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National Collaborating Centre for Methods and Tools

September 2016 · Issue 194

In this issue:

NCCMT’s Online Journal Club

Improve your critical appraisal skills!

On Thursday, October 13, the National Collaborating Centre for Methods and Tools will hold the first webinar of its new interactive webinar series hosted by our own esteemed Dr. Donna Ciliska, Senior Knowledge Translation Advisor. The series will take a small group discussion–based approach to understanding critical appraisal. Each Online Journal Club webinar will focus on a specific article related to a timely public health issue. Participants will be expected to read the session’s article in advance and be open to engaging in a discussion on the topic. The goal of the series is to have a candid, interactive discussion about critical appraisal. All questions are welcome.



Webinar 1: Can the use of text message reminders improve vaccination rates?

Thursday, October 13 
1:00 – 2:00 p.m. EDT 

This interactive webinar will focus on the use of mobile technology in improving vaccination rates among low-income populations. Participants are expected to download and read the five-page article, review the critical appraisal tool provided on the registration page and come to the meeting prepared to discuss the content.

Featured article:

Melissa S. Stockwell, Carolyn Westhoff, Elyse Olshen Kharbanda, Celibell Y. Vargas, Stewin Camargo, David K. Vawdrey, and Paula M. Castaño. Influenza Vaccine Text Message Reminders for Urban, Low-Income Pregnant Women: A Randomized Controlled Trial. American Journal of Public Health: February 2014, Vol. 104, No. S1, pp. e7-e12. doi: 10.2105/AJPH.2013.301620. Available here.

Registration for each webinar will be capped at 20 participants. Those who are unable to attend the preliminary session can join a waiting list for a subsequent session, which may be offered in the following weeks, depending on interest. Future journal club sessions will be posted in the NCCMT events calendar. Watch for more  information in the weekly Round-up and on social media (follow us on Twitter; "Like" us on Facebook). 

Click here to reserve your spot for the October 13 session! 

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The McMaster Optimal Aging Portal webinar recording is now available!

Do you promote healthy aging or advocate for seniors' issues in your work? Did you miss the NCCMT Spotlight on Methods and Tools: McMaster Optimal Aging Portal webinar?

You can now access the PowerPoint presentation (in English and French) and the audio recording (English only).

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New from Public Health+

New opioid analgesic use and the risk of injurious single-vehicle crashes in drivers aged 50-80 years: A population-based matched case-control study.

BACKGROUND: the increasing trend in opioid analgesic use among older drivers has raised concerns about their risk of being involved in car crashes. AIM: to investigate if older drivers who started using opioid analgesics have a higher probability of being involved in injurious crashes. METHODS: population-based matched case-control study. Data from population registers were merged using a personal identity number. Cases were drivers aged 50-80 years responsible for a single vehicle crash between 01.07.05 and 31.12.09 that led to at least one injured passenger (n = 4,445). Four controls were randomly matched to each case by sex, birth month/year, and residence area from persons holding a valid driving license who did not crash during the study period. New use was defined as at least one dispensation within 1-30 days prior to the crash, but none within the previous 31-180 days; frequent use when >/=3 dispensations were given within 0-180 days, with at least one within 31-180 days. Individuals using 1-2 non-opioid analgesic medications were used as reference category. Conditional logistic regression was used to estimate odds ratios (OR; 95% CI) adjusting for benzodiazepine use, co-morbidity, civil status and occupation. RESULTS: adjusted odds for new use were two-fold that of drivers using 1-2 non-opioid analgesics medications (2.0; 1.6-2.5). For frequent use, adjusted odds were also increased regardless of number of dispensations (3-4 = 1.7; 1.3-2.1, 5-6 = 1.6; 1.2-2.3, and >/=7 = 1.7; 1.3-2.1). CONCLUSION: new, but also frequent opioid analgesic use, resulted in an increased probability of single vehicle crashes. While more epidemiologic evidence is needed, patients could be advised to refrain from driving when using opioid analgesics.

The full text may be available from PubMed

Effective Parenting Interventions to Reduce Youth Substance Use: A Systematic Review.

