octobre 2015 · Numéro 150
Dans ce bulletin :
- Nous souhaitons connaître votre avis!
- Quoi de neuf dans Public Health +?
- Inscrivez-vous dès maintenant à ces webinaires gratuits du CCNMO
- Webinaire à venir de HealthEvidence.org
- Nouvelle étude visant à accroître la sensibilisation et lutilisation des données probantes en prévention du cancer
Nous souhaitons connaître votre avis!
Aidez à choisir le sujet de la prochaine vidéo de notre série Comprendre les données probantes issues de la recherche.
Les vidéos Comprendre les données probantes issues de la recherche (CDPIR) ont été créées dans le but d’expliquer des idées complexes par une narration concise en langage simple et des éléments animés pour illustrer des exemples réalistes en santé publique.
Il s’est avéré que les vidéos ont un effet positif sur les connaissances et l’auto-efficacité, alors nous prévoyons en produire une autre. (Cliquez ici pour lire notre article dans Sélection santé du ACSP : http://www.cpha.ca/fr/about/digest/39-3/1.aspx)
Les sujets abordés dans les quatre premières vidéos de la série (rapports de cotes, intervalles de confiance, graphiques en forêt et signification clinique) ont été choisis d’après les rétroactions à des ateliers et l’expérience vécue par des membres du personnel du CCNMO. Plus tard, nous avons invité des utilisateurs à participer à un sondage en ligne afin qu’ils choisissent des sujets pour d’autres vidéos dans la même série. Les réponses au sondage nous ont amenés à créer des vidéos sur le nombre de sujets à traiter, les valeurs P, le risque relatif, la prise de décisions fondée sur des données probantes, la pyramide des 6 S et la différence moyenne standardisée.
Maintenant, nous faisons encore appel à vous!
Sur quoi notre prochaine vidéo devrait-elle porter? Votez pour le sujet que vous voudriez voir inclure dans la série.
Le sondage est mené sur une période limitée. Veuillez soumettre vos réponses avant le 7 novembre 2015 afin que nous puissions nous mettre au travail.
Cliquez ici pour accéder au sondage maintenant : https://nccmt.co1.qualtrics.com/SE/?SID=SV_d5txIx4zb94MAAZ
Quoi de neuf dans Public Health +?
Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation.
BACKGROUND: Effective pharmacotherapies are available to help people who are trying to stop smoking, but quitting can still be difficult and providing higher levels of behavioural support may increase success rates further. OBJECTIVES: To evaluate the effect of increasing the intensity of behavioural support for people using smoking cessation medications, and to assess whether there are different effects depending on the type of pharmacotherapy, or the amount of support in each condition. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialised Register in May 2015 for records with any mention of pharmacotherapy, including any type of nicotine replacement therapy (NRT), bupropion, nortriptyline or varenicline that evaluated the addition of personal support or compared two or more intensities of behavioural support. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials in which all participants received pharmacotherapy for smoking cessation and conditions differed by the amount of behavioural support. The intervention condition had to involve person-to-person contact. The control condition could receive less intensive personal contact, or just written information. We did not include studies that used a contact-matched control to evaluate differences between types or components of support. We excluded trials recruiting only pregnant women, trials recruiting only adolescents, and trials with less than six months follow-up. DATA COLLECTION AND ANALYSIS: One author prescreened search results and two authors agreed inclusion or exclusion of potentially relevant trials. One author extracted data and another checked them.The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS: Forty-seven studies met the inclusion criteria with over 18,000 participants in the relevant arms. There was little evidence of statistical heterogeneity (I(2) = 18%) so we pooled all studies in the main analysis. There was evidence of a small but statistically significant benefit from more intensive support (RR 1.17, 95% CI 1.11 to 1.24) for abstinence at longest follow-up. All but four of the included studies provided four or more sessions of support to the intervention group. Most trials used NRT. We did not detect significant effects for studies where the pharmacotherapy was nortriptyline (two trials) or varenicline (one trial), but this reflects the absence of evidence.In subgroup analyses, studies that provided at least four sessions of personal contact for the intervention and no personal contact for the control had slightly larger estimated effects (RR 1.25, 95% CI 1.08 to 1.45; 6 trials, 3762 participants), although a formal test for subgroup differences was not significant. Studies where all intervention counselling was via telephone (RR 1.28, 95% CI 1.17 to 1.41; 6 trials, 5311 participants) also had slightly larger effects, and the test for subgroup differences was significant, but this subgroup analysis was not prespecified. In this update, the benefit of providing additional behavioural support was similar for the subgroup of trials in which all participants, including controls, had at least 30 minutes of personal contact (RR 1.18, 95% CI 1.06 to 1.32; 21 trials, 5166 participants); previously the evidence of benefit in this subgroup had been weaker. This subgroup was not prespecified and a test for subgroup differences was not significant. We judged the quality of the evidence to be high, using the GRADE approach. We judged a small number of trials to be at high risk of bias on one or more domains, but findings were not sensitive to their exclusion. AUTHORS` CONCLUSIONS: Providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking has a small but important effect. Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 25%, based on a pooled estimate from 47 trials. Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support.
