This webinar has been made possible with support from the                  Canadian Institutes of Health Research       We...
The Health Evidence TeamMaureen Dobbins                     Kara DeCorby                          Daiva TirilisScientific ...
What is www.health-evidence.ca?                     Evidence                          inform              Decision Making
Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EI...
Questions?
Meetings, Planning &Dissemination Project
CIHR-Funded Reviews Kramer, M.S., & Kakuma, R. (2002). Optimal duration  of exclusive breastfeeding. Cochrane Database of...
Summary Statement:Kramer (2002)
Overall Considerations1234567
Interpreting the EvidenceGrowth among EBF infants for 6 months vs. EBF for 3-4months and MBF thereafter through 6 months  ...
Weight Gain Weight gain at 3-8 months was significantly higher in MBF compared  to EBF infants (WMD – 12.45, 95% CI -23.4...
Weight Gain No impact for EBF vs. MBF infants on weight gain at 8-12 months.
Interpreting the EvidenceMorbidity and mortality among infants EBF for 6 months vs.EBF for 3-4 months and MBF thereafter t...
Gastrointestinal Infections• EBF infants were 33% less likely to have GI infection in the first 12  months compared to MBF...
Interpreting the EvidenceMorbidity and mortality among infants EBF for 6 months vs.EBF for 3-4 months and MBF thereafter t...
Acute Otitis Media (ear infection)• MBF infants were 28% more likely to have one or more episodes of  otitis media compare...
Overall Considerations1234567
Questions?
Summary Statement:Kramer (2003)
Overall Considerations                  Considerations for Public Health Practice  Conclusions from Health Evidence       ...
Interpreting the EvidenceNutritional advice to increase energy and protein intake          What’s the evidence?           ...
Preterm birth• Effective in reducing the risk of preterm birth (by 54% with the true  risk reduced from 2-79%).
Interpreting the EvidenceHigh protein supplementation          What’s the evidence?                        Implications fo...
Small-for-gestational Age• Increased risk of small for gestational age (by 58% with the true risk  reduced from 3-141%).
Interpreting the EvidenceEnergy/protein restriction in women with overweight or highweight gain         What’s the evidenc...
Head Circumference• Resulted in small head circumference at birth (by 1cm with a range  from 0.14 cm to 1.86 cm smaller).
Overall Considerations                Considerations for Public Health Practice Conclusions from Health Evidence          ...
Questions?
Discussion ForumPlease continue to discuss this topic and other        topics on our discussion forum.       www.health-ev...
EvaluationPlease check your emails for the evaluation    link. If you do not receive one, e-mail Jennifer McGugan at mcgug...
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Reproductive Health Program Planning in Public Health: What's the Evidence?

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Presented as part of a Canadian Institutes of Health funded Meetings, Planning & Dissemination grant (1 of 4 webinars). Recorded November 3, 2011.

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Reproductive Health Program Planning in Public Health: What's the Evidence?

