Network analysis of inter-organizational relationships and policy use among active living organizations in Alberta, Canada.

BACKGROUND: Coordinated partnerships and collaborations can optimize the efficiency and effectiveness of service and program delivery in organizational networks. However, the extent to which organizations are working together to promote physical activity, and use physical activity policies in Canada, is unknown. This project sought to provide a snapshot of the funding, coordination and partnership relationships among provincial active living organizations (ALOs) in Alberta, Canada. Additionally, the awareness, and use of the provincial policy and national strategy by the organizations was examined. METHODS: Provincial ALOs (N = 27) answered questions regarding their funding, coordination and partnership connections with other ALOs in the network. Social network analysis was employed to examine network structure and position of each ALO. Discriminant function analysis determined the extent to which degree centrality was associated with the use of the Active Alberta (AA) policy and Active Canada 20/20 (AC 20/20) strategy. RESULTS: The funding network had a low density level (density = .20) and was centralized around Alberta Tourism Parks and Recreation (ATPR; degree centralization = 48.77%, betweenness centralization = 32.43%). The coordination network had a moderate density level (density = .31), and was low-to-moderately centralized around a few organizations (degree centralization = 45.37%, betweenness centrality = 19.92%). The partnership network had a low density level (density = .15), and was moderate-to-highly centralized around ATPR. Most organizations were aware of AA (89%) and AC 20/20 (78%), however more were using AA (67%) compared to AC 20/20 (33%). Central ALOs in the funding network were more likely to use AA and AC 20/20. Central ALOs in the coordination network were more likely to use AC 20/20, but not AA. CONCLUSIONS: Increasing formal and informal relationships between organizations and integrating disconnected or peripheral organizations could increase the capacity of the network to promote active living across Alberta. Uptake of the AA policy within the network is high and appears to be facilitated by the most central ALO. Promoting policy use through a central organization appeared to be an effective strategy for disseminating the province-level physical activity policy and could be considered as a policy-uptake strategy by other regions.

Surgery and risk for multiple sclerosis: a systematic review and meta-analysis of case-control studies.

BACKGROUND: Although the precise etiology of multiple sclerosis is largely unknown, there is some speculation that a prior history of surgery may be associated with the subsequent risk for developing the disease. Therefore, we aimed to examine surgery as a risk factor for the diagnosis of multiple sclerosis. METHODS: We searched for observational studies that evaluated the risk for developing multiple sclerosis after surgery that occurred in childhood (≤ 20 years of age) or "premorbid" (> 20 years of age). We specifically included surgeries classified as: tonsillectomy, appendectomy, adenoidectomy, or "surgery". We performed a systematic review and meta-analyses and calculated odds ratios (OR) and their 95% confidence intervals (CIs) using a random effects model. RESULTS: We identified 33 case-control studies, involving 27,373 multiple sclerosis cases and 211,756 controls. There was a statistically significant association between tonsillectomy (OR = 1.32, 95% CI 1.08-1.61; 12 studies, I(2) = 44%) and appendectomy (OR = 1.16, 95% CI 1.01-1.34; 7 studies, I(2) = 0%) in individual's ≤ 20 years of age and the subsequent risk for developing multiple sclerosis. There was no statistically significant association between risk for multiple sclerosis and tonsillectomy occurring after age 20 (OR = 1.20, 95% CI 0.94-1.53; 9 studies, I(2) = 32%), in those with appendectomy at > 20 years (OR = 1.26, 95% CI 0.92-1.72; 5 studies, I(2) = 46%), and in those with adenoidectomy at ≤ 20 years of age (OR = 1.06, 95% CI 0.68-1.68; 3 studies, I(2) = 35%). The combined OR of 15 studies (N = 2,380) looking at "surgery" before multiple sclerosis diagnosis was not statistically significant (OR = 1.19, 95% CI 0.83-1.70; I(2) = 71%). CONCLUSIONS: We found a small but statistically significant and clinically important increased risk for developing multiple sclerosis, in those with tonsillectomy and appendectomy at ≤ 20 years of age. There was no convincing evidence to support the association of other surgeries and the risk for multiple sclerosis. Well-designed prospective etiological studies, pertaining to the risk for developing multiple sclerosis, ought to be conducted and should include the examination of various surgeries as risk factors.

