Status report--enhancing the Canadian Best Practices Portal.

TITLE: Rapport de la situation - Améliorer le Portail canadien des pratiques exemplaires.La mission de l'Agence de la santé publique du Canada (ASPC) est de : « promouvoir et protéger la santé des Canadiens au moyen du leadership, de partenariats, de l'innovation et de la prise de mesures dans le domaine de la santé publique ¼. Afin de contribuer à cette mission, l'ASPC a mis en œuvre de nombreuses initiatives de mobilisation des connaissances en vue d'appuyer la prise de décisions fondées sur des données probantes en santé publique. L'une de ces initiatives, lancées en 2006, est le Portail canadien des pratiques exemplaires, une base de données interrogeable en ligne qui contient le détail d'interventions communautaires efficaces visant à promouvoir la santé et à prévenir les maladies chroniques : http://cbpp-pcpe.phac-aspc.gc.ca/fr/. La conception du Portail s'est inscrite dans une initiative fédérale plus globale, qui comprenait la création de l'ASPC elle-même, visant à renforcer les capacités en santé publique au Canada en réaction au SRAS et aux recommandations du Comité consultatif national sur le SRAS et la santé publique. La nécessité d'établir une base de données de qualité élevée contenant des résumés de données probantes récentes sur l'efficacité des interventions auprès de la population et en santé publique avait été plus particulièrement cernée dans un rapport précédent, « Le chemin à parcourir : une consultation pancanadienne sur les priorités en matière de santé publique et des populations ¼.

Smoking and smoking relapse during pregnancy and postpartum: results of a qualitative study.

BACKGROUND: The purpose of this study was to describe women's smoking experience during pregnancy and postpartum. Primiparous women recruited during a randomized controlled trial to assess the effectiveness of postpartum visiting were invited to participate in a qualitative study. METHODS: A semistructured protocol guided the face-to-face interview. Interviews were audiotaped and transcribed. Data were coded independently by the authors, and the final coding system for emergent themes was developed through a consensus process. RESULTS: Of the 47 women invited to participate, 22 agreed to be interviewed. Three major themes emerged from the analysis: pregnancy as a context for stopping smoking, returning to smoking, and social pressures on smoking behavior. Concerns about the baby's health were cited as central reasons for stopping. Breastfeeding provided a reason for continued smoking cessation, whereas social events often demarcated a resumption of women's smoking choices. CONCLUSIONS: Results provide guidance for the timing and content of interventions to prevent smoking relapse.

Smoking in pregnancy and postpartum: relationship to mothers' choices concerning infant nutrition.

The objective of this study was to examine the relationship between maternal smoking status and infant nutrition. Women delivering in 5 hospitals in the Ottawa-Carleton region of Ontario were screened for eligibility over a 6-month period in 1993. Follow-up data were collected by telephone at 3 months postpartum using a validated questionnaire. Mothers were retrospectively asked about their infant-feeding choices and their smoking behaviours. Logistic regression analyses were used to determine the significance of demographic factors and maternal smoking behaviours in relationship to 3 feeding practices: bottlefeeding at birth, discontinued breastfeeding by 12 weeks, and introduction of solids by 12 weeks. A total of 796 women participated in the longitudinal study (90% follow-up rate). Less-educated; younger; single, separated or divorced; and foreign-born mothers were more likely to bottlefeed at birth. Less-educated women more often discontinued breastfeeding before 12 weeks. Mothers who had smoked during part or all of their pregnancy and were smoking at the time of the interview were significantly more likely than non-smokers to bottlefeed at birth or to discontinue breastfeeding by 12 weeks. Current smokers were also more likely than non-smokers to have introduced solid food by 12 weeks. Maternal smoking was a significant predictor of infant nutrition, with other sociodemographic factors taken into account. Smoking status should be included in clinical screening tools for infant nutrition. The relationship between other dimensions of maternal smoking (e.g., timing of quitting attempts, degree of partner support, partner's smoking behaviours) and infant-feeding practices warrants investigation.

Breastfeeding: a course for health professionals.

Breastfeeding advocates say that breastfeeding is health promotion in its purest form. Its considerable health benefits to the infant and the mother are well documented. Recent research has identified breastfeeding as a key factor in the prevention of sudden infant death syndrome and increased cognitive functioning. As a method of feeding, breastfeeding offers immediate economic advantages to the parents and long term economic savings to society. One author reports that the exclusive breastfeeding of infants for four months could save the Province of Ontario at least $862,000 a year just by reducing the need for the treatment of otitis media. Another researcher calculated the cost of treating 150 bottle-fed babies hospitalized for gastroenteritis at $450,000 Canadian, while reminding us that "hospitalization for gastroenteritis is almost unknown for exclusively breastfed infants." With all these known benefits, why is breastfeeding not more prevalent among Canadian mothers?

A randomized controlled trial of alternative approaches to community follow-up for postpartum women.

This three-group randomized controlled trial assessed the effectiveness of a postpartum public health nurse telephone visit on infant-care behaviours of primiparous women in Ottawa-Carleton. The impact of a clerk call on recruiting mothers to parent-baby groups was also described. Low risk primiparas were randomized into telephone visit, clerk call and control groups. At three months postpartum, there were no significant differences in infant-care behaviour scores among the study groups. Women who received the telephone visit had the highest parent-baby group attendance rates and among attenders, the highest rates of smoking during pregnancy, the least education, and lowest incomes. Analysis of variance revealed a significant interaction term between attendance at parent-baby groups and assigned study group. This effect disappeared after adjusting for age and education. The telephone visit was no more effective in producing the desired infant-care behaviour changes than a mailed out information package with or without a clerk phone call. However, the intervention did increase the utilization of parent-baby support groups by women who were more socioeconomically disadvantaged.

Breastfeeding: a course for health professionals.

Breastfeeding advocates say that breastfeeding is health promotion in its purest form. Its considerable health benefits to the infant and the mother are well documented. Recent research has identified breastfeeding as a key factor in the prevention of sudden infant death syndrome and increased cognitive functioning. As a method of feeding, breastfeeding offers immediate economic advantages to the parents and long-term economic savings to society. One author reports that the exclusive breastfeeding of infants for four months could save the Province of Ontario at least $862,000 a year just by reducing the need for the treatment of otitis media. Another researcher calculated the cost of treating 150 bottle-fed babies hospitalized for gastroenteritis at $450,000 Canadian, while reminding us that "hospitalization for gastroenteritis is almost unknown for exclusively breast-fed infants." With all these known benefits, why is breastfeeding not more prevalent among Canadian mothers?

Measuring perceptions of the exemplary nurse.

Qualitative and quantitative data identifying and weighting the perceived importance of different attributes of the "exemplary" nurse were collected from nursing respondents at different points in their professional development. Statistically significant differences in the attribute weights reported by fourth-year students and graduate nurses were observed. Because their pool was qualitatively different, quantitative comparisons with first-year students were not possible. The results indicate that these methods may be useful in examining the processes whereby the members of different groups (eg, nursing students and faculty) formulate and modify their assumptions about their own and others' professional values.