Very-low-birth-weight infant short-term post-discharge outcomes: A retrospective study of specialized compared to standard care.

OBJECTIVE: Ongoing health care challenges, low breast milk intake, and the need for rehospitalization are common during the first year of life after hospital discharge for very low birth weight (VLBW) infants. This retrospective cohort study examined breast milk intake, growth, emergency department (ED) visits, and non-surgical rehospitalizations for VLBW infants who received specialized post-discharge follow-up in western Canada, compared to VLBW infants who received standard follow-up in central Canada. DESIGN: Data were collected from two neonatal follow-up programs for VLBW babies (n = 150 specialized-care; n = 205 standard-care). Logistic regression was used to examine odds of breast milk intake and generalized estimating equations were used for odds of growth, ED visits and non-surgical rehospitalization by site. RESULTS: Specialized-care was associated with enhanced breast milk intake duration; the odds of receiving breastmilk at 4 months in the specialized-care cohort was 6 times that in the standard-care cohort. The specialized-care cohort had significantly more ED visits and rehospitalizations. However, for infants with oxygen use beyond 36 weeks compared to those with no oxygen use, the standard-care cohort had over 7 times the odds of rehospitalization where as the specialized-care cohort with no increased odds of rehospitalization. CONCLUSION: Specialized neonatal nursing follow-up was associated with continued breastmilk intake beyond discharge. Infants in the specialized-care cohort used the ED and were hospitalized more often than the standard-care cohort with the exception of infants with long term oxygen needs.

Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination.

BACKGROUND: Understanding reasons for and against vaccination from the parental perspective is critical for designing vaccination campaigns and informing other interventions to increase vaccination uptake in Canada. The objective of this study was to understand maternal vaccination decision making for children. METHODS: Mothers participating in a longitudinal community-based pregnancy cohort, the All Our Babies study in Calgary, Alberta, completed open-ended survey questions providing explanations for the vaccination status of their child by 24 months postpartum. Qualitative responses were linked to administrative vaccination records to examine survey responses and recorded child vaccination status. RESULTS: There were 1560 open-ended responses available; 89% (n = 1391) provided explanations for vaccinating their children, 5% (n = 79) provided explanations for not vaccinating/delaying, and 6% (n = 90) provided explanations for both. Themes were similar for those vaccinating and not vaccinating/delaying; however, interpretations were different. Two broad themes were identified: Sources of influence and Deliberative Processes. Sources of influence on decision making included personal, family, and external experiences. Deliberative Processes included risk, research, effectiveness, and balancing risks/benefits. Under Deliberative Processes, responsibility was a category for those vaccinating; while choice, instrumental/practical, and health issues were categories for those not vaccinating/delaying. Mothers' levels of conviction and motivation provided a Context for understanding their decision making perspectives. CONCLUSIONS: Vaccination decision making is complex and impacted by many factors that are similar but contribute to different decisions depending on mothers' perspectives. The results of this study indicate the need to examine new intervention approaches to increase uptake that recognize and address feelings of pressure and parental commitment to choice.

Differences in caesarean rates across women's socio-economic status by diverse obstetric indications: Cross-sectional study.

BACKGROUND: The existing inconsistent association between the caesarean rate and maternal socio-economic status (SES) may be the result of a failure to examine the association across indications for caesarean. This study examined the variation in caesarean rates by maternal SES across diverse obstetric-indications. METHODS: Data on demographics, education, insurance status, medical-conditions, and obstetric characteristics needed to classify deliveries according to Robson's 10 obstetric-groups were extracted from the 2015 US birth certificate data (n = 3 988 733). Multivariable log-binomial regression was used to analyse the data adjusting for confounders. RESULTS: The caesarean rate was 34.1% for women with high SES and 26.8% for those with low SES. After adjustment for confounders, the rate was similar between women with graduate degrees and those who did not complete high school (relative risk (RR) 1.0, 95% confidence interval (CI) 0.9, 1.1). However, different rates of caesareans across SES were observed for particular obstetric-indications. Notably, women with graduate education compared to those who did not complete high school were more likely to have a caesarean (RR 3.0, 95% CI 2.9, 3.1) for a low-risk condition (group 1: nulliparous women with single, cephalic, ≥37 gestational weeks, and spontaneous labour). Women with private insurance were more likely to have a caesarean in almost all obstetric groups, compared to those without private insurance or Medicaid. CONCLUSION: Examining the overall caesarean rate obscures the relationship between SES and the use of caesarean for particular obstetric-indications. The unequal utilisation of caesareans across SES highlights overuse and potential underuse of the caesareans among American women.