Exploring the relationship between socioeconomic status, control beliefs and exercise behavior: a multiple mediator model.

The purpose of this study was to examine the relationship between control beliefs, socioeconomic status and exercise intentions and behavior. Specifically, we examined whether distal and proximal control beliefs mediated the association between socioeconomic status and exercise intentions and behavior. A one time, cross sectional mail out survey (N = 350) was conducted in a large urban Canadian city. Distal (i.e., personal constraints) and proximal (i.e., scheduling self-efficacy) control beliefs mediated the association between socioeconomic status and exercise, explaining approximately 30% of the variance. Proximal control beliefs (i.e., scheduling self-efficacy) partially mediated the association between socioeconomic status and intentions, with the models explaining approximately 50% of the variance. Compared to individuals with lower socioeconomic status, individuals with higher socioeconomic status reported more exercise and stronger intentions to exercise. This was at least partly because higher socioeconomic status respondents reported fewer barriers in their lives, and were more confident to cope with the scheduling demands of exercise.

An examination of psychosocial correlates of exercise tolerance in cardiac rehabilitation participants.

This study explored the influence of psychosocial factors on an important prognostic indictor among heart patients, exercise tolerance (ET). Prior to attending cardiac rehabilitation (CR), 100 men and 24 women completed a survey assessing social support and self-efficacy for exercise in CR followed by an ET test (ETT) measured in metabolic equivalents (METS) 1 month later. Regression analyses showed that age was the strongest predictor of METS, but that income and the psychosocial variables also significantly impacted on METS. Overall, 50% of the variance in METS was explained by the predictor variables. These results show that psychosocial factors affect the ET of heart patients. Future research should examine the prognostic role of these psychosocial factors as they affect ET as well as their influence on behavioral mechanisms such as exercise.

Diet quality, nutrition and physical activity among adolescents: the Web-SPAN (Web-Survey of Physical Activity and Nutrition) project.

OBJECTIVE: To assess the overall diet quality of a sample of adolescents living in Alberta, Canada, and evaluate whether diet quality, nutrient intakes, meal behaviours (i.e. meal skipping and consuming meals away from home) and physical activity are related. DESIGN: A cross-sectional study design. Students completed the self-administered Web-Survey of Physical Activity and Nutrition (Web-SPAN). Students were classified as having poor, average or superior diet quality based on Canada's Food Guide to Healthy Eating (CFGHE). SETTING: One hundred and thirty-six schools (37 %) within forty-four public and private school boards (75 %) in Alberta, Canada. SUBJECTS: Grade 7 to 10 Alberta students (n 4936) participated in the school-based research. RESULTS: On average, students met macronutrient requirements; however, micronutrient and fibre intakes were suboptimal. Median CFGHE food group intakes were below recommendations. Those with poor diet quality (42 %) had lower intakes of protein, fibre and low-calorie beverages; higher intakes of carbohydrates, fat and Other Foods (e.g. foods containing mostly sugar, high-salt/fat foods, high-calorie beverages, low-calorie beverages and high-sugar/fat foods); a lower frequency of consuming breakfast and a higher frequency of consuming meals away from home; and a lower level of physical activity when compared with students with either average or superior diet quality. CONCLUSIONS: Alberta adolescents were not meeting minimum CFGHE recommendations, and thus had suboptimal intakes and poor diet quality. Suboptimal nutritional intakes, meal behaviours and physical inactivity were all related to poor diet quality and reflect the need to target these health behaviours in order to improve diet quality and overall health and wellness.

Determinants of diet quality among Canadian adolescents.

