Correction: A guiding framework for needs assessment evaluations to embed digital platforms in partnership with Indigenous communities.

[This corrects the article DOI: 10.1371/journal.pone.0279282.].

Identifying latent classes of physical activity profiles over time among adolescents in Ontario, Canada.

BACKGROUND: Physical activity behaviours are known to be highly correlated. Adolescents who participate in one type of physical activity (e.g., physical education) have a greater likelihood of participating in other physical activities (e.g., organized sports); however, little research has examined participation rates in various physical activity behaviours concurrently. This study identified longitudinal physical activity profiles among secondary school aged youth in Ontario, Canada. METHODS: We used data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada. Using a repeated measures latent class analysis, Ontario students who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917). Latent classes were defined by: PE participation, guideline adherence (≥ 60 min/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics. RESULTS: Three distinct latent classes were identified for females and four were identified for males. These classes were: (1) Guidelines (high probability of guideline adherence; females: 44%; males: 16%), (2) PE & Sports (high probability of PE and sport participation; females: 33%; males: 43%), (3) Guidelines & Sports (high probability of guideline adherence and sport participation; females: 23%; males: 23%;), and (4) Inactive (low probability of all physical activity indicators; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethno-racial identity, weekly spending money, strength training, and English and math grades were associated with class membership among males. CONCLUSIONS: Findings suggest that latent physical activity profiles differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sport participation was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these activities alone may not be providing sufficient levels of physical activity that align with current recommendations for Canadian youth.

Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned.

Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.

A guiding framework for needs assessment evaluations to embed digital platforms in partnership with Indigenous communities.

INTRODUCTION: In community-based research projects, needs assessments are one of the first steps to identify community priorities. Access-related issues often pose significant barriers to participation in research and evaluation for rural and remote communities, particularly Indigenous communities, which also have a complex relationship with academia due to a history of exploitation. To bridge this gap, work with Indigenous communities requires consistent and meaningful engagement. The prominence of digital devices (i.e., smartphones) offers an unparalleled opportunity for ethical and equitable engagement between researchers and communities across jurisdictions, particularly in remote communities. METHODS: This paper presents a framework to guide needs assessments which embed digital platforms in partnership with Indigenous communities. Guided by this framework, a qualitative needs assessment was conducted with a subarctic Métis community in Saskatchewan, Canada. This project is governed by an Advisory Council comprised of Knowledge Keepers, Elders, and youth in the community. An environmental scan of relevant programs, three key informant interviews, and two focus groups (n = 4 in each) were conducted to systematically identify community priorities. RESULTS: Through discussions with the community, four priorities were identified: (1) the Coronavirus pandemic, (2) climate change impacts on the environment, (3) mental health and wellbeing, and (4) food security and sovereignty. Given the timing of the needs assessment, the community identified the Coronavirus pandemic as a key priority requiring digital initiatives. CONCLUSION: Recommendations for community-based needs assessments to conceptualize and implement digital infrastructure are put forward, with an emphasis on self-governance and data sovereignty.

Hair Cortisol and Health-Related Quality of Life in Children with Mental Disorder.

INTRODUCTION: Children living with mental disorder are at risk for lower health-related quality of life (HRQoL) compared to their peers. While evidence suggests that cortisol dysregulation is implicated in the onset of mental disorder, the extent to which cortisol is associated with HRQoL is largely unknown. Further, it remains unknown how comorbid physical illness may alter this relationship. This study examined whether the presence of a comorbid physical illness moderated the association between hair cortisol concentration (HCC) and HRQoL among children with mental disorder. METHODS: One-hundred children (4-17 years) receiving care from a pediatric hospital were recruited. The Mini International Neuropsychiatric Interview was used to measure mental disorder and the KIDSCREEN-27 to assess HRQoL. Cortisol extracted from children's hair was assayed using high-sensitivity ELISA. Multiple regression analyses tested the association between HCC and HRQoL. RESULTS: Presence of a physical illness was found to moderate the relationship between HCC and HRQoL in the domain of peers and social support [comorbidity: ß = -0.57 (-0.97, -0.17); no comorbidity: ß = 0.22 (-0.11, 0.55)]. CONCLUSION: The association between HCC and HRQoL in children with mental disorder is moderated by the presence of a physical illness, such that in children with comorbid physical and mental disorder, elevated HCC is associated with lower HRQoL. Approaches that reduce stress in these children may help promote optimal well-being. More research investigating physiological stress and psychosocial outcomes in children with mental disorder, particularly those with comorbid physical illness, is needed.