Ethnic disparities in children's oral health: findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada.

BACKGROUND: Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. METHODS: A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. RESULTS: We observed significant ethnic disparities in children's oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. CONCLUSIONS: Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for demographic, socioeconomic and caries-related behavioral factors, with Filipino, Arab, and Indigenous children being the most affected.

A qualitative inquiry on pregnant women's preferences for mental health screening.

BACKGROUND: Approaches to screening can influence the acceptance of and comfort with mental health screening. Qualitative evidence on pregnant women's comfort with different screening approaches and disclosure of mental health concerns is scant. The purpose of this study was to understand women's perspectives of different mental health screening approaches and the perceived barriers to the communication and disclosure of their mental health concerns during pregnancy. METHODS: A qualitative descriptive study was undertaken. Fifteen women, with a singleton pregnancy, were recruited from a community maternity clinic and a mental health clinic in Calgary, Canada. Semi-structured interviews were conducted during both the 2nd and 3rd trimesters. Data were analyzed using thematic analysis. RESULTS: Preferences for mental health screening approaches varied. Most women with a known mental health issue preferred a communicative approach, while women without a known mental health history who struggled with emotional problems were inclined towards less interactive approaches and reported a reluctance to share their concerns. Barriers to communicating mental health concerns included a lack of emotional literacy (i.e., not recognizing the symptoms, not understanding the emotions), fear of disclosure outcomes (i.e., fear of being judged, fear of the consequences), feeling uncomfortable to be seen vulnerable, perception about the role of prenatal care provider (internal barriers); the lack of continuity of care, depersonalized care, lack of feedback, and unfamiliarity with/uncertainty about the availability of support (structural barriers). CONCLUSIONS: The overlaps between some themes identified for the reasons behind a preferred screening approach and barriers reported by women to communicate mental health concerns suggest that having options may help women overcome some of the current disclosure barriers and enable them to engage in the process. Furthermore, the continuity of care, clarity around the outcomes of disclosing mental health concerns, and availability of immediate support can help women move from providing "the best answer" to providing an authentic answer.

Equity in children's dental caries before and after cessation of community water fluoridation: differential impact by dental insurance status and geographic material deprivation.

BACKGROUND: One of the main arguments made in favor of community water fluoridation is that it is equitable in its impact on dental caries (i.e., helps to offset inequities in dental caries). Although an equitable effect of fluoridation has been demonstrated in cross-sectional studies, it has not been studied in the context of cessation of community water fluoridation (CWF). The objective of this study was to compare the socio-economic patterns of children's dental caries (tooth decay) in Calgary, Canada, in 2009/10 when CWF was in place, and in 2013/14, after it had been discontinued. METHODS: We analyzed data from population-based samples of schoolchildren (grade 2) in 2009/10 and 2013/14. Data on dental caries (decayed, missing, and filled primary and permanent teeth) were gathered via open mouth exams conducted in schools by registered dental hygienists. We examined the association between dental caries and 1) presence/absence of dental insurance and 2) small area index of material deprivation, using Poisson (zero-inflated) and logistic regression, for both time points separately. For small-area material deprivation at each time point, we also computed the concentration index of inequality for each outcome variable. RESULTS: Statistically significant inequities by dental insurance status and by small area material deprivation were more apparent in 2013/14 than in 2009/10. CONCLUSIONS: Results are consistent with increasing inequities in dental caries following cessation of CWF. However, further research is needed to 1) confirm the effects in a study that includes a comparison community, and 2) explore possible alternative reasons for the findings, including changes in treatment and preventive programming.

Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging.

