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OBJECTIVE: Family-based, behavioral treatment has been shown to be an effective intervention for the management of pediatric obesity. The goal of this study was to compare the cost-effectiveness of two protocols for the delivery of family-based behavioral treatment. REASEARCH METHODS AND PROCEDURES: Thirty-one families with obese children were randomized to groups in which families were provided mixed treatment incorporating both group and individualized treatment vs group treatment only. Costeffectiveness of treatment was defined as the magnitude of reduction in standardized BM I and percentage overweight per dollar spent for recruitment and treatment. Anthropometric data were assessed at baseline, 6 months and 12 months postrandomization. RESULTS: Results for the 24 families with complete data showed the group intervention was significantly more cost-effective than the mixed treatment. This was due to the similarity between the two groups in Z-BMI or percentage overweight change for children and their parents, while the mixed treatment was significantly more expensive to deliver than the group treatment. DISCUSSION: These findings suggest that a family-based, behavioral intervention employing group treatment alone is a more cost-effective approach to treating pediatric obesity than a mixed group plus individual format. [ABSTRACT FROM AUTHOR]

Gary S Goldfield,1–5 Lauren Marie Dowler,5 Mark Walker,6,7 Jameason D Cameron,3 Zachary M Ferraro,1 Eric Doucet,3 Kristi B Adamo1–31Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 2Department of Paediatrics, 3School of Human Kinetics, 4School of Psychology, University of Ottawa, 5Department of Psychology, Carleton University, 6Ottawa Hospital Research Institute, 7Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, CanadaBackground: Excessive gestational weight gain is associated with postpartum weight retention and downstream child obesity. Dopamine plays a critical role in the regulation of energy intake and body weight. The purpose of this study was to examine the relationship between excessive gestational weight gain and dopamine pathway-related polymorphisms, namely the variable nucleotide tandem repeat in the 3´untranslated region (UTR) region of the SLC6A3 (DAT-1) dopamine transporter gene and the 30-base pair variable nucleotide tandem repeat polymorphism of the 5´UTR of the monoamine oxidase-A (MAO-A) gene.Methods: Ninety-three women of mean age 31.7 ± 4.2 years were recruited from the Ottawa and Kingston birth cohort and assessed at 12–20 weeks’ gestation. Mean body mass index was 22.7 ± 2.5 kg/m2. Excessive gestational weight gain was defined according to the 2009 Institute of Medicine guidelines based on body mass index. Genotype analyses were performed using polymerase chain reaction and agarose gel electrophoresis.Results: There was no relationship between the prevalence or magnitude of excessive gestational weight gain among women with the 3´ UTR single nucleotide polymorphism of the DAT-1 gene. However, 70% (19 of 27) of women carrying the MAO-A 4/4 (high activity) allele exceeded recommendations for gestational weight gain compared with 48% (32 of 60) of those with the pooled 3/3, 3/4, and 3/3.5 (low activity) alleles (P < 0.05). Similarly, those with the MAO-A 4/4 allele had significantly greater gestational weight gain than those with the 3/3, 3/4, or 3/3.5 pooled genotypes (19.3 ± 4.1 versus 17.0 ± 5.0 kg, P = 0.03).Conclusion: Carriers of the 4/4 variants of the MAO-A gene may be at increased risk for excessive gestational weight gain.Keywords: gestational weight gain, dopamine genes, monoamine oxidase-A

Abstract Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

To examine energy intake adaptations to a 10-week aerobic exercise program in obese adolescents. Methods Twenty-six 12-17year old obese adolescents were asked to cycle twice a week for an hour in a research laboratory. Body composition, aerobic fitness (submaximal fitness test) and energy intake (3-day food record) were assessed before and immediately after the 10-week intervention Results The average time spent pedaling per session was 55.3±12.1min for a mean energy expenditure of 2196±561kJpersession. The intervention produced significant improvements in percentage of body fat (44.5±10.6% vs. 43.4±9.8%; p<0.05) but no significant weight and fat-free mass change. Peak workload (79.5±20.8W vs. 87.3±17.6W; p<0.05) and peak heart rate (174.6±18.7bpm vs. 166.2±21.0bpm; p<0.01) were improved. The mean total daily energy intake (in kJ/day) showed a tendency to decrease through the intervention (7440±1744 to 6740±2124kJ; p=0.07) but a high inter-individual variability observed in the energy intake response to the intervention may explain the non-significant association between the energy intake response and weight loss. Conclusion A 10-week aerobic exercise program may result in a small decrease in energy intake and an associated decrease in percentage of body fat but no weight loss in obese adolescents. This lack of weight loss could be explained by a decrease in spontaneous energy expenditure outside the intervention sessions. [ABSTRACT FROM AUTHOR]