  1. 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome!Reproductive HealthProgram Planning:What’s the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. The Health Evidence TeamMaureen Dobbins Kara DeCorby Daiva TirilisScientific Director Administrative Director Research CoordinatorTel: 905 525-9140 ext 22481 Tel: (905) 525-9140 ext. 20461 Tel: (905) 525-9140 ext. 20460E-mail: dobbinsm@mcmaster.ca E-mail: kdecorby@health-evidence.ca E-mail: dtirilis@health-evidence.caLori Greco Heather Husson Robyn Traynor Lyndsey McRaeKnowledge Broker Project Manager Research Coordinator Research Assistant
  3. 3. What is www.health-evidence.ca? Evidence inform Decision Making
  4. 4. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  5. 5. Questions?
  6. 6. Meetings, Planning &Dissemination Project
  7. 7. CIHR-Funded Reviews Kramer, M.S., & Kakuma, R. (2002). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews,2002 (Issue 1), Art. No. CD003517. DOI: 10.1002/14651858.CD003517. Kramer, M.S., Kakuma, R. (2003). Energy and protein intake in pregnancy. Cochrane Database of Systematic Reviews,2003 (Issue 4), Art. No.: CD000032. DOI: 10.1002/14651858.CD000032.
  8. 8. Summary Statement:Kramer (2002)
  9. 9. Overall Considerations1234567
  10. 10. Interpreting the EvidenceGrowth among EBF infants for 6 months vs. EBF for 3-4months and MBF thereafter through 6 months What’s the evidence? Implications for practice & policy Weight Gain (4 studies) • Public health activities should• Weight gain at 3-8 months was significantly higher in acknowledge evidence indicating that MBF compared to EBF infants (WMD – 12.45, 95% MBF infants gain slightly more weight CI -23.46 to -1.44 g/mo). than EBF infants at 3-12 months, although there are no differences in Weight for age (2 studies) weight gain at any other time points.• EBF infants had significantly lower scores for weight for age at six months (WMD -0.09, 95% CI -0.16 to -0.02), nine months (WMD -0.10, 95% CI -0.18 to - 0.02), and 12 months (WMD -0.09, 95% CI -0.17 to -0.01) compared to MBF infants.
  11. 11. Weight Gain Weight gain at 3-8 months was significantly higher in MBF compared to EBF infants (WMD – 12.45, 95% CI -23.46 to -1.44 g/mo).
  12. 12. Weight Gain No impact for EBF vs. MBF infants on weight gain at 8-12 months.
  13. 13. Interpreting the EvidenceMorbidity and mortality among infants EBF for 6 months vs.EBF for 3-4 months and MBF thereafter through 6 months What’s the evidence? Implications for practice & policy Gastrointestinal infections (1 study) • Public health messages and programs should indicate that infants who are EBF• EBF infants were 33% less likely to have GI infection are less likely to have gastrointestinal in the first 12 months compared to MBF infants infections compared to MBF infants (RR 0.67, 95% CI 0.46 to 0.97).• There was no reduction in risk of hospitalization
  14. 14. Gastrointestinal Infections• EBF infants were 33% less likely to have GI infection in the first 12 months compared to MBF infants (RR 0.67, 95% CI 0.46 to 0.97).
  15. 15. Interpreting the EvidenceMorbidity and mortality among infants EBF for 6 months vs.EBF for 3-4 months and MBF thereafter through 6 months What’s the evidence? Implications for practice & policy Acute otitis media (ear infections) (2 studies) • Public health messages and programs should indicate that infants who are EBF• MBF infants were 28% more likely to have one or are less likely to have otitis media more episodes of otitis media compared to EBF compared to MBF infants; infants (RR 1.28, 95% CI 1.04 to 1.57).
  16. 16. Acute Otitis Media (ear infection)• MBF infants were 28% more likely to have one or more episodes of otitis media compared to EBF infants (RR 1.28, 95% CI 1.04 to 1.57).
  17. 17. Overall Considerations1234567
  18. 18. Questions?
  19. 19. Summary Statement:Kramer (2003)
  20. 20. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General ImplicationsThis well done review is based on low quality Public health programs should include:studies. • nutritional advice to women (but not as a sole strategy)Balanced energy/protein supplementation • encourage balanced energy/protein• improves fetal growth supplements• may reduce the risk of fetal and neonatal Public health programs should not encourage: death • isocaloric protein supplements for pregnant• equally likely to have a very minimal or women quite large impact on preterm birth • high protein supplements for pregnant• has no impact on gestational diabetes, women preeclampsia, and growth and development • energy/protein restriction for overweight• may result in possible harms (e.g. reduced pregnant women fetal growth) The findings should be used cautiously given the low quality of the evidence.*Note: The results presented are our owninterpretation for increasing energy intake.
  21. 21. Interpreting the EvidenceNutritional advice to increase energy and protein intake What’s the evidence? Implications for practice & policy• Effective in reducing the risk of preterm • Public health organizations should not birth (by 54% with the true risk reduced include nutritional advice as a sole from 2-79%). intervention. • Public health messaging should emphasize that increased energy and protein intake is associated with a decreased risk of preterm birth.
  22. 22. Preterm birth• Effective in reducing the risk of preterm birth (by 54% with the true risk reduced from 2-79%).
  23. 23. Interpreting the EvidenceHigh protein supplementation What’s the evidence? Implications for practice & policy• Increased risk of small for gestational age • Public health programs should not promote (by 58% with the true risk reduced from 3- or provide high protein supplementation as 141%). it has no impact on most maternal, fetal, and• No impact on all other outcome infant health outcomes and may, in fact, have adverse outcomes.
  24. 24. Small-for-gestational Age• Increased risk of small for gestational age (by 58% with the true risk reduced from 3-141%).
  25. 25. Interpreting the EvidenceEnergy/protein restriction in women with overweight or highweight gain What’s the evidence? Implications for practice & policy• Resulted in small head circumference at • Public health programs should not include birth (by 1cm with a range from 0.14 cm to energy/protein restriction as a means of 1.86 cm smaller). improving maternal, fetal, or infant health outcomes, since energy/protein restriction is not likely to be beneficial for maternal or infant health and may lead to smaller head circumference among infants.
  26. 26. Head Circumference• Resulted in small head circumference at birth (by 1cm with a range from 0.14 cm to 1.86 cm smaller).
  27. 27. Overall Considerations Considerations for Public Health Practice Conclusions from Health Evidence General ImplicationsThis well done review is based on low quality Public health programs should include:studies. • nutritional advice to women (but not as a sole strategy)Balanced energy/protein supplementation • encourage balanced energy/protein• improves fetal growth supplements• may reduce the risk of fetal and neonatal Public health programs should not encourage: death • isocaloric protein supplements for pregnant• equally likely to have a very minimal or women quite large impact on preterm birth • high protein supplements for pregnant• has no impact on gestational diabetes, women preeclampsia, and growth and development • energy/protein restriction for overweight• may result in possible harms (e.g. reduced pregnant women fetal growth) The findings should be used cautiously given the low quality of the evidence.
  28. 28. Questions?
  29. 29. Discussion ForumPlease continue to discuss this topic and other topics on our discussion forum. www.health-evidence.ca/forum/Login with your health-evidence username and password or register if you aren’t a member yet.Join us for a LIVE on Monday, November 7 at 1:00 pm EST to have your questions answered in real time!
  30. 30. EvaluationPlease check your emails for the evaluation link. If you do not receive one, e-mail Jennifer McGugan at mcgugj@mcmaster.ca Thank you for your participation!
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