|
The
following is a research letter reprinted from The Lancet, Vol. 355,
February 12, 2000
We investigated multiple sclerosis in adolescents in British Columbia
before and after a hepatitis B vaccination programme was begun. There
was no evidence of a link between hepatitis B vaccination and multiple
sclerosis or other demyelinating disease.
In October, 1998, despite a absence of any objective scientific evidence,
1,2 French health authorities suspended hepatitis B (HB)
vaccination of adolescent schoolchildren because of public concerns
that HB vaccination might be linked to new cases or exacerbations of
demyelinating diseases, in particular multiple sclerosis. Since then,
the overall use of HB vaccine has fallen in France, where vaccine labels
now list multiple sclerosis as a contraindication. 3The World
Health Organization, along with other groups such as Canada's Laboratory
Centre for Disease Control (LCDC) and the US Centers for Disease Control
and Prevention, decried this decision, emphasising that external experts,
as part of a special consultative session in September, 1998, carefully
reviewed the data and did not find evidence to support any such relation.
4WHO further emphasised that no definitive evidence supports
a causal association between multiple sclerosis and any vaccine. 5
The most useful data to investigate a causal association between HB
vaccination and multiple sclerosis would come from a comparison of vaccinated
and non-vaccinated individuals. There are scant data for adolescent
populations, among whom multiple sclerosis is much less common than
in adults. In British Columbia (BC), Canada, HB vaccination has been
offered annually to 11-12-year-old students (grade six) since October,
1992. The number and proportion of students who completed the three-dose
vaccination series has been determined by the BC Centre for Disease
Control. From October, 1992 to September, 1998, when programme participation
averaged 92.3%, 267,412 grade six students completed the vaccination
series (A King, unpublished data), providing a follow-up of about 966000
person-years. During the 6.75 years (January, 1986 to September, 1992)
preceding the HB vaccination programme, about 41237 children attended
grade six annually, providing about 1.14 million person-years of observation.
We looked at the onset of multiple sclerosis among adolescents aged
11-17 years of age. Data were obtained from the medical records of the
British Columbia's Children's Hospital (BCCH), the only paediatric hospital
in the province, and the database of the provincial multiple sclerosis
clinic. All paediatric neurologists in the province were also contacted
to confirm that all cases known to them were assessed in the specified
settings.
There were nine cases of adolescent onset multiple sclerosis among
288657 who had attended grade six during the prevaccination period (January,
1986 to September, 1992) (table). This number was not significantly
different from the five cases out of a total of 289651 grade six students
from October, 1992 to September, 1998, of whom 267412 (92.3%) completed
the three-dose vaccination series ..X2 test. These data provide no evidence
for a relation between HB vaccination, at age 11-12 years and the subsequent
onset of School-based hepatitis B vaccination programme and adolescent
multiple sclerosis despite improved diagnostic methods in recent years
(e.g. easier access to magnetic resonance image scans at the Children's
Hospital).
Estimated number of grade six students
|
Prevaccination |
Postvaccination |
| Total
eligible for vaccination |
|
289,651 |
| Total
vaccinated |
|
267,412* |
| Total
cases of adolescent multiple sclerosis |
9 |
5 |
| Total
adolescents without multiple sclerosis |
288,648 |
289,646 |
| Total
denominator |
288,657† |
289,651* |
* 267,412 students
completed the three-dose HB vaccination series, which represents 92.3%
of the 289,651 grade six students offered HB vaccination.
†The
number of grade six students for the period 1986 to 1992 is an estimate,
based on available numbers for 1992 to 1998; this may, in fact, be an
overestimatate given the migratory pattern into BC
Frequency
of adolescent onset multiple sclerosis in BC
We also
obtained data from the medical records of the Children's Hospital to
allow an assessment of the number of cases of postinfectious encephalomyelitis,
since French concerns included demyelinating diseases other than multiple
sclerosis. Before the initiation of the HB vaccination programme, there
were 29 cases of postinfectious encephalomyelitis (25 among children
up to 10 years and 4 among 11-17 years olds). After the HB vaccination
programme began, there were 31 cases of postinfectious encephalomyelitis
(28 among children up to 10 years; three among 11-17 year olds, of which
none occurred during the year in which the child was actually in grade
six). These data provide no evidence for a link between vaccination
and postinfectious encephalomyelitis.
