novembre 2015 · Numéro 151
Dans ce bulletin :
- Présentation de notre dernier module dapprentissage en ligne
- Avez-vous manqué lun de nos webinaires?
- Quoi de neuf dans Public Health +?
- Inscrivez-vous dès maintenant à ces webinaires gratuits du CCNMO
- Webinaire à venir de HealthEvidence.org
Présentation de notre dernier module dapprentissage en ligne
Prise de décisions fondée sur les données probantes pour les gestionnaires
À qui le module est-il destiné?
Grâce à ce module, vous apprendrez à :
- utiliser une liste de contrôle pour déterminer si votre personnel suit les sept étapes du CCNMO pour la santé publique fondée sur des données probantes;
- évaluer et orienter avec confiance les processus décisionnels de votre personnel;
- vous assurer que les programmes et les interventions que recommande votre personnel reposent sur les meilleures données probantes qui soient.
Prise de décisions fondée sur des données probantes pour les gestionnaires favorise l’apprentissage par un scénario réaliste en santé publique. Exercez vos compétences en remplissant la liste de contrôle pour le scénario. Voyez dans quelle mesure vos réponses correspondent aux nôtres.
Ouvrez une session dans le Centre d'apprentissage pour commencer le module Prise de décisions fondée sur des données probantes pour les gestionnaires maintenant! http://www.nccmt.ca/learningcentre/index.php
Avez-vous manqué lun de nos webinaires?
L’enregistrement de certains de nos récents webinaires est maintenant offert en ligne.
Vous pouvez rattraper les webinaires que vous avez manqués, revoir ceux que vous avez trouvés particulièrement intéressants et partager les liens vers ces activités avec vos collègues.
Ajouts récents :
Webinaire en deux parties sur l’Outil de préparation en matière de politiques
1re partie : aperçu de l’Outil de préparation en matière de politiques
- Enregistrement du webinaire (en anglais seulement) : https://www.youtube.com/watch?v=FPzViyniKDQ
- Diapositives de l’exposé (en français) : http://www.slideshare.net/NCCMT/nccmt-webinar-policyreadinesstoolpt19172015fr
2e partie : utiliser l’Outil de préparation en matière de politiques en santé publique
- Enregistrement du webinaire (en anglais seulement) : https://www.youtube.com/watch?v=cHtFaVCpvhE
- Diapositives de l’exposé (en français) : http://www.slideshare.net/NCCMT/nccmt-webinaire-outil-de-prparation-en-matire-de-politiques-2e-partie?related=1
Webinaire sur la fiche technique Anatomie d’un examen systématique du CCNMO
- Enregistrement du webinaire (en anglais seulement) : https://youtu.be/JjxbbJNXTCw
- Diapositives de l’exposé (en français) : http://www.slideshare.net/NCCMT/nccmt-webinaire-fiche-technique-anatomie-dun-examen-systmatique?related=1
Surveillez les autres enregistrements de webinaire qui seront publiés plus tard : https://www.youtube.com/playlist?list=PL50nkPezdX7mBtoN87KovgYix_2h3lOxr
Quoi de neuf dans Public Health +?
Corticosteroids for the common cold.
