Modifiable factors related to life-space mobility in community-dwelling older adults: results from the Canadian Longitudinal Study on Aging.

BACKGROUND: The most common methods for measuring mobility in older adulthood include performance-based tests, such as the Timed-Up-and-Go and gait speed. While these measures have strong predictive validity for adverse outcomes, they are limited to assessing what older adults do in standardized settings, rather than what they do in their daily life. Life-space mobility, which is the ability to move within environments that expand from one's home to the greater community, has been proposed as a more comprehensive measure of mobility. The aim of this study was to determine the association between modifiable factors and life-space mobility in older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). METHODS: Life-space mobility was measured using the Life Space Index (LSI). Explanatory factors included physical, psychosocial and cognitive determinants, as well as pain, fatigue, driving status, nutrition, body mass index, smoking status, and vision. To estimate the association between the LSI and explanatory variables, univariate and multivariable ordinary least squares regression analyses were performed. RESULTS: All adults 65 years and older (n = 12,646) were included in the analysis. Fifty percent were women and the mean age was 73.0 (SD5.7). The mean LSI score was 80.5, indicating that, on average, the sample was able to move outside of their neighborhood independently. All explanatory variables were significantly associated with the LSI except for balance and memory. The top 3 variables that explained the most variation in the LSI were driving, social support and walking speed. CONCLUSION: To our knowledge, this was the first study to examine the association between life-space mobility and a comprehensive set of modifiable factors that were selected based on a theoretical framework and existing research evidence. This study had two important messages. First, driving, social support and walking speed emerged as the most significant correlates of life-space mobility in older adults. Second, life-space mobility is multifactorial and interventions that are pragmatic in their design and testing are needed that consider the complexity involved. A multi-disciplinary approach to examining life-space mobility in older adults is needed to optimize opportunities for healthy aging and develop strategies that support mobility in older adulthood.

Women's experiences breastfeeding in public places.

This two-part field study compared researchers' recorded observations to mothers' perceptions of attention they received while publicly breastfeeding. In part 1, four breastfeeding and four bottle-feeding mothers each made eight restaurant visits. On average, there were more neutral looks from customers (P = .01) during breastfeeding visits, but no differences in the amount of overtly negative or positive attention given during breastfeeding versus bottle feeding. In part 2, four breastfeeding mothers made a total of 24 visits to shopping malls. There were more neutral looks given while mothers were breastfeeding and more smiles and comments while they were not feeding, but no difference in total amount of attention received. Breastfeeding mothers acknowledged they had anticipated some undesirable attention but instead received little attention. Nevertheless, they felt "vulnerable" nursing in public. Certain proactive behaviors and personal attributes as well as support from other women enabled them to breastfeed successfully in public.

Community computing: perceptions of technology access, use and policies in urban Ontario.

The perceptions of community service providers about access to public technology and uses of technology to support population health were investigated. Perceptions about policies regarding access to technology for the public were also pursued. Qualitative semistructured interviews with service providers in the community were used. One-hour semistructured interviews were conducted with representatives from five community organizations and one business in an urban centre with a population of 400,000. Respondents believed that computers are here to stay, that that they can provide a valuable means for information access and that they have the potential to support communication in local communities. Perceived barriers were also identified.

A systematic review of the relationship between breastfeeding and early childhood caries.

This systematic review investigated the relationship between early childhood caries (ECC) and breastfeeding. The systematic review methodology used by the Cochrane Collaboration was modified and adopted for this review. 28 of 151 articles (18.5%) were relevant for the study and were rated as strong (0), moderate (3), weak (9) or very weak (16). Validity scores indicated whether a study met the reviewer's criteria for research rigour. The percentage of studies that received a passing score for each criterion examined were: study design (3.6%), confounders (21%), data collection method (54%), definition of ECC (57%), dental health practices (28%) and infant feeding practices (4%). A lack of methodological consistency related to the study of the association of breastfeeding and ECC, and inconsistent definitions of ECC and breastfeeding, make it difficult to draw conclusions. Moderate articles indicate that breastfeeding for over one year and at night beyond eruption of teeth may be associated with ECC. Due to conflicting findings in less rigorous research studies, no definitive time at which an infant should be weaned was determined, and parents should begin an early and consistent mouth care regime.

Do consumer infant feeding publications and products available in physicians' offices protect, promote, and support breastfeeding?

The purpose of this study was to determine if consumer infant feeding publications and products distributed by physicians' offices protect, promote, and support breastfeeding. A total of 127 physician office practices completed a mailed questionnaire that measured the types of print and nonprint materials available and policies and practices regarding these resources. Commercially produced pamphlets were available in 114 (90%) of the offices surveyed, and were twice as likely to be routinely distributed as pamphlets from nonprofit agencies and government. Many publications contained outdated recommendations about breastfeeding; the most accurate publications were available in only 29 (23%) of practices surveyed. Magazines contravening the WHO Code were widely available (91 offices; 72%) and routinely distributed (58 offices; 46%). One hundred one offices (80%) accepted free formula and 48 (38%) routinely distributed it. Few offices had a policy (n = 25; 20%) or criteria (n = 17; 13%) for selecting infant feeding resources. Those with policies were less likely to distribute commercial pamphlets. In the majority of offices surveyed, physicians' offices accepted and routinely distributed publications and products which do not "protect, promote, and support" breastfeeding. Offices are encouraged to have policies guiding the distribution of infant feeding materials.

A local community's approach to breastfeeding promotion.

An understanding of theories of group development and the program planning process are critical to any community group's effective functioning. This paper describes the developmental stages experienced by a multi-agency, multi-disciplinary regional breastfeeding committee. The stages of forming, storming, norming, performing, and adjourning devised by Tuckman and Jensen are clearly evident in the growth of this group and can be useful to any other group. The basis for the group's decision-making regarding tasks and activities are addressed by the three health promotion planning approaches: education, policy development, and environmental support. This paper outlines the steps utilized by the committee to develop a series of breastfeeding promotion factsheets as one of its major activities.

An evaluation of breastfeeding promotion literature: does it really promote breastfeeding?

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.

Experiences of nursing joint appointments in a teaching health unit.

This article describes the experiences of five community health nursing faculty who are jointly appointed between McMaster University School of Nursing and the Hamilton-Wentworth Department of Public Health Services in Hamilton, Ontario, Canada. The appointees are actively involved in service, education, and research activities within the teaching health unit, a specially funded project of the Ontario Ministry of Health. Various kinds of consultation and expertise are offered by joint appointees to staff and management within the Department of Public Health Services. The amount of time and effort invested in a particular activity or project varies as staff, students, and joint appointees each make their contributions. Several lessons are learned in acting out our diverse roles in this exciting and challenging service environment.