October 2015 · Issue 149
In this issue:
- Announcing two new online learning modules
- Safe Work Space, Healthy Work Place: Celebrating Healthy Workplace Month
- New from Public Health+
- Register now for our next Spotlight on Methods and Tools webinars
- Upcoming webinars from HealthEvidence.org
- New Study Enhancing Awareness and Use of Cancer Prevention Evidence
Announcing two new online learning modules
EIDM Essentials: Key issues in evidence-informed decision making gives you a quick overview of the seven-step process recommended by NCCMT. In one hour or less, you can find out what evidence-informed public health is all about! From there, you can move on to the full (original) certificate module: Introduction to Evidence-Informed Decision Making in Public Health.
Evidence-informed Decision Making for Managers is designed especially for public health managers and directors. This one-hour module gives you the skills and information you need to guide your team through the EIDM process.
These are non-certificate modules. Learners who complete these abbreviated modules will receive a statement of completion.
Both the EIDM for Managers and EIDM Essentials modules are available in the Learning Centre: http://www.nccmt.ca/learningcentre/index.php
Safe Work Space, Healthy Work Place: Celebrating Healthy Workplace Month
Help organizations use evidence to build better workplaces
People spend a lot of time at work so increasing the safety and health of workplaces can make a real difference in lives of the population you serve. As a public health professional, you may be asked by an organization to recommend strategies to improve the health and safety of its workers. That organization may be your own! We have resources to help you find research evidence to inform your recommendations.
Learn how to tailor your search
By basing your recommendations on high quality evidence, you can help promote the development of practices and a culture that support health. Given the variety of issues facing different organizations, your search for evidence will need to be tailored. A clearly defined PICO (population, intervention, comparison, outcome) question will help (http://www.nccmt.ca/registry/view/eng/138.html). Complete our online learning module, Searching for Research Evidence in Public Health (http://www.nccmt.ca/learningcentre/), to learn more about searching or visit our website for more information about the evidence-informed public health process (http://www.nccmt.ca/eiph/index-eng.html).
Find the research evidence you need quickly
Our Search Pyramids can also help you find different types of research evidence quickly. These online tools provide links to different resources to help guide your search. There are links to pre-appraised evidence and evidence that has not yet been pre-appraised. Healthy workplaces consider issues such as physical health, mental health and workplace safety. NCCMT’s online learning module, Searching for Research Evidence in Public Health, will show you how to conduct an efficient search. NCCMT’s Injury Prevention, Environmental Health and Mental Health Search Pyramids will make finding relevant information even easier. Login to the Learning Centre to access these free resources (http://www.nccmt.ca/learningcentre).
Celebrate Healthy Workplace Month by learning how to search efficiently for high quality research evidence with our online Searching module and Search Pyramids on injury prevention, mental health and environmental health. That way you will be ready if an organization asks you for help in developing a safe and healthy workplace.
To learn more about Healthy Workplace Month, visit: http://healthyworkplacemonth.ca/en/
New from Public Health+
Calcium intake and risk of fracture: systematic review.
OBJECTIVE: To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures. DESIGN: Systematic review of randomised controlled trials and observational studies of calcium intake with fracture as an endpoint. Results from trials were pooled with random effects meta-analyses. DATA SOURCES: Ovid Medline, Embase, PubMed, and references from relevant systematic reviews. Initial searches undertaken in July 2013 and updated in September 2014. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials or cohort studies of dietary calcium, milk or dairy intake, or calcium supplements (with or without vitamin D) with fracture as an outcome and participants aged >50. RESULTS: There were only two eligible randomised controlled trials of dietary sources of calcium (n=262), but 50 reports from 44 cohort studies of relations between dietary calcium (n=37), milk (n=14), or dairy intake (n=8) and fracture outcomes. For dietary calcium, most studies reported no association between calcium intake and fracture (14/22 for total, 17/21 for hip, 7/8 for vertebral, and 5/7 for forearm fracture). For milk (25/28) and dairy intake (11/13), most studies also reported no associations. In 26 randomised controlled trials, calcium supplements reduced the risk of total fracture (20 studies, n=58 573; relative risk 0.89, 95% confidence interval 0.81 to 0.96) and vertebral fracture (12 studies, n=48 967. 0.86, 0.74 to 1.00) but not hip (13 studies, n=56 648; 0.95, 0.76 to 1.18) or forearm fracture (eight studies, n=51 775; 0.96, 0.85 to 1.09). Funnel plot inspection and Egger`s regression suggested bias toward calcium supplements in the published data. In randomised controlled trials at lowest risk of bias (four studies, n=44 505), there was no effect on risk of fracture at any site. Results were similar for trials of calcium monotherapy and co-administered calcium and vitamin D. Only one trial in frail elderly women in residential care with low dietary calcium intake and vitamin D concentrations showed significant reductions in risk of fracture. CONCLUSIONS: Dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent.