The full text may be available from PubMed
A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes.
OBJECTIVES: We evaluated the weight loss effectiveness of a YMCA model for the Diabetes Prevention Program (DPP) lifestyle intervention. METHODS: Between July 2008 and November 2010, we individually randomized 509 overweight or obese, low-income, nondiabetic adults with elevated blood glucose in Indianapolis, Indiana, to receive standard care plus brief lifestyle counseling or be offered a group-based YMCA adaptation of the DPP (YDPP). Primary outcome was mean weight loss difference at 12 months. In our intention-to-treat analyses, we used longitudinal linear or logistic regression, multiply imputing missing observations. We used instrumental variables regression to estimate weight loss effectiveness among participants completing 9 or more intervention lessons. RESULTS: In the YDPP arm, 161 (62.6%) participants attended >/= 1 lesson and 103 (40.0%) completed 9 or more lessons. In intention-to-treat analysis, mean 12-month weight loss was 2.3 kilograms (95% confidence interval [CI] = 1.1, 3.4 kg) more for the YDPP arm than for standard care participants. In instrumental variable analyses, persons attending 9 or more lessons had a 5.3-kilogram (95% CI = 2.8, 7.9 kg) greater weight loss than did those with standard care alone. CONCLUSIONS: The YMCA model for DPP delivery achieves meaningful weight loss at 12 months among low-income adults.
The full text may be available from PubMed
Behavioral Programs for Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis.
Background: Whether behavioral approaches for self-management programs benefit individuals with type 1 diabetes is unclear. Purpose: To determine the effects of behavioral programs for patients with type 1 diabetes on behavioral, clinical, and health outcomes and to investigate factors that might moderate effect. Data Sources: 6 electronic databases (1993 to June 2015), trial registries and conference proceedings (2011 to 2014), and reference lists. Study Selection: 35 prospective controlled studies involving participants of any age group that compared behavioral programs with usual care, active controls, or other programs. Data Extraction: One reviewer extracted and another verified data. Two reviewers assessed quality and strength of evidence (SOE). Data Synthesis: Moderate SOE showed reduction in glycated hemoglobin (HbA1c) at 6 months after the intervention compared with usual care (mean difference, -0.29 [95% CI, -0.45 to -0.13]) percentage points and compared with active controls (-0.44 [CI, -0.69 to -0.19]) percentage points. At end of intervention and 12 months` follow-up or longer, there were no statistically significant differences in HbA1c (low SOE) for comparisons with usual care or active control. Compared with usual care, generic quality of life at program completion did not differ (moderate SOE). Other outcomes had low or insufficient SOE. Adults appeared to benefit more for glycemic control at program completion (-0.28 [CI, -0.57 to 0.01]) percentage points than did youth (-0.12 [CI, -0.43 to 0.19]) percentage points. Program intensity appeared not to influence effectiveness; some individual delivery appears beneficial. Limitations: All studies had medium or high risk of bias. There was scarce evidence for many outcomes. Conclusion: Behavioral programs for type 1 diabetes offer some benefit for glycemic control, at least at short-term follow-up, but improvement for other outcomes has not been shown. Primary Funding Source: Agency for Healthcare Research and Quality.