Although
the HB vaccination programme continues to be monitored in BC and other
Canadian provinces by LCDC as part of a comprehensive surveillance programme
of vaccine-associated adverse effects, there are no plans in Canada
to reduce or stop school-based HB vaccination programmes. This decision
is in accordance with recent WHO recommendations.4
Acknowledgements
We thank
John Weil, SmithKline Beecham Biologicals, Rixensart, Belgium, for helpful
discussion.
Source
A.
Dessa Sadovnick, PhD
David W. Scheifele, MD
Department of Medical Genetics
University of British Columbia and Vaccine Evaluation Centre
British Columbia's Children's Hospital
Vancouver, British Columbia Canada
Correspondence
to:
Dr.
A. Dessa Sadovnick
GF 401, Koerner Pavilion
Vancouver Hospital and Health Sciences Centre - UBC Site
Vancouver, British Columbia
Canada V6T 2B5 (Email: popl@interchange.ubc.ca)
Contact'
Lorraine
Schiedel
STD Nurse Consultant
Disease Control Service
Public Health Branch
Telephone: (416) 327-7429
Facsimile: (416) 327-7439
References
- Walsh
E. A shadow falls on hepatitis B vaccination effort. Science
1998; 281: 630-31 [PubMed]
- Kane
MA. Commentary: public perception and the safety of immunization.
Vaccine 1998; 16: S73-S75.
- Pless
R. Surveillance section, vaccine-associated adverse events, Laboratory
Centre for Disease Control, Health Canada. Hep B/MS/QA, 23/04/98.
- Halsey
NA, Duclos P, Van Damme P, Margolis H. Hepatitis B vaccine and central
nervous system demyelinating diseases. Pediatr Infect Dis 1999;
16: 23-24 [PubMed].
- Kastrukoff
LF, Rice GPA, Virology In: Multiple Sclerosis, Paty DW, Ebers GC,
eds. Philadelphia: F A Davis Company, 1997: 370-402.
Disease
Control Service
For
further information on the non-association between hepatitis B vaccine
and multiple sclerosis see the following references:
- Statement
on hepatitis B vaccine from the Centers for Disease Control (CDC),
Atlanta, Georgia http://www.cdc.gov/ncidod/diseases/hepatitis/b/faqbvax.htm#7
-
Statement from World Health Organization (WHO) http://www.who.int/wer/pdf/1997/wer7221.pdf
- Statement
from MS International Organization http://www.ifmss.org.uk/newpwms/frame-HepatitisB2.htm
Unexplained Illness and Death Among Injecting-Drug
Users - Glasgow, Scotland; Dublin, Ireland; and England, April - June
2000
The following article is from Morbidity and Mortality Weekly Report
(MMWR), June 09, 2000 / 49(22);489-492
ISince
April 19, 2000, 30 injecting-drug users (IDUs) died or were hospitalized
with unexplained severe illness in Glasgow, Scotland. Illness was characterized
by extensive local inflammation at a subcutaneous or intramuscular injection
site often followed by hypotension and circulatory collapse. Since April
24, 2000, 15 IDUs in Dublin, Ireland, and 14 IDUs in England with similar
illnesses have been identified. Despite debridement and broad spectrum
antibiotics, 30 (51%) of the 59 patients in all three countries have
died. This report further describes the clinical syndrome and key epidemiologic
features of the illness as characterized by a preliminary investigation
by health authorities in Scotland, Ireland, England, and the United
States (1).
A case of unexplained illness was defined as soft tissue inflammation
(i.e., abscess, cellulitis, fasciitis, or myositis) at an injection
site, and either 1) severe systemic toxicity (i.e., sustained systolic
blood pressure <90 mm Hg despite fluid resuscitation and total peripheral
white blood cell count [WBC] >30,000 cells/mm3), or 2) postmortem
evidence of a diffuse toxic or infectious process including pleural
effusions and soft tissue edema or necrosis, in an IDU admitted to a
hospital or found dead since April 1, 2000. As of June 5, in Glasgow,
16 (53%) of 30 IDUs evaluated had illnesses that met the case definition
(Figure 1). In Dublin, eight (53%) of 15 IDUs, and in England, six (42%)
of 14 IDUs had illnesses that met the case definition (Figure 1). Demographic
information, peripheral WBC, and case-fatality among IDUs were similar
in all three countries (Table 1). Most cases had progressive symptoms
with a median of 3 days (range: 0--14 days) between illness onset and
hospitalization. Among persons who died while hospitalized, the median
time from admission to death was 2 days (range: 0--13 days). Pleural
effusion and extensive edema at an injection site were prominent features
at postmortem examination.
