Alimentation infantile et changements climatiques : une opportunité prometteuse.

The method of infant feeding has consequences for the production of greenhouse gases (GHG) as well as for the risks to infants posed by climate change. Breastfeeding can reduce the carbon footprint associated with the use of commercial infant formula by nearly 50% while reducing its water footprint and waste. It is also an excellent way of coping with emergencies associated with climate change, such as water shortages, since breastfed children are better protected than those fed with formula. To ensure that the protection offered by breastfeeding can be realized, we present elements that can help decision-makers seize a promising opportunity: improve infant feeding support for women and families.

RéSUMé: Le mode d'alimentation infantile a des répercussions sur les émissions de gaz à effets de serre (GES) de même que sur les risques que posent les changements climatiques pour les nourrissons. L'allaitement peut réduire de près de 50 % l'empreinte carbone associée à l'utilisation des préparations commerciales pour nourrissons (PCN) et diminuer leur empreinte hydrique et les déchets associés. C'est aussi une excellente façon de faire face aux situations d'urgence associées aux changements climatiques, telles les difficultés d'accès à l'eau, puisque l'enfant allaité est mieux protégé que celui alimenté avec des PCN. Pour s'assurer que la protection offerte par l'allaitement puisse se concrétiser, nous présentons des éléments pouvant aider les décideurs à saisir une opportunité prometteuse : améliorer le soutien à l'alimentation infantile pour les femmes et les familles.

Understanding the challenges related to breastfeeding education and barriers to curricular change: a systems perspective for transforming health professions education.

Objectives: A majority of women and families wish that their babies be breastfed. However, too many still receive insufficient or inappropriate initial care from health professionals (HPs) who have limited breastfeeding (BF) competencies. We investigated barriers and potential solutions to improve the undergraduate training programs for various HPs. Methods: Focus groups were carried out in three universities in Quebec and one in Ontario (Canada), with 30 faculty and program directors from medicine, midwifery, nursing, nutrition, and pharmacy. Discussions were subjected to thematic content analysis, before being validated in a strategic planning workshop with 48 participants from the same disciplines, plus dentistry and chiropractic. Findings: Substantive improvements of undergraduate training programs for BF could be obtained by addressing challenges related to the insufficient, or lack of, (i) interactions among various HPs, (ii) opportunities for practical learning, (iii) specific standards to guide course content, (iv) real-life experience with counselling, and (v) understanding of the influence of attitudes on professional practice. Several potential solutions were proposed and validated. The re-interpretation of the results in light of various literature led to an emerging framework that takes a systems perspective for enhancing the education of HPs on BF. Conclusions: To improve the education of HPs so as to enable them to provide relevant support for future mothers, mothers and their families, solutions need to be carried out to address challenges in the health system, the education system as well as regarding the curricular change process.

Objectifs: La majorité des femmes et des familles souhaitent que leur bébé soit allaité. Toutefois, plusieurs ne reçoivent pas un soutien adéquat de la part de professionnels de la santé (PS) qui ont des compétences limitées en allaitement. Nous avons étudié les barrières et les solutions potentielles en vue de rehausser la formation initiale de divers PS. Méthodes: Des groupes de discussion ont été organisés dans trois universités du Québec et une en Ontario (Canada) avec 30 directeurs de programmes et membres du corps professoral en médecine, pratique sage-femme, sciences infirmières, nutrition et pharmacie. Les discussions ont fait l'objet d'une analyse de contenu thématique laquelle fut ensuite validée dans un atelier de planification stratégique avec 48 participants des mêmes disciplines auxquelles se sont ajoutées dentisterie et chiropratique. Résultats: Des améliorations substantielles des compétences en allaitement dans les programmes de formation initiale pourraient être obtenues en travaillant sur les défis associés à l'insuffisance, ou à l'absence de, (i) interactions entre les divers PS, (ii) opportunités d'apprentissages pratiques, (iii) normes spécifiques pour guider les contenus de cours, (iv) expériences réelles avec le counseling, et (v) compréhension de l'influence des attitudes sur la pratique professionnelle. La ré-interprétation des résultats à la lumière de la littérature a fait émerger un cadre conceptuel avec une perspective systémique pour guider le rehaussement de la formation en allaitement des divers PS. Conclusions: Afin d'améliorer la formation des PS pour qu'ils/elles puissent fournir un soutien pertinent aux futures mères, aux mères et à leurs familles, des solutions visant à la fois les défis dans le système de santé, dans le système d'éducation et dans le processus de changement curriculaire doivent être mises en œuvre.

Contribution of natural resources to nutritional status in a protected area of Gabon.