Background: The ability to cope with concussion symptoms and manage stress is an important determinant of risk for prolonged symptoms., Objective: This open-label mixed-methods pilot study assessed the acceptability and credibility of a mindfulness-based intervention delivered through a digital therapeutic (DTx; therapeutic smartphone app) for pediatric concussion., Methods: Participants aged 12 to 18 years were recruited from an emergency department within 48 hours of a concussion (acute cohort) or from a tertiary care clinic at least 1-month post-concussion (persisting symptoms cohort). Participants completed a novel 4-week mindfulness-based intervention, for 10 to 15 minutes/day, at a minimum of 4 days/week. At 2 weeks, participants completed a credibility and expectancy questionnaire. At 4 weeks, participants completed questionnaires assessing satisfaction, usability and working alliance, as well as a semi-structured phone interview., Results: Ten participants completed the study outcomes (7 acute; 3 persisting symptoms). The intervention was perceived as credible (median/max possible = 6.50/9.00 [6.83,8.75]) and DTx was usable (median/max possible = 70.00/100.00 [55.00,82.50]). Participants rated their satisfaction with the DTx (median/max possible = 27.00/32.00 [24.50,29.50]) and the working alliance with the digital mindfulness guides (median/max possible = 3.92/5.00 [3.38-4.33]) as high. Four themes were identified from the qualitative data: (a) positive attributes; (b) negative attributes; (c) ideas for modifications; and (d) technical issues., Conclusion: Results show modifications to the DTx, instructions and mindfulness intervention, and potential ways to increase adherence by leveraging positive attributes. A randomized control trial will assess the effectiveness of the DTx MBI to decrease the risk of persisting symptoms and reduce the symptom burden following pediatric concussion., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AAL reported being one of the authors of the Mindfulness-Based Intervention for Concussion protocol used in this study, she did not receive any financial benefit. AAL received funding from the Ontario Brain Institute NERD program for a separate component of the study. AAL has no other conflict of interest to disclose. BJS is the Chief Scientist and CEO of Mobio Interactive PTE LTD (Singapore), the parent company of Mobio Interactive Inc. (Toronto, Canada), and he owned approximately 22% of the company at the time of manuscript submission. BJS exclusively served as a technical liaison for the study and did not contribute to the specific study design, or select the outcome measures, nor did he directly contribute to, or have influence over, data collection or analysis. RZ is the cofounder, Scientific Director, and a minority shareholder in 360 Concussion Care, an interdisciplinary concussion clinic. RZ holds a Clinical Research Chair in Pediatric Concussion from University of Ottawa, and is on the concussion advisory board for Parachute Canada (a non-profit injury prevention charity). VS receives royalties for the publication of a book on concussion by Flammarion. The remaining authors have no conflicts of interest to report., (© The Author(s) 2024.)

Background: Concussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child's quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms., Objective: The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group., Methods: This study is a double-blind Health Canada-regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion., Results: The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted., Conclusions: This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications., Trial Registration: ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802., International Registered Report Identifier (irrid): DERR1-10.2196/57226., (©Andrée-Anne Ledoux, Roger Zemek, Molly Cairncross, Noah Silverberg, Veronik Sicard, Nicholas Barrowman, Gary Goldfield, Clare Gray, Ashley D Harris, Natalia Jaworska, Nick Reed, Bechara J Saab, Andra Smith, Lisa Walker. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.04.2024.)

Background: Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence-the extent to which digital encounters feel like they are occurring in person-may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored., Objective: This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents' development of therapeutic alliance and social presence with the intervention., Methods: Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention., Results: Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by "developing a genuine connection" with their mindfulness guides and "sensing real people." Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides' "personal backgrounds and voices," such that participants felt more connected to the guides by knowing information about them and through the guides' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would., Conclusions: Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment., (©Kiarah M K O'Kane, Thalia Otamendi, Noah D Silverberg, Esther Choi, Veronik Sicard, Roger Zemek, Katherine Healey, Olivier Brown, Lauren Butterfield, Andra Smith, Gary Goldfield, Rachel Kardish, Bechara Saab, Andrée-Anne Ledoux, Molly Cairncross. Originally published in JMIR Formative Research (https://formative.jmir.org), 22.03.2024.)