OBJECTIVE: To determine potential risk factors for developing positional plagiocephaly in infants seven to 12 weeks of age in Calgary, Alberta. METHODS: A prospective cohort design was used. Healthy term infants (n=440), seven to 12 weeks of age, from well-child clinics at four community health centres in Calgary, Alberta were assessed by the primary author and a registered nurse research assistant using Argenta's plagiocephaly assessment tool. Parents completed a questionnaire surveying risk factors. RESULTS: The incidence of positional plagiocephaly was estimated to be 46.6%. The following risk factors were identified using multiple logistic regression: right-sided head positional preference (OR 4.66 [95% CI 2.85 to 7.58]; P<0.001), left-sided head positional preference (OR 4.21 [95% CI 2.45 to 7.25]; P<0.001), supine sleep position (OR 2.67 [95% CI 1.58 to 4.51]; P<0.001), vacuum/forceps assisted delivery (OR 1.88 [95% CI 1.02 to 3.49]; P=0.04) and male sex (OR 1.55 [95% CI 1.00 to 2.38]; P=0.05). CONCLUSION: Advice to vary infants' head positions needs to be communicated to parents/guardians well before the two-month well-child clinic visit. This could occur in the prenatal period by prenatal care providers or educators, or during the neonatal period by postpartum and public health nurses. Prevention education may be emphasized for parents/guardians of male infants and infants who have had assisted deliveries.

OBJECTIF: Déterminer les facteurs de risque potentiels de plagiocéphalie positionnelle chez les nourrissons de sept à 12 semaines à Calgary, en Alberta. MÉTHODOLOGIE: Dans une cohorte prospective, des nourrissons à terme et en santé (n=440) de sept à 12 semaines provenant de cliniques d'enfants en santé de quatre centres de santé communautaire de Calgary, en Alberta, ont été évalués par l'auteur principal et une infirmière adjointe à la recherche au moyen de l'outil d'évaluation de la plagiocéphalie d'Argenta. Les parents ont rempli un questionnaire pour déterminer les facteurs de risque. RÉSULTATS: L'incidence de plagiocéphalie positionnelle a été évaluée à 46,6 %. Les facteurs de risque suivants ont été déterminés au moyen de la régression logistique multiple : préférence positionnelle de la tête à droite (RC 4,66 [95 % IC 2,85 à 7,58]; P<0,001), préférence positionnelle de la tête à gauche (RC 4,21 [95 % IC 2,45 à 7,25]; P<0,001), position de sommeil en décubitus dorsal (RC 2,67 [95 % IC 1,58 à 4,51]; P<0,001), accouchement assisté par ventouses ou forceps (RC 1,88 [95 % IC 1,02 à 3,49]; P=0,04) et sexe masculin (RC 1,55 [95 % IC 1,00 à 2,38]; P=0,05). CONCLUSION: Il faut conseiller aux parents ou aux tuteurs de modifier la position de la tête du nourrisson bien avant le rendez-vous à la clinique pour enfants en santé à deux mois. Ces conseils pourraient être donnés pendant la période prénatale par les dispensateurs ou les éducateurs de soins prénatals ou par des infirmières postnatales ou des infirmières de santé publique pendant la période néonatale. On peut donner des conseils de prévention aux parents ou aux tuteurs des nourrissons de sexe masculin et de ceux qui ont eu un accouchement assisté.

Comparing CenteringPregnancy® to standard prenatal care plus prenatal education.

