractéristiques démographiques associées à l'utilisation des services ont été analysées à l'aide de modèles de régression logistique pour chaque année étudiée. Les changements dans les rapports de cotes au fil du temps ont servi à analyser les tendances. RéSULTATS: Pour chaque année, c'était la présence d'un trouble de l'humeur ou d'un trouble anxieux qui était la plus largement associée à l'utilisation des SSM. Les tendances ont indiqué une association accrue entre l'état de santé mentale autoévalué et l'utilisation des services; une moins bonne santé mentale autoévaluée était associée à une hausse de 62 % de la probabilité d'utilisation des services en 2011 et à une hausse de 83 % en 2016. Le sexe féminin était associé à une probabilité accrue d'utilisation des SSM (intervalle : 59­107 %). Comparativement aux répondants blancs, les personnes originaires de l'Asie de l'Est, du Sud-Est ou du Sud présentaient une probabilité réduite d'utilisation des SSM. Malgré la variabilité de l'ampleur de l'association chez les Asiatiques du Sud, nous avons observé une tendance à la baisse dans la probabilité d'avoir accédé aux soins (probabilité réduite de 55 % en 2011 et de 74 % en 2016) chez les Asiatiques de l'Est et du Sud-Est. CONCLUSION: Ces tendances indiquent des changements dans les caractéristiques démographiques associées à l'accès aux SSM (p. ex. l'état de santé mentale autoévalué), ainsi qu'une iniquité persistante dans l'utilisation des SSM au Canada chez les hommes et les personnes appartenant aux groupes ethniques asiatiques.

Examining the interactive association of family- and neighborhood-level socio-economic characteristics on children's sleep beyond the associations of residency and neighborhood violence.

OBJECTIVE: To examine the interactive association of neighborhood and family socio-economic characteristics (SEC) on children's sleep. DESIGN: Secondary data analyses were completed on the 2014 Ontario Child Health Study, a cross-sectional sample of 10,802 children aged 4-17. PARTICIPANTS: Children (aged 4-11, 50% male; N = 6264) with available sleep outcome data. METHODS: Multilevel modeling was used to assess the interactive relationship between family- and neighborhood-level poverty in relation to child sleep outcomes (problems falling asleep, problems staying asleep, weekday and weekend time in bed), above the associations of variables known to be related to sleep at the child (ie, child age, sex, internalizing problems, externalizing problems, chronic illness), family (ie, negative parenting behaviors, family structure, parent mental health, years lived in neighborhood, parent education level), and neighborhood levels (ie, neighborhood size, antisocial behavior). RESULTS: Neighborhood poverty (p < .01, ß = -0.001, 95% confidence interval [-0.007, -0.002]) was significantly related to shorter weekday time in bed and the interactive association of family and neighborhood poverty was significantly related to weekend time in bed (p < .05, ß = 0.012, 95% confidence interval [0.004, 0.021]). Children living in low poverty neighborhoods with families of higher SEC backgrounds, and children living in high poverty neighborhoods with families of lower SEC backgrounds had the shortest weekend time in bed (9.7 hours). CONCLUSIONS: There is a compound relationship of family and neighborhood poverty on children's sleep above and beyond family- and child-level risk factors.

Complex skills are required for new primary health care researchers: a training program responds.

BACKGROUND: Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY: In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION: We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.

"His Main Problem Was Not Being in a Relationship With God": Perceptions of Depression, Help-Seeking, and Treatment in Evangelical Christianity.

Some Christian communities may understand mental illness as the result of spiritual causes, such as sin, demons, or a lack of faith. Such perceptions are likely to influence how Christian individuals conceptualise and experience their mental health and enact help-seeking behaviours. This study explores perceptions of depression and mental health help-seeking in evangelical Christianity by using a novel qualitative story completion task. A convenience sample of 110 Christian participants from the United Kingdom completed a third-person, fictional story stem featuring a male with depression who entered his local church. A contextualist-informed thematic analysis illustrated how the disclosure of depression was represented as eliciting negative social reactions, potentially rendering individuals with depression as socially dislocated. Stories suggested that, increasingly, evangelical Christians may perceive a spiritualisation of mental illness, which negates reference to psychological, social, and biomedical representations, as unhelpful. Findings reveal the risks of a solely spiritual aetiology of depression and highlight how existing mental ill-health can be exacerbated if fundamentalist beliefs and approaches to therapeutic care are prioritised over holistic models of care. Methodologically, this study demonstrates the value of a rarely-used tool in psychology-the story completion task-for examining socio-cultural discourses and dominant meanings surrounding stigmatised topics or populations.

