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Biomedical subjects

Louise Potvin

Publications and source records attributed to Louise Potvin.

At least 19 recordsLinked to original sources
PubMed2006

Participatory research in public health: creating innovative alliances for health.

This article discusses alliances within local socio-sanitary space, one in which community sector and health sector actors, public health researchers and funding bodies meet. The discussion is based on the study of a research space made up of representatives of actors found at the local level. Both the minutes of the discussions of 12 meetings of the research team, and the collaborative outputs produced throughout the research initiative provide the empirical data for a qualitative analysis. The findings reveal a research space concomitantly constituted by aspects of "non-cooperative games" and of networks based on innovation-fostering knowledge exchanges, which can be viewed, from the perspective of a reflexive epistemology, as a tool for implementing innovative alliances in local, health-promoting socio-sanitary space.

Cooperative Behavior↗
PubMed2006

Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental study.

BACKGROUND: Drug utilization review (DUR) programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing. METHODS: We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test. RESULTS: The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing. CONCLUSION: Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs.

Cisapride↗
PubMed2006

Understanding place and health: a heuristic for using administrative data.

The increasing availability, use and limitations of administrative data for place-based population health research, and a lack of theory development, created the context for the current paper. We developed a heuristic to interrogate administrative data sets and to help us develop explanatory pathways for linking place and health. Guided by a worked example, we argue that some items in administrative data sets lend themselves to multiple theories, creating problems of inference owing to the implications of using inductive versus deductive reasoning during the research process, and that certain types of theories are privileged when used administrative data bases.

Canada↗
PubMed2005

From walkability to active living potential: an "ecometric" validation study.

BACKGROUND: The purpose of this paper is to establish the reliability and validity of a neighborhood-level measure of active living potential by applying principles of ecometrics. METHODS: Following a 3-day training session, observers (n =8) were provided with a map of a predetermined walking route constructed through the joining of ten randomly selected street blocks. Then, using an 18-item observation grid, pairs of observers performed ratings of 112 neighborhoods. Resulting observations produced a hierarchically structured data set including 4032 observations nested within observers, which in turn were nested within neighborhoods. Data from the 2001 Canadian census were linked to the neighborhood data. RESULTS: Application of ecometric multilevel modeling analyses showed that once interitem and interobserver variability were statistically controlled, about one third of the variability in observations were at the between-neighborhood level. Reliability estimates were 0.78 for items measuring activity-friendliness, 0.76 for safety, and 0.83 for density of destinations. Assessment of the convergent validity of the instrument identified that safety of the environment was positively associated with neighborhood affluence. Density of destinations was negatively associated with affluence and positively associated with higher proportions of persons in the neighborhood walking to work. CONCLUSIONS: The three dimensions of the neighborhood active-living potential measure have good reliability and convergent validity and are able to capture between neighborhood differences. Measurement characteristics would have been difficult to ascertain without the ecometrics methodology.

Environment Design↗
PubMed2005

Understanding the dimensions of socioeconomic status that influence toddlers' health: unique impact of lack of money for basic needs in Quebec's birth cohort.

STUDY OBJECTIVES: To examine the unique impact of financial difficulties as measured by a lack of money for basic needs on the occurrence of health problems between the ages of 17 and 29 months, controlling for mother's level of education and neonatal health problems. DESIGN AND PARTICIPANTS: Analyses were performed on the 29 month data of the Quebec longitudinal study of child development. This longitudinal study followed up a birth cohort annually. Interviews were conducted in the home with the mother in 98.8% of cases. This information was supplemented with data from birth records. At 29 months, the response rate was 94.2% of the initial sample (n = 1946). The main outcome measures were mothers' report of acute health problems, asthma episodes, and hospitalisation as well as growth delay and a composite index of health problems (acute problems, asthma attack, growth delay). MAIN RESULTS: Children raised in a family experiencing a serious lack of money for basic needs during the preceding year were more likely to be reported by their mothers as presenting acute health problems, a growth delay, two or more health problems, and to have been hospitalised for the first time within the past few months as compared with babies living in a family not experiencing a lack of money for basic needs regardless of the mother's level of education and of neonatal health problems. CONCLUSION: Financial difficulties as measured by a lack of money for basic needs have a significant and unique impact on toddlers' health.

Acute Disease↗
PubMed2005

Post-Quebec.

Explore the source record for details and available documents.

Congresses as Topic↗
PubMed2005

Unpacking the black box: a deconstruction of the programming approach and physical activity interventions implemented in the Kahnawake Schools Diabetes Prevention Project.