BACKGROUND: There is significant evidence to support the importance of prenatal care in preventing adverse outcomes such as preterm birth and low infant birth weight. Previous studies have indicated that the benefits of prenatal care are not evenly distributed throughout the social strata. In addition, emerging evidence suggests that among particular populations, rates of preterm birth are unchanged or increasing. This suggests that an alternate care model is necessary, one that seeks to addresses some of the myriad of social factors that also contribute to adverse birth outcomes. In previous studies, the group prenatal care model CenteringPregnancy® had been shown to reduce adverse birth outcomes, but to date, no comparison had been made with a model that included prenatal education. This study sought to investigate whether any significant difference remained within the comparison groups when both models accounted for social factors. METHODS: This analysis was based on survey data collected from a prospective cohort of pregnant women through the All Our Babies Study in Calgary, Alberta. RESULTS: At baseline, there were significant differences between the comparison groups in their psychosocial health, with the women in the CenteringPregnancy® group scoring higher levels of depressive symptoms, stress and anxiety. At four months postpartum, the differences between the groups were no longer significant. CONCLUSIONS: These results suggest that CenteringPregnancy® can recruit and retain a demographically vulnerable group of women with a constellation of risk factors for poor pregnancy and birth outcomes, including poverty, language barriers and poor mental health. Post program, the rates of stress, anxiety and depression were similar to other women with more social and financial advantage. These findings suggest that CenteringPregnancy® may be a community based care strategy that contributes to improved mental health, knowledge, and behaviours to optimize outcomes for mothers and children.

A qualitative study of the experience of CenteringPregnancy group prenatal care for physicians.

BACKGROUND: This study sought to understand the central meaning of the experience of group prenatal care for physicians who were involved in providing CenteringPregnancy through a maternity clinic in Calgary, Canada. METHOD: The study followed the phenomenological qualitative tradition. Three physicians involved in group prenatal care participated in a one-on-one interview between November and December 2009. Two physicians participated in verification sessions. Interviews followed an open ended general guide and were audio recorded and transcribed. The purpose of the analysis was to identify meaning themes and the core meaning experienced by the physicians. RESULTS: Six themes emerged: (1) having a greater exchange of information, (2) getting to knowing, (3) seeing women get to know and support each other, (4) sharing ownership of care, (5) having more time, and (6) experiencing enjoyment and satisfaction in providing care. These themes contributed to the core meaning for physicians of "providing richer care." CONCLUSIONS: Physicians perceived providing better care and a better professional experience through CenteringPregnancy compared to their experience of individual prenatal care. Thus, CenteringPregnancy could improve work place satisfaction, increase retention of providers in maternity care, and improve health care for women.

The All Our Babies pregnancy cohort: design, methods, and participant characteristics.

BACKGROUND: The prospective cohort study design is ideal for examining diseases of public health importance, as its inherent temporal nature renders it advantageous for studying early life influences on health outcomes and research questions of aetiological significance. This paper will describe the development and characteristics of the All Our Babies (AOB) study, a prospective pregnancy cohort in Calgary, Alberta, Canada designed to examine determinants of maternal, infant, and child outcomes and identify barriers and facilitators in health care utilization. METHODS: Women were recruited from health care offices, communities, and through Calgary Laboratory Services before 25 weeks gestation from May 2008 to December 2010. Participants completed two questionnaires during pregnancy, a third at 4 months postpartum, and are currently being followed-up with questionnaires at 12, 24, and 36 months. Data was collected on pregnancy history, demographics, lifestyle, health care utilization, physical and mental health, parenting, and child developmental outcomes and milestones. In addition, biological/serological and genetic markers can be extracted from collected maternal and cord blood samples. RESULTS: A total of 4011 pregnant women were eligible for recruitment into the AOB study. Of this, 3388 women completed at least one survey. The majority of participants were less than 35 years of age, Caucasian, Canadian born, married or in a common-law relationship, well-educated, and reported household incomes above the Calgary median. Women who discontinued after the first survey (n=123) were typically younger, non-Caucasian, foreign-born, had lower education and household income levels, were less likely to be married or in a common-law relationship, and had poor psychosocial health in early pregnancy. In general, AOB participants reflect the pregnant and parenting population at local and provincial levels, and perinatal indicators from the study are comparable to perinatal surveillance data. CONCLUSIONS: The extensive and rich data collected in the AOB cohort provides the opportunity to answer complex questions about the relationships between biology, early experiences, and developmental outcomes. This cohort will contribute to the understanding of the biologic mechanisms and social/environmental pathways underlying associations between early and later life outcomes, gene-environment interactions, and developmental trajectories among children.

Social equity in Human Papillomavirus vaccination: a natural experiment in Calgary Canada.