The Pain Coping Questionnaire short-form: preliminary reliability and validity.

INTRODUCTION: The Pain Coping Questionnaire (PCQ) has support for its validity and reliability as a tool to understand how a child copes with pain of an extended duration. However, measure length may limit feasibility in clinical settings. OBJECTIVES: The primary goal of this study was to develop a short-form (PCQ-SF) that could be used for screening how children cope with chronic or recurrent pain and examine its reliability and validity. METHODS: The PCQ-SF was developed in a stepwise manner. First, a confirmatory factor analysis was computed using an amalgamated data set from the validation studies of the PCQ (N = 1225). Next, ratings from researchers and clinicians were obtained on PCQ item content and clarity (n = 12). Finally, the resulting 16-item short-form was tested in a pediatric sample living with chronic and recurrent pain (65 parent-child dyads; n = 128). RESULTS: The PCQ-SF has acceptable preliminary reliability and validity. Both statistical and expert analyses support the collective use of the 16 items as an alternative to the full measure. CONCLUSIONS: The compact format of the PCQ-SF will allow practitioners in high-volume clinical environments to quickly determine a child's areas of strengths and weaknesses when coping with pain. Future research using larger more diverse samples to confirm clinical validity is warranted.

Thoughts and affect experienced by parents of preschool- and school-aged children during night-waking interactions.

Measures of parents' cognitions have advanced our understanding of infants' sleep. But, few comparable measures exist for use with parents of preschool- or school-age children. The Parents' night-waking thoughts and affect questionnaire (PNTQ), a self-report measure of parents' thoughts and feelings when their children wake during the night, addresses this need. This scale was evaluated in two community samples of parents (N = 473). Sample 1 included preschool-age children (2-5-years-old), and Sample 2 included preschool- and school-age children (2-10-years-old). A subsample completed 1-month test-retest reliability for the PNTQ (n = 201). Parents completed the PNTQ and measures of agreement with night-waking strategies, parenting stress, mental health, and night-waking. The psychometric properties of the PNTQ (i.e., internal consistency, test-retest reliability; content, construct, and convergent validity) were evaluated. A four-factor solution (positive thoughts about limit-setting, positive thoughts about active comforting, concerns about limit-setting, and distress about night-waking) demonstrated adequate fit in Sample 1 (robust CFI = .900; robust RMSEA = .060), which was replicated in Sample 2 (robust CFI = .870; robust RMSEA = .080). Internal consistency (αc = .68-.88) and test-retest reliability (r = .46-.80) were acceptable across subscales and samples. There was good evidence for convergent validity in both samples-including correlating with parent-reported night-waking behaviour. The PNTQ is a promising measure of thoughts and affect related to night-waking experienced by parents whose children wake during the night. The PNTQ may increase understanding of parents' use of specific night-waking strategies and may account for resistance to employing alternate techniques. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Parenting Practices, Bedtime Routines, and Consistency: Associations with Pediatric Sleep Problems.

OBJECTIVES: Investigate the direct and moderating effects of daytime parenting practices on the relationship between bedtime routines and pediatric sleep problems. METHODS: A community sample of 407 parents with children 2-10 years old completed measures of parenting practices (i.e., laxness and over-reactivity) and bedtime routines (i.e., consistency and reactivity to changes in routines). Sleep problems (i.e., severity and signaled night waking) were assessed by a parent-report questionnaire and sleep diaries. RESULTS: Higher parenting laxness (ß = .13) and less bedtime routine consistency (ß = -.34) significantly predicted sleep problem severity. Laxness moderated the relationship between bedtime reactivity and sleep problem severity: when bedtime reactivity was high, higher parental laxness was associated with more severe sleep problems. CONCLUSIONS: Daytime parenting practices are important to consider when children are reactive to changes in bedtime routines, as permissive or inconsistent daytime parenting practices were found to be associated with more severe sleep problems. Future research should examine the effects of parenting practices and bedtime routines on problematic signaled night waking in a clinical sample of children.

Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families.

OBJECTIVE: The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS: Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS: While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS: The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Biomimetic Polymer Surfaces by High Resolution Molding of the Wings of Different Cicadas.

