Lori Curtis

Antecedent-Consequence Conditions in Maternal Mood and Child Adjustment: A Four-Year Cross-Lagged Study

Examined the mutual influence on maternal depressive symptoms and child adjustment problems and their antecedent-consequence conditions across 3 cycles of panel data collected over a 4-year period in the National Longitudinal Survey of Children and Youth (NLSCY). Results indicated stability in, and relations between, maternal and child outcomes. Cross-lagged panel correlations showed that maternal depressive symptoms tended to precede child aggression and hyperactivity but tended to follow child emotional problems. Temporal relations were interpreted in the context of mechanisms that transmit risk between mothers and children. Logistic regression analysis showed bidirectional risk between maternal mood and child adjustment after earlier symptoms were statistically controlled. These findings indicate that maternal depression increases the risk of adjustment problems in children, and vice versa, underscoring the intergenerational transmission of psychopathology.

Temporal relations in daily-reported maternal mood and disruptive child behavior

Examined temporal relations between maternal mood and disruptive child behaviour using daily assessments of 30 mother–child dyads carried out over 8 consecutive weeks (623 pooled observations). Pooled time-series analyses showed synchronous fluctuation in child behaviour and maternal distress. Time-lagged models showed temporal relations between maternal and child outcomes that changed according to the type of maternal mood and child behaviour being reported. Controlling for cross-sectional relations, maternal anger and fatigue were related to previous child inattentive/impulsive/overactive behaviour (IO) and maternal confusion related to previous child oppositional/defiant behaviour (OD). However, maternal depression, low vigour, anger, and anxiety each predicted subsequent child IO and maternal confusion and anxiety each predicted subsequent child OD. Mutual influences on maternal and child functioning were interpreted in the context of interpersonal mechanisms that mediate psychological problems within families and their implications for treatment.

All in the Family: A Simultaneous Model of Parenting Style and Child Conduct

The upbringing of children is modeled as a modified principal agent problem in which children attempt to maximize their own well-being when faced with a parenting strategy chosen by the parent, to maximize parents perception of family well-being. Thus, children as well as parents are players, but children have higher discount rates than parents. The simultaneity of parenting and child behaviour is confirmed using the 1994 Canadian National Longitudinal Survey of Children.

Child Poverty in Canada

A 1989 all-party motion of parliament called for the elimination of child poverty in Canada by the year 2000. Despite a series of policy initiatives, recent reports suggest that the child poverty rate may now be comparable to that in 1989. The apparent persistence of child poverty in Canada might reflect socioeconomic developments, or something about the way that child poverty is measured. Using micro data covering the period 1986 to 2000 we find little support for these explanations.

Lone Motherhood and Health Status

This study focuses on the health status of women with children, particularly lone mothers, the beneficiaries of many policies. Data from the 1994 Statistics Canadas National Population Health Survey indicate that lone mothers have, on average, consistently lower unconditional health status than married mothers. However, lone mothers also have, on average, lower levels of health inputs. Once age, income, education, lifestyle factors, family size, and other recognized determinants of health are controlled for, lone mothers are at least no worse off than married mothers when it comes to health status. This evidence points toward promoting policies directed at increasing the education, income and lifestyle factors of lone mothers if we wish to improve their health status.

Comparing Hospital Staff Nutrition Knowledge, Attitudes, and Practices Before and 1 Year After Improving Nutrition Care: Results From the More-2-Eat Implementation Project

BACKGROUND Staff play key roles in the prevention, detection, and treatment of hospital malnutrition. Understanding staff knowledge, attitudes, and practices (KAP) is important for developing and evaluating change management strategies. METHODS The More-2-Eat project improved nutrition care in 5 Canadian hospitals by implementing the Integrated Nutrition Pathway for Acute Care (INPAC). To understand staff views before (T1) and after 1 year of implementation (T2), a reliable KAP questionnaire, based on INPAC, was administered. T2 included questions about involvement in implementation. The mean difference between T2 and T1 responses was calculated, and t tests were used for comparisons. RESULTS The questionnaire was completed at T1 (n = 189) and T2 (n = 147) (unpaired); 57 staff completed both questionnaires (paired). A significant increase in total score was seen in unpaired results at T2 (from 93.6/128 [range, 51-124] to 99.5/128 [range, 54-119]; t = 5.97, P < .0001), with an increase in knowledge/attitudes (KA) (t = 2.4, P = .016) and practice (t = 3.57, P < .0001) components. There were no statistically significant changes in paired responses. Seventy percent (n = 102/147) noticed positive changes in practices, 12% (n = 18) noticed positive/negative changes, 1% (n = 1) noticed negative change, and 17% (n = 25) noticed no change. Fifty-nine percent (n = 86) felt involved in the change, and these staff had higher KA and KAP scores than those who did not feel involved. CONCLUSION Staff involvement is important in the implementation process for improving nutrition care.