PURPOSE: Dietary intakes and nutrition behaviours were examined among different diet quality groups of Canadian adolescents. METHODS: This cross-sectional study included 2850 Alberta and Ontario adolescents aged 14 to 17, who completed a self-administered web-based survey that examined nutrient intakes and meal behaviours (meal frequency and meal consumption away from home). RESULTS: Mean macronutrient intakes were within Acceptable Macronutrient Distribution Ranges; however, micronutrient intakes and median food group intakes were below recommendations based on Canada's Food Guide to Healthy Eating (CFGHE). Overall diet quality indicated that 43%, 47%, and 10% of students had poor, average, and superior diet quality, respectively. Adolescents with lower diet quality had significantly different intakes of macronutrients and CFGHE-defined "other foods." In terms of diet quality determinants, those with poor diet quality had higher frequencies of suboptimal meal behaviours. Students with poor diet quality consumed breakfast and lunch less frequently than did those with average and superior diet quality. CONCLUSIONS: Canadian adolescents have low intakes of CFGHE-recommended foods and high intakes of "other foods." Those with poor diet quality had suboptimal macro-nutrient intakes and increased meal skipping and meal consumption away from home. Adherence to CFGHE may promote optimal dietary intakes and improve nutritional behaviours.

Advancing Optimal Development in Children: Examining the Construct Validity of a Parent Reflective Functioning Questionnaire.

BACKGROUND: Parental reflective functioning (PRF) is the capacity parents have to understand their own mental states and those of their children, as well as the influence of those mental states on behavior. Parents with greater capacity for PRF are more likely to foster secure attachment with their children. The Parental Development Interview is a gold standard measure of PRF but is hampered by cost, training, and length of administration. The 18-item Parent Reflective Functioning Questionnaire (PRFQ-18) is a simpler option developed to capture 3 types of PRF: (1) prementalizing, (2) parent's certainty, and (3) interest and curiosity surrounding a child's mental state. OBJECTIVE: The aim of this study was to examine the factor structure and select psychometric properties of the PRFQ in a sample of Canadian parents. METHODS: We examined the factor structure and discriminant and construct validity of the PRFQ-18 among 306 parents (males=120 and females=186) across Canada; the age range of children was 0 to 12 years. Parents also completed Web-based measures of perceived stress, parental coping, parenting competence, and social support. RESULTS: A confirmatory factor analysis confirmed the hypothesized 3-factor structure of the PRFQ-18 providing evidence that the PRFQ-18 may be a useful and practical measure of PRF in Canadian adults and showed minor revisions may improve the suitability of the PRFQ-18 for assessing PRF. CONCLUSIONS: These results add support for the construct validity of the PRFQ-18.

An experimental investigation of the relation between catastrophizing and activity intolerance.

The present study examined the value of a measure of catastrophizing as a predictor of activity intolerance in response to delayed onset muscle soreness (DOMS). A sample of 50 (17 men, 33 women) sedentary undergraduates participated in an exercise protocol designed to induce muscle soreness and were asked to return 2 days later to perform the same physical maneuvers. Participants performed five strength exercises that emphasized the eccentric component of the muscle contraction in order to induce DOMS. Dependent variables of interest were the proportion reduction in total weight lifted, and the number of repetitions. Analyses revealed that catastrophizing, assessed prior to the first exercise bout, was significantly correlated with negative mood, pain and with reduction in weight lifted. Regression analyses revealed that catastrophizing predicted reductions in weight lifted even after controlling for pain and negative mood. These findings extend previous research in demonstrating that catastrophizing is associated with objective indices of activity intolerance associated with pain. Implications of these findings for understanding pain-related disability are addressed.

Physical trauma and risk of multiple sclerosis: a systematic review and meta-analysis of observational studies.

