Preschoolers observe and imitate the behaviors of those who are similar to them. Therefore, peers may be important role models for preschoolers' dietary intake and physical activity in childcare centers. This study examined whether peers' behaviors predict change in preschoolers' dietary intake and physical activity in childcare centers over 9 months.A total of 238 preschoolers (3 to 5 years old) from 23 childcare centers in two Canadian provinces provided data at the beginning (October 2013 and 2014) and the end (June 2014 and 2015) of a 9-month period for this longitudinal study. Dietary intake was collected at lunch using weighed plate waste and digital photography on two consecutive weekdays. Physical activity was assessed using accelerometers over five days. Multilevel linear regressions were used to estimate the influence of peers' behaviors on preschoolers' change in dietary intake and physical activity over 9 months.Results showed that preschoolers whose dietary intake or physical activity level deviated the most from those of their peers at the beginning of the year demonstrated greater change in their intakes and activity levels over 9 months (all p values<0.05), which enabled them to become more similar to their peers. This study suggests that preschoolers' dietary intake and physical activity may be influenced by the behaviors of their peers in childcare centers. Since peers could play an important role in promoting healthy eating behaviors and physical activity in childcare centers, future studies should test interventions based on positive role modeling by children.4

Background Some individuals living with obesity are free from typical cardiometabolic risk factors and are termed metabolically healthy obese (MHO). The patterns of physical activity and sedentary behaviors among MHO are currently unknown. Methods This study includes 414 youth (12–18 years old), 802 adults (19–44 years old), and 1230 older adults (45–85 years old) living with obesity from the 2003-2004 or 2005-2006 NHANES cycles. Time spent in bouts of 1, 5, 10, 30, and 60 minutes for moderate-to-vigorous physical activity (MVPA) and sedentary time was measured objectively using accelerometers. Participants were categorized as MHO if they had no cardiometabolic risk factors above the identified thresholds (triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, and glucose). Results The proportion of MHO was 19%, 14%, and 12% in youth, adults, and older adults, respectively. MHO adults displayed a higher 1-minute bout of MVPA per day compared to non-MHO (p = 0.02), but no difference was observed for MVPA and sedentary behavior patterns for youth and older adults. When adjusted for confounders, all bouts of sedentary behavior patterns in youth were significantly associated with being classified as MHO. Conclusion This study suggests that greater sedentary time is associated with cardiometabolic risk factors in youth even if they are physically active.

Physical activity (PA) infrastructures can provide youth chances to engage in PA. As determinants of organized and unorganized PA (OPA and UPA) may differ, we investigated if proximity to PA infrastructures (proximity) was associated with maintenance of OPA and UPA over 3 years.Youth from New Brunswick, Canada (n = 187; 10–12 years at baseline) reported participation in OPA and UPA every 4 months from 2011 to 2014 as part of the MATCH study. Proximity data were drawn from parent's questionnaires. Proximity scores were divided into tertiles. Kaplan–Meier and Cox proportional hazard models were used to assess associations between proximity and maintenance of OPA and UPA.There were no crude or adjusted differences in average maintenance of participation in OPA [mean number of survey cycle participation (95%CI) was 6.6 (5.7–7.5), 6.3 (5.5–7.1), and 5.8 (5.1–6.6)] or UPA [6.8 (6.2–7.4), 5.9 (5.3–6.5), and 6.6 (5.9–7.3)] across low, moderate, and high tertiles of proximity, respectively.Findings suggest that proximity does not affect maintenance of participation in OPA or UPA during adolescence. Other environmental aspects may have a greater effect. Further research is needed before conclusions can be made.

To investigate cross-sectional association between sedentary activities and moderate-to-vigorous physical activities' (MVPA) patterns, and the likelihood of having diabetes, MetS, or both conditions. This cross-sectional analysis from the National Health and Nutrition Examination Survey 2003-2004 and 2005-2006 cycles included 2456 adults. The primary exposure variables were sedentary and MVPA patterns (1-, 5-, 10-, 30-, and 60-minute bouts) measured by accelerometer. The primary outcome measure was the subgroup categorization: healthy group, MetS group, diabetes group, and Mets & diabetes group. No differences were observed regarding proportion of sedentary patterns among groups, but differences were observed for the proportion of time spent doing MVPA in 5-, 10-, and 30-minute bouts among groups (all P < .05). When comparing individuals having both MetS & diabetes to the MetS group and the diabetes group, all bout lengths of sedentary behavior were significantly different (P < .05). The patterns of sedentary behavior were not associated with higher odds of being classified with Mets & diabetes when adjusted for total MVPA time (all P > .05). Interestingly, the odds of being in the healthy group were associated with MVPA patterns following adjustment for total sedentary time. The findings suggest it is more important to focus on exercise performed at moderate-tovigorous intensity, of any bout length, compared to sitting less to lower the odds of MetS and diabetes.

Background: A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. Methods: Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. Results: Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. Conclusions: Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.