Exploring Extreme Weather and Recess Policies, Practices, and Procedures in the Canadian Context.

The purpose of this study was to explore the different policies, practices, and procedures that are used on weather and recess in the Canadian context. Fifty school websites were examined, and ten key informants were interviewed. Policies, practices, and procedures from school websites were downloaded, and interviews were transcribed verbatim and analyzed using a qualitative content analysis. Fourteen schools had an outwardly facing policy, practice, or procedure for weather and recess. Cold temperatures were the most often cited reason for modifying recess to be indoors, with temperatures ranging from -20 to -40 for complete indoor recess. Precipitation was only found in four online documents but was mentioned as a reason to modify recess by all key informants. Additionally, key informants discussed variability in how recess policies, practices, and procedures were followed. The findings of this study illustrate inconsistencies in both formal and informal school weather and recess policies. With outdoor recess providing numerous opportunities to improve various domains of well-being, it is pertinent to understand the conditions on which it is being modified.

Examining the status of rural post-graduate family medicine education.

Introduction: Rural populations in Canada are generally in worse health when compared to their urban counterparts. In 2014, the College of Family Physicians of Canada and the Society of Rural Physicians of Canada formed a joint Task force to advocate for improved health in rural communities. As a task force, they developed the Rural Road Map for Action. This paper uses the Rural Road Map for Action as a framework to examine the current state of family medicine's Post-Graduate Medical Education (PGME) in Canada. Methods: Surveys were sent to the programme directors of all English- and French-speaking post-graduate family medicine programmes. Both quantitative and qualitative methods were used to analyse survey responses. Results: Thirteen of 17 respondents completed the questionnaire. Despite on-going efforts, our results suggest that few programmes have equity and diversity admission's policies for rural and Indigenous students; a gap exists between the number of residents who are educated in rural areas and those who end up practising in rural areas; residents lack skills in Indigenous health; and more funded professional development opportunities are needed for rural physicians. Conclusion: Rural healthcare concerns are typically under-represented in PGME. The Rural Road Map for Action brings focus to the specific healthcare needs of rural areas, highlighting a recruitment and retention strategy that aligns education, practice, policy and research activities. Medical schools and national physician organisations need to continue to advocate for the health of rural communities through increasing the rural physician workforce and providing appropriate training for rural practice.

Résumé Introduction: Les populations rurales du Canada sont généralement en moins bonne santé que leurs homologues urbaines. En 2014, le Collège des médecins de famille du Canada et la Société de la médecine rurale du Canada ont formé un groupe de travail conjoint pour défendre l'amélioration de la santé dans les collectivités rurales. En tant que groupe de travail, ils ont élaboré le Plan d'action pour la médecine rurale. Le présent document utilise ce Plan comme cadre pour examiner l'état actuel de la formation médicale postuniversitaire (FMP) de la médecine familiale au Canada. Méthodes: Les enquêtes ont été envoyées aux directeurs de programme de tous les programmes de médecine familiale postuniversitaire anglophones et francophones. Des méthodes quantitatives et qualitatives ont été utilisées pour analyser les réponses. Résultats: Treize des 17 répondants ont rempli le questionnaire. Malgré les efforts en cours, nos résultats suggèrent que peu de programmes ont des politiques d'admission en matière d'équité et de diversité pour les étudiants ruraux et autochtones; un écart existe entre le nombre de résidents qui sont formés dans les zones rurales et ceux qui finissent par exercer dans ces zones; les résidents manquent de compétences en matière de santé autochtone et; que davantage d'opportunités de développement professionnel financées sont nécessaires pour les médecins ruraux. Conclusion: Les préoccupations relatives aux soins de santé en milieu rural sont généralement sous-représentées dans la FMP. Le Plan d'action pour la médecine rurale met l'accent sur les besoins spécifiques des zones rurales en matière de soins de santé, en soulignant une stratégie de recrutement et de rétention qui aligne les activités d'éducation, de pratique, de politique et de recherche. Les facultés de médecine et les organisations nationales de médecins doivent continuer à défendre la santé des collectivités rurales en augmentant le nombre de médecins ruraux et en offrant une formation appropriée à la pratique rurale. Mots-clés: éducation médicale rurale, plan d'action pour la médecine rurale, santé rurale.

Impact of a professional development session based on learner evaluations within a preceptor community of practice.