The full text may be available from PubMed
Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity: RCT.
OBJECTIVE: To investigate the efficacy of water preloading before meals as a weight loss strategy for adults with obesity. METHODS: A two-group randomized controlled trial was conducted in Birmingham, England. Eighty-four adults with obesity were recruited from general practices. All participants were given a face-to-face weight management consultation at baseline (30 min) and a follow-up telephone consultation at 2 weeks (10 min). At baseline, participants were randomized to either drinking 500 ml of water 30 min before their main meals or an attention control group where participants were asked to imagine their stomach was full before meals. The primary outcome was weight change at 12-week follow-up. Several measures of adherence were also used, including 24 h total urine collections. RESULTS: 41 participants were randomized to the intervention group and 43 to the comparator group. The water preloading group lost -1.3 kg (95% CI -2.4 to -0.1, P = 0.028) more than comparators at follow up. Adjusting for ethnicity, deprivation, age, and gender resulted in the intervention group losing -1.2 kg (95% CI -2.4 to 0.07, P = 0.063) more than the comparator. CONCLUSIONS: There is preliminary evidence that water preloading before main meals leads to a moderate weight loss at follow up. ISRCTN33238158.
The full text may be available from PubMed
A systematic review of SNAPO (Smoking, Nutrition, Alcohol, Physical activity and Obesity) randomized controlled trials in young adult men.
OBJECTIVES: To investigate the effectiveness of Smoking, Nutrition, Alcohol, Physical activity and Obesity (SNAPO) interventions in young men exclusively. The secondary aim was to evaluate the recruitment, retention and engagement strategies. METHODS: A search with no date restrictions was conducted across seven databases. Randomized controlled trials recruiting young men only (aged 18-35years) into interventions targeting any SNAPO risk factors were included. RESULTS: Ten studies were included (two nutrition, six alcohol use, two targeting multiple SNAPO risk factors). Six studies (two nutrition, three alcohol use and one targeting multiple SNAPO risk factors) demonstrated significant positive short-term intervention effects, but impact was either not assessed beyond the intervention (n=3), had short-term follow-up (</=6months) (n=2) or not sustained beyond six months (n=1). Overall, a high risk of bias was identified across studies. Only one study undertook a power calculation and recruited the required sample size. Adequate retention was achieved in three studies. Effectiveness of engagement strategies was not reported in any studies. CONCLUSIONS: Despite preliminary evidence of short-term effectiveness of SNAPO interventions in young men, few studies characterized by a high risk of bias were identified. High quality SNAPO interventions for young men are warranted.
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 recherche (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
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,
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
Pour vous inscrire : http://ow.ly/Sif54
Nouvelle étude visant à accroître la sensibilisation et lutilisation des données probantes en prévention du cancer
Health Evidence a commencé à recruter des professionnels de la santé publique à travers le Canada dans les domaines de la consommation du tabac et d'alcool, de la promotion de comportements sécuritaires au soleil, de la nutrition et de l'activité physique. Nous demanderons à ces derniers de participer à une étude Soutien à la sensibilisation et à l'utilisation des connaissances en prévention du cancer dans la pratique financée par les Instituts de recherche en santé du Canada (http://www.cihr-irsc.gc.ca/f/193.html).
Situé à l’Université McMaster, ce projet vise à renforcer les capacités des professionnels de la santé publique dans l’utilisation des données probantes dans la prise de décisions en planification de programmes. Les participants recevront, sur une période de 18 mois, des données de recherche rigoureuses, sous la forme de revues systématiques par l'intermédiaire de trois différentes stratégies : Twitter, des webinaires, et/ou des courriels personnalisés. Les participants seront interrogés au tout début de l’étude (automne 2015) et à la fin de l'étude (printemps 2017) pour évaluer la sensibilisation et l’utilisation des données probantes issues de la recherche.