Bi-directional relationships between physical activity and mental health among a large sample of Canadian youth: a sex-stratified analysis of students in the COMPASS study.

OBJECTIVE: The aim of this research was to examine the bidirectional association between self-reported symptoms of mental disorder and physical activity among a large sample of Canadian secondary school students over time. METHODS: Linked survey data were obtained from 28,567 grade 9 to 12 students across Canada participating in two waves of the COMPASS Study (2017-18; 2018-19). Autoregressive cross-lagged models were run to examine the reciprocal relationships between self-reported moderate-to-vigorous physical activity (MVPA) and symptoms of depression (CESD-10) and anxiety (GAD-7). Models were stratified by gender, and accounted for grade, ethno-racial identity, and school-level clustering. RESULTS: Autoregressive associations show that neither symptoms of anxiety nor depression, at baseline, were predictive of mean MVPA at follow-up - consistent for the full sample and among both males and females. Higher MVPA among males at baseline was associated with lower symptoms of both anxiety (ß = - 0.03, p = 0.002) and depression (ß = - 0.05, p < 0.001) at follow-up. However, among females, higher MVPA at baseline was associated with greater symptoms of anxiety (ß = 0.03, p < 0.001), but not symptoms of depression (ß = 0.01, p = 0.073), at follow-up. CONCLUSION: In our large sample of Canadian secondary school students, associations between physical activity and symptoms of mental disorder were not bi-directional, and these relationships differed in males and females. This study illustrates the complex nature of the relationship between physical activity and symptoms of mental disorder among youth. While results support the benefits of promoting physical activity among males to prevent or manage internalizing symptoms, the relationship among females warrants further investigation.

Factors Associated with Students Meeting Components of Canada's New 24-Hour Movement Guidelines over Time in the COMPASS Study.

This study aimed to determine if secondary school students are meeting the new Canadian 24-Hour Movement Guidelines (24-MG), as well as each individual recommendation (physical activity; sleep; sedentary behavior) within the 24-MG, and which student-level characteristics predict meeting the 24-MG, both cross-sectionally and longitudinally. This study is the first to examine longitudinal changes in students meeting the 24-MG, as well as student-level characteristics that were predictive of favourable shifts in movement patterns. Cross-sectional data were obtained for 11,793 grade 9 students across Canada as part of the COMPASS study. Of this sample, 3713 students provided linked follow-up data from grade 9 to grade 12. The probability of meeting the guidelines was modeled using two-level logistic regression analyses, adjusting for student-level co-variates and school clustering. Only 1.28% (p < 0.0001) of the sample met the overall 24-MG. Among grade 9 students, 35.9% (p < 0.0001), 50.8% (p < 0.0001), and 6.4% (p < 0.0001) were meeting the individual recommendations for physical activity, sleep, and screen time, respectively. Of those students, less than half were still meeting them by grade 12. Community sport participation was the only predictor of all three individual recommendations within the 24-MG. Longitudinal analyses found that community sport participation and parental support and encouragement were significantly associated with Grade 12 students starting to meet the physical activity and screen time recommendations, respectively, after having not met them in grade 9. Findings can be used to inform policy and public health practice, as well as to inform future research examining causal relationships between the variables.

Measurement Invariance of the WHODAS 2.0 Across Youth With and Without Physical or Mental Conditions.

Initial evidence suggests that the WHO Disability Assessment Schedule (WHODAS 2.0) is valid and reliable in general youth populations; however, its psychometric properties in specific subgroups are less established. The primary objective was to test for measurement invariance of the 12-item WHODAS 2.0 in an epidemiological sample of youth aged 15 to 19 years with and without physical or mental conditions. Using data from 1,851 youth in the Canadian Community Health Survey-Mental Health, invariance was tested using multiple-group confirmatory factor analysis. Within-domain item correlations were significant and ordinal coefficient alphas were .91, .94, .93, and .92 for the healthy control, physical, mental, and comorbid groups, respectively. Partial measurement invariance was demonstrated for the WHODAS 2.0, with evidence of noninvariance for item residuals and factor variances related to cognition and participation. While these domain-specific comparisons may be biased, valid comparisons of overall disability across subgroups of youth can be made with confidence.

Hair Cortisol Concentration and Mental Disorder in Children With Chronic Physical Illness.