BACKGROUND: The Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The vaccine is provided in two different service delivery models depending upon the acceptance of the program by the local school board. Vaccinations may be provided "in-school" or in "community" through appointments at Public Health Clinics. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, "in-school" and "community", and to examine if socioeconomic status (SES) was a contributing factor. METHODS: Individual data from the Calgary Zone Public Health vaccination database for all grade 5 and 9 girls in Calgary for school years 2008-2011 were analyzed using descriptive statistics. These data included vaccination records for 35,592 girls. Logistic regression was used to examine the effect of delivery system and SES status on being vaccinated, controlling for school type. RESULTS: HPV vaccination completion rates were 75% (95% confidence interval = 74.7%, 75.8%) for girls with an "in-school" compared to 36% (95% confidence interval = 35.3%, 37.2%) for girls in schools with a "community" service delivery model. A girl's neighbourhood SES was related to the likelihood of being HPV vaccinated depending on the service delivery model available to her. For girls attending a Public school with an "in-school" delivery model, the proportion completing vaccination increased as SES decreased (high SES = 79%; medium SES = 79%; low SES = 83%; p-value<0.001). For girls attending Calgary Catholic School District schools with the "community" delivery model there was a decrease in immunization rates from high and mid to low SES (high SES = 41%; medium SES = 42%; low SES = 34%; p-value<0.001). These results show that those with lower SES were differentially disadvantaged by not having access to an "in-school" vaccination delivery model. CONCLUSION: Service delivery models make a difference in HPV vaccination completion rates and create inequities for health protection and disease prevention based on socioeconomic status.

A comparison between late preterm and term infants on breastfeeding and maternal mental health.

The objective of this study was to compare breastfeeding, postpartum mental health, and health service utilization between a group of late preterm (LP) maternal infant pairs and term counterparts. Data was drawn from a prospective community-based cohort in Calgary, Alberta. Bivariate and multivariable analyses were performed. LP infants were more likely to have had a longer median length of stay after birth (P < 0.001) and a higher re-hospitalization rate at 4-months (P < 0.001) compared to term infants. Mothers of LP infants were more likely to report immediate breastfeeding difficulties (P < 0.001) and earlier cessation of breastfeeding at 4-months postpartum (P = 0.008). Multivariable analyses revealed that LP status was an independent risk factor for excessive symptoms of maternal anxiety (OR = 2.07; 95 % CI = 1.08,3.98), but not for depression, stress, or low parenting morale. LP infants and their families are a vulnerable population with unique developmental trajectories. Further longitudinal research is required.

Healthy eating guidelines for a school jurisdiction: collaborative design and implementation.

PURPOSE: Healthy eating is a determinant of optimal growth, and schools provide an ideal setting in which to influence students' diets. The Healthy Eating Guidelines Initiative (HEGI) was a partnership among education, health, and community stakeholders to develop and implement healthy eating guidelines across a school jurisdiction. An evaluation was conducted to examine the potential impact of the HEGI on the school food environment and students' self-reported diets. METHODS: All schools in the jurisdiction were invited to participate in the evaluation. Participating schools included elementary, middle, high, and mixed grades schools. A school environment assessment and a student questionnaire were used to collect data before and after the HEGI. RESULTS: Twenty-two (71%) of 31 schools participated in the evaluation. The guidelines were successfully implemented in 17 of these 22 schools. Overall, a greater proportion of students reported healthier eating behaviours at the conclusion of the HEGI. In particular, a greater proportion of students in schools with cafeteria-style food service showed significantly improved self-reported dietary behaviours. These changes were not seen among students at schools with limited or no on-site food service. CONCLUSIONS: The findings are consistent with those of previous studies, and indicate that guidelines for a school jurisdiction can have a positive impact on the school food environment and students' food intake. The HEGI shows promise as a strategy to promote healthy eating among students.

Resources available for parent-provider vaccine communication in pregnancy in Canada: a scoping review.