BACKGROUND: We aimed to examine physical trauma as a risk factor for the subsequent diagnosis of MS. METHODS: We searched for observational studies that evaluated the risk for developing MS after physical trauma that occurred in childhood (≤20 years) or "premorbid" (>20 years). We performed a meta-analysis using a random effects model. RESULTS: We identified 1362 individual studies, of which 36 case-control studies and 4 cohort studies met the inclusion criteria for the review. In high quality case-control studies, there were statistically significant associations between those sustaining head trauma in childhood (OR=1.27; 95% CI, 1.12-1.44; p<0.001), premorbid head trauma (OR=1.40; 95% CI, 1.08-1.81; p=0.01), and other traumas during childhood (OR=2.31; 95% CI, 1.06-5.04; p=0.04) and the risk of being diagnosed with MS. In lesser quality studies, there was a statistical association between "other traumas" premorbid and spinal injury premorbid. No association was found between spinal injury during childhood, or fractures and burns at any age and the diagnosis of MS. The pooled OR of four cohort studies looking at premorbid head trauma was not statistically significant. CONCLUSIONS: The result of the meta-analyses of high quality case-control studies suggests a statistically significant association between premorbid head trauma and the risk for developing MS. However, cohort studies did not. Future prospective studies that define trauma based on validated instruments, and include frequency of traumas per study participant, are needed.

Changes in dietary and physical activity risk factors for type 2 diabetes in Alberta youth between 2005 and 2008.

OBJECTIVE: Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008). METHODS: The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008. RESULTS: Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p<0.05); and carbohydrate, protein, fibre and vegetable and fruit intakes were higher in 2008 (p<0.05). In 2008, a lower proportion of students were: overweight, obese, consuming high GI, high GL, high fat, low fibre, low veg/fruit intake (p<0.05). No differences existed in magnesium or PA levels between the two time points. CONCLUSIONS: Improvements were observed between 2005 and 2008 in terms of the proportion of adolescents having specific risk factors for T2D. The cause of these changes could not be determined. Continued monitoring of adolescent lifestyle habits and monitoring of exposure to health promotion programming is recommended.

Anthropometric and dietary predictors of insulin sensitivity in 10- to 14-year-old boys and girls.

The high prevalence of pediatric obesity has made preventing chronic diseases through healthy lifestyle behaviours a priority within pediatrics. Examining the association between diet and insulin sensitivity (IS) in youth may provide important insights for tailoring preventative dietary interventions. The objective of this study was to explore the associations among anthropometry, diet, and IS in 10- to 14-year-olds. In this cross-sectional study, the primary outcome measure was IS, measured noninvasively using a (13)C glucose breath test. Exposure variables included body mass index (BMI) z score and several dietary variables, including glycemic index (GI), glycemic load, and fiber, magnesium, vegetable and fruit, and fat intakes, all of which were derived from a validated, Web-based 24-h recall tool. Multiple regression analyses were performed for boys and girls separately. In total, 378 students (227 girls) aged 12.1 ± 1.2 years were studied. In this sample ∼24% of youth were considered overweight or obese (BMI z score = 0.41 ± 0.93). Multiple regression analyses showed that BMI z score was negatively and independently associated with (13)C insulin sensitivity score ((13)CISS) in both boys and girls (boys: ß = -0.501; girls: ß = -0.446; both p < 0.001). GI was negatively and independently related to (13)CISS in boys (ß = -0.195, p < 0.05) but not in girls. Other dietary variables were not associated with IS. In addition to BMI z score, a low GI diet predicted (13)CISS in boys but not in girls. This finding suggests that interventions that reduce BMI (in both sexes) and include a low GI diet among boys may improve IS.

Adolescent weight status and related behavioural factors: web survey of physical activity and nutrition.

Purpose. To identify whether non-overweight students were different from their overweight or obese peers with respect to diet, suboptimal meal behaviours, and physical activity using a self-administered web-based survey. Methods. 4097 adolescents living in Alberta, Canada completed Web-SPAN (Web Survey of Physical Activity and Nutrition). Students were classified as overweight or obese, and differences were described in terms of nutrient intakes, physical activity, and meal behaviours. Results. Non-overweight students consumed significantly more carbohydrate and fibre, and significantly less fat and high calorie beverages, and had a higher frequency of consuming breakfast and snacks compared to overweight or obese students. Both non-overweight and overweight students were significantly more active than obese students. Conclusions. This research supports the need to target suboptimal behaviours such as high calorie beverage consumption, fat intake, breakfast skipping, and physical inactivity. School nutrition policies and mandatory physical education for all students may help to improve weight status in adolescents.