BACKGROUND: In protected areas, legislation restricts the population's access to natural food resources, which might have an impact on their welfare. OBJECTIVE: To assess the contribution of the individual use of natural resources to nutritional status in the rural population of the Gamba Complex of Gabon. METHODS: Four villages were selected to represent the rural population. All households were invited to participate, and 95% agreed. In each of the two major seasons, data were collected from all individuals (n = 637) in these 95 households during a 7-day period using a weighed food-consumption survey, observations, interviews, and anthropometric measures. RESULTS: Among children 5 to 9 years of age (n = 82) and adolescents (n = 169), their use of natural resources was the best predictor of nutritional status (explaining 8% of the variance), mainly via its contribution to the achievement of nutrient requirements. The use of natural resources was not a predictor for children 6 to 23 months (n = 28) or 24 to 59 months of age (n = 63), where the best predictors were access to care (26%) and health status (15%), respectively. Household food security predicted nutritional status in women caregivers (n = 96), although negatively. CONCLUSIONS: Natural resources contribute to the nutritional status of children 5 to 9 years of age and adolescents but not of other groups. The intrahousehold allocation of food, particularly of natural food resources, needs to be investigated to better appreciate the contribution of natural resources to the population's well-being. Women seem particularly vulnerable. Other than activities related to conservation, work is needed to understand the role of natural resources for populations living within and around protected areas.

Public('s) nutrition.

OBJECTIVE: To promote the new field of 'public nutrition' as a means to address, in a more efficient, sustainable and ethical manner, the world-wide epidemic of malnutrition--undernutrition and specific nutrient deficiencies, and also obesity and other nutrition-related chronic diseases. STRATEGY: Grounded in the health promotion model, public nutrition applies the population health strategy to the resolution of nutrition problems. It encompasses 'public health nutrition', 'community nutrition' and 'international nutrition' and extends beyond them. It fits within the conceptual framework of 'the new nutrition science' and is an expression of this reformulated science in practice. Its fundamental goal is to fulfil the human right to adequate food and nutrition. It is in the interest of the public, it involves the participation of the public and it calls for partnerships with other relevant sectors beyond health. Public nutrition takes a broader view of nutritional health, addressing the three interrelated determinant categories of food systems and food security; food and health practices; and health systems. It assesses and analyses how these influence the immediate determinants that are dietary intake and health status so as to direct action towards effective progress. To further enhance the relevance and effectiveness of action, public nutrition advocates improved linkages between policies and programmes, research and training. A renewed breed of professionals for dietetics and nutrition, trained along those lines, is suggested. CONCLUSION: There is a critical need to develop new knowledge, approaches and skills to meet the pressing nutrition challenges of our times.

Psychosocial determinants of the intention of nurses and dietitians to recommend breastfeeding.

OBJECTIVES: To identify the major psychosocial determinants of the intention of nurses and dietitians to recommend breastfeeding to new mothers for six months as well as the salient beliefs underlying this intention. METHOD: Following an open-ended questionnaire that sought to elicit their most significant beliefs, a standardized questionnaire based on a modified model of Ajzen's theory of planned behaviour, was sent to New Brunswick nurses and dietitians who graduated between January 1992 and December 1996. Multiple regression analysis determined which variables contributed the most to the prediction of intention. RESULTS: The main determinants of intention were perceived behavioural control and perceived professional norm. They explained 69% of the variance in intention. All salient beliefs underlying the perceived behavioural control were significantly associated with intention. CONCLUSION: To help nurses and dietitians to support and promote breastfeeding more effectively, programs should focus on changing perceived and true barriers to recommending breastfeeding, as well as the related perceived professional norm.

Characterization of household food insecurity in Québec: food and feelings.

This study was undertaken to understand food insecurity from the perspective of households who experienced it. The results of group interviews and personal interviews with 98 low-income households from urban and rural areas in and around Québec City, Canada, elicited the meaning of "enough food" for the households and the range of manifestations of food insecurity. Two classes of manifestations characterized the experience of food insecurity: (1) its core characteristics: a lack of food encompassing the shortage of food, the unsuitability of both food and diet and a preoccupation with continuity in access to enough food; and a lack of control of households over their food situation; and (2) a related set of potential reactions: socio-familial perturbations, hunger and physical impairment, and psychological suffering. The results substantiate the existence of food insecurity among Québecers and confirm that the nature of this experience is consistent with many of the core components identified in upstate New York. This study underlines the monotony of the diet, describes the feeling of alienation, differentiates between a lack of food and the reactions that it engenders, and emphasizes the dynamic nature of the experience.