OBJECTIVE: Vaccination in pregnancy (VIP) is a protective measure for pregnant individuals and their babies. Healthcare provider's (HCP) recommendations are important in promoting VIP. However, a lack of strong recommendations and accessible resources to facilitate communication impact uptake. This study sought to determine the extent of and characterise the resources available for parent-provider vaccine communication in pregnancy in Canada using a behavioural theory-informed approach. DESIGN: Scoping review. METHODS: In accordance with the JBI methodology, nine disciplinary and interdisciplinary databases were searched, and a systematic grey literature search was conducted in March and January 2022, respectively. Eligible studies included resources available to HCPs practising in Canada when discussing VIP, and resources tailored to pregnant individuals. Two reviewers piloted a representative sample of published and grey literature using inclusion-exclusion criteria and the Authority, Accuracy, Coverage, Objectivity, Date, Significance guidelines (for grey literature only). Sixty-five published articles and 1079 grey reports were screened for eligibility, of which 19 articles and 166 reports were included, respectively. RESULTS: From the 19 published literature articles and 166 grey literature reports, 95% were driven by the 'Knowledge' domain of the Theoretical Domains Framework, while n=34 (18%) addressed the 'Skills' domain. Other gaps included a lack of VIP-specific tools to address hesitancy and a lack of information on culturally safe counselling practices. CONCLUSION: The study suggests a need for resources in Canada to improve VIP communication skills and improve access to vaccination information for HCPs and pregnant individuals. The absence of such resources may hinder VIP uptake.

Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care.

BACKGROUND: Pregnant women in Canada have traditionally received prenatal care individually from their physicians, with some women attending prenatal education classes. Group prenatal care is a departure from these practices providing a forum for women to experience medical care and child birth education simultaneously and in a group setting. Although other qualitative studies have described the experience of group prenatal care, this is the first which sought to understand the central meaning or core of the experience. The purpose of this study was to understand the central meaning of the experience of group prenatal care for women who participated in CenteringPregnancy through a maternity clinic in Calgary, Canada. METHODS: The study used a phenomenological approach. Twelve women participated postpartum in a one-on-one interview and/or a group validation session between June 2009 and July 2010. RESULTS: Six themes emerged: (1) "getting more in one place at one time"; (2) "feeling supported"; (3) "learning and gaining meaningful information"; (4) "not feeling alone in the experience"; (5) "connecting"; and (6) "actively participating and taking on ownership of care". These themes contributed to the core phenomenon of women "getting more than they realized they needed". The active sharing among those in the group allowed women to have both their known and subconscious needs met. CONCLUSIONS: Women's experience of group prenatal care reflected strong elements of social support in that women had different types of needs met and felt supported. The findings also broadened the understanding of some aspects of social support beyond current theories. In a contemporary North American society, the results of this study indicate that women gain from group prenatal care in terms of empowerment, efficiency, social support and education in ways not routinely available through individual care. This model of care could play a key role in addressing women's needs and improving health outcomes.

Feasibility and Acceptability of Internet-Based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis.

BACKGROUND: Prenatal mental health is a global health concern. Despite the far-reaching impact of prenatal mental health issues, many women do not receive the psychological care they require. Women in their childbearing years are frequent users of the internet and smartphone apps. Prenatal women are prime candidates for internet-based support for mental health care. OBJECTIVE: This study aimed to examine the feasibility and acceptability of internet-based interpersonal psychotherapy (IPT) for prenatal women. METHODS: Semistructured interviews were conducted with women who had received internet-based IPT modules with guided support as a component of a randomized controlled trial evaluating the scale-up implementation of a digital mental health platform (The Healthy Outcomes of Pregnancy and Postpartum Experiences digital platform) for pregnant women. Qualitative thematic analysis was used to explore and describe women's experiences. Data were analyzed for emerging themes, which were identified and coded. RESULTS: A total of 15 prenatal women were interviewed to examine their experiences and views on the feasibility and acceptability of internet-based IPT modules. Participants found the content informative and appreciated the ways in which the digital mental health platform made the IPT modules accessible to users. Participants voiced some differing requirements regarding the depth and the way information was presented and accessed on the digital mental health platform. The important areas for improvement that were identified were acknowledging greater depth and clarity of content, the need for sociability and relationships, and refinement of the digital mental health platform to a smartphone app. CONCLUSIONS: This study provides useful evidence regarding treatment format and content preferences, which may inform future development. It also provides research data on the feasibility and acceptability of web-based applications for prenatal mental health care. TRIAL REGISTRATION: ClinicalTrials.gov NCT01901796; https://clinicaltrials.gov/ct2/show/NCT01901796.