Emerging evidence suggests that advanced neuroimaging modalities such as arterial spin labelling (ASL) might have prognostic utility for pediatric concussion. This study aimed to: 1) examine group differences in global and regional brain perfusion in youth with concussion or orthopedic injury (OI) at 72 h and 4 weeks post-injury; 2) examine patterns of abnormal brain perfusion within both groups and their recovery; 3) investigate the association between perfusion and symptom burden within concussed and OI youths at both time-points; and 4) explore perfusion between symptomatic and asymptomatic concussed and OI youths. Youths ages 10.00-17.99 years presenting to the emergency department with an acute concussion or OI were enrolled. ASL-magnetic resonance imaging scans were conducted at 72 h and 4 weeks post-injury to measure brain perfusion, along with completion of the Health Behavior Inventory (HBI) to measure symptoms. Abnormal perfusion clusters were identified using voxel-based z-score analysis at each visit. First, mixed analyses of covariance (ANCOVAs) investigated the Group*Time interaction on global and regional perfusion. Post hoc region of interest (ROI) analyses were performed on significant regions. Second, within-group generalized estimating equations investigated the recovery of abnormal perfusion at an individual level. Third, multiple regressions at each time-point examined the association between HBI and regional perfusion, and between HBI and abnormal perfusion volumes within the concussion group. Fourth, whole-brain one-way ANCOVAs explored differences in regional and abnormal perfusion based on symptomatic status (symptomatic vs. asymptomatic) and OIs at each time-point. A total of 70 youths with a concussion [median age (interquartile range; IQR) = 12.70 (11.67-14.35), 47.1% female] and 29 with an OI [median age (IQR)  =  12.05 (11.18-13.89), 41.4% female] were included. Although no Group effect was found in global perfusion, the concussion group showed greater adjusted perfusion within the anterior cingulate cortex/middle frontal gyrus (MFG) and right MFG compared with the OI group across time-points ( ps ≤ 0.004). The concussion group showed lower perfusion within the right superior temporal gyrus at both time-points and bilateral occipital gyrus at 4 weeks, ( ps ≤ 0.006). The number of hypoperfused clusters was increased at 72 h compared with 4 weeks in the concussion youths ( p  < 0.001), but not in the OIs. Moreover, Group moderated the HBI-perfusion association within the left precuneus and superior frontal gyrus at both time-points, ( ps ≤ 0.001). No association was found between HBI and abnormal perfusion volume within the concussion group at any visits. At 4 weeks, the symptomatic sub-group ( n  = 10) showed lower adjusted perfusion within the right cerebellum and lingual gyrus, while the asymptomatic sub-group ( n  = 59) showed lower adjusted perfusion within the left calcarine, but greater perfusion within the left medial orbitofrontal cortex, right middle frontal gyrus, and bilateral caudate compared with OIs. Yet, no group differences were observed in the number of abnormal perfusion clusters or volumes at any visit. The present study suggests that symptoms may be associated with changes in regional perfusion, but not abnormal perfusion levels.

Introduction: The Strengths and Difficulties Questionnaire (SDQ), for assessing behavioural and emotional difficulties, has been used internationally as a screening measure for mental health problems. Our objective was to validate the existing (British) SDQ cut-points in a sample of Canadian children and youth, and develop new Canadian SDQ cut-points if needed., Methods: This study includes data from children and youth aged 6 to 17 years from the Canadian Health Measures Survey (n = 3435) and outpatient records from the Children's Hospital of Eastern Ontario (n = 1075). The parent-reported SDQ data were collected. We adjusted the existing SDQ cut-points using a distributional and receiver-operating characteristic (ROC) curve approach. We subsequently calculated the sensitivity, specificity and diagnostic odds ratio of the existing and new SDQ clinical cut-points to determine whether the new cut-points had better clinical utility, using both analytic approaches., Results: Our data show differences in the screening effectiveness between the existing British and the Canadian-specific clinical cut-points. Specificity is maximized using the Canadian distributional cut-points, improving the likelihood of identifying true negative results. The total SDQ score met the threshold for clinical utility (diagnostic odds ratio > 20) using both the existing and new cut-points; however, the individual scales did not reach clinical utility threshold using either cut-points., Conclusions: Future Canadian SDQ research should consider the new cut-points derived from our study population and the existing British cut-points to allow for historical and international comparisons., Competing Interests: The authors report no conflicts of interest related to this study.

Introduction: Shorter and/or disrupted sleep during adolescence is associated with cognitive and mental health risks, particularly in females. We explored the relationship between bedtime behavior patterns co-varying with Social Jet Lag (SJL) and School Start Times (SST) and neurocognitive performance in adolescent female students., Methods: To investigate whether time of day (morning vs. afternoon), early SSTs and days of the school week can be correlated with neurocognitive correlates of sleep insufficiency, we recruited 24 female students aged 16-18 to report sleep logs, and undergo event-related electroencephalographic recordings on Monday, Wednesday, mornings, and afternoons. Using a Stroop task paradigm, we analyzed correlations between reaction times (RTs), accuracy, time of day, day of week, electroencephalographic data, and sleep log data to understand what relationships may exist., Results: Participants reported a 2-h sleep phase delay and SJL. Stroop interference influenced accuracy on Monday and Wednesday similarly, with better performance in the afternoon. For RTs, the afternoon advantage was much larger on Monday than Wednesday. Midline Event-Related Potentials (ERPs) yielded higher amplitudes and shorter latencies on Wednesday morning and Monday afternoon, in time windows related to attention or response execution. A notable exception were delayed ERP latencies on Wednesday afternoon. The latter could be explained by the fact that delta EEG waves tended to be the most prominent, suggesting heightened error monitoring due to accumulating mental fatigue., Discussion: These findings provide insights into the interaction between SJL and SST and suggest evidence-based criteria for planning when female adolescents should engage in cognitive-heavy school activities such as tests or exams., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 D’Angiulli, Byczynski, Yeh, Garrett, Goldfield, Devenyi, Devenyi and Leisman.)

