February 2013 · Issue 21
In this issue:
- Developing evidence-based recommendations in public health?
- New in Registry of Methods and Tools
- Mark your calendar!
- New from Public Health+
- Other upcoming events
Developing evidence-based recommendations in public health?
Looking for ways to incorporate stakeholders’ perspectives?
Check out Renfrew et al’s (2008) method!
Practice standards and policies have a greater chance of being effective if stakeholders have an opportunity to provide input during the development process. The authors provide a structured method for involving practitioners, service commissioners and service users in the development of evidence-based recommendations in public health.
For more info, check out:
Incorporating stakeholder views in developing evidence-based recommendations in public health (http://www.nccmt.ca/registry/view/eng/158.html)
New in Registry of Methods and Tools
Knowledge broker role in public health organizations
http://www.nccmt.ca/registry/view/eng/160.html
Political will for evidence-informed policy making
http://www.nccmt.ca/registry/view/eng/161.html
Mark your calendar!
Spotlight Webinar
Policy Readiness Tool from the University of Alberta’s School of Public Health
March 19, 2013
1:00 – 2:30 pm, EST
The Policy Readiness Tool: Understanding a Municipality's Readiness for Policy Change and Strategies for Taking Action supports policy change at the municipal level. Developed by the School of Public Health, University of Alberta, the Policy Readiness Tool assesses a municipality's level of readiness for policy change and identifies strategies to support municipalities in policy initiatives specific to their level of readiness.
Presenters: Dr. Candace Nykiforuk & Shandy Reed
For more information and to register, visit: http://bit.ly/XKPOJ8
NCCMT Pre-Convention Workshop @ TOPHC 2013
Methods and tools to support evidence-informed decision making in public health practice
April 2, 2013 (Toronto Sheraton Downtown Hotel)
Deadline to Register is March 22, 2013
This preconference workshop will focus on methods and tools for each step of the Evidence-Informed Public Health (EIPH) process that will support evidence-informed public health in Canada.
A high priority public health topic in Ontario will form the foundation of a case scenario that will be used to work through the steps of evidence-informed public health. The workshop will combine both large group presentations and small group work and discussion. Participants will have the opportunity to apply the identified method and/or tool for each step to the case scenario.
Registration is free of charge. Space is limited.
Register online : http://www.nccmtpreconworkshoptophc2013.eventbrite.com/
New from Public Health+
A randomized controlled trial to evaluate the effectiveness of CouPLES: A spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol.
OBJECTIVE: This randomized controlled trial evaluated the effectiveness of a telephone-delivered, spouse-assisted lifestyle intervention to reduce patient LDL-C. METHOD: From 2007 to 2010, 255 outpatients with LDL-C>76mg/dL and their spouses from the Durham Veterans Affairs Medical Center were randomized to intervention or usual care. The intervention comprised nine monthly goal-setting telephone calls to patients and support planning calls to spouses. Outcomes were assessed at 11months. RESULTS: Patients were 95% male and 65% White. LDL-C did not differ between groups (mean difference=2.3mg/dL, 95% CI=-3.6, 8.3, p=0.44), nor did the odds of meeting goal LDL-C (OR=0.95, 95% CI=0.6, 1.7; p=0.87). Intakes of calories (p=0.03), total fat (p=0.02), and saturated fat (p=0.02) were lower for the intervention group. Cholesterol and fiber intake did not differ between groups (p=0.11 and 0.26, respectively). The estimated rate of moderate intensity physical activity per week was 20% higher in the intervention group (IRR=1.2, 95% CI=1.0, 1.5, p=0.06). Most participants did not experience a change in cholesterol medication usage during the study period in the intervention (71.7%) and usual care (78.9%) groups. CONCLUSION: This intervention might be an adjunct to usual primary care to improve adherence to lifestyle behaviors.
The full text may be available from PubMed
Priming after a fractional dose of inactivated poliovirus vaccine.
