Validation of desk-based audits using Google Street View(®) to monitor the obesogenic potential of neighbourhoods in a pediatric sample: a pilot study in the QUALITY cohort

BACKGROUND: The suitability of geospatial services for auditing neighbourhood features relevant to pediatric obesity remains largely unexplored. Our objectives were to (i) establish the measurement properties of a desk-based audit instrument that uses Google Street View (®) to assess street- and neighbourhood-level features relevant to pediatric obesity (QUALITY-NHOOD tool, the test method) and (ii) comment on its capacity to detect changes in the built environment over an 8-year period. In order to do so, we compared this tool with an on-site auditing instrument (the reference method). METHODS: On-site audits of 55 street- and neighbourhood-level features were completed in 2008 in 512 neighbourhoods from the QUALITY cohort study. In 2015, both repeat on-site and desk-based audits were completed in a random sample of 30 of these neighbourhoods. RESULTS: Agreement between both methods was excellent for almost all street segment items (range 91.9-99.7%), except for road type (81.0%), ads/commercial billboards (81.7%), road-sidewalk buffer zone (76.1%), and road-bicycle path buffer zone (53.3%). It was fair to poor for perceived quality, safety and aesthetics items (range 59.9-87.6%), as well as for general impression items (range 40.0-86.7%). The desk-based method over-detected commercial billboards and road-sidewalk buffer zone, and generally rated neighbourhoods as less safe, requiring more effort to get around, and having less aesthetic appeal. Change detected over the 8-year period was generally similar for both methods, except that the desk-based method appeared to amplify the increase in the number of segments with signs of social disorder. CONCLUSIONS: The QUALITY-NHOOD tool is deemed adequate for evaluating and monitoring changes in pedestrian- and traffic-related features applicable to pediatric populations. Applications for monitoring the obesogenic nature of neighbourhoods appear warranted.</br

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

<p>Abstract</p> <p>Background</p> <p>Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso.</p> <p>Methods</p> <p>A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team.</p> <p>Results</p> <p>The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks).</p> <p>Conclusion</p> <p>The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

La qualité des services de garde et le développement cognitif des enfants: une étude des enfants québécois

Numéro de référence interne originel : a1.1 g 107

Repeat self-harm hospitalizations in Canada: a survival analysis

Abstract Background Repeat self-harm hospitalizations are associated with a greater risk of suicide and place a substantial burden on the healthcare system. In Canada, despite growing awareness of self-harm as a public heath issue, most existing research has focused on the prevalence of self-harm, with less attention given to repeat admissions. This study aims to assess the risk of repeat self-harm hospitalizations in Canada and identify population subgroups at higher risk. Methods We included 74,055 patients discharged between April 2016 and March 2022, with self-harm hospitalizations recorded in the Canadian Institute for Health Information’s Discharge Abstract Database and the Ontario Mental Health Reporting System. After an initial self-harm hospitalization, patients were followed for repeat admissions during the study period. The risk of readmission was estimated using Kaplan-Meier survival analysis, while hazard ratios for factors such as sex, age group, method of self-harm and the presence of a mental disorder diagnosis, were calculated using Cox regression models. Results Among patients hospitalized for self-harm, the risk of readmission was 9.3% within one year and 13.0% within three years of the index hospitalization. Three-quarters of readmissions occurred within the first year, and 90% occurred within two years. Females had a higher risk of readmission than males (hazard ratio = 1.32), with the highest risk observed among females aged 10–14 years (19.2% within three years), while patients aged 65 years and older had the lowest risk for both males and females. Females who self-harmed by cutting and patients of both sexes who used substance-related poisoning methods, as well as patients with a mental disorder diagnosis, were also at greater risk of readmissions. Conclusion In Canada, approximately one in ten patients hospitalized for self-harm were readmitted, with most readmissions occurring within the subsequent first year. Certain subgroups, including females, young girls, individuals who engaged in self-harm through cutting or substance use, and those with a mental disorder, face higher risks. This study provides insights to guide targeted interventions aimed at preventing recurrence, informing resource allocation, and emphasizing the need for comprehensive mental health support to improve outcomes for at-risk individuals

Tendances et motivations associées à la polyconsommation de substances : une revue rapide des données qualitatives