BACKGROUND: Physician preceptors play key roles in teaching medical professional trainees but receive little formal teacher training. One proposed way to improve teaching is by providing preceptors with learner feedback. The feedback from learner evaluations often has a limited impact with changes to teaching practice difficult to implement. This study explores the effect of using learner feedback to create a professional development session on teaching within a preceptor community of practice. METHODS: In this case study, 15 preceptors agreed to release their learner evaluations, and ten participated in the professional development session. Immediately and 2-3 months after the session, participants completed surveys on their intention to change and the changes made. The community of practice lead was interviewed to discuss the professional development session's impact. Qualitative approaches were used to analyze the data. RESULTS: From the learner evaluations, nine areas of improvement were identified and discussed. All attendees made changes to their teaching practices, which the community of practice lead confirmed. Fewer changes were identified at the community of practice group level. CONCLUSION: Using learner evaluations to structure a professional development session within a community of practice can help identify areas of improvement and create strategies to address these challenges.

Intake of Fruits, Vegetables, and Sugar-Sweetened Beverages among a Sample of Children in Rural Northern Ontario, Canada.

There is evidence to suggest that dietary intake of children differs by rural/urban place of residence: rural children may have a higher intake of foods high in fat and sugar than those living in urban environments. The aim of this study was to examine the intake of fruits and vegetables (FV) and the frequency of sugar-sweetened beverage (SSB) consumption, among a sample of rural children in Northern Ontario, Canada, in two different seasons. Sociodemographic factors and children's FV and SSB intake were measured using two repeated cross-sectional surveys, and seasonal information was based on the month of data collection. Logistic regressions were used to examine the odds of children eating five or more FVs, and the odds of 'frequently or always' consuming SSBs. During the fall, children reported eating five or more FV more often, when compared to winter (53.9% vs. 48.3%). In the fall, 25.8% of children reported 'frequently or always' drinking SSB, compared with 16.9% in winter. Indigenous children were less likely to eat five or more FV (OR 0.34 (95% CI 0.12-0.95)) in the fall when compared to non-Indigenous children. Findings indicate that intake of FV among rural students in this region is low, and the frequency of SSB is high, when compared with national recommendations.

Exploring rural medical education: a study of Canadian key informants.

INTRODUCTION: Recruiting and retaining primary healthcare professionals is a global healthcare problem. Some countries have been using medical education as a strategy to aid in the recruitment and retention of these healthcare professionals. The purpose of this study is to engage with key informants and explore the learning processes that support medical students to prepare for a rural career. METHODS: Seven key informants with extensive experience in rural medical education participated in semi-structured interviews. The interviews were audio-recorded and professionally transcribed. Transcripts were analyzed using thematic analysis. RESULTS: Four key themes were identified. Respondents discussed the different ways they conceptualized 'rural'. Informants suggested that relationships could either be barriers or facilitators to rural practice and that certain educational strategies were necessary to help train students for rural careers. Finally, informants discussed different characteristics that rural physicians need. CONCLUSION: The finding of this study suggests that preparing students for rural practice requires a multifaceted approach. Specifically, using certain educational strategies, pre-selecting or developing certain characteristics in students, and helping students develop relationships that attach them to a community or support working in a rural community are warranted.

Perceived neighbourhood safety moderates the relationship between active school travel and health-related quality of life.

There is a dearth of studies examining associations between active school travel and children's health-related quality of life. Additionally, studies have not examined how perceived neighbourhood characteristics may moderate these associations. This study aims to examine the relationship between regular active school travel, children's physical and psychosocial health-related quality of life, and the potential moderating effects of their perceived neighbourhood safety (interpersonal and traffic). This cross-sectional study used data from Ontario schoolchildren (aged 8-14) as part of the Spatial Temporal Environment and Activity Monitoring (STEAM) Project. Results showed no significant direct relationship between regular active school travel and children's physical or psychosocial functioning; but the relationships were moderated by perceived neighbourhood safety. Regular active school travelers with high levels of perceived neighbourhood interpersonal safety, had higher physical and psychosocial functioning than regular active school travelers with low levels of perceived neighbourhood interpersonal safety. Additionally, at higher levels of perceived neighbourhood traffic safety, regular active school travelers had higher psychosocial functioning than regular active school travelers with lower perceived neighbourhood traffic safety. Interventions promoting active school travel should consider the environments through which children will be traveling.