An ecological lens was used to deconstruct the programming approach and unpack physical activity interventions implemented through the Kahnawake Schools Diabetes Prevention Project. Despite a surge of interest in ecologically based health promotion programming, optimal combinations of interventions and programming approaches to promote community physical activity involvement have not been systematically studied. The authors obtained physical activity intervention descriptions through archive retrieval and face-to-face interviews with intervention staff. Programming approach, intervention targets, strategies for change, and delivery settings were assessed by applying the intervention analysis procedure to intervention descriptions. A complex intervention package was found containing a host of multitarget, multisetting intervention strategies designed and implemented through dynamic exchanges between a diversity of community partners. This study provides a first step toward better understanding community intervention packages and programming strategies for promoting physical activity involvement within a community setting.

Child↗
PubMed2005

Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien'keha:ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project.

OBJECTIVES: Report the 8-year impact on body size, physical activity, and diet of a community-based diabetes prevention program for elementary-school children in a Kanien'keha:ka (Mohawk) community in Canada. METHODS: Follow-up (1994-1996) of subjects in the intervention and comparison community and repeat cross-sectional measurements in the intervention community alone from 1994 to 2002. Measures included triceps and subscapular skinfold thicknesses, body mass index (BMI), weekly number of 15-minute episodes of physical activity, run/walk test times, television watching, and consumption of sugared foods, fatty foods, and fruits and vegetables. RESULTS: The longitudinal data of 1994-1996 showed some early positive effects of the program on skinfold thickness but not on BMI, physical activity, fitness, or diet. Repeat cross-sectional measures from 1994 to 2002 showed increases in skinfold thickness and BMI. Physical activity, fitness, and television watching showed favorable trends from 1994 to 1999 that were not sustained in 2002. Key high-fat and high-sugar foods consumption decreased, as did consumption of fruits and vegetables. CONCLUSIONS: Although early results showed some successes in reducing risk factors for type 2 diabetes, these benefits were not maintained over 8 years.

Body Mass Index↗
PubMed2005

Integrating social theory into public health practice.

The innovative practice that resulted from the Ottawa Charter challenges public health knowledge about programming and evaluation. Specifically, there is a need to formulate program theory that embraces social determinants of health and local actors' mobilization for social change. Likewise, it is imperative to develop a theory of evaluation that fosters reflexive understanding of public health programs engaged in social change. We believe advances in contemporary social theory that are founded on a critique of modernity and that articulate a coherent theory of practice should be considered when addressing these critical challenges.

Global Health↗
PubMed2005

[From Amiens to Quebec: the first milestones of an on-going adventure].

The first two international conferences on local and regional health programmes held in Amiens and Quebec have paved the road for a new public health paradigm. The conferences have served to share experiences from the field to re-think practice and create bridges between health promotion, prevention, care and integration at both the action and decision levels, and amongst diverse actors from the field. The challenges have been put forth, in Amiens in 2001 and in Quebec three years later. The next step is to pursue and enrich these exchanges at the international level reinforcing the Francophone position by capitalising on approaches and tools, and mobilising new partners. The next rendezvous for this on-going adventure is set for the third conference.

Congresses as Topic↗
PubMed2004

Legitimizing diabetes as a community health issue: a case analysis of an Aboriginal community in Canada.

The Kahnawake Schools Diabetes Prevention Project (KSDPP) is an ongoing participatory research and intervention project aimed at the primary prevention of type 2 diabetes. Formally initiated in 1994 with strong community support, KSDPP provides a fertile opportunity to learn about how a community came to identify the need for preventive action on a health problem such as diabetes. The purpose of our study was to describe the various conditions in the community of Kahnawake, which gave rise to its mobilization for the prevention of type 2 diabetes. Qualitative data consisted of 12 individual interviews and one focus group with key community members and health professionals living and/or working in the community of Kahnawake, along with historically relevant documents. The data collection and analysis procedures of the grounded theory method were applied. Results describe a preceding phase to formal KSDPP implementation, triggered by returning research results on the community prevalence of type 2 diabetes. This phase of 'legitimizing diabetes as a community health issue' is characterized by a shift in the perceived preventability of diabetes among community members; from a problem that was to be lived with to a problem that was to be prevented. The shift in perceptions was facilitated by the context in the community, described by structural developments, cognitive and relational elements. In addition to reaffirming the critical importance of utilizing lay knowledge during the planning of a health promotion intervention, our study has uncovered some of the key conditions through which individuals in the community came to participate in the identification and planning of a diabetes prevention project.

Canada↗
PubMed2003

Effects of low income on infant health.