BACKGROUND: To reduce the costs of maintaining a poliovirus immunization base in low-income areas, we assessed the extent of priming immune responses after the administration of inactivated poliovirus vaccine (IPV). METHODS: We compared the immunogenicity and reactogenicity of a fractional dose of IPV (one fifth of a full dose) administered intradermally with a full dose administered intramuscularly in Cuban infants at the ages of 4 and 8 months. Blood was collected from infants at the ages of 4 months, 8 months, 8 months 7 days, and 8 months 30 days to assess single-dose seroconversion, single-dose priming of immune responses, and two-dose seroconversion. Specimens were tested with a neutralization assay. RESULTS: A total of 320 infants underwent randomization, and 310 infants (96.9%) fulfilled the study requirements. In the group receiving the first fractional dose of IPV, seroconversion to poliovirus types 1, 2, and 3 occurred in 16.6%, 47.1%, and 14.7% of participants, respectively, as compared with 46.6%, 62.8%, and 32.0% in the group receiving the first full dose of IPV (P<0.008 for all comparisons). A priming immune response to poliovirus types 1, 2, and 3 occurred in 90.8%, 94.0%, and 89.6% of participants, respectively, in the group receiving the fractional dose as compared with 97.6%, 98.3%, and 98.1% in the group receiving the full dose (P=0.01 for the comparison with type 3). After the administration of the second dose of IPV in the group receiving fractional doses, cumulative two-dose seroconversion to poliovirus types 1, 2, and 3 occurred in 93.6%, 98.1%, and 93.0% of participants, respectively, as compared with 100.0%, 100.0%, and 99.4% in the group receiving the full dose (P<0.006 for the comparisons of types 1 and 3). The group receiving intradermal injections had the greatest number of adverse events, most of which were minor in intensity and none of which had serious consequences. CONCLUSIONS: This evaluation shows that vaccinating infants with a single fractional dose of IPV can induce priming and seroconversion in more than 90% of immunized infants. (Funded by the World Health Organization and the Pan American Health Organization; Australian New Zealand Clinical Trials Registry number, ACTRN12610001046099.).
The full text may be available from PubMed
Enhancing long-term weight loss maintenance: 2 year results from the Keep It Off randomized controlled trial.
OBJECTIVE: The Keep It Off trial evaluated the efficacy of a phone-based weight loss maintenance intervention among adults who had recently lost weight in Minnesota (2007-2010). METHODS: 419 adults who had recently lost >/=10% of their body weight were randomized to the ``Guided`` or ``Self-Directed`` intervention. Guided participants received a 10 session workbook, 10 biweekly, eight monthly and six bimonthly phone coaching calls, bimonthly weight graphs and tailored letters based on self-reported weights. Self-Directed participants received the workbook and two calls. Primary outcomes are weight change and maintenance (regain of <2.5% of baseline body weight). RESULTS: Mixed model repeated-measures analysis examining weight change revealed a significant time by treatment group interaction (p<0.0085). Guided participants regained significantly less weight than the Self-Directed participants at 12 and 24months. The odds of 24month maintenance were 1.37 (95% CI: 0.97-2.03) times greater in the Guided than in the Self-Directed group. When maintenance rates were compared across all follow-ups, there was a consistently higher maintenance rate for Guided participants (HR 1.31, 95% CI: 1.12-1.54). CONCLUSIONS: A sustained, supportive phone- and mail-based intervention promotes weight loss maintenance relative to a brief intervention for participants who have recently lost weight.
The full text may be available from PubMed
Health Information Technology in Screening and Treatment of Child Obesity: A Systematic Review.
BACKGROUND AND OBJECTIVES:Childhood obesity is a major problem in the United States, yet screening and treatment are often inaccessible or ineffective. Health information technology (IT) may improve the quality, efficiency, and reach of chronic disease management. The objective of this study was to review the effect of health IT (electronic health records [EHRs], telemedicine, text message or telephone support) on patient outcomes and care processes in pediatric obesity management.METHODS:Medline, Embase, and the Cochrane Registry of Controlled Trials were searched from January 2006 to April 2012. Controlled trials, before-and-after studies, and cross-sectional studies were included if they used IT to deliver obesity screening or treatment to children aged 2 to 18 and reported impact on patient outcomes (BMI, dietary or physical activity behavior change) or care processes (BMI screening, comorbidity testing, diet, or physical activity counseling). Two independent reviewers extracted data and assessed trial quality.RESULTS:Thirteen studies met inclusion criteria. EHR use was associated with increased BMI screening rates in 5 of 8 studies. Telemedicine counseling was associated with changes in BMI percentile similar to that of in-person counseling and improved treatment access in 2 studies. Text message or telephone support was associated with weight loss maintenance in 1 of 3 studies.CONCLUSIONS:To date, health IT interventions have improved access to obesity treatment and rates of screening. However, the impact on weight loss and other health outcomes remains understudied and inconsistent. More interactive and time-intensive interventions may enhance health IT`s clinical effectiveness in chronic disease management.
The full text may be available from PubMed
Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial.
