Neurological Surveillance in Moderate-Late Preterm Infants-Results from a Dutch-Canadian Survey.

Preterm birth remains an important cause of abnormal neurodevelopment. While the majority of preterm infants are born moderate-late preterm (MLPT; 32-36 weeks), international and national recommendations on neurological surveillance in this population are lacking. We conducted an observational quantitative survey among Dutch and Canadian neonatal level I-III centres (June 2020-August 2021) to gain insight into local clinical practices on neurological surveillance in MLPT infants. All centres caring for MLPT infants designated one paediatrician/neonatologist to complete the survey. A total of 85 out of 174 (49%) qualifying neonatal centres completed the survey (60 level I-II and 25 level III centres). Admission of MLPT infants was based on infant-related criteria in 78/85 (92%) centres. Cranial ultrasonography to screen the infant's brain for abnormalities was routinely performed in 16/85 (19%) centres, while only on indication in 39/85 (46%). In 57/85 (67%) centres, neurological examination was performed at least once during admission. Of 85 centres, 51 (60%) followed the infants' development post-discharge, with follow-up duration ranging from 1-52 months of age. The survey showed a wide variety in neurological surveillance in MLPT infants among Dutch and Canadian neonatal centres. Given the risk for short-term morbidity and long-term neurodevelopmental disabilities, future studies are required to investigate best practices for in-hospital care and follow-up of MLPT infants.

Associations between the built environment and physical activity among adults with low socio-economic status in Canada: a systematic review.

OBJECTIVE: To synthesize literature on the associations between the built environment and physical activity among adults with low socio-economic status (SES) in Canada. METHODS: Using a pre-specified study protocol (PROSPERO ID: CRD42019117894), we searched seven databases from inception to November 2018, for peer-reviewed quantitative studies that (1) included adults with low SES living in Canada and (2) estimated the association between self-reported or objectively measured built characteristics and self-reported or objectively measured physical activity. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Findings were synthesized using a narrative approach. SYNTHESIS: Of the 8338 citations identified by our search, seven studies met the inclusion criteria. Most studies included adults living in one province (Alberta, British Columbia, Ontario, or Quebec), with one study including a national sample. All studies were cross-sectional, and none controlled for residential self-selection. Sampling designs and data collection strategies were heterogeneous. Sample sizes ranged between 78 and 37,241 participants. Most studies measured SES using household income. Street connectivity, greenness, destination density, and walkability were positively associated with physical activity. Relative to the objectively measured built environment, associations between the self-reported built environment and physical activity were less consistent. Studies were of fair to good quality. CONCLUSION: Findings suggest that the neighbourhood built environment is associated with physical activity among adults with low SES in Canada. More rigorous study designs are needed to determine whether or not the built environment and physical activity are causally related within this vulnerable population.

RéSUMé: OBJECTIF: Faire une synthèse de la littérature scientifique sur les associations entre l'environnement bâti et l'activité physique chez les adultes de faible statut socioéconomique (SSE) au Canada. MéTHODE: À l'aide d'un protocole d'étude préétabli (numéro d'identification PROSPERO : CRD42019117894), nous avons interrogé sept bases de données, entre l'inception de chacune et novembre 2018, pour repérer les études quantitatives évaluées par les pairs qui : 1) incluaient des adultes de faible SSE vivant au Canada; et 2) estimaient l'association entre les caractéristiques autodéclarées ou objectivement mesurées de l'environnement bâti et l'activité physique autodéclarée ou objectivement mesurée. La qualité des études a été évaluée à l'aide de l'outil Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Nous avons fait la synthèse des constatations selon une démarche narrative. SYNTHèSE: Sur les 8 338 citations repérées dans notre recherche, sept études répondaient aux critères d'inclusion. La plupart incluaient des adultes vivant dans une province (Alberta, Colombie-Britannique, Ontario ou Québec), et une étude comportait un échantillon national. Toutes les études étaient transversales, et aucune ne tenait compte de l'auto-sélection de la résidence. Les modes d'échantillonnage et les stratégies de collecte de données étaient hétérogènes. La taille des échantillons variait de 78 à 37 241 participants. La plupart des études mesuraient le SSE à l'aide du revenu des ménages. La connectivité des rues, la verdure, la densité des destinations et la marchabilité étaient associées positivement à l'activité physique. Par rapport à l'environnement bâti objectivement mesuré, les associations entre l'environnement bâti autodéclaré et l'activité physique étaient moins constantes. La qualité des études était de moyenne à bonne. CONCLUSION: Nos constatations indiquent que l'environnement bâti du quartier est associé à l'activité physique chez les adultes de faible SSE au Canada. Des protocoles d'étude plus rigoureux sont nécessaires pour déterminer s'il existe ou non une relation causale entre l'environnement bâti et l'activité physique dans cette population vulnérable.

