There are many health benefits of regular physical activity and improving physical fitness levels can reduce the risk of chronic disease. Accumulating evidence suggests the neighborhood built environment is important for supporting physical activity; however, few studies have investigated the contribution of the neighborhood built environment to fitness levels. We examined the associations between objectively-determined and self-reported neighborhood walkability and overall and specific components of perceived health-related fitness (cardiorespiratory, muscular strength, and flexibility) in a random sample of 592 adults from two areas of Calgary (Canada). Participants provided complete data to an online questionnaire capturing perceived cardiorespiratory fitness (CRF), muscular strength (MST), flexibility, moderate-to-vigorous intensity physical activity (MVPA), resistance training, and sociodemographic characteristics. The questionnaire also captured participant’s perceptions of their neighborhood’s walkability (Physical Activity Neighborhood Environment Scale; PANES) and the physical activity supportiveness of neighborhood parks (Park Perceptions Index; PPI). Objectively-measured neighborhood walkability was estimated using Walk Score®. The average (SD) age of participants was 46.6 (14.8) years and 67.2% were female. Participants, on average, participated in at least 30-minutes of MVPA on 3.4 (2.1) days/week and undertook resistance training 2.0 (1.8) days/week. Adjusting for covariates, Walk Score® was not associated with any fitness outcomes. Adjusting for covariates, the PANES index was positively associated (p < 0.05) with CRF, MST, flexibility, and overall fitness and the PPI was positively associated (p < 0.05) with all fitness outcomes except MST. Our findings provide novel preliminary evidence suggesting the neighborhood built environment may be important for supporting higher health-related fitness levels in adults.

Background and Aims Colorectal cancer (CRC) can be prevented through colonoscopic polypectomy, but this exposes patients to risks, including delayed post-polypectomy bleeding (DPPB). Endoscopists increasingly use clips prophylactically with the aim of preventing DPPB. However, clips are costly, and data to support their efficacy in this context are inconsistent. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of prophylactic clipping for preventing DPPB. Methods We searched electronic databases and other relevant sources for randomized controlled trials assessing the efficacy of prophylactic clipping versus no clipping for the prevention of DPPB. Pooled relative risks were determined using a fixed-effects model. Subgroup analyses were also performed. Results A total of 2305 citations were initially screened. Seven randomized controlled trials satisfied all criteria for inclusion. The quality of included studies was generally low to moderate. A total of 2851 patients underwent 5405 polypectomies. Delayed post-polypectomy bleeding occurred at an overall pooled rate of 2.5%. No overall benefit of clipping for preventing DPPB was observed, with a pooled relative risk of 0.86 (95% confidence interval [CI], 0.55 to 1.36). No significant patient or polyp factors predicting DPPB were found through subgroup analyses. No publication bias was identified. Conclusions Randomized trials to date do not demonstrate a protective effect of prophylactic clipping for the prevention of DPPB, and therefore, the practice of routine prophylactic clipping appears unjustified. Additional high quality randomized trials are required to identify higher-risk groups that may benefit from prophylactic clipping.

Introduction: Few self-report tools capture neighbourhood physical activity. The aim of our study was to modify a widely-used self-report tool (International Physical Activity Questionnaire -IPAQ) to capture neighbourhood physical activity and estimate the test-retest reliability of these modifications. Material and Methods: Seventy-five adults completed the modified IPAQ twice, 7-days apart, capturing neighbourhood days·week -1 and usual minutes·day -1 of bicycling and walking for transport and leisure, moderate physical activity, and vigorous physical activity. Test-retest reliability was assessed with Intraclass Correlations (ICC), percent of overall agreement and Kappa statistics (κ). Results: Consistency in participation in neighbourhood PA ranged from k = 0.21 for moderate physical activity to k = 0.55 for vigorous physical activity, while proportion of overall agreement ranged from 64.0% for moderate physical activity to 81.3% for bicycling for transportation. ICC for reported neighbourhood PA between the two occasions ranged from ICC = 0.33 for moderate physical activity to ICC = 0.69 for bicycling for transportation for days·week -1 , ICC = 0.17 for bicycling for transportation to ICC = 0.48 for walking for leisure for minutes·day -1 , and ICC = 0.31 for vigorous physical activity to ICC = 0.52 for walking for leisure for minutes·week -1 . Conclusions: With the exception of minutes spent bicycling for transportation, our findings suggest that IPAQ items can be modified to provide

