Background Older adults (OAs) residing in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity because of multiple comorbidities, including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage OAs in exercise and encourage social interaction. However, previously used systems such as the Nintendo Wii are no longer commercially available, and the physical design of other exergames is not suitable for OAs (ie, fall risks, accessibility issues, and games geared toward a younger population) with diverse physical and cognitive impairments. Objective This study aims to design and develop a novel, user-centered, evidence-based exergaming system for use among OAs in LTC homes. In addition, we aim to identify facilitators and barriers to the implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff input. Methods This study used a user-centered design (UCD) process that consisted of 4 rounds of usability testing. The exergame was developed and finalized based on existing evidence, end user and stakeholder input, and user testing. Semistructured interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat. Results A total of 28 participants, 13 LTC residents, and 15 staff and family members participated in the UCD process for over 18 months to design and develop the novel exergaming intervention, the MouvMat. The iterative use of validated scales (System Usability Scale, 8-item Physical Activity Enjoyment Scale, and modified Treatment Evaluation Inventory) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over 4 rounds of usability testing, suggesting that identified areas for refinement and improvement were appropriately addressed by the team. A qualitative analysis of semistructured interview data found that residents enjoyed engaging with the prototype and appreciated the opportunity to increase their PA. In addition, staff and stakeholders were drawn to MouvMat’s ability to increase residents’ autonomous PA. The intended and perceived benefits of MouvMat use, that is, improved physical and cognitive health, were the most common facilitators of its use identified by study participants. Conclusions This study was successful in applying UCD to collaborate with LTC residents, despite the high number of physical and sensory impairments that this population experiences. By following a UCD process, an exergaming intervention that meets diverse requirements (ie, hardware design features and motivation) and considers environmental barriers and residents’ physical and cognitive needs was developed. The effectiveness of MouvMat in improving physical and cognitive abilities should be explored in future multisite randomized controlled trials.

Background We aim to describe the general characteristics of how the Canadian newspaper The Globe and Mail reports on opioid-related news, the opioid crisis and its victims, and explore how Canadians’ perceptions of the opioid crisis could have developed over time from this reporting. The Globe and Mail has the highest circulation among Canadian newspapers and is Canada’s newspaper of record. Methods Reviewers performed independent, blinded bibliometric searches of all The Globe and Mail articles archived in the Canadian Periodicals Index Quarterly spanning an 18-year period (1 January 2000–1 June 2018) related to the keywords “opioids” or “drugs and opioids” and “opiates”. Independently and in duplicate, reviewers manually extracted qualitative data from articles and identified emergent themes. Articles were screened independently by both reviewers based on the inclusion criteria. Conflicts were resolved by discussion and consensus. Social representation theory was used as a framework for describing how the opioid crisis is portrayed in Canada. Results Our search yielded 650 relevant opioid articles. The number of articles peaked in 2009, 2012, and in 2016, coinciding with major developments in the epidemic. The language used in this discourse has evolved over the years and has slowly shifted towards less stigmatizing language. Content analysis of the articles revealed common social representations attributing responsibility to pharmaceutical companies, physicians, and foreign countries. Conclusions The Globe and Mail’s coverage of the opioid crisis is focused on basic social representations and attributed responsibility for the crisis to a few collectives. A shift toward coverage of the root causes of the opioid epidemic could positively influence the general public’s perception of the opioid crisis and promote deeper understanding of the issue. Journalists face several obstacles to achieve greater focus and framing of the opioid crisis; a closer working relationship between the media and the research community is needed.

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Background Preterm birth complications are the leading cause of death among children under 5 years of age, and this imposes a heavy burden on healthcare and social systems, particularly in low- and middle-income countries where reliable estimates of gestational age may be difficult to obtain. Metabolic analyte data can aid in accurately estimating gestational age. However, important costs are associated with this approach, which are related to the collection and analysis of newborn samples, and its cost-effectiveness has yet to be determined. Objective This study aimed to evaluate the cost-effectiveness of an internationally validated gestational age estimation algorithm based on neonatal blood spot metabolite data in combination with clinical and demographic variables (birthweight, sex, and multiple birth status) compared with a basic algorithm that uses only clinical and demographic variables in classifying infants as preterm or term (using a 37-week dichotomous preterm or term classification) and determining gestational age. Study Design The cost per correctly classified preterm infant and per correctly classified small-for-gestational-age infant for the metabolic algorithm vs the basic algorithm were estimated with data from an implementation study in Bangladesh. Results Over 1 year, the metabolic algorithm correctly classified an average of 8.7 (95% confidence interval, 1.3–14.7) additional preterm infants and 145.3 (95% confidence interval, 128.0–164.7) additional small-for-gestational-age infants per 1323 infants screened compared with the basic algorithm using only clinical and demographic variables. The incremental annual cost of adopting the metabolic algorithm was $100,031 (95% confidence interval, $86,354–$115,725). If setup costs were included, the cost was $120,496 (95% confidence interval, $106,322–$136,656). Compared with the basic algorithm, the incremental cost per preterm infant correctly classified by the metabolic algorithm is $11,542 ($13,903 with setup), and the incremental cost per small-for-gestational-age infant is $688 ($829 with setup). Conclusion This research quantifies the cost per detection of preterm or small-for-gestational-age infant in the implementation of a newborn screening program to aid in improved classification of preterm and, in particular, small-for-gestational-age infants in low- and middle-income countries.