Fluoridation cessation and oral health equity: a 7-year post-cessation study of Grade 2 schoolchildren in Alberta, Canada.

OBJECTIVE: Community water fluoridation, because of its universal scope and passive mechanism of uptake, is one component of a multifaceted approach to promoting equity in dental health. The objective of this study was to examine social inequities in children's dental health in the Canadian cities of Calgary (fluoridation cessation in 2011) and Edmonton (still fluoridated). METHODS: We analyzed data from surveys of population-based samples of Grade 2 (approx. age 7) children in Calgary in 2009/2010 (pre-cessation; n=557) and in both Calgary and Edmonton in 2013/2014 (Calgary, n=3230; Edmonton, n=2304) and 2018/2019 (Calgary, n=2649; Edmonton, n=2600) (post-cessation). We estimated associations between several socioeconomic indicators and dental caries indicators (i.e., dental caries experience [deft, DMFT] and untreated decay in two or more teeth [untreated decay]) using zero-inflated Poisson, binary logistic regression, and the concentration index of inequality. We compared those associations over time (between survey waves) and between cities at post-cessation. RESULTS: Persistent social inequities in deft and untreated decay were evident; for example, having no dental insurance was significantly associated with higher odds of untreated decay across city and survey wave. In most (but not all) cases, differences between cities and survey waves were consistent with an adverse effect of fluoridation cessation on dental health inequities. For example, the association between no dental insurance and higher odds of untreated decay in Calgary was greater in 2018/2019 (later post-cessation) than in 2009/2010 (pre-cessation; odds ratio [OR] for comparison of coefficients = 1.89 [1.36-2.63], p<0.001) and 2013/2014 (early post-cessation; OR for comparison of coefficients = 1.67 [1.22-2.28], p=0.001); that same association in 2018/2019 was greater in Calgary (fluoridation cessation) than in Edmonton (still fluoridated) (OR for comparison of coefficients = 1.44 [1.03-2.02], p=0.033). CONCLUSION: Social inequities in dental caries were present in both Calgary and Edmonton. Those inequities tended to be worse in Calgary where fluoridation was ceased. Our findings may be relevant to other settings where income inequality is high, dental services are costly, and dental public health infrastructure is limited.

RéSUMé: OBJECTIF: En raison de sa portée universelle et de son mécanisme de réception passif, la fluoration de l'eau des communautés s'inscrit dans une démarche multidimensionnelle de promotion de l'équité en santé dentaire. Notre étude visait à examiner les iniquités sociales en santé dentaire chez les enfants dans les villes canadiennes de Calgary (où la fluoration a cessé en 2011) et d'Edmonton (où l'eau est encore enrichie en fluor). MéTHODE: Nous avons analysé les données d'enquêtes menées auprès d'échantillons populationnels d'élèves de 2e année (environ 7 ans) à Calgary en 2009-2010 (avant l'arrêt; n = 557), et à Calgary et Edmonton en 2013-2014 (Calgary, n = 3 230; Edmonton, n = 2 304) et en 2018-2019 (Calgary, n = 2 649; Edmonton, n = 2 600) (après l'arrêt). Nous avons estimé les associations entre plusieurs indicateurs socioéconomiques et indicateurs de caries dentaires (c.-à-d. l'expérience de caries dentaires [dceo, DCMO] et de dégradation non traitée dans deux dents ou plus [dégradation non traitée]) à l'aide de la régression de Poisson à surreprésentation de zéros, de la régression logistique binaire et de l'indice de concentration des inégalités. Nous avons comparé ces associations dans le temps (entre les cycles de l'enquête) et entre les deux villes après l'arrêt de la fluoration. RéSULTATS: Des iniquités sociales persistantes selon l'indice dceo [dents cariées, extraites et obturées] et la dégradation non traitée étaient manifestes; par exemple, l'absence d'assurance dentaire présentait une corrélation significative avec une probabilité accrue de dégradation non traitée d'une ville à l'autre et d'un cycle à l'autre de l'enquête. Dans la plupart des cas (mais pas tous), les différences entre les villes et entre les cycles de l'enquête correspondaient à un effet indésirable de l'arrêt de la fluoration sur les iniquités en santé dentaire. Par exemple, l'association entre l'absence d'assurance dentaire et la probabilité accrue de dégradation non traitée à Calgary était plus importante en 2018-2019 (longtemps après l'arrêt) qu'en 2009-2010 (avant l'arrêt; rapport de cotes [RC] pour comparaison des coefficients = 1,89 [1,36-2,63], p < 0,001) et qu'en 2013-2014 (peu après l'arrêt; RC pour comparaison des coefficients = 1,67 [1,22-2,28], p = 0,001); cette même association en 2018-2019 était plus importante à Calgary (où la fluoration a cessé) qu'à Edmonton (où l'eau est encore enrichie en fluor) (RC pour comparaison des coefficients = 1,44 [1,03-2,02], p = 0,033). CONCLUSION: Des iniquités sociales relativement aux caries dentaires étaient présentes tant à Calgary qu'à Edmonton. Ces iniquités avaient tendance à être plus importantes à Calgary, où la fluoration a cessé. Nos constatations pourraient être pertinentes dans les autres endroits où l'inégalité des revenus est élevée, où les soins dentaires coûtent cher et où les infrastructures en santé publique dentaire sont limitées.