BACKGROUND: There is an urgent need for effective, affordable interventions to prevent child mental health problems in low- and middle-income countries. AIMS: To determine the effects of a universal pre-school-based intervention on child conduct problems and social skills at school and at home. METHOD: In a cluster randomised design, 24 community pre-schools in inner-city areas of Kingston, Jamaica, were randomly assigned to receive the Incredible Years Teacher Training intervention (n = 12) or to a control group (n = 12). Three children from each class with the highest levels of teacher-reported conduct problems were selected for evaluation, giving 225 children aged 3-6 years. The primary outcome was observed child behaviour at school. Secondary outcomes were child behaviour by parent and teacher report, child attendance and parents` attitude to school. The study is registered as ISRCTN35476268. RESULTS: Children in intervention schools showed significantly reduced conduct problems (effect size (ES) = 0.42) and increased friendship skills (ES = 0.74) through observation, significant reductions to teacher-reported (ES = 0.47) and parent-reported (ES = 0.22) behaviour difficulties and increases in teacher-reported social skills (ES = 0.59) and child attendance (ES = 0.30). Benefits to parents` attitude to school were not significant. CONCLUSIONS: A low-cost, school-based intervention in a middle-income country substantially reduces child conduct problems and increases child social skills at home and at school.
The full text may be available from PubMed
Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules.
OBJECTIVE: To evaluate a universal obesity prevention intervention, which commenced at infant age 4-6 months, using outcome data assessed 6 months after completion of the first of two intervention modules and 9 months from baseline. DESIGN: Randomised controlled trial of a community-based early feeding intervention. SUBJECTS AND METHODS: Six hundred and ninety-eight first-time mothers (mean age 30+/-5 years) with healthy term infants (51% male) aged 4.3+/-1.0 months at baseline. Mothers and infants were randomly allocated to self-directed access to usual care or to attend two group education modules, each delivered over 3 months, that provided anticipatory guidance on early feeding practices. Outcome data reported here were assessed at infant age 13.7+/-1.3 months. Anthropometrics were expressed as z-scores (WHO reference). Rapid weight gain was defined as change in weight-for-age z-score (WAZ) of >+0.67. Maternal feeding practices were assessed via self-administered questionnaire. RESULTS: There were no differences according to group allocation on key maternal and infant characteristics. At follow-up (n=598 (86%)), the control group infants had higher BMI-for-age z-score (BMIZ) (0.42+/-0.85 vs 0.23+/-0.93, P=0.009) and were more likely to show rapid weight gain from baseline to follow-up (odds ratio (OR)=1.5, confidence interval (CI) 95%=1.1-2.1, P=0.014). Mothers in the control group were more likely to report using non-responsive feeding practices that fail to respond to infant satiety cues such as encouraging eating by using food as a reward (15% vs 4%, P=0.001) or using games (67% vs 29%, P<0.001). CONCLUSIONS: These results provide early evidence that anticipatory guidance targeting the `when, what and how` of solid feeding can be effective in changing maternal feeding practices and, at least in the short term, reducing anthropometric indicators of childhood obesity risk. Analyses of outcomes at later ages are required to determine if these promising effects can be sustained.
The full text may be available from PubMed
Other upcoming events
Canadian Knowledge Mobilization Forum 2013
Working together in Knowledge Mobilization: closing the loop between research and practice
June 3 & 4, 2013 (Mississauga – Centre for Health & Safety Innovation)
First Call for Presentations: February 22, 2013 – for inclusion in Connection Grants application to the Social Sciences and Humanities Research Council of Canada led by Forum Chair, Dr. David Phipps http://www.knowledgemobilization.net/cfp_ckf13
(Second Call for Presentations & Posters may be opened if required)
Workshop Opportunity from the Mental Health Commission of Canada
Reaching Out: Effective Approaches to Sharing Knowledge about Mental Health
July 10 & 11, 2013 (Victoria, B.C.)
The SPARK Training Institute is an initiative created by the Mental Health Commission of Canada to help participants learn techniques for moving evidence-informed research from the fields of mental health, substance use and addictions more quickly into practice.
The Institute brings together dozens of participants within Canada for two days of training with internationally respected knowledge exchange professionals, followed by ongoing mentoring. Ideally, participants come from diverse areas of mental health and different geographic locations within Canada.
Applications to the workshop are being accepted until March 1, 2013.
http://www.mentalhealthcommission.ca/English/Pages/Spark_Institute_ENG.aspx