Geography influences dietary intake, physical activity and weight status of adolescents.

Purpose. The purpose of this study was to assess rural and urban differences in the dietary intakes, physical activity levels and weight status of a large sample of Canadian youth in both 2005 and 2008. Materials and Methods. A cross-sectional study of rural and urban adolescents (n = 10, 023) in Alberta was conducted in both 2005 and 2008 using a web-based survey. Results. There was an overall positive change in nutrient intakes between 2005 and 2008; however, rural residents generally had a poorer nutrient profile than urban residents (P < .001). They consumed less fibre and a greater percent energy from saturated fat. The mean physical activity scores increased among rural youth between 2005 and 2008 (P < .001), while remaining unchanged among urban youth. Residence was significantly related to weight status in 2005 (P = .017), but not in 2008. Conclusion. Although there were small improvements in nutrient intakes from 2005 to 2008, several differences in the lifestyle behaviours of adolescents living in rural and urban areas were found. The results of this study emphasize the importance of making policy and program recommendations to support healthy lifestyle behaviours within the context of the environments in which adolescents live.

The use of complementary and alternative medicines among a sample of Canadian menopausal-aged women.

INTRODUCTION: Despite questionable efficacy and safety, many women use a variety of complementary and alternative medicine (CAM) therapies to relieve menopause symptoms. METHODS: We examined the determinants and use of CAM therapies among a sample of menopausal-aged women in Canada by using a cross-sectional Web-based survey. RESULTS: Four hundred twenty-three women who were contacted through list serves, e-mail lists, and Internet advertisements provided complete data on demographics, use of CAM, therapies, and menopausal status and symptoms. Ninety-one percent of women reported trying CAM therapies for their symptoms. Women reported using an average of five kinds of CAM therapies. The most common treatments were vitamins (61.5%), relaxation techniques (57.0%), yoga/meditation (37.6%), soy products (37.4%), and prayer (35.7%). The most beneficial CAM therapies reported were prayer/spiritual healing, relaxation techniques, counseling/therapy, and therapeutic touch/Reiki. Demographic factors and menopausal symptoms contributed to 14% of the variance (P < .001) in the number of CAM therapies tried. DISCUSSION: Results support previous research showing that menopausal women have high user rates of CAM therapy and show that specific demographic factors and somatic symptomatology relate to use of CAM therapies. Health care providers can benefit from understanding the determinants and use of CAM by women during the menopause transition if they are to help and provide quality care for this population.

Dietary patterns associated with glycemic index and glycemic load among Alberta adolescents.

The purpose of this study was to assess the dietary glycemic index (GI) and glycemic load (GL) of adolescents, based on a Web-based 24-h recall, and to investigate dietary predictors of GI and GL. In addition, the relationship between GI and GL and weight status was examined. A Web-based 24-h recall was completed by 4936 adolescents, aged 9-17 years; macronutrient and food group intakes were assessed using the ESHA Food Processor, the Canadian Nutrient File, and Canada's Food Guide. Dietary GI and GL were calculated based on published GI values for foods. Students provided self-reported height and mass. Multiple regression models assessed the ability of food group choices and food behaviours to predict GI and GL. Mean GI was 55 for girls and 56 for boys. Mean GL was 128 for girls and 168 for boys. Food group choices explained 26% of the variation in GI (p < 0.01) and 84% of the variation in GL (p < 0.01). The number of meals per day explained 10% (p < 0.01), and eating meals outside of the home accounted for 2.5% (p < 0.01) of the variation in GL; however, these results disappeared when adjusted for total energy intake. The GI was positively correlated with body mass index in girls (r = 0.05, p = 0.02), and GL was significantly higher among nonoverweight boys than overweight boys. This study identified eating patterns related to daily GI and GL, and suggests certain dietary patterns that could have beneficial effects on health. It also showed that GI and GL were weakly related to weight status.

The enduring impact of social factors on exercise tolerance in men attending cardiac rehabilitation.