Cultures of blood and tissue yielded multiple organisms from several
patients including group A streptococcus, Staphylococcus aureus,
Clostridium species, and Bacillus species. However, the variable
and polymicrobial results and potential postmortem contamination complicate
the interpretation of these findings and fail to reveal a definitive
etiologic agent. Clinical and drug specimens are being evaluated at
CDC, the Public Health Laboratory Service in England, and local laboratories
in Glasgow and Dublin. Culture, serologic, molecular, immunopathologic,
and histopathologic evaluation of blood and tissue from case-patients
have revealed no evidence of Bacillus anthracis. B. anthracis
was isolated from the cerebrospinal fluid of an IDU residing in Oslo,
Norway, hospitalized in early April 2000 with a localized abscess, elevated
WBC (45,000 cells/mm3), and hemorrhagic meningitis resulting
in death (2).
Investigations continue to characterize further the 29 reported unexplained
illnesses among IDUs whose illnesses failed to meet the case definition
but may be linked to this outbreak. Surveillance activities have been
initiated in all hospitals in Scotland, Ireland, England, and Wales
to identify additional cases. Information regarding these illnesses
is being disseminated to medical practitioners and IDUs, and a case-control
study is under way to identify risk factors for disease and to develop
prevention strategies. As of June 5, no similar illnesses have been
reported in the United States to CDC through the Council of State and
Territorial Epidemiologists.
Reported by: S Ahmed, MD, L Gruer, MD, C McGuigan, MD, G Penrice,
MD, K Roberts, MPhil, Dept of Public Health, Greater Glasgow Health
Board; J Hood, MD, Dept of Microbiology, Glasgow Royal Infirmary; P
Redding, MD, Dept of Microbiology, Victoria Infirmary Glasgow; G Edwards,
MD, Stobhill General Hospital; C Farris, MD, Dept of Clinical Microbiology,
Glasgow Western Infirmary; D Cromie, MD, Dept of Public Health, Lanarkshire
Health Board; H Howie, MD, Dept of Public Health, Grampian Health Board;
A Leonard, MD, Dept of Microbiology, Monklands Hospital; D Goldberg,
MD, A Taylor, PhD, S Hutchinson, MSc, S Wadd, PhD, R Andraghetti, MD,
Scottish Centre for Infection and Environmental Health, Glasgow, Scotland.
J Barry, MD, G Sayers, MD, M Cronin, MD, T O'Connell, MD, M Ward, MD,
P O'Sullivan, MD, B O'Herlihy, MD, Eastern Regional Health Authority,
Dept of Public Health; E Keenan, MD, J O'Connor, MD, L Mullen, MSc,
B Sweeney, MD, Eastern Regional Health Authority Area Health Boards'
Drug Svcs; D O'Flanagan, MD, D Igoe, MD, National Disease Surveillance
Centre; C Bergin, MD, S O'Briain, MD, C Keane, MD, E Mulvihill, MD,
P Plunkett, MD, G McMahon, MD, T Boyle, MD, S Clarke, MD, St. James's
Hospital; E Leen, MD, James Connolly Memorial Hospital; M Cassidy, MD,
State Pathology Svc, Dublin, Ireland. T Djuretic, MD, N Gill, MD, V
Hope, PhD, J Jones, MD, G Nichols, PhD, A Weild, MPhil, Public Health
Laboratory Svc (PHLS) Communicable Disease Surveillance Centre; R George,
MD, PHLS Respiratory and Systemic Infection Laboratory; P Borriello,
PhD, PHLS Central Public Health Laboratory, London, England; J Brazier,
PhD, J Salmon, MD, PHLS Anaerobe Reference Unit, Cardiff, Wales; N Lightfoot,
MD, PHLS North, Newcastle; A Roberts, PhD, Centre for Applied Microbiology
and Research, Porton Down, England. Infectious Diseases Pathology Activity,
Div of Viral and Rickettsial Diseases; Bioterrorism Preparedness and
Response Program; Meningitis and Special Pathogens Br, Div of Bacterial
and Mycotic Diseases, National Center for Infectious Diseases; and EIS
officers, CDC
Editorial Note
The localized inflammatory process affecting skin or muscle combined
with systemic toxicity characterized by a leukemoid reaction suggests
the role of a toxin-mediated cause of illness among IDUs in Scotland,
Ireland, and England. Despite extensive microbiologic evaluation for
several of these cases, no specific causative pathogen has been identified.