Despite continued interest in neighborhood correlates of physical activity, few self-report questionnaires exist that capture neighborhood-based physical activity. Furthermore, there is little evidence about the measurement validity of self-report measures of neighborhood-based physical activity. Notably, self-reported neighborhood physical activity has not been validated against combined accelerometer and global positioning system (GPS)-assessed physical activity. Thus, the purpose of this study was to estimate the concurrent validity of a recently adapted tool for capturing self-reported neighborhood-based physical activity (i.e., the Neighborhood International Physical Activity Questionnaire; N-IPAQ). Adults (n = 75) from four Calgary (Alberta, Canada) neighborhoods wore an accelerometer and GPS monitor for 7 consecutive days after which they self-reported their physical activity from the past week using the N-IPAQ. Bland-Altman plots and Spearman correlations estimated the concurrent validity between N-IPAQ and accelerometer/GPS physical activity (estimated for the administrative boundary, 400-m and 800-m radial buffers). The mean (95% Confidence Interval [CI]) difference between the N-IPAQ and accelerometer/GPS estimated total daily minutes of physical activity differed for the 400-m (1.9 min, −26.2 to 29.9), 800-m (10.6 min, −16.0 to 37.1), and administrative boundary buffers (14.7 min, −11.5 to 41.0). The strongest Spearman correlations were found between the N-IPAQ and 800-m radial buffer accelerometer-captured vigorous-intensity physical activity (r = .41 [95% CI: .18 to .60]), and the N-IPAQ and administrative boundary accelerometer-captured vigorous-intensity physical activity (r = .43 [95% CI: .20 to .62]). Our findings suggest that the N-IPAQ provides good estimates of neighborhood-based physical activity and could be used when investigating neighborhood correlates of physical activity.

Background A diverse range of interventions increase physical activity (PA) but few studies have explored the contextual factors that may be associated with intervention effectiveness. The built environment (BE) may enhance or reduce the effectiveness of PA interventions, especially interventions that encourage PA in neighbourhood settings. Several studies have investigated the effects of the neighbourhood BE on intervention-facilitated PA, however, a comprehensive review of evidence has yet to be conducted. In our systematic review, we synthesize evidence from quantitative studies that have examined the relationships between objectively-measured neighbourhood BE and intervention-facilitated PA in adults. Method In October 2021, we searched 7 databases (Medline, CINAHL, Embase, Web of Science, SPORTDiscus, Environment Complete, and Cochrane Central Register of Controlled Trials) for English-language studies reporting on randomized and non-randomized experiments of physical activity interventions involving adults (≥18 years) and that estimated the association between objectively-measured BE and intervention-facilitated physical activity. Results Twenty articles, published between 2009 and 2021, were eligible for inclusion in the review. Among the 20 articles in this review, 13 included multi-arm experiments and 7 included single-arm experiments. Three studies examined PA interventions delivered at the population level and 17 examined interventions delivered at the individual level. PA intervention characteristics were heterogeneous and one-half of the interventions were implemented for at least 12-months (n = 10). Most studies were undertaken in North America (n = 11) and most studies (n = 14) included samples from populations identified as at risk of poor health (i.e., metabolic disorders, coronary heart disease, overweight, cancer, high blood pressure, and inactivity). Fourteen studies found evidence of a neighbourhood BE variable being negatively or positively associated with intervention-facilitated PA. Conclusion Approximately 70% of all studies reviewed found evidence for an association between a BE variable and intervention-facilitated PA. The BE’s potential to enhance or constrain the effectiveness of PA interventions should be considered in their design and implementation.