A growth status measurement pilot in four Calgary area schools: perceptions of grade 5 students and their parents.

Reliable measures of growth in children are necessary for planning and evaluating obesity prevention programs. Currently, measured growth data are unavailable in Calgary for school-age children. This single sample, cross-sectional study included Grade 5 students and their parents. Height and weight measurements of 305 students (68% of those eligible) were taken in private in June 2007 and converted to Body Mass Index (BMI) categories. All but one student (99.7%) completed a questionnaire assessing perceptions of the measurement process. Parents received their child's growth data, an information package on healthy eating and active living, additional resources, and a questionnaire. A third of parents completed the questionnaire. Most students (94.1%) reported feeling "OK" or "Happy" about being measured. In addition, 93.2% of parents reported having "Low" or "Neutral" concerns about the measurement. Furthermore, 28.1% of responding parents reported seeking additional resources or considered making a lifestyle change for their family following the pilot. Measurement of students completed in private by nurses was acceptable to participants.

Maximizing maternal health and value for money in postpartum depression screening: a cost-effectiveness analysis using the All Our Families cohort and administrative data in Alberta, Canada.

BACKGROUND: Postpartum depression (PPD) affects 10-15% of women, is costly and debilitating, yet often remains undiagnosed. Within Alberta, Canada, screening is conducted at public health well child clinics using the Edinburgh Postnatal Depression Scale. If screened high-risk, women are offered referral to their family physicians for follow up diagnosis and treatment. METHODS: We developed a decision tree to estimate the cost-effectiveness of PPD screening versus not screening in Alberta over a two-year time horizon using a public healthcare payer perspective. Both the current practice (51% attending referral) and a scenario analysis (100% attending referral) are presented. RESULTS: Current practice results suggest screening leads to an incremental cost-effectiveness ratio (ICER) of $17,644 USD per quality adjusted life year (QALY). At a population-level, this resulted in an annual 813 (11%) additional cases diagnosed, 120 additional QALYs gained, and an additional cost of $2.1 million relative to not screening. With 100% attending referral, the ICER fell to $13,908 per QALY, resulting in an annual 1997 (27%) additional cases diagnosed, 249 additional QALYs gained, and an additional cost of $3.5 million relative to not screening. LIMITATIONS: We were unable to explore the cost-effectiveness of PPD screening versus not screening for secondary populations, including children. CONCLUSIONS: The results suggest screening may be most valuable when participation and compliance are maximized, where all women screened high-risk attend referral. This leads to greater value for money and increased maternal health gains across the population. Collaboration among public health and primary care services is encouraged to improve outcomes.