CONTEXT: Parenting interventions may prevent adolescent substance use; however, questions remain regarding the effectiveness of interventions across substances and delivery qualities contributing to successful intervention outcomes. OBJECTIVE: To describe the effectiveness of parent-focused interventions in reducing or preventing adolescent tobacco, alcohol, and illicit substance use and to identify optimal intervention targeted participants, dosage, settings, and delivery methods. DATA SOURCES: PubMed, PsycINFO, ERIC, and CINAHL. STUDY SELECTION: Randomized controlled trials reporting adolescent substance use outcomes, focusing on imparting parenting knowledge, skills, practices, or behaviors. DATA EXTRACTION: Trained researchers extracted data from each article using a standardized, prepiloted form. Because of study heterogeneity, a qualitative technique known as harvest plots was used to summarize findings. RESULTS: A total of 42 studies represented by 66 articles met inclusion criteria. Results indicate that parenting interventions are effective at preventing and decreasing adolescent tobacco, alcohol, and illicit substance use over the short and long term. The majority of effective interventions required </=12 contact hours and were implemented through in-person sessions including parents and youth. Evidence for computer-based delivery was strong only for alcohol use prevention. Few interventions were delivered outside of school or home settings. LIMITATIONS: Overall risk of bias is high. CONCLUSIONS: This review suggests that relatively low-intensity group parenting interventions are effective at reducing or preventing adolescent substance use and that protection may persist for multiple years. There is a need for additional evidence in clinical and other community settings using an expanded set of delivery methods.

The full text may be available from PubMed

The effect of aquatic exercise on physical functioning in the older adult: a systematic review with meta-analysis.

BACKGROUND: ageing and sedentary behaviour cause negative changes in the neuromuscular systems of healthy older adults resulting in a decrease in physical functioning. Exercising in water (aquatic exercise, AE) has been shown to be effective at improving physical functioning in this population; however, no systematic review with meta-analysis has been published. PURPOSE: to investigate the effect of AE on physical functioning in healthy older adults compared to control or land-based exercise (LE) through a systematic review with meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, Cinahl, PEDro, SPORTDiscus, Web of Science, Cochrane Library, published before 31st December 2015. STUDY SELECTION: in total, 28 studies met the inclusion criteria and were included in the systematic review; 24 studies with 1,456 subjects (89% female) and with mean age 66.4 years were included in the meta-analysis. DATA EXTRACTION: data were extracted and checked for accuracy by three independent reviewers. DATA SYNTHESIS: size of treatment effect was measured using the standardised mean difference with 95% confidence intervals (CIs). RESULTS: compared to control interventions, AE had a moderate positive effect on physical functioning 0.70 [95% CI 0.48 to 0.92]. Compared to LE, AE had a small positive effect on physical functioning 0.39 [0.12 to 0.66]. LIMITATIONS: there is a high risk of bias and low methodological quality in the studies particularly when comparing AE to LE with possible over estimation of the benefit of AE. CONCLUSIONS: AE may improve physical functioning in healthy older people and is at least as effective as LE.

The full text may be available from PubMed

Live Attenuated Versus Inactivated Influenza Vaccine in Hutterite Children: A Cluster Randomized Blinded Trial.

Background: Whether vaccinating children with intranasal live attenuated influenza vaccine (LAIV) is more effective than inactivated influenza vaccine (IIV) in providing both direct protection in vaccinated persons and herd protection in unvaccinated persons is uncertain. Hutterite colonies, where members live in close-knit, small rural communities in which influenza virus infection regularly occurs, offer an opportunity to address this question. Objective: To determine whether vaccinating children and adolescents with LAIV provides better community protection than IIV. Design: A cluster randomized blinded trial conducted between October 2012 and May 2015 over 3 influenza seasons. Setting: 52 Hutterite colonies in Alberta and Saskatchewan, Canada. Participants: 1186 Canadian children and adolescents aged 36 months to 15 years who received the study vaccine and 3425 community members who did not. Intervention: Children were randomly assigned according to community in a blinded manner to receive standard dosing of either trivalent LAIV or trivalent IIV. Measurements: The primary outcome was reverse transcriptase polymerase chain reaction-confirmed influenza A or B virus in all participants (vaccinated children and persons who did not receive the study vaccine). Results: Mean vaccine coverage among children in the LAIV group was 76.9% versus 72.3% in the IIV group. Influenza virus infection occurred at a rate of 5.3% (295 of 5560 person-years) in the LAIV group versus 5.2% (304 of 5810 person-years) in the IIV group. The hazard ratio comparing LAIV with IIV for influenza A or B virus was 1.03 (95% CI, 0.85 to 1.24). Limitation: The study was conducted in Hutterite communities, which may limit generalizability. Conclusion: Immunizing children with LAIV does not provide better community protection against influenza than IIV. Primary Funding Source: The Canadian Institutes for Health Research.