Hyoscine butylbromide, also known as hyoscyamine or scopolamine, and sold under the trade name Buscopan, is an antimuscarinic agent commonly used to induce smooth muscle relaxation and reduce spasmodic activity of the gastrointestinal (GI) tract during endoscopic procedures. However, the balance between desirable and undesirable (adverse) effects is not clear when used during GI endoscopy. The Clinical Affairs Committee of the Canadian Association of Gastroenterology (CAG) conducted systematic reviews and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations for the use of Buscopan during GI endoscopy. To summarize, we recommend against the use of Buscopan before or during colonoscopy (strong recommendation, high certainty of evidence). We suggest against the use of Buscopan before or during gastroscopy (conditional recommendation, very low certainty of evidence). We suggest the use of Buscopan before or during ERCP (conditional recommendation, very low certainty of evidence). More research is needed to determine whether patients undergoing advanced procedures such as endoscopic mucosal resection or endoscopic submucosal dissection benefit from its use. Buscopan should be used with caution in patients with cardiac comorbidities. According to its product monograph, Buscopan is contraindicated in patients with tachycardia, angina, and cardiac failure. Thus, Buscopan should be used very cautiously in patients with these conditions, and only when the potential benefits of its use outweigh the potential risks in a particular case. Such patients require careful cardiac monitoring in an environment where resuscitation equipment and appropriately trained staff to use it are readily available. According to its product monograph, Buscopan is also contraindicated in patients with prostatic hypertrophy with urinary retention, and therefore, should be used very cautiously in such patients as well, and only when the potential benefits of its use outweigh the potential risks in a particular case. Obtaining a preprocedural history of glaucoma is unlikely to be of value when considering Buscopan use. However, in cases where Buscopan has been used, patients should be counselled postprocedurally and told to present to an emergency facility should they experience eye pain, redness, decreased vision, nausea and vomiting or headache.

Different models of accelerometer have the potential to provide a different estimate of the same physical activity or sedentary behavior. Our study compared the outputs of the Active Style Pro (ASP) and ActiGraph (AG) devices in assessing predicted metabolic equivalents (METs) for specific activities under laboratory conditions. Thirty healthy young adults wore two hip accelerometers (ASP and AG), simultaneously while performing twenty-two activities (eight sedentary, eight household, and six ambulatory activities) in a controlled laboratory setting. For the AG, predicted METs for each activity was calculated using four equations based on vertical-axis and vector magnitude data. Separate paired t-tests and Bland–Altman analysis examined the difference and agreement in METs between AG using four commonly used equations and ASP measurements for each activity. AG devices using different equations calculated significantly different outcomes for most activities compared with ASP devices. The smallest differences in predicted METs estimates between ASP and AG were observed for ambulatory activities. Ambulatory activities demonstrated the best agreement between ASP and AG regardless of which AG equation was used. Our findings can be used to assist researchers in their selection of accelerometer and output estimation equations for measuring physical activity and sedentary behavior in adults.

Purpose A high recurrence rate following ablative therapy of hepatocellular carcinoma (HCC) necessitates routine follow-up imaging (secondary surveillance) to facilitate early re-treatment. We evaluate our unique secondary surveillance algorithm (with use of alternating MRI and CEUS) by assessment of the relative diagnostic accuracy of MRI and CEUS in detection of residual/recurrent tumor. Potential benefits of alternating surveillance are compared to the use of MRI alone. Materials and methodsThis prospective observational IRB approved study included 231 patients with 354 treated tumors between January 2017 and June 2020. Treated lesions underwent secondary surveillance for a minimum of 7 months and up to 3 years, median follow-up 14 months. Secondary surveillance involved MRI performed at 1 month after treatment, followed by CEUS and MRI at alternate 3-month intervals (i.e., CEUS at month 4, MRI at month 7, etc.), for a total of 2 years. An equivocal finding on one imaging modality triggered expeditious evaluation with the alternate modality. Arterial phase hyperenhancement and washout comprise the classic features of recurrent tumor on both modalities. Results A total of 746 MRI and 712 CEUS examinations were performed, and a total of 184 tumor recurrences detected, MRI (n = 82) and CEUS (n = 102) (p = 0.19). There was no difference in the sensitivity (71.0-85.0% and 80.9-92.0%), specificity (97.4-99.2% and 98.5-99.9%), and area under the ROC curve (0.85-0.92 and 0.91-0.96) between MRI and CEUS, respectively. 23 of 82 recurrent tumors identified on MRI were equivocal and confirmed with expedited CEUS. 9 equivocal cases on MRI were disproved by expedited CEUS. On CEUS, 1 of the 102 recurrent tumors was equivocal and confirmed on MRI, and 2 equivocal CEUS cases were disproved by MRI. Conclusion MRI and CEUS performed similarly in our secondary surveillance algorithm for HCC in their ability to detect tumor recurrence, and showed no significant difference in their relative diagnostic test accuracy measures. Of greater interest, equivocal results on MRI (typically due to difficulty in distinguishing tumor recurrence from post-treatment change/ shunting) were either confirmed or disproven by CEUS in all cases. Secondary surveillance of treated HCC with alternating MRI and CEUS shows equivalent performance of each modality. CEUS resolves equivocal MRI and optimally demonstrates APHE and washout in tumor recurrence.