BACKGROUND: The common cold is a frequent illness, which, although benign and self limiting, results in many consultations to primary care and considerable loss of school or work days. Current symptomatic treatments have limited benefit. Corticosteroids are an effective treatment in other upper respiratory tract infections and their anti-inflammatory effects may also be beneficial in the common cold. This updated review has included one additional study. OBJECTIVES: To compare corticosteroids versus usual care for the common cold on measures of symptom resolution and improvement in children and adults. SEARCH METHODS: We searched Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 4), which includes the Acute Respiratory Infections (ARI) Group`s Specialised Register, the Database of Reviews of Effects (DARE) (2015, Issue 2), NHS Health Economics Database (2015, Issue 2), MEDLINE (1948 to May week 3, 2015) and EMBASE (January 2010 to May 2015). SELECTION CRITERIA: Randomised, double-blind, controlled trials comparing corticosteroids to placebo or to standard clinical management. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. We were unable to perform meta-analysis and instead present a narrative description of the available evidence. MAIN RESULTS: We included three trials (353 participants). Two trials compared intranasal corticosteroids to placebo and one trial compared intranasal corticosteroids to usual care; no trials studied oral corticosteroids. In the two placebo-controlled trials, no benefit of intranasal corticosteroids was demonstrated for duration or severity of symptoms. The risk of bias overall was low or unclear in these two trials. In a trial of 54 participants, the mean number of symptomatic days was 10.3 in the placebo group, compared to 10.7 in those using intranasal corticosteroids (P value = 0.72). A second trial of 199 participants reported no significant differences in the duration of symptoms. The single-blind trial in children aged two to 14 years, who were also receiving oral antibiotics, had inadequate reporting of outcome measures regarding symptom resolution. The overall risk of bias was high for this trial. Mean symptom severity scores were significantly lower in the group receiving intranasal steroids in addition to oral amoxicillin. One placebo-controlled trial reported the presence of rhinovirus in nasal aspirates and found no differences. Only one of the three trials reported on adverse events; no differences were found. Two trials reported secondary bacterial infections (one case of sinusitis, one case of acute otitis media; both in the corticosteroid groups). A lack of comparable outcome measures meant that we were unable to combine the data. AUTHORS` CONCLUSIONS: Current evidence does not support the use of intranasal corticosteroids for symptomatic relief from the common cold. However, there were only three trials, one of which was very poor quality, and there was limited statistical power overall. Further large, randomised, double-blind, placebo-controlled trials in adults and children are required to answer this question.
The full text may be available from PubMed
Intermittent oral iron supplementation during pregnancy.
BACKGROUND: Anaemia is a frequent condition during pregnancy, particularly among women in low- and middle-income countries. Traditionally, gestational anaemia has been prevented with daily iron supplements throughout pregnancy, but adherence to this regimen due to side effects, interrupted supply of the supplements, and concerns about safety among women with an adequate iron intake, have limited the use of this intervention. Intermittent (i.e. two or three times a week on non-consecutive days) supplementation has been proposed as an alternative to daily supplementation. OBJECTIVES: To assess the benefits and harms of intermittent supplementation with iron alone or in combination with folic acid or other vitamins and minerals to pregnant women on neonatal and pregnancy outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group`s Trials Register (31 July 2015), the WHO International Clinical Trials Registry Platform (ICTRP) (31 July 2015) and contacted relevant organisations for the identification of ongoing and unpublished studies (31 July 2015). SELECTION CRITERIA: Randomised or quasi-randomised trials. DATA COLLECTION AND ANALYSIS: We assessed the methodological quality of trials using standard Cochrane criteria. Two review authors independently assessed trial eligibility, extracted data and conducted checks for accuracy. MAIN RESULTS: This review includes 27 trials from 15 countries, but only 21 trials (with 5490 women) contributed data to the review. All studies compared daily versus intermittent iron supplementation. The methodological quality of included studies was mixed and most had high levels of attrition.The overall assessment of the quality of the evidence for primary infant outcomes was low and for maternal outcomes