The full text may be available from PubMed

Effects of WiiActive exercises on fear of falling and functional outcomes in community-dwelling older adults: a randomised control trial.

BACKGROUND: the study compares the effects of a Nintendo Wii exercise programme and a standard Gym-based exercise intervention on fear of falling, knee strength, physical function and falls rate in older adults. METHODS: eighty community-dwelling adults aged 60 years and above with short physical performance battery score of 5-9 points and modified falls efficacy scale (MFES) score of </=9 points participated in the parallel-group randomised trial. Each intervention arm involved an hour of intervention per week, totalling 12 sessions over 12 weeks. Besides 1-year fall incidence, the participants were evaluated on MFES, knee extensor strength (KES), timed-up-and-go test, gait speed, 6-minute walk test and narrow corridor walk test at weeks 13 and 24. RESULTS: at week 13, between interventions, the effect of MFES changes did not reach statistical significance (difference = -0.07 point, 95% CI -0.56 to 0.42, P = 0.78); at week 24, the Wii group showed statistically significant effects over the Gym group (difference = 0.8 point, 95% CI 0.27 to 1.29, P < 0.01). For KES, the two groups did not differ statistically at week 13 (difference = -2.0%, 95% CI -5.6 to -1.7, P = 0.29); at week 24, the Gym group had greater strength gains than the Wii group (difference = -5.1%, 95% CI -8.7 to -1.5, P < 0.01). No between-group differences were observed for other outcome measures. CONCLUSION: on completion of a 12-week Nintendo Wii exercise programme, there was no significant benefit seen on fear of falling when compared to a standard Gym-based exercise intervention; however, post-intervention there was an apparent reduction in fear of falling in the group allocated to Wii training, despite knee strength apparently improving more in those allocated to the Gym. It is possible that long-term gains after using the Wii might be due to a carry-over effect. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12610000576022.

The full text may be available from PubMed

A randomised comparison of two faecal immunochemical tests in population-based colorectal cancer screening.

OBJECTIVE: Colorectal cancer screening programmes are implemented worldwide; many are based on faecal immunochemical testing (FIT). The aim of this study was to evaluate two frequently used FITs on participation, usability, positivity rate and diagnostic yield in population-based FIT screening. DESIGN: Comparison of two FITs was performed in a fourth round population-based FIT-screening cohort. Randomly selected individuals aged 50-74 were invited for FIT screening and were randomly allocated to receive an OC -Sensor (Eiken, Japan) or faecal occult blood (FOB)-Gold (Sentinel, Italy) test (March-December 2014). A cut-off of 10 microg haemoglobin (Hb)/g faeces (ie, 50 ng Hb/mL buffer for OC-Sensor and 59 ng Hb for FOB-Gold) was used for both FITs. RESULTS: In total, 19 291 eligible invitees were included (median age 61, IQR 57-67; 48% males): 9669 invitees received OC-Sensor and 9622 FOB-Gold; both tests were returned by 63% of invitees (p=0.96). Tests were non-analysable in 0.7% of participants using OC-Sensor vs 2.0% using FOB-Gold (p<0.001). Positivity rate was 7.9% for OC-Sensor, and 6.5% for FOB-Gold (p=0.002). There was no significant difference in diagnostic yield of advanced neoplasia (1.4% for OC-Sensor vs 1.2% for FOB-Gold; p=0.15) or positive predictive value (PPV; 31% vs 32%; p=0.80). When comparing both tests at the same positivity rate instead of cut-off, they yielded similar PPV and detection rates. CONCLUSIONS: The OC-Sensor and FOB-Gold were equally acceptable to a screening population. However, FOB-Gold was prone to more non-analysable tests. Comparison between FIT brands is usually done at the same Hb stool concentration. Our findings imply that for a fair comparison on diagnostic yield between FIT`s positivity rate rather than Hb concentration should be used. TRIAL REGISTRATION NUMBER: NTR5385; Results.