Objective: To examine the proportion of participants with poor sleep quality, evaluate the associations between sleep quality and anthropometric and cardiometabolic health markers, and evaluate the effect of high intensity interval training (HIIT) and continuous aerobic exercise training (CAET) on sleep quality in polycystic ovary syndrome (PCOS)., Design: Secondary analysis of a pilot randomized controlled trial., Patients: Women with PCOS aged 18-40 years., Measurements: The Pittsburgh Sleep Quality Index (PSQI) was measured at baseline and following a 6-month exercise intervention. A PSQI score >5 indicates poor sleep. Linear regression was used to evaluate the associations between PSQI score and anthropometric and cardiometabolic health markers, and the effect of exercise training on these associations., Results: Thirty-four participants completed the PSQI at baseline, and 29 postintervention: no-exercise control (n = 9), HIIT (n = 12) and CAET (n = 8). At baseline, 79% had poor sleep quality. Baseline PSQI score was positively correlated with body mass index, waist circumference, body weight, haemoglobin A1c and insulin resistance. Mean PSQI score changes were -0.4 (SD 1.1), -0.7 (SD 0.6) and -0.5 (SD 0.9) for control, HIIT and CAET, respectively. For HIIT participants, change in PSQI score was associated with changes in body weight (B = .27, 95% CI 0.10-0.45) and waist circumference (B = .09, 95% CI 0.02-0.17)., Conclusion: Most participants had poor sleep quality which was associated with poorer anthropometric and cardiometabolic health markers. There were no statistically significant changes in PSQI score with exercise training. With HIIT training, decreases in the sleep efficiency score were associated with reductions in body weight and waist circumference. Further studies are needed to determine the effect of exercise training on sleep quality., (© 2023 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.)

Background: Since cannabis has been legalized in Canada for medical and recreational use, there has been an increased demand on pharmacists for cannabis counselling. The objective of this study was to determine the concerns, beliefs and attitudes of Canadian pharmacists and pharmacy students towards using cannabis., Methods: An online survey was synthesized under 3 broad themes: concerns, beliefs and attitudes about cannabis, consisting of 27 questions capturing demographics and Likert scale responding to survey questions. We examined whether there were differences in responses by geographic location (i.e., Ontario, Quebec, Canada), sex or practice setting (i.e., community, hospital)., Results: Across Canada, there were 654 survey respondents, with 399 in Ontario and 95 in Quebec. Approximately 24% indicated they had used cannabis since legalization, 69% indicated they believed cannabis should be available for medical and recreational use and 34% indicated their perceptions towards cannabis had become more positive since legalization. Relative to Quebec or the rest of Canada, respondents from Ontario were significantly more likely to be comfortable providing counselling to and answering questions of patients on the safety and efficacy of medical cannabis use. Examining sex differences across Canada, male respondents were more comfortable than female counselling patients on the safety and efficacy of medical cannabis., Conclusion: The current results reinforce the perceived need by pharmacists and pharmacy students for targeted education, and future research in cannabis education should consider potential gender differences in attitudes and beliefs surrounding cannabis therapy., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2022.)

Objective: This prospective longitudinal study assesses the reciprocal relationship between physical activity, including sport participation, and depressive and anxiety symptoms, conceptualized as emotional distress, over time., Method: Boys and girls are from the Quebec Longitudinal Study of Child Development birth cohort (N = 1428). Trajectories of emotional distress symptoms from ages 6 to 10 years, assessed by teachers, were generated using latent class analysis. Multinomial logistic regression analyses examined sport participation at age 5 years, measured by parents, as a predictor of emotional distress trajectory outcomes. Analyses of covariance compared physical activity, measured by children at age 12 years, across different trajectories of emotional distress., Results: We identified 3 emotional distress trajectories: "low" (77%), "increasing" (12%), and "declining" (11%). Boys who never participated in sport at age 5 years were more likely to be in the "increasing" (adjusted odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.01-2.63) or "declining" (adjusted OR = 2.19, 95% CI = 1.28-3.75) emotional distress trajectories compared with boys who participated in any sporting activity. Furthermore, boys in the "low" emotional distress trajectory demonstrated better physical activity outcomes at age 12 years (F(2, 1438) = 6.04, p < 0.05). These results, exclusively for boys, are above and beyond pre-existing individual and family factors., Conclusion: This study supports the relevance of enhancing current public health strategies to understand and promote physical activity and emotional adjustment in early childhood to achieve better a more active lifestyle and overall health across development. We underscore male needs for physical activity for health promotion., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Several psychosocial models have been proposed to explain the etiology of eating disorders (EDs) and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors (socio-environmental, psychological, and behavioral) expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth (60% female, 14.00 ± 1.61) from 41 schools in the Ottawa region, Canada. Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Obeid, Flament, Buchholz, Henderson, Schubert, Tasca, Thai and Goldfield.)