Although the initial symptoms of anthrax can be nondescript before the
onset of circulatory collapse and death (3), the absence of B. anthracis
bacteremia or histologic or molecular evidence for B. anthracis suggests
that anthrax-associated toxemia is not a cause of illness among these
IDUs. Streptococcal toxic shock syndrome and staphylococcal toxic shock
syndrome are both characterized by the sudden onset of shock and organ
failure, often associated with skin and soft tissue damage (4,5). However,
most cases in Scotland, Ireland, and England have not had group A streptococcus
isolated (a required feature of streptococcal toxic shock syndrome),
and none developed a rash or desquamation of the palms and soles (diagnostic
criteria of staphylococcal toxic shock syndrome). Fastidious, anaerobic
bacteria, such as Clostridium species, have caused a distinctive, toxin-mediated,
often fatal infection characterized by sudden onset of shock with unrelenting
hypotension, myonecrosis, generalized tissue edema, and a profound leukemoid
reaction in the absence of high fever and rash (6)---a clinical course
resembling that seen among cases in Scotland, Ireland, and England.
Laboratory procedures have been enhanced for the identification of anaerobic
bacteria and noninfectious toxins.
The emergence of a new illness among IDUs is possible because the injection
of nonsterilized drugs into skin and soft tissue can provide a suitable
environment for contaminating pathogens and their toxins or noninfectious
toxins alone. Up to 32% of IDUs, particularly those who inject drugs
subcutaneously or intramuscularly, have soft tissue abscesses or cellulitis
at any given time (7,8). Unusual infections have been linked to subcutaneous
or intramuscular drug use, including tetanus and wound botulism among
heroin and black tar heroin users, respectively, in California (9,10),
and group A streptococcal infections among cocaine users in Switzerland
(11). Microbial or chemical contamination can occur at one of many steps,
including production, mixing, dilution, or preparation of the drugs
or at the time of injection through contaminated paraphernalia or skin.
Because the source of contamination remains unknown and may be common
in these countries, this investigation highlights the importance of
enhanced surveillance for syndrome-based illness across national boundaries.
Health-care providers and public health personnel are encouraged to
report persons with illnesses meeting the case definition to their designated
public health authorities.
References
- Eastern Regional Health Authority and
National Disease Surveillance Centre. Serious unexplained illness
among injecting drug users in Scotland: update. Eurosurveillance Weekly
2000;4:000601. Available at http://www.eurosurv.org/2000/000601.htm.
Accessed June 2000.
- Høiby EA. Systemic anthrax in an injecting
drug user: Oslo, Norway---April 2000. Eurosurveillance Weekly 2000;4:000511.
Available at http://www.eurosurv.org/2000/000511. Accessed June 2000.
- Dixon TC, Meselson M, Guillemain J, Hanna
PC. Anthrax. N Engl J Med 1999;341:815--26.
- The Working Group on Severe Streptococcal
Infections. Defining the group A streptococcal toxic shock syndrome.
JAMA 1993;269:390--1.
- Reingold AL, Hargrett NT, Dan BB, Shands
KN, Strickland BY, Broome CV. Nonmenstrual toxic shock syndrome: a
review of 130 cases. Ann Intern Med 1982;96:871--4.
- McGregor JA, Soper DE, Lovell G, Todd
JK. Maternal deaths associated with Clostridium sordellii infection.
Am J Obstet Gynecol 1989;161:987--95.
- Binswanger IA, Kral AH, Bluthenthal RN,
Rybold DJ, Edlin BR. High prevalence of abscesses and cellulitis among
community-recruited injection drug users in San Francisco. Clin Infect
Dis 2000;30:579--81.
- Vlahov D, Sullivan M, Astemborski J,
Nelson KE. Bacterial infections and skin cleaning prior to injection
among intravenous drug users. Public Health Rep 1992;107:595--8.
- CDC. Tetanus among injecting-drug users---California,
1997. MMWR 1998;47:149--51.
- Passaro DJ, Werner SB, McGee J, Mac Kenzie
WR, Vugia DJ. Wound botulism associated with black tar heroin among
injecting drug users. JAMA 1998;279:859--63.