Introduction La polyconsommation (l’usage de plusieurs substances en même temps ou sur une courte période) est une pratique courante chez les personnes qui consomment des drogues. La récente hausse de la mortalité et des surdoses associées à la polyconsommation rend essentielle la compréhension des motivations qui sous-tendent cette tendance. Cette revue visait à résumer les connaissances actuelles sur les raisons pour lesquelles plusieurs substances peuvent être combinées au cours d’un épisode spécifique de consommation de drogues. Méthodes Nous avons effectué une revue rapide de la littérature pour cerner les études empiriques qui décrivent les motivations et les tendances associées à la polyconsommation de substances. Les études incluses ont été publiées entre 2010 et 2021 et repérées au moyen de MEDLINE, Embase, PsycINFO et Google Scholar. Résultats Nous avons inclus 13 études qualitatives ou à méthodes mixtes dans notre analyse. Les substances ont été combinées séquentiellement pour atténuer les symptômes de sevrage ou prolonger un état d’euphorie (« high »). L’usage simultané était motivé par l’intention de contrer ou d’équilibrer les effets d’une substance par ceux d’une autre, d’augmenter un état d’euphorie, de réduire la consommation globale ou de reproduire l’effet d’une autre substance non accessible ou plus coûteuse. L’automédication en vue de soulager un problème de santé était une autre des raisons à un usage séquentiel ou simultané. Conclusion La polyconsommation de substances est souvent motivée par le désir d’améliorer une expérience en fonction des effets attendus des combinaisons. Il nous faut mieux comprendre les raisons qui sous-tendent la combinaison de substances sinous voulons atténuer les répercussions de la crise actuelle des surdoses. </sec

Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence

Introduction Polysubstance use—the use of substances at the same time or close in time—is a common practice among people who use drugs. The recent rise in mortality and overdose associated with polysubstance use makes understanding current motivations underlying this pattern critical. The objective of this review was to synthesize current knowledge of the reasons for combining substances in a single defined episode of drug use. Methods We conducted a rapid review of the literature to identify empirical studies describing patterns and/or motivations for polysubstance use. Included studies were published between 2010 and 2021 and identified using MEDLINE, Embase, PsycINFO and Google Scholar. Results We included 13 qualitative or mixed-method studies in our analysis. Substances were combined sequentially to alleviate withdrawal symptoms or prolong a state of euphoria (“high”). Simultaneous use was motivated by an intention to counteract or balance the effect(s) of a substance with those of another, enhance a high or reduce overall use, and to mimic the effect of another unavailable or more expensive substance. Selfmedication for a pre-existing condition was also the intention behind sequential or simultaneous use. Conclusion Polysubstance use is often motivated by a desire to improve the experience based on expected effects of combinations. A better understanding of the reasons underlying substance combination are needed to mitigate the impact of the current overdose crisis. </sec

Body image emotions, perceptions, and cognitions distinguish physically active and inactive smokers

AbstractObjectivesTo determine if body image emotions (body-related shame and guilt, weight-related stress), perceptions (self-perceived overweight), or cognitions (trying to change weight) differ between adolescents characterized by smoking and physical activity (PA) behavior.MethodsData for this cross-sectional analysis were collected in 2010–11 and were available for 1017 participants (mean (SD) age=16.8 (0.5) years). Participants were categorized according to smoking and PA status into four groups: inactive smokers, inactive non-smokers, active smokers and active non-smokers. Associations between body image emotions, perceptions and cognitions, and group membership were estimated in multinomial logistic regression.ResultsParticipants who reported body-related shame were less likely (OR (95% CI)=0.52 (0.29–0.94)) to be in the active smoker group than the inactive smoker group; those who reported body-related guilt and those trying to gain weight were more likely (2.14 (1.32–3.48) and 2.49 (1.22–5.08), respectively) to be in the active smoker group than the inactive smoker group; those who were stressed about weight and those perceiving themselves as overweight were less likely to be in the active non-smoker group than the inactive smoker group (0.79 (0.64–0.97) and 0.41 (0.19–0.89), respectively).ConclusionBody image emotions and cognitions differentiated the active smoker group from the other three groups