PURPOSE: This study explored the influence of social support on a prognostic indicator among cardiac patients, exercise tolerance. The relationship of sociodemographic factors to social support was examined, as well as the role of social support as a potential mediator between sociodemographic factors and exercise tolerance. METHODS: Archival data were collected from a sample of 254 men referred to cardiac rehabilitation. An exercise tolerance test was completed upon entry into cardiac rehabilitation, after 14 weeks, and after 9 months. RESULTS: Sociodemographic factors and social support reported upon entry into the cardiac rehabilitation program were related to initial and post-cardiac rehabilitation exercise tolerance, after controlling for admitting diagnoses, medical history, smoking, and perceived severity of illness. Overall, 28% of the variance in exercise tolerance was explained at baseline, 19% at 14 weeks, and 20% at 9 months. Specifically, older individuals had poorer exercise tolerance, whereas those with more income had better exercise tolerance. Social support was positively related to exercise tolerance at all 3 times. Older men reported less social support than younger men did, and those with more income reported more social support. However, social support did not mediate the relationship between sociodemographic factors and exercise tolerance. CONCLUSIONS: Results support the potential use of broad social factors in examining the determinants of prognostic factors for heart patients.

Examining the role of social support and group cohesion in exercise compliance.

The present study sought to examine the role of social support and group cohesion in the compliance behavior of females required to exercise for health-related reasons. Compliance behavior was assessed as attendance and dropout behavior. Participants (N = 49) drawn from a clinical exercise group completed questionnaires to assess cohesion and social support. Discriminant function analyses were able to discriminate between high and low attenders as well as between dropouts and graduates. Participants reporting high scores on the support provision of reliable alliance and the cohesion factor of ATG-Task, along with low scores on the social support provision of guidance, were more likely to attend a higher proportion of classes. For dropouts, participants with higher scores on the support provision of reliable alliance were less likely to drop out. As a secondary objective, it was found that cohesion and social support variables both contributed to the successful prediction of attendance.

Relationships between exercise regulations and motivational consequences in university students.

The aim of this study was to examine propositions stemming from Self-Determination Theory (SDT) that contend motivational consequences vary as a function of different regulations in the exercise domain. Participants (N = 276; n = 98 men; n = 178 women) completed inventories assessing exercise regulations, current exercise behavior, and behavioral intentions to continue exercising for the next 4 months and the effort and importance associated with exercise participation. Bivariate analyses indicated autonomous exercise regulations (identified and intrinsic) were the strongest correlates of each motivational consequence across both sexes, and introjected regulation was positively associated with exercise consequences in women. Simultaneous multiple regression analyses indicated that exercise regulations accounted for a sizeable portion of the variance across each motivational consequence in both sexes (R2adj values ranged from .20 to .53). Both regression and structure coefficients revealed that introjected regulation was a stronger motivational force in women than men, and identified regulation was the most important predictor of all three motivational consequences in both sexes. Collectively, these findings suggest that exercise regulations differentially predict motivational consequences across sexes, and future research using this theoretical framework for examining motivational issues pertinent to the exercise domain appears warranted.

Is the theory of planned behavior a useful framework for understanding exercise adherence during phase II cardiac rehabilitation?

PURPOSE: This study evaluated the theory of planned behavior (TPB) as a framework for understanding exercise adherence during phase II cardiac rehabilitation (CR). METHODS: A total of 215 patients completed a baseline questionnaire that included the TPB constructs and past exercise. Exercise adherence was measured via program attendance during phase II CR. RESULTS: Hierarchic regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 30% of the variance in exercise intention, with attitude, subjective norm, and PBC each making significant unique contributions to intention. Furthermore, exercise intention explained 12% of the variance in exercise adherence. Finally, the behavioral, normative, and control beliefs provided novel information concerning why patients in phase II CR hold certain attitudes, subjective norms, PBC, and exercise intentions. CONCLUSION: Results of the present study provide evidence that the TPB is a useful framework for understanding exercise intentions and adherence during phase II CR.