August 2014 · Issue 93
In this issue:
- Share your thoughts. Help shape the future of the NCCMT
- New in Registry of Methods and Tools
- New from Public Health+
- Another Online Learning Module Coming Soon!
Share your thoughts. Help shape the future of the NCCMT
Please participate in this brief survey!
If you work in public health in Canada, the National Collaborating Centre for Methods and Tools (NCCMT) is interested in hearing about your current public health practice and what resources and supports you need to incorporate research evidence into practice.
Our goal is to provide products and services that target gaps and priorities for evidence-informed decision-making identified by public health professionals across Canada.
What can NCCMT do to help you in your practice?
Please take 10 to15 minutes to complete this survey to help us identify and prioritize our activities for the next five years.
To participate in the survey, visit http://ow.ly/AuuhK.
Those working in Canada who complete the survey are invited to enter a draw for a free registration for the Canadian Public Health Association 2015 conference, including travel!
All responses will remain anonymous. No individual data will be reported. If you have any questions about this survey, you may contact us (kyabagg@mcmaster.ca).
The survey closes September 5, 2014.
New in Registry of Methods and Tools
Organizational context for evidence-based practices: The Alberta Context Tool (ACT)
http://www.nccmt.ca/registry/view/eng/216.html
New from Public Health+
Structural and community-level interventions for increasing condom use to prevent the transmission of HIV and other sexually transmitted infections.
BACKGROUND: Community interventions to promote condom use are considered to be a valuable tool to reduce the transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). In particular, special emphasis has been placed on implementing such interventions through structural changes, a concept that implies public health actions that aim to improve society`s health through modifications in the context wherein health-related risk behavior takes place. This strategy attempts to increase condom use and in turn lower the transmission of HIV and other STIs. OBJECTIVES: To assess the effects of structural and community-level interventions for increasing condom use in both general and high-risk populations to reduce the incidence of HIV and STI transmission by comparing alternative strategies, or by assessing the effects of a strategy compared with a control. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, from 2007, Issue 1), as well as MEDLINE, EMBASE, AEGIS and ClinicalTrials.gov, from January 1980 to April 2014. We also handsearched proceedings of international acquired immunodeficiency syndrome (AIDS) conferences, as well as major behavioral studies conferences focusing on HIV/AIDS and STIs. SELECTION CRITERIA: Randomized control trials (RCTs) featuring all of the following.1. Community interventions (`community` defined as a geographical entity, such as cities, counties, villages).2. One or more structural interventions whose objective was to promote condom use. These type of interventions can be defined as those actions improving accessibility, availability and acceptability of any given health program/technology.3. Trials that confirmed biological outcomes using laboratory testing. DATA COLLECTION AND ANALYSIS: Two authors independently screened and selected relevant studies, and conducted further risk of bias assessment. We assessed the effect of treatment by pooling trials with comparable characteristics and quantified its effect size using risk ratio. The effect of clustering at the community level was addressed through intra-cluster correlation coefficients (ICCs), and sensitivity analysis was carried out with different design effect values. MAIN RESULTS: We included nine trials (plus one study that was a subanalysis) for quantitative assessment. The studies were conducted in Tanzania, Zimbabwe, South Africa, Uganda, Kenya, Peru, China, India and Russia, comprising 75,891 participants, mostly including the general population (not the high-risk population). The main intervention was condom promotion, or distribution, or both. In general, control groups did not receive any active intervention. The main risk of bias was incomplete outcome data.In the meta-analysis, there was no clear evidence that the intervention had an effect on either HIV seroprevalence or HIV seroincidence when compared to controls: HIV incidence (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.69 to 1.19) and HIV prevalence (RR 1.02, 95% CI 0.79 to 1.32). The estimated effect of the intervention on other outcomes was similarly uncertain: Herpes simplex virus 2 (HSV-2) incidence (RR 0.76, 95% CI 0.55 to 1.04); HSV-2 prevalence (RR 1.01, 95% CI 0.85 to 1.20); syphilis prevalence (RR 0.91, 95% CI 0.71 to 1.17); gonorrhoea prevalence (RR 1.16, 95% CI 0.67 to 2.02); chlamydia prevalence (RR 0.94, 95% CI 0.75 to 1.18); and trichomonas prevalence (RR 1.00, 95% CI 0.77 to 1.30). Reported condom use increased in the experimental arm (RR 1.20, 95% CI 1.03 to 1.40). In the intervention groups, the number of people reporting two or more sexual partners in the past year did not show a clear decrease when compared with control groups (RR 0.90, 95% CI 0.78 to 1.04), but knowledge about HIV and other STIs improved (RR 1.15, 95% CI 1.04 to 1.28, and RR 1.23, 95% CI 1.07 to 1.41, respectively). The quality of the evidence was deemed to be moderate for nearly all key outcomes. AUTHORS` CONCLUSIONS: There is no clear evidence that structural interventions at the community level to increase condom use prevent the transmission of HIV and other STIs. However, this conclusion should be interpreted with caution since our results have wide confidence intervals and the results for prevalence may be affected by attrition bias. In addition, it was not possible to find RCTs in which extended changes to policies were conducted and the results only apply to general populations in developing nations, particularly to Sub-Saharan Africa, a region which in turn is widely diverse.
The full text may be available from PubMed
The Effect of a ``Maintain, Don`t Gain`` Approach to Weight Management on Depression Among Black Women: Results From a Randomized Controlled Trial.
Objectives. We evaluated the effect of a weight gain prevention intervention (Shape Program) on depression among socioeconomically disadvantaged overweight and obese Black women. Methods. Between 2009 and 2012, we conducted a randomized trial comparing a 12-month electronic health-based weight gain prevention intervention to usual primary care at 5 central North Carolina community health centers. We assessed depression with the Patient Health Questionnaire (PHQ-8). We analyzed change in depression score from baseline to 12- and 18-month follow-up across groups with mixed models. We used generalized estimating equation models to analyze group differences in the proportion above the clinical threshold for depression (PHQ-8 score >/= 10). Results. At baseline, 20% of participants reported depression. Twelve-month change in depression scores was larger for intervention participants (mean difference = -1.85; 95% confidence interval = -3.08, -0.61; P = .004). There was a significant reduction in the proportion of intervention participants with depression at 12 months with no change in the usual-care group (11% vs 19%; P = .035). All effects persisted after we controlled for weight change and medication use. We saw similar findings at 18 months. Conclusions. The Shape Program, which includes no mention of mood, improved depression among socioeconomically disadvantaged Black women. (Am J Public Health. Published online ahead of print July 17, 2014: e1-e8. doi:10.2105/AJPH.2014.302004).
The full text may be available from PubMed
Another Online Learning Module Coming Soon!
New module will support Evaluate step of evidence-informed public health.
NCCMT is adding to our suite of online learning modules. With this module, we now provide online learning support for each step of the EIPH process. The next module in our series -- Evaluating KT Strategies in Public Health -- will focus on the seventh and final step: Evaluate.
Like others in the series, this module uses a realistic public health scenario and several interactivities to support learning. This module builds on the Implementing KT Strategies in Public Health module and uses the “group function” currently available in NCCMT’s Learning Centre. While the module can be completed by an individual, we encourage learners to complete the module with colleagues for a more complete and realistic experience.