Stroke disproportionately affects racial minorities, and the level to which stroke treatment practices differ across races is understudied. Here, we performed a systematic review of disparities in stroke treatment between racial minorities and White patients. A systematic literature search was performed on PubMed to identify studies published from January 1, 2010, to April 5, 2021 that investigated disparities in access to stroke treatment between racial minorities and White patients. A total of 30 studies were included in the systematic review. White patients were estimated to use emergency medical services at a greater rate (59.8%) than African American (55.6%), Asian (54.7%), and Hispanic patients (53.2%). A greater proportion of White patients (37.4%) were estimated to arrive within 3 hours from onset of stroke symptoms than African American (26.0%) and Hispanic (28.9%) patients. A greater proportion of White patients (2.8%) were estimated to receive tPA (tissue-type plasminogen activator) as compared with African American (2.3%), Hispanic (2.6%), and Asian (2.3%) patients. Rates of utilization of mechanical thrombectomy were also lower in minorities than in the White population. As shown in this review, racial disparities exist at key points along the continuum of stroke care from onset of stroke symptoms to treatment. Beyond patient level factors, these disparities may be attributed to other provider and system level factors within the health care ecosystem.

Past research suggests that the relationship between health and schooling is axiomatic. Physical activity, including sport participation, putatively facilitates school performance. However, the direction of this link lacks clarity. We examine the mutual links between sport and classroom engagement in 452 boys and 514 girls from ages 6 to 12 years. Participants are from the Quebec Longitudinal Study of Child Development, a prospective-longitudinal birth cohort. First, trajectories of classroom engagement from ages 6 to 10 years, assessed by teachers, were generated using latent class analysis. Second, analyses of covariance (ANCOVAs) compared leisure time physical activity, self-reported by children at age 12 years, across trajectories of classroom engagement. Third, ANCOVAs compared classroom engagement, measured by teachers at age 12 years, across trajectories of extracurricular sport between ages 6 to 10 years. We identified two classroom engagement trajectories: 'High' (77%) and 'Moderate' (23%). For girls, being in the 'High' trajectory predicted significantly higher levels of physical activity (F(1, 966) = 5.21, p < .05). For boys, being in the 'Consistent participation' extracurricular sport trajectory predicted significantly higher levels of classroom engagement (F(1, 966) = 6.29, p < .05). Our analyses controlled for pre-existing individual and family factors. Our findings suggest that sport participation and engaged classroom behavior positively influence each other during childhood. They support the pertinence of investing financial resources in youth intervention so that children can develop their potential both in sporting contexts and in the classroom to foster optimal growth and development., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Background: The aim of the study was to investigate whether early changes (1-week) in energy balance-related measures would predict changes in body weight (BW) and fat losses in women living with overweight/obesity., Methods: BW, body composition (DXA), resting energy expenditure (REE)(indirect calorimetry), olfactory performance (Sniffin' Sticks), appetite and palatability (visual analogue scale) were measured at baseline, after a 1-week of caloric restriction as well as post-intervention (at 10 and 20 weeks) in a group of 30 women living with overweight/obesity., Results: A significant decrease in REE (p = 0.033) was noted after 1 week. Fasting desire to eat (p = 0.004), hunger (p = 0.001) and prospective food consumption (p = 0.001) all increased after 1 week. Similarly, significant increases in AUC SQ for desire to eat (p = 0.01), hunger (p = 0.005) and prospective food consumption (p = 0.001) were noted after 1 week. However, these early changes were not associated to final BW or FM losses at the end of the weight loss intervention., Conclusion: Despite significant changes in REE and appetite soon after the onset of a BW loss intervention, these early changes do not seem to predict final BW or FM losses at the end of the program in women living with overweight/obesity., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Background: food is a powerful reinforcer that motivates people to eat. The TaqI A1 polymorphism (rs1800497; T>C) downstream of the dopamine D2 receptor (DRD2) gene has been associated with diminished DRD2 receptor density, higher food reinforcement, and impaired eating behavior in adults. Objective: to evaluate the association between the rs1800497 polymorphism and the reinforcing value of food and eating in the absence of hunger in Chilean children. Material and method: nineteen Chilean children (aged 8-12 years) who were carriers of the A1-allele and 19 age- and gender-matched non-carriers (A2-allele) were evaluated on the reinforcing value of food and eating in the absence of hunger. Anthropometric measures were performed by standard procedures. Briefly, children received a standard pre-load lunch followed by an ad-libitum exposure to palatable foods. Results: no differences were found between A1-allele carriers and non-carriers, whether obese or non-obese, in ad libitum energy intake, macronutrient consumption, or the relative reinforcing value of food (p > 0.05). In obese children, A1 carriers reported significantly lower satiety and fullness before lunch (p < 0.05). However, in children with normal weight A1 carriers were found to exhibit trends for greater satiety and fullness before lunch when compared to non-carriers, but this trend reversed after lunch such that carriers exhibited lower satiety and fullness (p = 0.06). Conclusions: although TaqI A1 may play an important role in some eating behavior-related traits such as satiety and fullness, especially in obese children, our findings indicate that this polymorphism does not appear to affect eating in the absence of hunger or food reinforcement in children.

