octobre 2015 · Numéro 149
Dans ce bulletin :
- Présentation de deux nouveaux modules d'apprentissage en ligne
- Lieu de travail sécuritaire, lieu de travail sain : célébrez le Mois de la santé au travail
- Quoi de neuf dans Public Health +?
- Inscrivez-vous dès maintenant à ces webinaires gratuits du CCNMO
- Webinaires à venir de HealthEvidence.org
- Nouvelle étude visant à accroître la sensibilisation et lutilisation des données probantes en prévention du cancer
Présentation de deux nouveaux modules d'apprentissage en ligne
L’essentiel de la PDFDP : éléments clés de la prise de décisions fondée sur des données probantes vous donne un rapide aperçu du processus en sept étapes que le CCNMO recommande. En une heure ou moins, vous pourrez découvrir en quoi consiste la santé publique fondée sur des données probantes! Ensuite, vous pourrez passer au module complet (original) menant à un certificat Introduction à la prise de décisions fondée sur des données probantes.
Prise de décisions fondée sur des données probantes pour les gestionnaires est destiné spécialement aux gestionnaires et aux directeurs en santé publique. Ce module vous procure les compétences et les renseignements nécessaires pour guider votre équipe tout au long du processus de PDFDP.
Ces modules ne conduisent pas à un certificat : Les apprenants qui terminent ces modules reçoivent attestations d’achèvement.
PDFDP pour les gestionnaires et L’essentiel de la PDFDP sont disponible dans le Centre d’Apprentissage : http://www.nccmt.ca/learningcentre/index.php
Lieu de travail sécuritaire, lieu de travail sain : célébrez le Mois de la santé au travail
Aider les organismes à utiliser des données probantes pour améliorer les lieux de travail
Les gens passent beaucoup de temps au travail, alors rendre les lieux de travail plus sécuritaires et sains peut vraiment changer la vie de la population que vous servez. En tant que professionnel ou professionnelle de la santé publique, il se peut qu’un organisme vous demande de recommander des stratégies pour améliorer la santé et la sécurité de ses travailleurs. Il pourra s’agir du vôtre! Nous offrons des ressources qui vous permettent de trouver des données probantes issues de la recherche pour orienter vos recommandations.
Apprendre comment adapter votre recherche
En fondant vos recommandations sur des données probantes de grande qualité, vous pouvez contribuer à promouvoir l’élaboration de pratiques et la création d’une culture favorisant la santé. Étant donné les divers enjeux auxquels différents organismes sont confrontés, votre recherche de données probantes devra être adaptée. Une question PICR (population, intervention, comparaison, résultat) clairement définie vous sera utile (http://www.nccmt.ca/registry/view/fra/138.html). Faites notre module d’apprentissage en ligne Trouver des données probantes issues de la recherche en santé publique (http://www.nccmt.ca/learningcentre/) afin d’en apprendre davantage sur la recherche ou allez sur notre site Web pour en savoir plus sur le processus de santé publique fondée sur des données probantes (http://www.nccmt.ca/eiph/index-fra.html).
Trouver rapidement des données probantes issues de la recherche
Nos pyramides de recherche peuvent aussi vous aider à trouver rapidement divers types de données probantes issues de la recherche. Ces outils en ligne procurent des liens vers différentes ressources pour mieux orienter votre recherche. Il y a des liens vers des données probantes préévaluées et d’autres qui ne l’ont pas été encore. Le module en ligne, Trouver des données probantes issues de la recherche en santé publique, vous montrera comment effectuer une recherche efficace. Les pyramides de recherche sur la prévention des blessures, la santé environnementale et la santé mentale faciliteront encore davantage la recherche de renseignements pertinents. Ouvrez une session dans le Centre d’apprentissage pour avoir accès à ces ressources (http://www.nccmt.ca/learningcentre/).
Célébrez le Mois de la santé au travail en apprenant comment chercher efficacement avec notre module en ligne Trouver (des données probantes issues de la recherche en santé publique) et nos pyramides de recherche sur la prévention des blessures, la santé mentale et la santé environnementale. Ainsi vous pourrez répondre à l’appel si un organisme vous demande de l’aider à créer un milieu de travail sécuritaire et sain.
Afin d’en apprendre davantage sur le Mois de la santé au travail, allez au : http://healthyworkplacemonth.ca/fr/
Quoi de neuf dans 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
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
Webinaires 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.