Examining weather-related factors on physical activity levels of children from rural communities.

OBJECTIVE: The objective was to examine the influence of weather on moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) levels of children aged 8-14 years from rural communities, an understudied Canadian population. METHODS: Children (n = 90) from four communities in rural Northwestern Ontario participated in this study between September and December 2016. Children's MVPA and LPA were measured using an Actical accelerometer and demographic data were gathered from surveys of children and their parents. Weather data were collected from the closest weather station. Cross-classified regression models were used to assess the relationship between weather and children's MVPA and LPA. RESULTS: Boys accumulated more MVPA than girls (b = 26.38, p < 0.01), children were more active on weekdays as compared with weekends (b = - 16.23, p < 0.01), children were less active on days with precipitation (b = - 22.88, p < 0.01), and higher temperature led to a significant increase in MVPA (b = 1.33, p < 0.01). As children aged, they accumulated less LPA (b = - 9.36, p < 0.01) and children who perceived they had higher levels of physical functioning got more LPA (b = 25.18, p = 0.02). Similar to MVPA, children had higher levels of LPA on weekdays (b = - 37.24, p < 0.01) as compared to weekend days and children accumulated less LPA (b = -50.01, p < 0.01) on days with rain. CONCLUSION: The study findings indicate that weather influences rural children's MVPA and LPA. Future research is necessary to incorporate these findings into interventions to increase rural children's overall PA levels and improve their overall health.

RéSUMé: OBJECTIF: Examiner l'influence de la météo sur les niveaux d'activité physique modérée à vigoureuse (APMV) et d'activité physique légère (APL) des enfants de 8 à 14 ans vivant en milieu rural, une population canadienne sous-étudiée. MéTHODE: Des enfants (n = 90) de quatre communautés rurales du Nord-Ouest de l'Ontario ont participé à l'étude entre septembre et décembre 2016. Leurs niveaux d'APMV et d'APL ont été mesurés à l'aide d'un accéléromètre de marque Actical, et leurs données démographiques ont été obtenues en sondant les enfants et leurs parents. Les données météorologiques ont été obtenues auprès de la station météorologique la plus proche. Des modèles de régression recoupés ont servi à analyser la relation entre la météo et l'APMV et l'APL des enfants. RéSULTATS: Les garçons ont accumulé plus d'APMV que les filles (b = 26,38 p < 0,01); les enfants étaient plus actifs les jours de semaine que les fins de semaine (b = -16,23 p < 0,01); les enfants étaient moins actifs les jours avec précipitations (b = -22,88 p < 0,01); et les températures élevées étaient associées à une augmentation significative de l'APMV (b = 1,33 p < 0,01). En grandissant, les enfants accumulaient moins d'APL (b = -9,36 p < 0,01) et les enfants qui pensaient avoir des niveaux d'activité physique plus élevés accumulaient plus d'APL (b = 25,18 p = 0,02). Comme pour l'APMV, les enfants avaient des niveaux d'APL plus élevés les jours de semaine (b = -37,24 p < 0,01) que les fins de semaine, et les enfants accumulaient moins d'APL (b = -50,01 p < 0,01) les jours de pluie. CONCLUSION: Les constatations de l'étude montrent que la météo influence l'APMV et l'APL des enfants en milieu rural. Il faudrait pousser la recherche pour intégrer ces constatations dans des interventions pour faire augmenter les niveaux d'activité physique globaux des enfants en milieu rural et améliorer leur santé globale.

Measuring Temporal Differences in Rural Canadian Children's Moderate-to-Vigorous Physical Activity.

The purpose of this study was to measure the factors that influence children's moderate-to-vigorous physical activity (MVPA) during school curriculum time, recess time, and outside school time in a rural area. During the Fall and Winter of 2016, 34 boys and 55 girls aged 8-14 years from rural communities in rural Northwestern Ontario participated in the Spatial Temporal Environment and Activity Monitoring project. The children's MVPA was measured using an accelerometer, and child-level demographic, behavioral, and environmental data were gathered from surveys, passively logging global positioning units, and municipal datasets. Data on daily temperature and precipitation were gathered from the closest Environment Canada weather station. A mixed model was used to assess the relationship between child- and day-level factors and children's MVPA. On average, children were getting 12.9 min of MVPA during recess, 17.7 min during curriculum time, and 29.0 min of MVPA outside school time. During all three time points, boys were more active than girls. During curriculum time, children in lower grades were more active, and the weather had differing impacts depending on the time of day. The findings of this study illustrate the differences in MVPA and the factors that influence MVPA by time of day. Examining different time segments provides valuable information for understanding children's MVPA patterns.