We reanalyzed, modeled and simulated Event-Related Potential (ERP) data from 13 healthy children (Mean age = 5.12, Standard Deviation = 0.75) during a computerized visual sustained target detection task. Extending an ERP-based ACT-R (Adaptive Control of Thought-Rational) neurocognitive modeling approach, we tested whether visual sustained selective-set attention in preschool children involves the enhancement of neural response to targets, and it shows key adult-like features (neurofunctional homology). Blinded automatic peaks analysis was conducted on vincentized binned grand ERP averages. Time-course and distribution of scalp activity were detailed through topographic mapping and paths analysis. Reaction times and accuracy were also measured. Adult Magnetic Resonance Imaging-based mapping using ACT-R dipole source modeling and electric-field spiking simulation provided very good fit with the actual ERP data ( R 2 > 0.70). In most electrodes, between 50 and 400 ms, ERPs concurrent with target presentation were enhanced relative to distractor, without manual response confounds. Triangulation of peak analysis, ACT-R modeling and simulation for the entire ERP epochs up to the moment of manual response (~700 ms, on average) suggested converging evidence of distinct but interacting processes of enhancement and planning for response release/inhibition, respectively. The latter involved functions and structures consistent with adult ERP activity which might correspond to a large-scale network, implicating Dorsal and Ventral Attentional Networks, corticostriatal loops, and subcortical hubs connected to prefrontal cortex top-down working memory executive control. Although preliminary, the present approach suggests novel directions for further tests and falsifiable hypotheses on the origins and development of visual selective attention and their ERP correlates.

Purpose: The objective of the present study is to examine physical and mental health trajectories of change in youth with severe obesity attending a tertiary care weight management program. It was predicted that younger children would show favourable changes in body mass index (BMI), markers of cardiovascular health, quality of life, and mental health., Methods: This 2-year longitudinal study examined health trajectories of children referred to a weight management program at a Canadian paediatric tertiary care centre from November 2010 to December 2013. Participants were 209 of 217 consecutive referred paediatric patients (families) aged 3 to 17 years who met criteria for severe obesity and consented to participate. To maximize generalizability of results, there were no exclusion criteria. Primary outcomes were children's quality of life and BMI. Secondary outcomes included anxiety, depression, and non-high-density lipoprotein cholesterol levels., Results: The findings suggest an improvement in mental health, quality of life, and cardiometabolic health of children and adolescents of all ages over the 2 years of programming. These positive findings were consistent across gender, age, and distance to the program. BMI trajectory changes varied across age cohorts such that younger children showed more favourable outcomes. The retention rate over the 2 years was high at 82.9%., Conclusions: This is the first study to show improvements in both physical and mental health outcomes beyond 1 year in a tertiary care setting with a high-risk population of children and youth with severe obesity. Findings highlight the need to examine both mental and physical health outcomes beyond 1 year., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The brave decision made by many Canadian athletes to share their experience with mental illness has fed a growing dialogue surrounding mental health in competitive and high-performance sport. To affect real change for individuals, sport culture must change to meet demands for psychologically safe, supportive, and accepting sport environments. This position statement addresses mental health in competitive and high-performance sport in Canada, presenting solutions to current challenges and laying a foundation for a unified address of mental health by the Canadian sport community. The paper emerged from the first phase of a multidisciplinary Participatory Action Research (PAR) project, in which a sport-focused mental health care model housed within the Canadian Centre for Mental Health and Sport (CCMHS) is currently being designed, implemented, and evaluated by a team of 20 stakeholders, in collaboration with several community partners and advisors.

The transition to menopause is a critical period of significant biopsychosocial change. The purpose of this study was to examine the influence of the transition to menopause and volume of physical activity on levels of perceived stress over five years in 102 healthy middle-aged women. Questionnaire and accelerometer data were analyzed using linear mixed models. Adjusting for age and body mass index, there were no significant effects of menopause status or time on perceived stress. Independent of menopause status, minutes per week of vigorous activity was associated with lower perceived stress in years 1 and 2 of the study.

