November 2013 · Issue 58

In this issue:

Social Media A Credible Way to Reach Priority Groups
New in Registry of Methods and Tools
New from Public Health+
Do you know about the other National Collaborating Centres?

Social Media A Credible Way to Reach Priority Groups

Building CASTLEs in Hamilton, Niagara, Haldimand-Norfolk and Brant Regions

From the lack of transportation, to language and trust issues, people in Hamilton, Niagara, Haldimand-Norfolk and Brant public health regions named dozens of barriers that prevented them from screening for breast, cervical and colorectal cancers. Residents of these communities, identified as never- or under-screened, include recent immigrants, Aboriginal peoples, those with language or literacy issues, people with disabilities and older people. They live in low-income housing communities and may be dealing with past trauma or cultural issues, such as the need for female accompaniment to appointments. Together with fear of the results, these barriers translate into screening participation rates well below Cancer Care Ontario targets. Social media is potentially a way to raise awareness about screening in these groups.

Faye Parascandalo, the regional lead for the CASTLE (Creating Access to Screening and Training in the Living Environment) project at the City of Hamilton Public Health Services, works with her team to remove these barriers and increase cancer screening participation among groups at higher risk of mortality from preventable cancers, due to the inequities they face.

The CASTLE project is designed to break down barriers, build structural and supportive pathways, and provide access to screening to help reduce disparities in cancer screening. It includes a range of multi-sectoral partners, including researchers at McMaster and Brock Universities, and uses peer-to-peer mentorship and community training, communication and social media. The project’s Community Health Brokers work with individuals to create tailored solutions to logistical, structural, systematic and individual barriers to screening. Social media factors in with focused cancer screening messages developed specifically for the under/never screened populations and distributed through interactive website messaging, Facebook, Twitter and a blog. “Small media” channels include posters and videos.

While developing a funding proposal for the program, Faye learned about the Centres for Disease Control (CDC) Social Media Toolkit, through a weekly e-mail from NCCMT.

The kit provided a comprehensive process to develop, implement and evaluate a social media plan, which became an instrumental part of their successful proposal. Its academic references helped validate the use of social media in health promotion campaigns. “We needed to be sure that spending a good portion of our budget on social media was going to be worthwhile. Having a credible, well-researched resource helped us make that leap,” says Faye. The examples, work pages and templates proved invaluable in planning the project, in a way that was sustainable and transferable.

Together with other useful resources she found on the NCCMT website, Faye highly recommends the CDC toolkit, a tool “so comprehensive, it helps organizations consider all aspects of social media, whether they are experts or new to the options available.”

For a look at the CASTLE project in action, go to www.castlenow.ca. A review of the Centres for Disease Control (CDC) Social Media Toolkit is available at the NCCMT website, at http://www.nccmt.ca/registry/view/eng/90.html.

New in Registry of Methods and Tools

Critically appraising practice guidelines: The AGREE II instrument
http://www.nccmt.ca/registry/view/eng/100.html

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New from Public Health+

Screening for type 2 diabetes: a short report for the National Screening Committee.

