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Objective: Acute agitation in pediatrics is commonly encountered in hospital settings, can contribute to significant physical and psychological distress, and management is highly varied in practice. As such, the development of a standardized pharmacologic guideline is paramount. We aimed to develop a novel clinical pathway (CP) for management of acute agitation for all hospitalized pediatric patients in Canada. Methods: Healthcare professionals in Canada with expertise in treating and managing pediatric agitation formed a working group and developed a CP through conducting a literature review, engaging key partners, and obtaining interdisciplinary consensus (iterative real-time discussions with content experts). Once developed, the preliminary CP was presented to additional internal and external partners via multiple grand rounds and a webinar; feedback from participants guided final CP revisions. Results: The working group created a pediatric inpatient CP to guide pharmacologic management of agitation and serve as an easy-to-use clinical and educational resource with three complementary sections including: 1) a treatment algorithm, 2) a quick reference medication chart, and 3) two supporting documents, which provide a general overview of non-pharmacologic strategies prior to CP implementation and an illustrative scenario to accompany the medication chart to ensure effective utilization. Conclusions: This is the first CP to standardize pharmacological treatment and management of acute agitation in children in inpatient settings in Canada. Although further research is warranted to assess implementation and support process improvement, the CP can be adapted by individual institutions to assist in prompt pharmacological management of pediatric agitation to potentially improve outcomes for patients, families, and healthcare professionals. [ABSTRACT FROM AUTHOR]

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Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ultra-processed foods (UPFs) have become a major contributor to the diets of Canadians, with a recent report from Statistics Canada suggesting Canadians are consuming almost one-half of their calories from UPFs. Research has linked UPF consumption with increased risk for chronic diseases such as cardiovascular disease and type 2 diabetes, among others. This paper sought to investigate the popularity of UPFs, particularly among children and teens, utilizing the socioecological model as a framework to illustrate how influences at multiple levels (i.e., public policy, organizational, community, interpersonal, and individual) have played a role in the proliferation of UPFs. Evidence from previous studies is used to identify how factors at different levels may influence UPF consumption and discuss potential strategies for reducing UPF consumption. To meaningfully reduce UPF consumption among Canadians, all levels should be considered, with the goal of creating a healthier Canadian population.

The Biochemical Evaluation of a Health Intervention Programme (B.E. H.I.P.) investigated the impact of progressive exercise intensity in overweight and obese children. A 5-month prospective randomized crossover design (XA, immediate intervention; OB, control group; XB, delayed intervention, OA, postintervention follow-up) with a 10-week health intervention programme was employed. The intervention utilized a progressive increase in high-intensity exercise (≥75% maximum heart rate) and included 3 nutrition and 2 parent education sessions. Primary analysis was completed with ( i) XA versus OB and ( ii) all intervention participants (collapsed XA and XB = XAXB). Prepubertal overweight and obese male and female children ( n = 27) between 5 and 10 years of age were randomly allocated to XA ( n = 16; 11 females; waist circumference = 80.0 ± 10.6 cm) or OB ( n = 11; 3 females; waist circumference = 76.6 ± 7.5 cm). The primary variables were heart rate and percent fat mass. All variables, including body composition, habitual activity, and serum lipids, were repeatedly measured for up to a maximum of 7 time points. Energy expenditure was quantitatively measured throughout each exercise class ( n = 20). A significantly longer time in the exercise sessions was spent in high-intensity (35.1%-60.0%) versus low- to moderate-intensity (64.9%-40.0%) exercise as the intervention progressed from the first to the last attended exercise class (Fisher exact test, p < 0.0001). The percent fat mass decreased in all intervention participants (-2.2%, p < 0.0001). XA had a greater slope decrease than OB for percent fat mass ( p = 0.00051) and triglycerides ( p = 0.0467). In conclusion, high-intensity exercise, within a comprehensive health programme that includes nutrition education, improved the lipid and physiological health profiles of obese children. [ABSTRACT FROM AUTHOR]