- Böhlen LM, Mühlemann K, Dubuis O, Aebi
C, Täuber MG. Outbreak among drug users caused by a clonal strain
of group A streptococcus. Emerg Infect Dis 2000;6:175--9.
Comment
As stated
in the Editorial Note, this outbreak highlights the need for enhanced
surveillance and prompt sharing of information by public health authorities.
The following case definition has been developed for use in the United
Kingdom and Ireland:
An
IDU admitted to hospital or found dead since 1 April 2000 with soft
tissue inflammation (abscess, cellulitis, fasciitis, or myositis) at
an injection site AND either severe systemic toxicity (total
peripheral white blood cell count > 30 x 109/L and sustained
systolic pressure < 90 mmHg despite fluid resuscitation) or evidence
at necropsy of a diffuse toxic or infectious process including pleural
effusion and soft tissue oedema or necrosis at an injection site.
To date,
we are unaware of similar current illnesses occurring in IDUs in the
United States or Canada.
Discussions
with regional representatives of Ontario's 19 needle/syringe exchange
programs on June 13, 2000 revealed no reports of unusual deaths, hospital
admissions or increased infections in IDUs in the province.
In this
instance, it now appears that the source of the illness was the heroin,
contaminated either at source or along the distribution network and
intense investigations are being undertaken to identify the agent involved.
However, drug users need to be constantly reminded of the dangers of
both intramuscular and intravenous injections and encouraged to seek
medical help anytime abscesses occur. New information on this unique
outbreak will be shared as soon as it becomes available.
Update:
MMWR, June 23,2000 / 49(24);543-5
Among
the 35 patients with illnesses meeting the case definition, nine (26%)
have laboratory evidence of clostridial infections based on culture
isolation or 16S ribosomal DNA polymerase chain reaction and sequencing
performed on blood or tissue, including three C. novyi, three
C. perfringens, one with both C. novyi and C. perfringens,
and two clostridial species awaiting further typing. Of the remaining
41 patients with illnesses who failed to meet the case definition but
who may be linked to this outbreak, and for whom data are available,
nine (22%) have evidence of clostridial infections, including five C.
novyi and four with species pending. Although the role of other
pathogens requires further delineation, only four (11%) patients with
illnesses meeting the case definition have evidence of other etiologic
agents (Staphylococcus aureus, group A Streptococcus,
and group C Streptococcus), compared with 12 (29%) of 41 patients
with unexplained soft tissue infections but lacking severe systemic
toxicity.
Contact
Dr.
Evelyn Wallace, MB, ChB
Senior Medical Consultant
Disease Control Service
Communiqué
Public Health Research, Education and Development Program
From
Theory to Practice: Supporting Our Communities' Parent
Introduction
This article offers
an example of how research informs program planning and influences practice.
Using the results from a survey of parents with preschoolers, practitioners
adapted the work of others and formed a coalition to develop and implement
a population-based approach to support parents and to promote the health
of children in the counties of Elgin, Middlesex and Oxford.
The Literature
The
early years are the foundation for healthy growth and development, future
learning and health1,2. A key requisite for healthy child
development is secure attachment to a nurturing adult who can provide
consistent care, support and affection early in life. Parents provide
the primary social network for children, therefore enhancing parental
capacity is an effective strategy for healthy child development.
The
Federal/Provincial/Territorial Advisory Committee on Population Health3
provides further support for the importance of parenting. This document
cites normal birthweight, effective parenting, good nutrition,
the absence of trauma, plentiful opportunities for stimulation in early
childhood and the development of mastery or self-confidence as factors
which contribute to lifelong health.
It follows
that communities/programs that support parents in their parenting role
promote healthy child development. A healthy child is one who reaches
physical, emotional and social developmental milestones and is ready
for school at the time of school entry. Such a child has the ability
to learn, think critically, form positive relationships and develop
problem solving and coping skills, is confident and demonstrates positive
health related behaviour.
The
Carnegie Task Force on Meeting the Needs of Young Children4
suggested that although no job is as important or challenging as that
of a parent, society acts as though parenting skills come naturally.
The task force concluded that many parents can benefit from parent education
and support since. Parenting can be demanding and at times overwhelming
even in the best of circumstances. Parental roles change with children's
rapid physical, emotional and intellectual development.
The
Survey: Parents with Children 4 years of age and under5
A review
of the literature reinforced the decision by Middlesex-London Health
Unit to survey parents of children four years of age and under in the
Middlesex-London area. The survey was designed to identify what topics
parents would like more information on, their preferred method of obtaining
information, where and when they want to access needed information and
support, and barriers to getting the information they need. The goal
was to use the results to plan a comprehensive population health approach
that would target parents of young children.