Implications of the Introduction of the Goods and Services Tax for Families in Canada

Dans cet article, nous appliquons le modèle QAIDS (Quadratic Almost Ideal Demand System) aux données de l’Enquête canadienne sur les dépenses des familles pour analyser les changements qu’a entraînés la mise en place de la taxe sur les produits et services (TPS) dans le bien-être des ménages, et particulièrement des ménages comprenant des enfants. Nous calculons ces changements en estimant la différence de dépenses nécessaire pour maintenir l’utilité indirecte d’avant la TPS. Nous observons que deux ménages sur trois, et un ménage à faible revenu sur trois, ont vu leur bien-être décroître ; les résultats sont les mêmes pour les ménages comprenant des enfants. Nous concluons ainsi que l’objectif invoqué au moment de la création de la TPS, soit accroître le bien-être des ménages à faible revenu et à revenu moyen, n’a pas été atteint.

Handgrip Strength, but Not 5-Meter Walk, Adds Value to a Clinical Nutrition Assessment: McNicholl et al

BACKGROUND Decreased physical functioning is associated with malnutrition and common in acute care patients; determining loss of function is often considered part of a comprehensive nutrition assessment. Handgrip strength (HGS) and 5-meter timed walk (5m) are functional measures used in a variety of settings. This analysis sought to determine which functional measure could be added to a hospital nutrition assessment, based on its feasibility and capacity to discriminate patient subgroups. METHODS Eligible medical patients (no delirium/dementia, admitted from community; n = 1250), recruited from 5 hospitals that participated in a previous multisite action research study, provided data on demographics, HGS, 5m, nutrition status, perceived disability, and other characteristics. RESULTS Significantly more patients (z = 17.39, P < .00001) were able to complete HGS than 5m (92% versus 43%, respectively). Median HGS was 28.0 kg for men and 14.7 kg for women. Of patients who completed the 5m, mean completion time was 8.98 seconds (median, 6.79 seconds, SD = 6.59). 5m and HGS scores were significantly worse with patient-perceived disability (z = -9.56, t = 10.69, respectively; P < .0001; 95% confidence interval [CI], [7.33, 10.63]; [1.76, 3.18]). HGS was associated with nutrition status (t = 4.13, P < .001; 95% CI [2.02, 5.67]), although it showed poor validity as a single nutrition indicator. CONCLUSIONS These data indicate that HGS is a more useful functional measure than 5m when added to a hospital nutrition assessment. Determination of HGS cutpoints to identify low strength in acute care patients will promote its use.

Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study

Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected patients recruited from 5 medical units across Canada (n = 513) consented to 30-days post-discharge data collection with 48.5% (n = 249) completing the telephone interview. Use of nutrition care post-discharge was reported and bivariate analysis completed with relevant covariates for the two most frequently reported activities, following recommendations post-discharge or use of oral nutritional supplements (ONS). A total of 42% (n = 110) received nutrition recommendations at hospital discharge, with 65% (n = 71/110) of these participants following those recommendations; 26.5% (n = 66) were taking ONS after hospitalization. Participants who followed recommendations were more likely to report following a special diet (p = 0.002), different from before their hospitalization (p = 0.008), compared to those who received recommendations, but reported not following them. Patients taking ONS were more likely to be at nutrition risk (p < 0.0001), malnourished (p = 0.0006), taking ONS in hospital (p = 0.01), had a lower HGS (p = 0.0013; males only), and less likely to believe they were eating enough to meet their body’s needs (p = 0.005). This analysis provides new insights on nutrition-care post-discharge.