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) has been increasing, owing to increases in overweight and obesity, decreasing physical activity and the changing demographic structure of the population. People can develop T2DM without symptoms and up to 20% may be undiagnosed. They may have diabetic complications, such as retinopathy, by the time they are diagnosed, or may suffer a heart attack, without warning. Undiagnosed diabetes can be detected by raised blood glucose levels. AIM: The aim of this review was to provide an update for the UK National Screening Committee (NSC) on screening for T2DM. METHODS: As this review was undertaken to update a previous Health Technology Assessment review published in 2007, and a more recent Scottish Public Health Network review, searches for evidence were restricted from 2009 to end of January 2012, with selected later studies added. The databases searched were MEDLINE, EMBASE, MEDLINE-in-Process & Other Non-Indexed Citations, Science Citation Index and Conference Proceedings Citation Index. The case for screening was considered against the criteria used by the NSC to assess proposed population screening programmes. RESULTS: Population screening for T2DM does not meet all of the NSC criteria. Criterion 12, on optimisation of existing management, has not been met. A report by the National Audit Office (NAO) gives details of shortcomings. Criterion 13 requires evidence from high-quality randomised controlled trials that screening is beneficial. This has not been met. The Ely trial of screening showed no benefit. The ADDITION trial was not a trial of screening, but showed no benefit in cardiovascular outcomes from intensive management in people with screen-detected T2DM. Criterion 18 on staffing and facilities does not appear to have been met, according to the NAO report. Criterion 19 requires that all other options, including prevention, should have been considered. A large proportion of cases of T2DM could be prevented if people avoided becoming overweight or obese. The first stage of selection would use risk factors, using data held on general practitioner computer systems, using the QDiabetes Risk Score, or by sending out questionnaires, using the Finnish Diabetes Risk Score (FINDRISC). Those at high risk would have a measure of blood glucose. There is no perfect screening test. Glycated haemoglobin (HbA1c) testing has advantages in not requiring a fasting sample, and because it is a predictor of vascular disease across a wider range than just the diabetic one. However, it lacks sensitivity and would miss some people with diabetes. Absolute values of HbA1c may be more useful as part of overall risk assessment than a dichotomous `diabetes or not diabetes` diagnosis. The oral glucose tolerance test is more sensitive, but inconvenient, more costly, has imperfect reproducibility and is less popular, meaning that uptake would be lower. CONCLUSIONS: When considered against the NSC criteria, the case for screening is less strong than it was in the 2007 review. The main reason is the absence of cardiovascular benefit in the two trials published since the previous review. There is a case for selective screening as part of overall vascular risk assessment. Population screening for T2DM does not meet all of the NSC criteria. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

The full text may be available from PubMed

Maternal Vitamin D3 Supplementation during the Third Trimester of Pregnancy: Effects on Infant Growth in a Longitudinal Follow-Up Study in Bangladesh.

OBJECTIVE: To estimate the effects of prenatal vitamin D supplementation on infant growth in Dhaka, Bangladesh. STUDY DESIGN: Longitudinal follow-up of infants born at term or late preterm (>/=34 weeks) to participants in a randomized double-blind trial of maternal third-trimester vitamin D3 (35 000 IU/wk; vitamin D ) vs placebo. Anthropometry was performed at birth, 1, 2, 4, 6, 9, and 12 months of age. The primary analysis (n = 145 overall; n = 134 at 1 year) was a comparison of mean length-for-age z-score (LAZ) based on World Health Organization standards. RESULTS: LAZ was similar between groups at birth, but 0.44 (95% CI, 0.06-0.82) higher in vitamin D vs placebo at 1 year, corresponding to a sex-adjusted increase of 1.1 cm (95% CI, 0.06-2.0). Mean change in LAZ from birth to 1 month was significantly greater in vitamin D (0.53 per month) vs placebo (0.19 per month; P = .004); but there was no significant divergence thereafter. In longitudinal (repeated-measures) analysis, average LAZ during infancy was 0.41 higher in vitamin D vs placebo (95% CI, 0.11-0.71, P = .01). Stunting was less common in vitamin D (17% of infants were ever stunted) vs placebo (31%; P = .049). Other anthropometric indices were similar between groups. CONCLUSIONS: Maternal vitamin D3 supplementation (35 000 IU/wk) during the third trimester of pregnancy enhanced early postnatal linear growth in a cohort of infants in Bangladesh.

The full text may be available from PubMed

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Do you know about the other National Collaborating Centres?

Get to know the whole NCCPH family

The NCCMT is one of six National Collaborating Centres for Public Health in Canada.

The National Collaborating Centres (NCCs) for Public Health promote and improve the use of scientific research and other knowledge to strengthen public health practices and policies in Canada. They identify knowledge gaps, foster networks and translate existing knowledge to produce and exchange relevant, accessible, and evidence-informed products with practitioners, policy makers and researchers.

While the NCCMT focuses on providing leadership and expertise in sharing what works in public health the other NCCs focus on aboriginal health, environmental health, infectious diseases, healthy public policy and social determinants of health.

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