In
November 1998, a convenience sample of parents and guardians in the
City of London and Middlesex County who had children four years of age
and under were asked to complete a self-administered questionnaire.
Various community organizations assisted with the distribution of the
survey to the families that attended their programs or services. Four
hundred and ninety-two (492) surveys were returned, with the majority,
445 (92.1%) completed by mothers.
Survey
Results
The
results of the survey clearly indicated that parents in Middlesex-London
want to obtain more information to assist them in their role as parents.
Respondents were willing to utilize a variety of strategies to obtain
this information, including written materials, parenting classes, speakers
or a parenting fair. Most, (89.6%), stated they preferred material in
a written format such as pamphlets, newsletters and magazines. Over
50% of respondents in the City of London and over 70% of the respondents
in Middlesex County felt that they did not know what resources were
available.
Barriers
to obtaining information were diverse, with "don't know what is offered"
as the most frequent response. Significantly more respondents with an
income of less than $20,000 identified cost, transportation, location
and language as barriers to obtaining information. Survey results reinforced
plans to reduce barriers such as cost, transportation, and language
by providing information and support to parents in their own homes
Call
to Action
The
results were shared with an interagency committee on parent education
and the advisory committee to the local Healthy Babies Healthy Children
Initiative. A decision was made to pursue a collaborative population
health strategy that focused on the parents of young children. In addition,
the findings were shared with agencies and community members who had
participated in the distribution of the survey and those who work with
parents and children in the preschool population. Having multi-sector
involvement and potentially using a variety of approaches was seen as
important in addressing determinants of health from the perspective
of parents.
A community
coalition of interested agencies, parents and services was called together
in the fall of 1999 to articulate a strategic plan for this initiative.
A number of strategies to address the identified concerns of parents
were discussed6. Consensus was reached to offer parents a
newsletter, mailed at regular intervals during their child's first five
years. This newsletter would provide information on healthy growth and
development, parenting, safety, stimulation and play and local community
resources. In order to meet the needs of a larger section of the southwest
region, representatives from Elgin-St. Thomas Health Unit and the Oxford
County Board of Health were invited to participate.
Customizing
the Experiences of Others
"Let's
Grow... with your child" is an age paced newsletter that was initiated
by the Bruce-Grey Owen Sound Interagency Committee in 1998. Following
on the strategic direction to offer a newsletter, a Tri-County Lets
Grow Committee was formed to customize this initiative for Elgin, Middlesex
and Oxford counties. The "Let's Grow…with your child" newsletter was
revised and adapted in collaboration with the Bruce-Grey Owen Sound
Interagency Committee to reflect the diverse cultures and current practices
in our communities.
A multi-sector
approach has proven highly successful. Committee members contribute
their unique perspectives to help guide the planning and coordination
of information given to parents. This collaborative effort is also assisting
local agencies in avoiding unnecessary duplication of resources. In
addition, linking families with current information about infant, toddler
and preschool growth and development and the supports and services that
are available, fills a gap. This gap exists in the years between supports
available to a family around the time of their child's birth until school
entry. Providing parents with information on developmental milestones
in a timely manner also helps to ensure the recognition and support
of those children not achieving their developmental milestones. Early
intervention, with these children, prior to reaching school age has
proven very effective.2
In addition,
the Tri-County Let's Grow Committee is actively working on the addition
of relevant material about local community resources and supports for
parents in our community. Parents who deliver a child in the counties
of Elgin, Middlesex and Oxford will now be given the opportunity to
subscribe, free of charge, to "Let's Grow…with your child". Barriers
to accessing information are reduced as the material is written at a
grade three to five level, has numerous pictures to illustrate strategies
for promoting healthy child development, is available at no cost, and
provides parents with an ongoing venue to receive information about
community resources and supports available to them at each stage of
their child's development.
"Let's
Grow... with your child" has been evaluated and received positive results
in the Bruce-Grey Owen Sound area. A comprehensive evaluation strategy
for the Elgin, Middlesex and Oxford initiative is planned.
Conclusions
Children in our communities are a priority. Research has shown that
experiences in early childhood can shape a child's future. Parents have
a vital role in providing the opportunities for children to achieve
their optimal physical, emotional and cognitive development. Communities
need to support parents in this role. "Let's Grow ...with your child",
is one component of an ongoing network of supports to assist parents
in developing their parental role.