Recent studies have shown that insect wings have evolved to have micro- and nanoscale structures on the wing surface, and biomimetic research aims to transfer such structures to application-specific materials. Herein, we describe a simple and cost-effective method of replica molding the wing topographies of four cicada species using UV-curable polymers. Different polymer blends of polyethylene glycol diacrylate and polypropylene glycol diacrylate were used as molding materials and a molding chamber was designed to precisely control the x, y, and z dimensions. Analysis by scanning electron microscopy showed that structures ranged from 148 to 854 nm in diameter, with a height range of 191-2368 nm, and wing patterns were transferred with high fidelity to the crosslinked polymer. Finally, bacterial cell studies show that the wing replicas possess the same antibacterial effect as the cicada wing from which they were molded. Overall, this work shows a quick and simple method for patterning UV-curable polymers without the use of expensive equipment, making it a highly accessible means of producing microstructured materials with biological properties.

Re-Accessing Mental Health Care After Age 18: A Longitudinal Cohort Study of Youth Involved with Community-based Child and Youth Mental Health Agencies in Ontario.

OBJECTIVE: About 20-26% of children and youth with a mental health disorder (depending on age and respondent) report receiving services from a community-based Child and Youth Mental Health (CYMH) agency. However, because agencies have an upper age limit of 18-years old, youth requiring ongoing mental health services must "transition" to adult-oriented care. General healthcare providers (e.g., family physicians) likely provide this care. The objective of this study was to compare the likelihood of receiving physician-based mental health services after age 18 between youth who had received community-based mental health services and a matched population sample. METHOD: A longitudinal matched cohort study was conducted in Ontario, Canada. A CYMH cohort that received mental health care at one of five CYMH agencies, aged 7-14 years at their first visit (N=2,822), was compared to age, sex, region-matched controls (N=8,466). RESULTS: CYMH youth were twice as likely as the comparison sample to have a physician-based mental health visit (i.e., by a family physician, pediatrician, psychiatrists) after age 18; median time to first visit was 3.3 years. Having a physician mental health visit before age 18 was associated with a greater likelihood of experiencing the outcome than community-based CYMH services alone. CONCLUSION: Most youth involved in community-based CYMH agencies will re-access services from physicians as adults. Youth receiving mental health services only within community agencies, and not from physicians, may be less likely to receive physician-based mental health services as adults. Collaboration between CYMH agencies and family physicians may be important for youth who require ongoing care into adulthood.

OBJECTIF: Environ 20 à 26 % des enfants et des adolescents souffrant d'un trouble de santé mentale (dépendant de l'âge et du répondant) déclarent recevoir des services d'un organisme communautaire de santé mentale pour enfants et adolescents (SMEA) Toutefois, puisque les organismes ont une limite d'âge supérieur de 18 ans, les jeunes nécessitant des services de santé mentale doivent faire la « transition ¼ aux soins pour adultes. Les prestataires de soins de santé généraux (p. ex., les médecins de famille) dispensent probablement ces services. La présente étude visait à comparer la probabilité de recevoir des services de santé mentale par un médecin après l'âge de 18 ans entre un jeune qui avait reçu des services de santé mentale et un échantillon apparié dans la population. MÉTHODE: Une étude de cohorte longitudinale appariée a été menée en Ontario, Canada. Une cohorte SMEA qui recevait des soins de santé mentale à l'un des cinq organismes SMEA, âgés entre 7 et 14 ans à leur première visite (N = 2,822), a été comparée pour l'âge, le sexe, les contrôles appariés par région (N = 8,466). RÉSULTATS: Les jeunes des SMEA étaient deux fois plus susceptibles que l'échantillon de comparaison d'avoir une visite de santé mentale par un médecin (c.-à-d. par un pédiatre médecin de famille, des psychiatres) après l'âge de 18 ans le temps moyen avant une première visite était 3,3 ans. Avoir une visite de santé mentale avec un médecin avant l'âge de 18 ans était associé à une plus grande probabilité de connaître le résultat que par les services SMEA communautaires à eux seuls. CONCLUSION: La plupart des jeunes impliqués dans les organismes communautaires SMEA accéderont de nouveau aux services de médecins en tant qu'adulte. Les jeunes recevant des services de santé mentale uniquement d'organismes communautaires et non de médecins peuvent être moins susceptibles de recevoir des services de santé mentale par un médecin en tant qu'adultes. La collaboration entre les organismes SMEA et les médecins de famille peut être importante pour les jeunes qui nécessitent des soins constants à l'âge adulte.