Background: Evidence of metabolic adaptations following weight loss is available in the literature. However, the impact of different degrees of caloric restriction on a comprehensive panel including energy expenditure (EE) and intake (EI), appetite, palatability and olfactory performance remains to be investigated. Accordingly, the purpose of the study was to investigate the changes in resting energy expenditure (REE), appetite, olfaction, palatability and EI in women who were engaged in either a slow (-500 kcal/day, 20-week) or in a rapid (-1000 kcal/ day, 10 weeks) weight loss program., Methods: Thirty-six women with obesity were randomized to a slow or to a rapid weight loss group. Body composition (DXA), REE (indirect calorimetry), olfactory performance (Sniffin' Sticks), appetite (Visual Analogue Scale) were assessed at multiple time points during the intervention., Results: A total of 30 participants completed the study (slow group n = 14; rapid group n = 16). Body weight decreased by -4.46 (3.99) % (P < .001) and - 6.23 (3.06) % (P = .001) in the slow and rapid groups, respectively. No differences in % weight loss were noted between groups (P = .175). Significant decreases in fat mass (P < .001), REE (P = .035), total EI (P = .001) were observed over time from both groups. However, no significant differences emerged between groups for any of the outcomes. The satiety quotient (SQ) at time 180 min significantly increased for desire to eat (P = .01), hunger (P = .011) and PFC (P = .002), while the area under the curve for postprandial appetite rates were not changed. No differences in palatability and olfactory performance were noted after the intervention., Conclusions: Our results suggest that different rates of weight loss exert similar effects on REE, appetite, satiety, and EI when weight loss are comparable., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to assess the association between the single-nucleotide polymorphism rs9939609 in the FTO gene and homeostatic/non-homeostatic eating behavior patterns in Chilean children., Methods: A cross-sectional study was conducted in 258 children (44% female; 8-14 y of age). Anthropometric measurements (weight, height, Z-score of height, body mass index, and waist circumference) were performed. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire; the Child Eating Behavior Questionnaire; the Three Factor Eating Questionnaire, and the Food Reinforcement Value Questionnaire. Genotype of rs9939609 was determined by a Taqman assay. Association of rs9939609 with eating behavior was assessed using non-parametric tests., Results: Allelic frequencies of rs9939609 were estimated as 77% for the A allele and 23% for the T allele. We found that normal-weight girl A carriers had higher scores of Satiety Responsiveness and Slowness on the Eating subscale. Normal-weight boy A carriers showed significantly higher scores on the Negative Affect and lower scores of the Desire to Drink subscale. In overweight children, A carriers showed higher scores on the Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Food Choice subscales and lower scores on the Satiety- Responsiveness and Slowness in Eating subscales. In obese children, we found higher scores on the Cognitive Restrained subscale and lower Food Choice., Conclusion: The rs9939609 A allele of the FTO gene is associated with eating behavior traits and may predispose to obesity., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The menopause transition is characterized by significant hormonal changes that may predispose women to psychosocial maladjustment. Prospective studies to date have focused primarily on negative mood states and show equivocal findings. The primary goal of this study was to identify patterns of change with respect to positive and negative mood states (vigor, depression, tension, and stress) over a 5-year period in a cohort of women undergoing the transition to menopause. A secondary aim was to determine whether the identified trajectories were associated with menopause status as well as baseline health-related and psychological characteristics. This longitudinal study observed 102 healthy Canadian women who were premenopausal at baseline (age 47-55 years). Analyses consisted of latent class growth modeling. Mood states were predominantly normal and stable, raising doubts regarding the notion that psychosocial distress is a common and natural occurrence during the transition to menopause. Neither time spent in perimenopause nor BMI had a significant influence on levels of mood indicators. However, higher scores on body image, self-esteem, and general health perceptions were predictive of more positive psychological outcomes over the 5-year period. Targeting improvements in self-perceptions may promote a healthier psychological adjustment during this natural transitional period in a women's lifespan.

Background: Evidence suggests that fat-free mass and resting metabolic rate (RMR), but not fat mass, are strong predictors of energy intake (EI). However, body composition and RMR do not explain the entire variance in EI, suggesting that other factors may contribute to this variance. Objective: We aimed to investigate the associations between body mass index (in kg/m 2 ), fat mass, fat-free mass, and RMR with acute (1 meal) and daily (24-h) EI and between fasting appetite ratings and certain eating behavior traits with daily EI. We also evaluated whether RMR is a predictor of the error variance in acute and daily EI. Design: Data collected during the control condition of 7 studies conducted in Ottawa, Ontario, Canada, were included in these analyses ( n = 191 and 55 for acute and daily EI, respectively). These data include RMR (indirect calorimetry), body composition (dual-energy X-ray absorptiometry), fasting appetite ratings (visual analog scales), eating behavior traits (Three-Factor Eating Questionnaire), and EI (food buffet or menu). Results: Fat-free mass was the best predictor of acute EI ( R 2 = 0.46; P < 0.0001). The combination of fasting prospective food consumption ratings and RMR was the best predictor of daily EI ( R 2 = 0.44; P < 0.0001). RMR was a statistically significant positive predictor of the error variance for acute ( R 2 = 0.20; P < 0.0001) and daily ( R 2 = 0.23; P < 0.0001) EI. RMR did, however, remain a statistically significant predictor of acute ( R 2 = 0.32; P < 0.0001) and daily ( R 2 = 0.30; P < 0.0001) EI after controlling for this error variance. Conclusions: Our findings suggest that combined measurements of appetite ratings and RMR could be used to estimate EI in weight-stable individuals. However, greater error variance in acute and daily EI with increasing RMR values was observed. Future studies are needed to identify whether greater fluctuations in daily EI over time occur with increasing RMR values. This trial was registered at clinicaltrials.gov as NCT02653378., (© 2017 American Society for Nutrition.)