The full text may be available from PubMed

Smoking cessation for people with chronic obstructive pulmonary disease.

BACKGROUND: Smoking cessation is the most important treatment for smokers with chronic obstructive pulmonary disease (COPD), but little is known about the effectiveness of different smoking cessation interventions for this particular group of smokers. OBJECTIVES: To evaluate the effectiveness of behavioural or pharmacological smoking cessation interventions, or both, in smokers with COPD. SEARCH METHODS: We searched all records in the Cochrane Airways Group Specialised Register of Trials. In addition to this electronic search, we searched clinical trial registries for planned, ongoing, and unpublished trials. We searched all databases from their inception. We checked the reference lists of all included studies and of other systematic reviews in relevant topic areas. We searched for errata or retractions from eligible trials on PubMed. We conducted our most recent search in March 2016. SELECTION CRITERIA: We included randomised controlled trials assessing the effectiveness of any behavioural or pharmacological treatment, or both, in smokers with COPD reporting at least six months of follow-up abstinence rates. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the data and performed the methodological quality assessment for each study. We resolved any disagreements by consensus. MAIN RESULTS: We included 16 studies (involving 13,123 participants) in this systematic review, two of which were of high quality. These two studies showed that nicotine sublingual tablet and varenicline increased the quit rate over placebo (risk ratio (RR) 2.60 (95% confidence interval (CI) 1.29 to 5.24) and RR 3.34 (95% CI 1.88 to 5.92)). Pooled results of two studies also showed a positive effect of bupropion compared with placebo (RR 2.03 (95% CI 1.26 to 3.28)). When pooling these four studies, we found high-quality evidence for the effectiveness of pharmacotherapy plus high-intensity behavioural treatment compared with placebo plus high-intensity behavioural treatment (RR 2.53 (95% CI 1.83 to 3.50)). Furthermore, we found some evidence that high-intensity behavioural treatment increased abstinence rates when compared with usual care (RR 25.38 (95% CI 8.03 to 80.22)) or low-intensity behavioural treatment (RR 2.18 (95% CI 1.05 to 4.49)). Finally, the results showed effectiveness of various combinations of psychosocial and pharmacological interventions. AUTHORS` CONCLUSIONS: We found high-quality evidence in a meta-analysis including four (1,540 participants) of the 16 included studies that a combination of behavioural treatment and pharmacotherapy is effective in helping smokers with COPD to quit smoking. Furthermore, we conclude that there is no convincing evidence for preferring any particular form of behavioural or pharmacological treatment.

The full text may be available from PubMed

Progestin-only contraceptives: effects on weight.