Examining Factors of Accelerometer-Measured Sedentary Time in a Sample of Rural Canadian Children.

The aim of this study was to examine potential child-level and day-level factors of accelerometer-measured sedentary time in a sample of rural Canadian children. Children (n = 86) from rural Northwestern Ontario participated in this study. Children's sedentary times were identified and logged using an accelerometer. Child-level data (socio-demographic, household, and environment) came from surveys of children and their parents and a passively logging global positioning unit. Day-level data on day type (weekday/weekend) and weather (temperature, precipitation) were based on the dates of data collection and meteorological data came from the closest Environment Canada weather station. Cross-classified regression models were used to assess the relationship between child-level and day-level correlates of sedentary time. Boys were less sedentary than girls (b = -30.53 p = 0.01). For each one-year age increase, children's sedentary time increased (b = 12.79 p < 0.01). This study indicates a difference in sedentary time based on a child's age and gender. However, family, environmental, and weather characteristics did not influence sedentary time in this sample. Health practitioners who deliver care for northern rural youth can provide targeted health advice regarding sedentary time and consider gender and age to be risk factors for these behaviors.

Exploring children's perceptions of barriers and facilitators to physical activity in rural Northwestern Ontario, Canada.

INTRODUCTION: Low levels of physical activity among children are a significant public health concern in several industrialized nations. The current research body has failed to gather adequate information on various geographic regions. Understanding barriers and facilitators in different rural regions is imperative for creating successful physical activity interventions for children in rural areas. The purpose of this study is to explore rural children's perspectives on physical activity and to discuss barriers or facilitators to physical activity participation in rural Northwestern Ontario, Canada. METHODS: Children (n=84) in Grades 4-8 (ages 8-14 years) in rural Northwestern Ontario participated in focus groups to discuss barriers and facilitators to physical activity. Twenty focus groups were conducted in schools. The focus groups were audio-recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis. Subthemes were created based on the explicit content of the data and grouped to form broader themes. RESULTS: Three key themes were identified: environment, social environment, and perceptions of safety. Environmental features include weather and the built environment. Social environment includes the role of friends and adults to either facilitate or restrict children's play. The fear of wildlife was pervasive across all focus groups and resulted in restricted independent mobility and physical activity. CONCLUSION: Rural children are typically under-represented in physical activity research. The findings of this study reveal that rural children experience some barriers to physical activity that are distinct from those of urban children. The findings suggest that researchers need to understand contextual nuances of the rural environment. Specific to the setting of Northwestern Ontario, these rural children could benefit from the addition of a skate park, indoor places to play, and more wildlife education.

Understanding factors associated with children achieving recommended amount of MVPA on weekdays and weekend days.

Low levels of moderate-to-vigorous physical activity (MVPA) are consistently reported for children from industrialized countries. Perennially inadequate levels of MVPA have been linked to increased chronic disease risks. Very few studies have compared physical activity levels among children from geographically diverse places, and how they differ on weekdays versus weekends. The purpose of this research is to examine the factors that influence whether children achieve 60 min of MVPA on weekdays compared to weekend days. Data were analyzed on children (n = 532) aged 8-14 years from communities in Southern and Northern Ontario, Canada that participated in the study between 2009 and 2016. Children's MVPA was measured using an Actical accelerometer, environmental features measured with a geographic information system, and demographic data came from child/parent surveys. Variables were selected using a least absolute shrinkage and selection operator. The variables were entered into logistic regression models to assess the relationship between children meeting the MVPA guidelines. During the week, boys were more active than girls (OR = 4.652 p < 0.001) and as age increased children were less likely to reach the MVPA guidelines (OR = 0.758 p = 0.013). On weekends boys were still more likely to meet the guidelines (OR = 1.683 p = 0.014) and children living in rural Northern Ontario were more likely to reach the MVPA guidelines compared to all groups in Southern Ontario. The findings indicate that different variables influence whether children meet the MVPA guidelines on weekdays compared to weekends. Comparing weekdays and weekends provides more useful information for creating effective MVPA interventions.