September 2014 · Issue 95
In this issue:
- Using NCCMTs Understanding Research Evidence videos to inform practice decisions
- Thanks for helping us evaluate our Understanding Research Evidence videos!
- New from Public Health+
Using NCCMTs Understanding Research Evidence videos to inform practice decisions
a user story from Peel Region
Last year, Maria Morais, a Supervisor of Workplace Health team at Peel Public Health, attended the annual week-long Evidence-Informed Decision Making (EIDM) workshop at McMaster University (http://ccebn.mcmaster.ca/). She returned to work with some new knowledge and some new tools to help share that knowledge.
During the EIDM course, participants are introduced to resources that can help them implement evidence-informed decisions in their workplaces, including NCCMT's Understanding Research Evidence videos (http://www.nccmt.ca/resources/multimedia-eng.html#ure).
How did Peel use NCCMT's videos?
Peel Public Health has a 10 Year Strategic Plan (http://www.peelregion.ca/health/health-status-report/stay-ahead-curve/). The videos are being used to support organizational strategic priorities such as evidence-informed decision making, performance management and workforce development as well as contributing to several Core Competencies for Public health in Canada (http://www.phac-aspc.gc.ca/php-psp/ccph-cesp/about_cc-apropos_ce-eng.php) and advancing Peel’s own Public Health Way (http://www.peelregion.ca/health/health-status-report/stay-ahead-curve/ph-way.htm).
Peel’s Workplace Health team consists of a diverse group of health promoters, nurses and coordinators with varying levels of public health experience and knowledge. Maria asked Lee-Ann Kosziwka and Hoi Ki Ding, team health promoters, to watch the URE videos, apply the concepts to a Public Health problem the team was dealing with and then facilitate peer-to-peer learning through a facilitated discussion. The knowledge transfer (KT) sessions were added to their team meeting agendas.
Maria Morais, Lee-Ann Kosziwka and Hoi Ki Ding from the Workplace Health team at Peel Public Health
The peer-led session focused on concepts and principles covered in each video. The two health promoters brought examples of data being reviewed for the Living Tobacco Free strategic priority to share with other members of the team. But, before delving into the numbers, the entire team watched the relevant URE video together.
For example, during one team meeting the team watched Understanding a Confidence Interval followed by a discussion of health status data provided to them by an epidemiologist that was being used by a workgroup to develop a workplace tobacco cessation strategy. They then watched Forest Plots: Understanding a Meta-Analysis in 5 Minutes or Less and reviewed an actual example from a journal article being reviewed by the same working group. The facilitated exercise included a discussion of the ways the concept could inform practice decisions and was intended to reinforce the applicability of the principles to the current work of the team.
Strengths of URE videos
NCCMT’s Understanding Research Evidence videos have been well received by the Workplace Health team. Staff appreciate that the research terms presented in the videos “are at a level that people can understand regardless of their level of expertise”. The videos are short and concise, presenting a single concept reinforced by an example of a real public health issue. According to the Workplace Health team, the videos are an effective method of practicing everyday public health and address a variety of the concepts and competencies that support evidence-informed decision making.
What impact have the URE videos had on practice at Peel?
The NCCMT videos are an effective and efficient means of transferring knowledge relevant to public health practitioners and anyone involved in program planning and evaluation. Maria, Lee-Ann and Hoi Ki say the videos also:
contribute to building public health competencies in the areas of Public Health Sciences and Assessment and Analysis;
- reinforce the importance of scrutinizing data for policy and program planning implementation and evaluation;
- encourage careful attention to how data is presented and interpreted;
- reinforce the importance of internal and external partnerships and collaboration;
- support knowledge transfer; and
- strengthen evidence-informed decision-making practices.
The Workplace Health team at Peel Region Public Health has used the videos to support knowledge translation among its members and to build capacity among their entire team.
But it doesn’t stop with the videos. Team members also individually utilize the online learning modules and Maria has started applying NCCMT’s Model of Evidence-Informed Decision Making in Public Health (http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf) to the internal Program Planning and Evaluation process rather than treating these as separate processes.
About the Understanding Research Evidence video series
Public health professionals are under increasing pressure to incorporate research evidence into their decisions. Understanding and interpreting that research evidence is an important part of practising evidence-informed public health and requires an understanding of some key statistical terms. NCCMT’s Understanding Research Evidence videos were developed to support this understanding within the public health workforce.
More Understanding Research Evidence videos are currently in production.
Watch for announcements in upcoming issues of the Round-up or on Twitter (https://twitter.com/nccmt).
Thanks for helping us evaluate our Understanding Research Evidence videos!
We appreciate your feedback.
Thank you to everyone who participated in our evaluation of the Understanding Research Evidence videos! Insights from NCCMT users help us improve our resources to better support the work of public health professionals. We're developing a report on the findings of our evaluation. Watch upcoming issues of the Weekly Round-Up for updates.
Winners from the draw for the online survey, telephone interviews, and video viewing sessions at CPHA have been announced. If you have questions about the evaluation, please contact us at nccmt@mcmaster.ca.
Thank you again to all respondents!