Objective: Numerous barriers to maintaining infection control practices through the use of personal protective equipment (PPE) exist in the emergency department (ED). This study examined the knowledge, self-reported behaviours, and barriers to compliance with infection control practices and the use of PPE in Canadian pediatric EDs. Methods: A self-administered survey instrument consisting of 21 questions was developed and piloted for this study. The survey was mailed to all individuals listed in the Pediatric Emergency Research Canada database of physicians practicing pediatric emergency medicine in Canada. Results: A total of 186 physicians were surveyed, and 123 (66%) participated. Twenty-two percent of participants reported that they had never received PPE training and 32% had not been trained in the previous 2 years. Fifty-three percent reported being very or somewhat comfortable with their knowledge of transmission-based isolation practices. Participants were correct on a mean of 4.9 of 11 knowledge-based questions (SD 1.7). For scenarios assessing self-reported use of PPE, participants selected answers that reflected PPE use in accordance with national infection control standards in a mean of 1.0 of 6 scenarios (SD 1.0). Participants reported that they would be more likely to use PPE if patients were clearly identified prior to physician assessment, equipment was accessible, and PPE use was made a priority in their ED. Conclusions: Knowledge and self-reported adherence to recommended infection control practices among Canadian pediatric emergency physicians is suboptimal. Early identification of patients requiring PPE, convenient access to PPE, and improved education regarding isolation and PPE practices may improve adherence. [ABSTRACT FROM AUTHOR]

When considering the impacts of historical trauma and colonization on the lived realities of Indigenous young people within Canada, it is essential that research uses strength-based, capacity-building approaches to ensure that the voices are heard and that their perspectives and advice can be actioned. A series of participatory workshops with adults and children were conducted within urban geographies to explore health-seeking behaviours, health knowledge, and community resiliency. Research took place in Manitoba, Canada (2015-2016, n = 36 girls and 24 adults) with First Nations and Métis community members and British Columbia, Canada (2017, n = 11 children and 15 adults) with Métis community members. Children participated in community transect walks, photo elicitation activities, discussion circles (with adult participant contribution), and projected community mapping exercises where they drew their ideal, imagined community. Community consensus processes were used for member checking as well as initial evaluation of research findings, including the establishment of key themes. Field notes, discussion transcripts, and images were analyzed for similarities and differences between ages, genders, cultural identifiers, and geographies. A key finding was the need for safe spaces that can also be brave spaces, or moments when the community can be free to push for change without reprimand. Children were particularly concerned with sustainable, appropriate housing, safe methods of transportation, access to green spaces, and environmental stewardship within their day-to-day lives. Novelty: Brave spaces are essential for achieving/maintaining wellness within Indigenous communities. This article responds to a need to shift to a determinants of life focus.