Psychosocial health issues are common among children with cardiac diagnoses. Understanding parent and child perceptions is important because parents are the primary health information source. Significant discrepancies have been documented between parent/child quality-of-life data but have not been examined among psychosocial diagnostic instruments. This study examined agreement and discrepancies between parent and child reports of psychosocial health and quality of life in the paediatric cardiology population. Children (n=50, 6-14 years) with diagnoses of CHDs (n=38), arrhythmia (n=5), cardiomyopathy (n=4), or infectious disease affecting the heart (n=3) were enrolled, completing one or more outcome measures. Children and their parents completed self-reports and parent proxy reports of quality of life - Pediatric Quality of Life Inventory - and psychosocial health - Behavioral Assessment Scale for Children (Version 2). Patients also completed the Multidimensional Anxiety Scale for Children. Associations (Pearson's correlations, Intraclass Correlation Coefficients) and differences (Student's t-tests) between parent proxy reports and child self-reports were evaluated. Moderate parent-child correlations were found for physical (R=0.33, p=0.03), school (R=0.43, p<0.01), social (R=0.36, p=0.02), and overall psychosocial (R=0.43, p<0.01) quality of life. Parent-child reports of externalising behaviour problems, for example aggression, were strongly correlated (R=0.70, p<0.01). No significant parent-child associations were found for emotional quality of life (R=0.25, p=0.10), internalising problems (R=0.17, p=0.56), personal adjustment/adaptation skills (R=0.23, p=0.42), or anxiety (R=0.07, p=0.72). Our data suggest that clinicians caring for paediatric cardiac patients should assess both parent and child perspectives, particularly in relation to domains such as anxiety and emotional quality of life, which are more difficult to observe.

Objectives: Studies have established a strong genetic component in eating behavior. The TaqI A1 polymorphism (rs1800497) has previously been associated with obesity and eating behavior. Additionally, this polymorphism has been associated with diminished dopamine D2 receptor (DRD2) density, higher body mass, and food reinforcement. The aim of this study was to evaluate the association between the DRD2 rs1800497 polymorphism and eating behavior in Chilean children., Methods: This was a cross-sectional study in which we selected 258 children (44% girls, 56% boys; ages 8-14 y) with a wide variation in body mass index. Anthropometric measurements were performed by standard procedures. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire (EAHQ), Child Eating Behavior Questionnaire, and the Food Reinforcement Value Questionnaire. Genotype of the rs1800497 was determined by polymerase chain reaction-restriction fragment length polymorphism. Association of the TaqI A1 variant (T allele) with eating behavior was assessed using nonparametric tests., Results: Compared with normal-weight children, the obese group demonstrated higher scores on the External Eating and Fatigue/Boredom subscales of the EAHQ. Higher scores were assessed in Food Responsiveness, Emotional Overeating, Enjoyment to Food and Desire to Drink subscales (P < 0.001) and lower scores of the Satiety Responsiveness and Slowness in Eating (P < 0.05). In the sex-specific analysis, the TaqI A1 allele was associated with higher scores on Satiety Responsiveness and Emotional Undereating subscales in obese girls, and higher scores of Enjoyment of Food subscale in boys., Conclusion: The TaqI A1 polymorphism may be a risk factor for eating behavior traits that may predispose children to greater energy intake and obesity., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The aim of this study was to develop and validate an electronic questionnaire, the Electronic Maternal Health Survey ( EMat Health Survey ), related to women's knowledge and perceptions of the current gestational weight gain guidelines (GWG), as well as pregnancy-related health behaviours. Constructs addressed within the questionnaire include self-efficacy, locus of control, perceived barriers, and facilitators of physical activity and diet, outcome expectations, social environment and health practices. Content validity was examined using an expert panel ( n = 7) and pilot testing items in a small sample ( n = 5) of pregnant women and recent mothers (target population). Test re-test reliability was assessed among a sample ( n = 71) of the target population. Reliability scores were calculated for all constructs ( r and intra-class correlation coefficients (ICC)), those with a score of >0.5 were considered acceptable. The content validity of the questionnaire reflects the degree to which all relevant components of excessive GWG risk in women are included. Strong test-retest reliability was found in the current study, indicating that responses to the questionnaire were reliable in this population. The EMat Health Survey adds to the growing body of literature on maternal health and gestational weight gain by providing the first comprehensive questionnaire that can be self-administered and remotely accessed. The questionnaire can be completed in 15-25 min and collects useful data on various social determinants of health and GWG as well as associated health behaviours. This online tool may assist researchers by providing them with a platform to collect useful information in developing and tailoring interventions to better support women in achieving recommended weight gain targets in pregnancy., Competing Interests: The authors declare no conflict of interest.