very low.Of the 21 trials contributing data, three studies provided intermittent iron alone, 14 intermittent iron + folic acid and four intermittent iron plus multiple vitamins and minerals in comparison with the same composition of supplements provided in a daily regimen.Overall, for women receiving any intermittent iron regimen (with or without other vitamins and minerals) compared with a daily regimen there was no clear evidence of differences between groups for any infant primary outcomes: low birthweight (average risk ratio (RR) 0.82; 95% confidence interval (CI) 0.55 to 1.22; participants = 1898; studies = eight; low quality evidence), infant birthweight (mean difference (MD) 5.13 g; 95% CI -29.46 to 39.72; participants = 1939; studies = nine; low quality evidence), premature birth (average RR 1.03; 95% CI 0.76 to 1.39; participants = 1177; studies = five; low quality evidence), or neonatal death (average RR 0.49; 95% CI 0.04 to 5.42; participants = 795; studies = one; very low quality). None of the studies reported congenital anomalies.For maternal outcomes, there was no clear evidence of differences between groups for anaemia at term (average RR 1.22; 95% CI 0.84 to 1.80; participants = 676; studies = four; I(2) = 10%; very low quality). Women receiving intermittent supplementation had fewer side effects (average RR 0.56; 95% CI 0.37 to 0.84; participants = 1777; studies = 11; I(2) = 87%; very low quality) and were at lower risk of having high haemoglobin (Hb) concentrations (greater than 130 g/L) during the second or third trimester of pregnancy (average RR 0.53; 95% CI 0.38 to 0.74; participants = 2616; studies = 15; I(2) = 52%; (this was not a primary outcome)) compared with women receiving daily supplements. There were no significant differences in iron-deficiency anaemia at term between women receiving intermittent or daily iron + folic acid supplementation (average RR 0.71; 95% CI 0.08 to 6.63; participants = 156; studies = one). There were no maternal deaths (six studies) or women with severe anaemia in pregnancy (six studies). None of the studies reported on iron deficiency at term or infections during pregnancy.Most of the studies included in the review (14/21 contributing data) compared intermittent oral iron + folic acid supplementation compared with daily oral iron + folic acid supplementation (4653 women) and findings for this comparison broadly reflect findings for the main comparison (any intermittent versus any daily regimen).Three studies with 464 women examined supplementation with intermittent oral iron alone compared with daily oral iron alone. There were no clear differences between groups for mean birthweight, preterm birth, maternal anaemia or maternal side effects. Other primary outcomes were not reported.Four studies with a combined sample size of 412 women compared intermittent oral iron + vitamins and minerals supplementation with daily oral iron + vitamins and minerals supplementation. Results were not reported for any of the review`s infant primary outcomes. One study reported fewer maternal side effects in the intermittent iron group, and two studies that more women were anaemic at term compared with those rec
The full text may be available from PubMed
Dried Blood Spots: A Tool to Ensure Broad Access to Hepatitis C Screening, Diagnosis, and Treatment Monitoring.
BACKGROUND: With the advent of highly efficient antiviral therapies for hepatitis C virus (HCV) infection, providing broad access to diagnosis and care is needed. The dried blood spot (DBS) technique can be used to collect, store, and ship whole-blood specimens. Our goal was to assess the performance of standardized HCV diagnostic and monitoring tools in the analysis of DBS. METHODS: Serum specimens and whole-blood specimens collected using the DBS technique from >500 patients were tested for virological markers used to diagnose and monitor HCV infection. RESULTS: Enzyme immunoassay detection of anti-HCV antibodies in specimens from DBS was reliable after establishment of a new signal-to-cutoff ratio. HCV RNA was detected DBS from the vast majority of patients with active replication, but HCV RNA levels were substantially lower than in serum specimens, implying that only the presence or absence of HCV RNA or changes in the HCV RNA level should be taken into consideration for therapy. Detection of HCV core antigen in specimens from DBS was not a sensitive marker of chronic HCV infection. HCV genotype determination was possible in the vast majority of DBS. CONCLUSIONS: This study shows that whole-blood specimens collected using the DBS technique can be confidently used to diagnose and monitor HCV infection. DBS could help improve access to care for HCV infection because they are suitable for use in large-scale screening programs, diagnosis, and therapeutic monitoring.
The full text may be available from PubMed
Independent Evaluation of Middle School-Based Drug Prevention Curricula: A Systematic Review.