BACKGROUND: Progestin-only contraceptives (POCs) are appropriate for many women who cannot or should not take estrogen. POCs include injectables, intrauterine contraception, implants, and oral contraceptives. Many POCs are long-acting, cost-effective methods of preventing pregnancy. However, concern about weight gain can deter the initiation of contraceptives and cause early discontinuation among users. OBJECTIVES: The primary objective was to evaluate the association between progestin-only contraceptive use and changes in body weight. SEARCH METHODS: Until 4 August 2016, we searched MEDLINE, CENTRAL, POPLINE, LILACS, ClinicalTrials.gov, and ICTRP. For the initial review, we contacted investigators to identify other trials. SELECTION CRITERIA: We considered comparative studies that examined a POC versus another contraceptive method or no contraceptive. The primary outcome was mean change in body weight or mean change in body composition. We also considered the dichotomous outcome of loss or gain of a specified amount of weight. DATA COLLECTION AND ANALYSIS: Two authors extracted the data. Non-randomized studies (NRS) need to control for confounding factors. We used adjusted measures for the primary effects in NRS or the results of matched analysis from paired samples. If the report did not provide adjusted measures for the primary analysis, we used unadjusted outcomes. For RCTs and NRS without adjusted measures, we computed the mean difference (MD) with 95% confidence interval (CI) for continuous variables. For dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% CI. MAIN RESULTS: We found 22 eligible studies that included a total of 11,450 women. With 6 NRS added to this update, the review includes 17 NRS and 5 RCTs. By contraceptive method, the review has 16 studies of depot medroxyprogesterone acetate (DMPA), 4 of levonorgestrel-releasing intrauterine contraception (LNG-IUC), 5 for implants, and 2 for progestin-only pills.Comparison groups did not differ significantly for weight change or other body composition measure in 15 studies. Five studies with moderate or low quality evidence showed differences between study arms. Two studies of a six-rod implant also indicated some differences, but the evidence was low quality.Three studies showed differences for DMPA users compared with women not using a hormonal method. In a retrospective study, weight gain (kg) was greater for DMPA versus copper (Cu) IUC in years one (MD 2.28, 95% CI 1.79 to 2.77), two (MD 2.71, 95% CI 2.12 to 3.30), and three (MD 3.17, 95% CI 2.51 to 3.83). A prospective study showed adolescents using DMPA had a greater increase in body fat (%) compared with a group not using a hormonal method (MD 11.00, 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (MD -4.00, 95% CI -6.93 to -1.07). A more recent retrospective study reported greater mean increases with use of DMPA versus Cu IUC for weight (kg) at years 1 (1.3 vs 0.2), 4 (3.5 vs 1.9), and 10 (6.6 vs 4.9).Two studies reported a greater mean increase in body fat mass (%) for POC users versus women not using a hormonal method. The method was LNG-IUC in two studies (reported means 2.5 versus -1.3; P = 0.029); (MD 1.60, 95% CI 0.45 to 2.75). One also studied a desogestrel-containing pill (MD 3.30, 95% CI 2.08 to 4.52). Both studies showed a greater decrease in lean body mass among POC users. AUTHORS` CONCLUSIONS: We considered the overall quality of evidence to be low; more than half of the studies had low quality evidence. The main reasons for downgrading were lack of randomizations (NRS) and high loss to follow-up or early discontinuation.These 22 studies showed limited evidence of change in weight or body composition with use of POCs. Mean weight gain at 6 or 12 months was less than 2 kg (4.4 lb) for most studies. Those with multiyear data showed mean weight change was approximately twice as much at two to four years than at one year, but generally the study groups did not differ significantly. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.

The full text may be available from PubMed

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Upcoming webinars from NCCMT

Spotlight on Methods and Tools webinar: Quality Assessment Tool for Quantitative Studies 

October 18, 2016
1:00 p.m. – 2:30 p.m. (EST)

Interested in a standardized process to appraise and synthesize research evidence?

Are you engaged in utilizing sources of high quality literature to support your decision-making process? Are you interested in learning about critical appraisal of intervention studies? Join us for a webinar to learn how the Quality Assessment Tool for Quantitative Studies can help you. 

Click here to register.

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Upcoming webinars from HealthEvidence.org

Community engagement in public health interventions for disadvantaged groups: What's the evidence?

September 21, 2016
11:00 a.m. – 12:00 p.m. (EDT)

Join Alison O'Mara-Eves, Research Officer, University College London, EPPI-Centre, and Ginny Brunton, Senior Health Researcher, University College London, EPPI-Centre, for an overview of findings from their systematic review examining the effectiveness of community engagement in public health interventions for disadvantaged groups.

Click here to register.
Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people: What's the evidence?

October 27, 2016 
11:30 a.m. – 12:30 p.m. (EDT)

Join Dr. Georgie MacArthur, National Institute of Health Research Postdoctoral Research Fellow, School of Social and Community Medicine, University of Bristol, for an overview of findings from her systematic review examining peer-led interventions to prevent tobacco, alcohol and/or drug use among young people. 

Click here to register.

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Past issues of the Round-up are available online: Weekly Digest Archive
NCCMT is funded by the Public Health Agency of Canada and affiliated with McMaster University.
Production of this newsletter has been made possible through a financial contribution from the Public Health Agency of Canada.
The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
Contact us at nccmt@mcmaster.ca or www.nccmt.ca.