This initiative demonstrates the importance of a comprehensive planning
approach: What are the needs? What is the evidence? What are the best
practices of others? Reviewing the literature, assessing the population,
building on the work of others, collaborating across sectors and evaluating
outcomes has provided a solid framework to deliver an innovative program
based on community needs. Our experiences demonstrate the pivotal role
of research, the importance of evidence-based decision making and how
such an approach influences program planning and informs public health
practice.
Acknowledgements
We wish to express our appreciation to Let's Grow, With Your Child,
Bruce-Grey Owen Sound Interagency Committee. Their work laid the foundation
and was critical in expediting the launch of this initiative in the
counties of Elgin, Middlesex and Oxford.
Sources
Cathy
Thomson*, RN, BScN, Public Health Nurse
Chair, Tri-County Let's Grow Committee
Public Health Nursing Division
Middlesex-London Health Unit
* now with Simcoe County District Health Unit
Charlene
Beynon, MScN, Acting Director
Education & Research Division (PHRED Program)
Middlesex-London Health Unit
Contact
Sandra
Mackenzie, RN, MScN
Manager, of Healthy Children (0-6 years) Program
Public Health Nursing Division
Middlesex-London Health Unit
Tel: (519) 663-5317
References
- Canadian
Institute of Child Health: The first years last forever: The new brain
research and your child's healthy development. Ottawa: Canadian Institute
of Child Health, 1998.
- McCain
M, Mustard J F. Reversing the Real Brain Drain, Early Years Study
Final Report. Toronto: The Canadian Institute for Advanced Research,
1999.
- Federal/Provincial/Territorial
Advisory Committee on Population Health. Building a National Strategy
for Healthy Child Development: Report of the Federal/Provincial/Territorial
Advisory Committee on Population Health. Ottawa: Minister of Public
Works and Government Services Canada, 1998
- Carnegie
Corporation of New York. Starting points: meeting the needs of our
youngest children. New York: Carnegie Corporation of New York, 1994.
- Middlesex-London
Health Unit. Preschool parenting needs survey report. Middlesex-London
Health Unit: London, Ontario, 1999
- Kishchuk
N, Laurendaeau M, Desjardins N Perreault R. Parental Support: Effects
of a Mass Media Intervention. Can J. Public Health, 86: 128-132.
Population
Health Service Comment
The results of this survey are noteworthy. This survey utilized a convenience
sample of women already accessing community services, yet 50% of respondents
in the City of London and 70% of the respondents in Middlesex County
"felt that they did not know what resources were available". What would
be the response if all parents, or parents not using community services
were surveyed? Part of the worth of a community resource or support
is its ability to reach the people who would benefit from it. While
we are making worthwhile efforts to ensure that parents are aware of
their local resources, this survey highlights that we have some way
to go yet. The "Let's Grow…with your child" newsletter is one positive
step towards linking parents with the information, resources and supports
they need to develop and grow as parents.
Since
the survey sample was limited to parents and guardians already accessing
community services, it also raises the question of whether the preference
for material in a written format is shared across all families in the
community. As barriers to obtaining information might vary for families
not included in the sample, the need for alternate approaches might
be an area for future evaluation or assessment.
The
article also got us thinking about the timing of effective public health
interventions to enhance capacity for parenting. The Reproductive Health
Technical Review Committee is currently exploring the inclusion of population-based
strategies that support readiness to parent prior to birth within the
Reproductive Health Program. Similarly, one-to-one supports and service
coordination-type strategies to support readiness to parent prior to
birth will be included in the Healthy Babies, Healthy Children prenatal
component. The aim is to provide a continuum of support to parents that
is continued in the Child Health/Healthy Babies, Healthy Children programs.
Future evaluation and assessment of the "Let's Grow…with your child"
might consider the need for/value of information and resources supporting
readiness to parent for families in the prenatal period, as well as
for families planning pregnancies.
Contacts
Dr.
Sandra Bennett, BDS, DDPH, MSc, DGrt
Senior Dental Consultant & Child Health Consultant
Elizabeth
Berry, MHSc
Senior Public Health Education Consultant
Elizabeth
Rael, MSc, PhD (candidate)
Senior Epidemiologist
Population
Health Service
Public Health Branch
Telephone: (416) 327-7377
Facsimile: (416) 327-7438
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