Importance: Lack of robust program evaluation has hindered the effectiveness of school-based drug abuse prevention curricula overall. Independently evaluated randomized controlled trials (RCTs) of universal, middle school-based drug abuse prevention curricula are the most useful indicators of whether such programs are effective or ineffective. Objective: To conduct a systematic review identifying independently evaluated RCTs of universal, middle school-based drug abuse prevention curricula; extract data on study quality and substance use outcomes; and assess evidence of program effectiveness. Evidence Review: PsycInfo, Educational Resources Information Center, Science Citation Index, Social Science Citation Index, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched between January 1, 1984, and March 15, 2015. Search terms included variations of drug, alcohol, tobacco, and marijuanause, as well as school, prevention, and effectiveness. Studies included in the review were RCTs carried out by independent evaluators of universal school-based drug prevention curricula available for dissemination in the United States that reported alcohol, tobacco, marijuana, or other drug use outcomes. Two researchers extracted data on study quality and outcomes independently using a data extraction form and met to resolve disagreements. Findings: A total of 5071 publications were reviewed, with 13 articles meeting final inclusion criteria. Of the 13 articles, 6 RCTs of 4 distinct school-based curricula were identified for inclusion. Outcomes were reported for 42 single-drug measures in the independent RCTs, with just 3 presenting statistically significant (P < .05) differences between the intervention group and the control group. One program revealed statistically significant positive effects at final follow-up (Lions-Quest Skills for Adolescence). Conclusions and Relevance: The results of our review demonstrate the dearth of independent research that appropriately evaluates the effectiveness of universal, middle school-based drug prevention curricula. Independent evaluations show little evidence of effectiveness for widely used programs. New methods may be necessary to approach school-based adolescent drug prevention.
The full text may be available from PubMed
Inscrivez-vous dès maintenant à ces webinaires gratuits du CCNMO
Ces webinaires sont offert en anglais. Les enregistrements seront disponibles en ligne après l'événement. Les diapositives PPT seront aussi affichées en ligne, en anglais et en français. Les diapos en langue française sont disponibles avant le webinaire; il suffit de les demander au : nccmt@mcmaster.ca
Webinaire portant sur le Cadre consolidé pour l'application de la recherce (CCAR)
12 novembre 2015
13 h à 14 h 30 (HNE)
Le Cadre consolidé pour l’application de la recherche peut vous aider à identifier les obstacles à l’application et les éléments qui la facilitent; à suivre le progrès vers les objectifs de l’application; et à évaluer les résultats ou l’impact de l’intervention.
Joignes-vous à nous pour en savoir davantage au sujet de l’outil CCAR : http://ow.ly/T7WHR
Consultez un aperçu de cet outil élaboré par le CCNMO au : http://www.nccmt.ca/registry/view/eng/210.html
Webinaire sur l’Outil d’applicabilité et de transférabilité des données probantes (Outil A&T).
9 décembre 2015
13 h à 14 h 30 (HNE)
Cet outil vous aide à décider si une intervention qui a réussi dans un contexte obtiendra les mêmes résultats dans un autre contexte. Les présentateurs du Service de santé publique de Sudbury et du district expliqueront comment le SSPSD utilise cet outil dans sa pratique.
Cliquez ici pour vous inscrire : http://ow.ly/T7WUe
Consultez le sommaire de l’Outil A&T élaboré par le CCNMO au: http://www.nccmt.ca/registry/view/fra/24.html
Webinaire à venir de HealthEvidence.org
Ces webinaires mettent en vedette des auteurs de revues systématiques qui présentent leurs résultats.
Supplémentation alimentaire pour améliorer la santé des enfants socio-économiquement défavorisés : quelles sont les données probantes?
23 novembre 2015
de 13 h à 14 h 30 (HAE)
Joignez-vous à Mme Elizabeth Kristjansson, Professeure, École de psychologie, Université d’Ottawa, pour un aperçu de sa dernière revue systématique Cochrane qui examine l’efficacité des programmes de supplémentation alimentaire pour améliorer la santé physique et psychosociale des enfants socio-économiquement défavorisés :
Kristjansson E., Francis D.K., Liberato S., Benkhalti J.M., Welch V., Batal M., et al. Supplémentation alimentaire pour améliorer la santé physique et psychosociale des enfants socio-économiquement défavorisés âgés de trois mois à cinq ans (2015). Cochrane Database of Systematic Reviews,2015(2), Art. No. : CD009924. Accessible au: http://healthevidence.org/view-article.aspx?a=28630