Objectives: The Newfoundland and Labrador diabetic ketoacidosis Project (NLdkaP) is a multi-intervention, province-wide project aimed at lowering rates of diabetic ketoacidosis (DKA) within the pediatric and young adult populations., Methods: The NLdkaP interventions were first selected, developed and implemented. We then conducted a retrospective study of hospitalization data over three 2-year periods: pre-, during and post-NLdkaP. Data included demographic factors, DKA hospitalizations and length of hospital stay., Results: There were 412 DKA hospitalizations over the study period. Before the NLdkaP, the provincial hospitalization rate of DKA for patients <25 years of age was 55.61 per 100,000. During the NLdkaP, the rate dropped to 38.48 per 100,000 (p<0.001). After the NLdkaP, the rate rose to 54.53 per 100,000 (p<0.001). Hospitalization rates were highest for females (p<0.001) and for those in the 19- to 24-year age group (p<0.001)., Conclusions: The NLdkaP was associated with decreased rates of DKA hospitalizations, but the rates remained relatively stable in both the pre- and postintervention periods. Although the approach and resources developed in the NLdkaP appear effective, continuous preventive efforts are needed to sustain reductions in DKA hospitalizations., (Copyright © 2021 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Daily life has changed for families due to the COVID-19 pandemic. The aim of this repeated cross-sectional study was to describe movement behaviours in Canadian children and youth 6 months into the pandemic (T2; October 2020) compared with the start of the pandemic (T1, April 2020). An online survey was distributed to parents ( N = 1568) of children and/or youth (5-17 years; 58% girls) in October 2020. The survey assessed changes in movement behaviours (physical activity and play, sedentary behaviours, and sleep) from before the pandemic to October 2020 (T2). We compared these data with spring data (T1; April 2020; Moore et al. 2020; Int. J. Behav. Nutr. Phys. Act, 17:85) collected using identical methodology ( N = 1472; 54% girls). We report correlations between movement behaviours and relevant parental factors and provide word frequency distributions for open-ended responses. During the second wave, 4.5% of children (4.6% girls; 4.3% boys) and 1.9% of youth (1.3% girls, 2.4% boys) met the movement guidelines (3.1% overall). Whereas, during the first wave, 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined guidelines (2.6% overall). Parental support was correlated with their child's movement behaviours (T1 and T2). Our study demonstrates the ongoing challenges for children and youth to engage in healthy movement during the pandemic. Novelty: Our large-scale national study demonstrates that children and youth were not meeting the 24-hour movement guidelines during the second wave of the pandemic. Our findings illustrate the need to protect children and youth from the collateral consequences of the pandemic.

To determine the physical literacy, defined as the capability for a physically active lifestyle, of children with medical conditions compared with healthy peers, this multicenter cross-sectional study recruited children with medical conditions from cardiology, neurology (including concussion), rheumatology, mental health, respirology, oncology, hematology, and rehabilitation (including cerebral palsy) clinics. Participants aged 8-12 years ( N  = 130; mean age: 10.0 ± 1.44 years; 44% female) were randomly matched to 3 healthy peers from a normative database, based on age, gender, and month of testing. Total physical literacy was assessed by the Canadian Assessment of Physical Literacy, a validated assessment of physical literacy measuring physical competence, daily behaviour, knowledge/understanding, and motivation/confidence. Total physical literacy mean scores (/100) did not differ ( t (498) = -0.67; p  = 0.44) between participants (61.0 ± 14.2) and matched healthy peers (62.0 ± 10.7). Children with medical conditions had lower mean physical competence scores (/30; -6.5 [-7.44 to -5.51]; p < 0.001) but higher mean motivation/confidence scores (/30; 2.6 [1.67 to 3.63]; p  < 0.001). Mean daily behaviour and knowledge/understanding scores did not differ from matches (/30; 1.8 [0.26 to 3.33]; p  = 0.02;/10; -0.04 [-0.38 to 0.30]; p  = 0.81; respectively). Children with medical conditions are motivated to be physically active but demonstrate impaired movement skills and fitness, suggesting the need for targeted interventions to improve their physical competence. Novelty: Physical literacy in children with diverse chronic medical conditions is similar to healthy peers. Children with medical conditions have lower physical competence than healthy peers, but higher motivation and confidence. Physical competence (motor skill, fitness) interventions, rather than motivation or education, are needed for these youth.

Background.: This study examined changes in performance and satisfaction with self-identified occupational performance goals during a specialized day treatment admission in children and adolescents with eating disorders. Weight-related outcomes for underweight youth were also examined., Methods.: A total of 63 youth participated in the study, with admission and discharge data on ratings of self-identified occupational performance goals (measured with the Canadian Occupational Performance Measure) available for 42 participants., Findings.: Significant improvements were found in ratings of satisfaction and performance with self-identified goals over the course of treatment. The program was also effective in supporting weight restoration for underweight youth, with a large effect size observed., Implications.: A symptom-focused day treatment program for paediatric eating disorders led to improvements in perceived occupational performance. Collaborating with youth to develop self-identified goals in the context of eating disorders treatment can foster autonomy and potentially improve treatment engagement.