The full text may be available from PubMed
Workplace interventions to prevent work disability in workers on sick leave.
BACKGROUND: Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. OBJECTIVES: To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. SEARCH METHODS: We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). AUTHORS` CONCLUSIONS: We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.
The full text may be available from PubMed
Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin-piperaquine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-la
BACKGROUND: Every year, more than 32 million pregnancies in sub-Saharan Africa are at risk of malaria infection and its adverse consequences. The effectiveness of the intermittent preventive treatment with sulfadoxine-pyrimethamine strategy recommended by WHO is threatened by high levels of parasite resistance. We aimed to assess the efficacy and safety of two alternative strategies: intermittent screening with malaria rapid diagnostic tests and treatment of women who test positive with dihydroartemisinin-piperaquine, and intermittent preventive treatment with dihydroartemisinin-piperaquine. METHODS: We did this open-label, three-group, randomised controlled superiority trial at four sites in western Kenya with high malaria transmission and sulfadoxine-pyrimethamine resistance. HIV-negative pregnant women between 16 and 32 weeks` gestation were randomly assigned (1:1:1), via computer-generated permuted-block randomisation (block sizes of three, six, and nine), to receive intermittent screening and treatment with dihydroartemisinin-piperaquine, intermittent preventive treatment with dihydroartemisinin-piperaquine, or intermittent preventive treatment with sulfadoxine-pyrimethamine. Study participants, study clinic nurses, and the study coordinator were aware of treatment allocation, but allocation was concealed from study investigators, delivery unit nurses, and laboratory staff. The primary outcome was malaria infection at delivery, defined as a composite of peripheral or placental parasitaemia detected by placental histology, microscopy, or rapid diagnostic test. The primary analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01669941. FINDINGS: Between Aug 21, 2012, and June 19, 2014, we randomly assigned 1546 women to receive intermittent screening and treatment with dihydroartemisinin-piperaquine (n=515), intermittent preventive treatment with dihydroartemisinin-piperaquine (n=516), or intermittent preventive treatment with sulfadoxine-pyrimethamine (n=515); 1368 (88%) women comprised the intention-to-treat population for the primary endpoint. Prevalence of malaria infection at delivery was lower in the intermittent preventive treatment with dihydroartemisinin-piperaquine group than in the intermittent preventive treatment with sulfadoxine-pyrimethamine group (15 [3%] of 457 women vs 47 [10%] of 459 women; relative risk 0.32, 95% CI 0.18-0.56; p<0.0001), but not in the intermittent screening and treatment with dihydroartemisinin-piperaquine group (57 [13%] of 452 women; 1.23, 0.86-1.77; p=0.26). Compared with intermittent preventive treatment with sulfadoxine-pyrimethamine, intermittent preventive treatment with dihydroartemisinin-piperaquine was associated with a lower incidence of malaria infection during pregnancy (192.0 vs 54.4 events per 100 person-years; incidence rate ratio [IRR] 0.28, 95% CI 0.22-0.36; p<0.0001) and clinical malaria during pregnancy (37.9 vs 6.1 events; 0.16, 0.08-0.33; p<0.0001), whereas intermittent screening and treatment with dihydroartemisinin-piperaquine was associated with a higher incidence of malaria infection (232.0 events; 1.21, 1.03-1.41; p=0.0177) and clinical malaria (53.4 events; 1.41, 1.00-1.98; p=0.0475). We recorded 303 maternal and infant serious adverse events, which were least frequent in the intermittent preventive treatment with dihydroartemisinin-piperaquine group. INTERPRETATION: At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine-pyrimethamine in the context of high sulfadoxine-pyrimethamine resistance and malaria transmission. However, dihydroartemisinin-piperaquine is a promising alternative drug to replace sulfadoxine-pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine. FUNDING: The Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine.
The full text may be available from PubMed
The SI! Program for Cardiovascular Health Promotion in Early Childhood: A Cluster-Randomized Trial.