BACKGROUND: Few population-based studies have analyzed the link between poverty and infant morbidity. In this study, we wanted to determine whether inadequate income itself has an impact on infant health. METHODS: We interviewed 2223 mothers of 5-month-old children participating in the 1998 phase of the Quebec Longitudinal Study of Child Development to determine their infant's health and the sociodemographic characteristics of the household (including household income, breast-feeding and the smoking habits of the mother). Data on the health of the infants at birth were taken from medical records. We examined the effects of household income using Statistics Canada definitions of sufficient (above the low-income threshold), moderately inadequate (between 60% and 99% of the low-income threshold) and inadequate (below 60% of the low-income threshold) income on the mother's assessment of her child's overall health, her report of her infant's chronic health problems and her report of the number of times, if any, her child had been admitted to hospital since birth. In the analysis, we controlled for factors known to affect infant health: infant characteristics and neonatal health problems, the mother's level of education, the presence or absence of a partner, the duration of breast-feeding and the mother's smoking status. RESULTS: Compared with infants in households with sufficient incomes, those in households with lower incomes were more likely to be judged by their mothers to be in less than excellent health (moderately inadequate incomes: adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.1; very inadequate incomes: adjusted OR 1.8, 95% CI 1.3-2.6). Infants in households with moderately inadequate incomes were more likely to have been admitted to hospital (adjusted OR 1.8, 95% CI 1.2-2.6) than those in households with sufficient incomes, but the same was not true of infants in households with very inadequate incomes (adjusted OR 0.7, 95% CI 0.4-1.2). Household income did not significantly affect the likelihood of an infant having chronic health problems. INTERPRETATION: Less than sufficient household incomes are associated with poorer overall health and higher hospital admission rates among infants in the first 5 months of life, even after adjustment for factors known to affect infant health, including the mother's level of education.

Adult↗
PubMed2003

Implementing participatory intervention and research in communities: lessons from the Kahnawake Schools Diabetes Prevention Project in Canada.

Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. Despite the usefulness of these approaches for evaluating targeted narrow-focused interventions, they may not be appropriate in community health promotion, especially in Aboriginal communities. Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process.

Child↗
PubMed2003

Community governance of the Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Mohawk Nation, Canada.

Health promotion emphasizes the importance of community ownership in the governance of community-based programmes, yet little research has been conducted in this area. This study examined perceptions of community ownership among project partners taking responsibility for decision-making related to the Kahnawake Schools Diabetes Prevention Project (KSDPP). Project partners were surveyed cross-sectionally at 18 months (T1) and 60 months (T2) into the project. The perceived influence of each project partner was assessed at T1 and T2 for three domains: (i) KSDPP activities; (ii) KSDPP operations; and (iii) Community Advisory Board (CAB) activities. Project staff were perceived to have the greatest influence on KSDPP activities, KSDPP operations and CAB activities at both T1 and T2. High mean scores of perceived influence for CAB members and community researchers, however, suggests that project decision-making was a shared responsibility among multiple community partners. Although academic researcher influence was consistently low, they were satisfied with their level of influence. This was unlike community affiliates, who were less satisfied with their lower level of influence. In keeping with Kanien'kehaka (Mohawk) culture, the findings suggest a participatory democracy or shared decision-making as the primary mode of governance of KSDPP.

Adult↗
PubMed2002

A theoretical and empirical analysis of context: neighbourhoods, smoking and youth.

Numerous studies are currently addressing the issue of contextual effects on health and disease outcomes. The majority of these studies fall short of providing a theoretical basis with which to explain what context is and how it affects individual disease outcomes. We propose a theoretical model, entitled collective lifestyles, which brings together three concepts from practice theory: social structure, social practices and agency. We do so in an attempt to move away from both behavioural and structural-functionalist explanations of the differential distribution of disease outcomes among areas by including a contextualisation of health behaviours that considers their meaning. We test the framework using the empirical example of smoking and pre-adolescents in 32 communities across Québec, Canada. Social structure is operationalised as characteristics and resources; characteristics are the socio-economic aggregate characteristics of individuals culled from the 1996 Canadian Census, and resources are what regulates and transforms smoking practices. Information about social practices was collected in focus groups with pre-adolescents from four of the participating communities. Using zero-order and partial correlations we find that a portrait of communities emerges. Where there is a high proportion of more socio-economically advantaged people, resources tend to be more smoking discouraging, with the opposite being true for disadvantaged communities. Upon analysis of the focus group material, however, we find that the social practices in communities do not necessarily reflect the "objectified" measures of social structure. We suggest that a different conceptualisation of accessibility and lifestyle in contextual studies may enable us to improve our grasp on how differential rates of disease come about in local areas.

Adolescent↗