The use of clinical practice guidelines (CPGs), particularly the routine implementation of evidence-based cardiovascular health maintenance and disease management recommendations, affords both expert and nonexpert practitioners the opportunity to achieve better, and at least theoretically similar, patient outcomes. However, health care practitioners are often stymied in their efforts to follow even well-researched and well-written CPGs as a consequence of contradictory information. The purposeful integration and harmonization of Canadian cardiovascular CPGs, regardless of their specific risk factor or clinical management focus, is critical to their widespread acceptance and implementation. This level of cooperation and coordination among CPG groups and organizations would help to ensure that their clinical practice roadmaps (ie, best practice recommendations) contain clear, concise and complementary, rather than contradictory, patient care information. Similarly, the application of specific tools intended to improve the quality of CPGs, such as the Appraisal of Guidelines for Research and Evaluation (AGREE) assessment tool, may also lead to improvements in CPG quality and potentially enhance their acceptance and implementation.
Notes
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Over 8,000 students in Grades 6 through 12, from Western Canada and the North West Territories were surveyed for the prevalence of licit and illicit drug use over a 1-year period ending June 30, 1992. The results were compared with three previous studies dating back to just over 5 years. While there was a slight decline between 1987 and 1990, the present study reveals a slight reverse in this trend. These results emphasize the need for continued education and perhaps the need for determining the reasons for use by this age group.
Conseil canadien d'agrément des services de santé, Développement des marchés nationaux et internationaux, candidat au doctorat en santé publique, Faculté de médecine, Université de Montréal. martin.beaumont@cchsa-ccass.ca
The objective of this pan-Canadian study was to evaluate the feasibility of developing a set of accreditation standards supported by an accreditation process for public health in Canada.
Twenty-four telephone interviews were conducted, recorded, transcribed and analyzed.
The scope of public health implied in respondents' answers included health protection, health promotion, disease prevention and surveillance. A large majority of the experts were in favour of implementing accreditation in public health. Of these, close to two thirds answered that public health needed its own standards to address some of the current gaps. People in health systems were faster to question the relevance of separate standards for public health to avoid creating artificial barriers within the continuum of care. Respondents who opposed an accreditation process for public health cited the lack of capacity currently in the system. Yet, proponents argued that accreditation could actually be used as a capacity-building tool and assist "to fight the tyranny of the urgent". Some identified the actual process of developing accreditation standards for public health as being a valuable exercise.
It appears that public health in Canada would benefit from an accreditation process developed in consultation with the field, to enhance visibility, capacity building, and performance through pan-Canadian standards which would also have to be flexible enough to accommodate specific provincial and local contexts.
Breastfeeding pamphlets are being produced for new mothers by both commercial and nonprofit sources in increasing quantities. A regional lactation committee decided to evaluate these materials on the basis of accuracy, degree of positive approach to breastfeeding, readability and compliance with the WHO/UNICEF Code on the Marketing of Breast Milk Substitutes. Results indicate that materials produced by non-profit sources scored higher in positive approach accuracy and WHO Code compliance compared with commercial sources. Only 2 of 22 pamphlets in the sample were written within the recommended reading level of Grade 5-8. None of the materials met all of the criteria for good promotional breastfeeding literature.
Canada, like the United States, held a "consensus conference on cholesterol" in 1988. Although the final report of the consensus panel recommended that total dietary fat not exceed 30 percent and saturated fat not exceed 10 percent of total energy intake, it did not specify an upper limit for dietary cholesterol. Similarly, the 1990, Health Canada publication "Nutrition Recommendations: The Report of the Scientific Review Committee" specified upper limits for total and saturated fat in the diet but did not specify an upper limit for cholesterol. Canada's Guidelines for Healthy Eating, a companion publication from Health Canada, suggested that Canadians "choose low-fat dairy products, lean meats, and foods prepared with little or no fat" while enjoying "a variety of foods." Many factors contributed to this position but a primary element was the belief that total dietary fat and saturated fat were primary dietary determinants of serum total and low-density lipoprotein (LDL) cholesterol levels, not dietary cholesterol. Hence, Canadian health authorities focused on reducing saturated fat and trans fats in the Canadian diet to help lower blood cholesterol levels rather than focusing on limiting dietary cholesterol. In an effort to allay consumer concern with the premise that blood cholesterol level is linked to dietary cholesterol, organizations such as the Canadian Egg Marketing Agency (CEMA) reminded health professionals, including registered dietitians, family physicians and nutrition educators, of the extensive data showing that there is little relationship between dietary cholesterol intake and cardiovascular mortality. In addition, it was pointed out that for most healthy individuals, endogenous synthesis of cholesterol by the liver adjusts to the level of dietary cholesterol intake. Educating health professionals about the relatively weak association between dietary cholesterol and the relatively strong association between serum cholesterol and saturated fat and trans fats helped keep consumers informed about healthy diets and ways to control blood cholesterol.
OBJECTIVE: The aim of the study was to examine the trends which have occurred during the past generation in body mass index (BMI) and in the prevalence of overweight and obesity among children in public schools in Nuuk, Greenland. STUDY DESIGN: The study is a retrospective cohort study of BMI among inschooling children (age 6 or 7 years old). A database was created on the basis of files from school-nurses containing information on height and weight among children having attended school in Nuuk since 1970. The database contained 10,121 measurements in total, whereas 2,801 were on inschooling children. Measurements from these children form the basis of this study. Mean and quartiles of BMI among the inschooling children in 5-year intervals were used to determine the development in BMI since 1980. On the basis of international cut-points for use among children and adolescents, the proportion of overweight and obese children and the trends since 1980 were determined. RESULTS: The mean BMI has risen by a total of a bit more than 6% since 1980, corresponding to a rise of 1.2-3.8% for every 5-year period. Increases are also observed when assessing the proportion of overweight and obese, which were 6.6% and 0.9%, respectively, among the inschooling children during the period 1980-1984. These proportions increased to 16.5% and 5.2%, respectively, in 2000-2004. CONCLUSION: This study has provided evidence that during the past two decades, children in Nuuk have undergone a development towards a higher prevalence of overweight and obesity.
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Comment In: Int J Circumpolar Health. 2005 Apr;64(2):107-915945280
Faculty of Nursing and Groupe de recherche et d'intervention en promotion de la santé (GRIPSUL), Université Laval, Québec, Canada G1K 7P4. Michel.Oneill@fsi.ulaval.ca
Ever since their beginning in 1986, Healthy Cities projects all over the world have been confronted with the issue of evaluation. However, after 20 years, many key dilemmas constantly reappear, people often looking for a kind of 'magic' list of universally applicable indicators to evaluate these initiatives. In this article we address five questions, allowing to illustrate the evaluative dilemmas the Healthy Communities movement is confronted with: Why evaluate Healthy Cities? What should be evaluated? Evaluate for who? Who should undertake the evaluation? How should the evaluation be performed? We conclude by formulating three recommendations in order to stimulate exchanges and debate. Our argument is based on a recent thorough analysis of the evaluative literature pertaining to the Healthy Cities movement, as well as on two decades of reflection on and involvement with this issue locally, nationally and internationally.