BACKGROUND: The preschool years offer a unique window of opportunity to instill healthy life-style behaviors and promote cardiovascular health. OBJECTIVES: This study sought to evaluate the effect of a 3-year multidimensional school-based intervention to improve life-style-related behaviors. METHODS: We performed a cluster-randomized controlled intervention trial involving 24 public schools in Madrid, Spain, that were assigned to either the SI! Program intervention or the usual curriculum and followed for 3 years. The SI! Program aimed to instill and develop healthy behaviors in relation to diet, physical activity, and understanding how the human body and heart work. The primary outcome was change in the overall knowledge, attitudes, and habits (KAH) score (range 0 to 80). The intervention`s effect on adiposity markers was also evaluated. RESULTS: A total of 2,062 children from 3 to 5 years of age were randomized. After 3 years of follow-up, the overall KAH score was 4.9% higher in children in the intervention group compared with the control group (21.7 vs. 16.4; p < 0.001). A peak effect was observed at the second year (improvement 7.1% higher than in the control group; p < 0.001). Physical activity was the main driver of the change in KAH at all evaluation times. Children in the intervention group for 2 years and 1 year showed greater improvement than control subjects (5.9%; p < 0.001 and 2.9%; p = 0.002, respectively). After 3 years, the intervention group showed a higher probability than the control group of reducing the triceps skinfold z-score by at least 0.1 (hazard ratio: 1.40, 95% confidence interval: 1.04 to 1.89; p = 0.027). CONCLUSIONS: The SI! Program is an effective strategy for instilling healthy habits among preschoolers, translating into a beneficial effect on adiposity, with maximal effect when started at the earliest age and maintained over 3 years. Wider adoption may have a meaningful effect on cardiovascular health promotion. (Evaluation of the Program SI! for Preschool Education: A School-Based Randomized Controlled Trial [Preschool_PSI!]; NCT01579708).
The full text may be available from PubMed
Register now for our next Spotlight on Methods and Tools webinars
These events will be presented in English. Audio recordings will be available following the event. The presentation slides will be posted online in English and French following the event.
Webinar featuring The Consolidated Framework for Implementation Research (CFIR)
November 12, 2015
1:00 pm – 2:30 pm (EST)
The Consolidated Framework for Implementation Research can help you identify barriers and facilitators to implementation, monitor progress toward implementation goals and evaluate the outcome or impact of an intervention.
Join us to learn more about the CFIR tool: http://ow.ly/T7WHR
To see the summary statement of this tool developed by NCCMT, click here: http://www.nccmt.ca/registry/view/eng/210.html
Webinar featuring NCCMT’s Applicability and Transferability of Evidence Tool (A&T Tool)
Dec. 9
1:00 pm – 2:30 pm (EST)
This tool helps you decide whether an intervention that worked in one setting will get similar results if implemented in another. Presenters from the Sudbury & District Health Unit describe how they use this tool in practice.
Click here to register: http://ow.ly/T7WUe
To see the summary statement of this tool developed by NCCMT, click here: http://www.nccmt.ca/registry/view/eng/24.html
Upcoming webinars from HealthEvidence.org
A monthly series from health Evidence TM featuring review authors presenting their findings
Food supplementation programmes for improving the health of socio-economically disadvantaged children: What’s the evidence?
November 23
1:00-2:30pm EST
Join Dr. Elizabeth Kristjansson, Professor, School of Psychology, University of Ottawa, for an overview of findings from her latest Cochrane review examining the effectiveness of food supplementation programmes for improving the physical and psychosocial health of socio-economically disadvantaged children:
Kristjansson E., Francis D.K., Liberato S., Benkhalti J.M., Welch V., Batal M., et al. (2015). Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years. Cochrane Database of Systematic Reviews,2015(2), Art. No.: CD009924
Click here to register: http://ow.ly/Sif54
New Study Enhancing Awareness and Use of Cancer Prevention Evidence
Health Evidence™ is now recruiting individual public health professionals across Canada working in the areas of tobacco/alcohol use, sun safety, healthy eating, and physical activity for participation in a Canadian Institutes of Health Research funded study entitled Supporting awareness and uptake of cancer prevention knowledge in practice (http://www.cihr-irsc.gc.ca/e/49485.html).
Situated at McMaster University, this project aims to build capacity among Canadian public health professionals to use research evidence in program planning decisions. Across 18 months, those choosing to participate will receive concise actionable messages based on high-quality systematic review evidence via: Twitter, webinars, and/or tailored email messages. Participants will be surveyed at baseline (Fall 2015) and follow-up (Spring 2017) to assess awareness and use of research evidence.