Associations between objectively-measured and self-reported neighbourhood walkability on adherence and steps during an internet-delivered pedometer intervention.

BACKGROUND: Accumulating evidence suggests that the built environment is associated with physical activity. The extent to which the built environment may support adherence to physical activity interventions is unclear. The aim of this study was to investigate whether the neighbourhood built environment constrains or facilitates adherence and steps taken during a 12-week internet-delivered pedometer-based physical activity intervention (UWALK). METHOD: The study was undertaken in Calgary (Canada) between May 2016 and August 2017. Inactive adults (n = 573) completed a telephone survey measuring sociodemographic characteristics and perceived neighbourhood walkability. Following the survey, participants were mailed a pedometer and instructions for joining UWALK. Participants were asked to report their daily pedometer steps into the online program on a weekly basis for 12 weeks (84 days). Walk Score® estimated objective neighbourhood walkability and the Neighbourhood Environment Walkability Scale-Abbreviated (NEWS-A) measured participants self-reported neighbourhood walkability. Regression models estimated covariate-adjusted associations of objective and self-reported walkability with: 1) adherence to the UWALK intervention (count of days with steps reported and count of days with 10000 steps reported), and; 2) average daily pedometer steps. RESULTS: On average, participants undertook 8565 (SD = 3030) steps per day, reported steps on 67 (SD = 22.3) of the 84 days, and achieved ≥10000 steps on 22 (SD = 20.5) of the 84 days. Adjusting for covariates, a one-unit increase in self-reported walkability was associated on average with 45.76 (95CI 14.91, 76.61) more daily pedometer steps. Walk Score® was not significantly associated with steps. Neither objective nor self-reported walkability were significantly associated with the UWALK adherence outcomes. CONCLUSION: The neighbourhood built environment may support pedometer-measured physical activity but may not influence adherence to pedometer interventions. Perceived walkability may be more important than objectively-measured walkability in supporting physical activity during pedometer interventions.

Diagnostic performance 1 h after simulation training predicts learning.

Although simulation training improves post-training performance, it is unclear how well performance soon after simulation training predicts longer term outcomes (i.e., learning). Here our objective was to assess the predictive value of performance 1 h post-training of performance 6 weeks later. We trained 84 first year medical students a simulated case of chest pain due to aortic stenosis. They then received training on a case of acute onset dyspnea due to pulmonary embolism, after which we evaluated diagnostic performance on their trained murmur followed by novel murmur. We repeated the evaluation of diagnostic performance on the same murmurs 6 weeks later. One hour post-training 88.1 % of students identified the training murmur, compared to 60.7 % for the novel murmur. Six weeks after training the corresponding results were 89.3 and 65.5 %, respectively (p < 0.0001 for both time periods). The probability of students diagnosing their training murmur 6 weeks post-training if they diagnosed this after 1 h (positive predictive value) was 0.89 [0.87, 0.93], and the probability of misdiagnosing their trained murmur 6 weeks post-training if they misdiagnosed this after 1 h (negative predictive value) was 0.10 [0.01, 0.40]. The corresponding positive and negative predictive values for the novel murmur were 0.69 [0.55, 0.80] and 0.39 [0.24, 0.57], respectively. Students who successfully diagnosed a cardiac murmur 1 h after simulation training were very likely to recognize the same murmur 6 weeks later, suggesting that we can use performance 1 h post-training as a learning outcome.