BACKGROUND: To examine changes in hair cortisol concentrations (HCC) in children with chronic physical illness and identify patterns of association between HCC and mental comorbidity. METHODS: A sample of 50 children aged 6 to 16 years were recruited within six months of being diagnosed with a chronic physical illness. Data were collected via hair samples, structured interviews, and behavioral checklists. RESULTS: There was no change in HCC over six months. Baseline HCC was associated with internalizing-odds ratio (OR) = 1.29 (90% confidence interval (CI): 1.01-1.66)-and externalizing disorders-OR = 1.32 (90% CI: 1.07-1.64). Externalizing disorder at six months was associated with elevated baseline-OR = 1.25 (90% CI: 1.02-1.53)-and six-month HCC-OR = 1.25 (90% CI: 1.02-1.54). Associations between HCC and mental disorder weakened over time, and for internalizing disorders, changed direction (i.e., inverse association), albeit not significantly. CONCLUSION: Results provide preliminary evidence that physiological stress, measured using HCC, may be implicated in the relationship between physical and mental illness, and these associations align with attenuated stress responses over time.

Multimorbidity in children and youth: a scoping review protocol.

INTRODUCTION: Multimorbidity (co-occurring physical and mental illness) is an important issue for clinicians and researchers with combined efforts aimed at promoting the health and well-being of individuals across the life course. In children and youth, experience of any chronic physical illness leads to a substantial increase in risk for mental illness. As a growing field of interest, research is needed to map the current state of the literature in child and youth multimorbidity in order to identify existing gaps and inform the direction of future investigations. METHODS AND ANALYSIS: We are proposing the conduct of a scoping review to explore the depth and breadth of existing evidence in the field of child and youth multimorbidity. The scoping review will follow the methodological framework developed by Arksey and O'Malley, and will incorporate additional scoping review recommendations made by Levac et al . A systematic search of the following four key databases will be conducted: (1) PubMed; (2) EMBASE; (3) PsycINFO; and (4) Scopus, using combinations of Medical Subject Headings (MeSH) and Emtree terms. We will also consult grey literature sources and hand-search reference lists of included studies to identify additional studies of relevance. For eligible studies that meet all identified inclusion and exclusion criteria, a data extraction tool will be used to collect and store key study characteristics that will be relevant for collating, summarising and reporting the results of the scoping review. This scoping review also presents a novel use of quality index scoring, which we anticipate will contribute to strengthening the rigour of the scoping review methodology. ETHICS AND DISSEMINATION: The proposed scoping review does not require ethical approval. Final study results will be disseminated via conference presentations, publication in a peer-reviewed journal and knowledge translation activities with relevant stakeholders.

Does shortening matter after clavicular fractures?

Healing of clavicular fractures with shortening of 15 mm or more has been associated with poor function and open reduction and internal fixation has been recommended as the appropriate initial treatment. We studied 41 patients at least three months after clavicular fracture. Clavicular shortening was calculated and shoulder function was assessed using the Constant Scoring method. Although three patients with shortening of 1.5 cm or more had low scores, this could be attributed to other factors. We could not demonstrate any relationship between clavicular shortening and shoulder function.

Comparison of basal and prandial insulin therapy in patients with secondary failure of sulphonylurea therapy.

A group of 35 normal weight patients with secondary failure of sulphonylurea therapy (fasting plasma glucose greater than 8.0 mmol l-1 on maximal dose of sulphonylurea) were randomly assigned to receive either a single injection of a basal insulin supplement (human ultralente insulin, n = 16) or three or four injections of a preprandial insulin supplement (human unmodified insulin, n = 19). Patients performed self-monitoring of capillary blood glucose and adjusted their insulin doses in an effort to achieve fasting and preprandial capillary glucose concentrations of less than 7.0 mmol l-1. Blood glucose control after 16 weeks of insulin therapy was improved to a similar extent by both regimens (HbA1 basal insulin group 12.5 +/- 1.2 (+/- SD) falling to 10.7 +/- 2.2%; preprandial group 12.0 +/- 1.6 falling to 9.5 +/- 1.6%). Preprandial insulin gave better control of daytime blood glucose levels but fasting plasma glucose did not differ between the two regimens (basal group 10.6 +/- 3.6, preprandial group 11.1 +/- 3.6 mmol l-1). Insulin dose was greater in the preprandial group (44.1 +/- 17.9 U day-1) than in the basal group (26.7 +/- 12.5 U day-1 (p less than 0.005), but there was no difference in the frequency or severity of hypoglycaemia between the two treatments. Only the preprandial therapy group showed significant weight gain (2.7 +/- 3.0 kg). While both regimens led to improvement of blood glucose control, these results suggest that neither basal nor preprandial insulin alone can achieve ideal blood glucose control through 24 h in patients with fairly severe failure of control on sulphonylurea therapy.