New from Public Health+
Ritonavir-boosted darunavir combined with raltegravir or tenofovir-emtricitabine in antiretroviral-naive adults infected with HIV-1: 96 week results from the NEAT001/ANRS143 randomised non-inferiority trial.
BACKGROUND: Standard first-line antiretroviral therapy for HIV-1 infection includes two nucleoside or nucleotide reverse transcriptase inhibitors (NtRTIs), but these drugs have limitations. We assessed the 96 week efficacy and safety of an NtRTI-sparing regimen. METHODS: Between August, 2010, and September, 2011, we enrolled treatment-naive adults into this randomised, open-label, non-inferiority trial in treatment-naive adults in 15 European countries. The composite primary outcome was change to randomised treatment before week 32 because of insufficient virological response, no virological response by week 32, HIV-1 RNA concentration 50 copies per mL or higher at any time after week 32; death from any cause; any new or recurrent AIDS event; or any serious non-AIDS event. Patients were randomised in a 1:1 ratio to receive oral treatment with 400 mg raltegravir twice daily plus 800 mg darunavir and 100 mg ritonavir once daily (NtRTI-sparing regimen) or tenofovir-emtricitabine in a 245 mg and 200 mg fixed-dose combination once daily, plus 800 mg darunavir and 100 mg ritonavir once daily (standard regimen). This trial was registered with ClinicalTrials.gov, number NCT01066962. FINDINGS: Of 805 patients enrolled, 401 received the NtRTI-sparing regimen and 404 the standard regimen, with median follow-up of 123 weeks (IQR 112-133). Treatment failure was seen in 77 (19%) in the NtRTI-sparing group and 61 (15%) in the standard group. Kaplan-Meier estimated proportions of treatment failure by week 96 were 17.8% and 13.8%, respectively (difference 4.0%, 95% CI -0.8 to 8.8). The frequency of serious or treatment-modifying adverse events were similar (10.2 vs 8.3 per 100 person-years and 3.9 vs 4.2 per 100 person-years, respectively). INTERPRETATION: Our NtRTI-sparing regimen was non-inferior to standard treatment and represents a treatment option for patients with CD4 cell counts higher than 200 cells per muL. FUNDING: European Union Sixth Framework Programme, Inserm-ANRS, Gilead Sciences, Janssen Pharmaceuticals, Merck Laboratories.
The full text may be available from PubMed
Lopinavir/Ritonavir-Based Antiretroviral Treatment (ART) Versus Efavirenz-Based ART for the Prevention of Malaria Among HIV-Infected Pregnant Women.
BACKGROUND: Human immunodeficiency virus (HIV)-infected pregnant women are at increased risk of malaria and its complications. In vitro and in vivo data suggest that the HIV protease inhibitors lopinavir/ritonavir may have potent antimalarial activity. We sought to evaluate whether lopinavir/ritonavir-based antiretroviral therapy (ART) reduced the risk of placental malaria. METHODS: HIV-infected, ART-naive pregnant women were enrolled between gestational weeks 12 and 28 and randomly assigned to receive lopinavir/ritonavir-based or efavirenz-based ART. Women received daily trimethoprim-sulfamethoxazole prophylaxis and insecticide-treated bed nets at enrollment and were followed up to 1 year after delivery. The primary outcome was placental malaria, defined by the detection of malaria parasites, using microscopy or polymerase chain reaction (PCR) analysis of placental blood specimens. Secondary outcomes included placental malaria, defined by histopathologic results; adverse birth outcomes; incidence of malaria; and prevalence of asymptomatic parasitemia. Analyses were done using an intention-to-treat approach. RESULTS: Of 389 subjects randomly assigned to a treatment group, 377 were followed through to delivery. There was no significant difference in the risk of placental malaria, as defined by thick smear or PCR findings, between the lopinavir/ritonavir-based and efavirenz-based ART arms (7.4% vs 9.8%; P = .45). Similarly, there were no differences in secondary outcomes between the 2 treatment arms. CONCLUSIONS: Lopinavir/ritonavir-based ART did not reduce the risk of placental or maternal malaria or improve birth outcomes, compared with efavirenz-based ART. Clinical Trials Registration. NCT00993031.
The full text may be available from PubMed
Treatment outcomes of overweight children and parents in the medical home.
OBJECTIVE: To test in the primary care setting the short- and long-term efficacy of a behavioral intervention that simultaneously targeted an overweight child and parent versus an information control (IC) targeting weight control only in the child. METHODS: Two- to 5-year-old children who had BMI >/=85th percentile and an overweight parent (BMI >25 kg/m(2)) were randomized to Intervention or IC, both receiving diet and activity education over 12 months (13 sessions) followed by 12-month follow-up (3 sessions). Parents in the Intervention group were also targeted for weight control and received behavioral intervention. Pediatricians in 4 practices enrolled their patients with the assistance of embedded recruiters (Practice Enhancement Assistants) who assisted with treatment too. RESULTS: A total of 96 of the 105 children randomized (Intervention n = 46; IC n = 50) started the program and had data at baseline. Children in the Intervention experienced greater reductions in percent over BMI (group x months; P = .002) and z-BMI (group x months; P < 0.001) compared with IC throughout treatment and follow-up. Greater BMI reduction was observed over time for parents in the Intervention compared with IC (P < .001) throughout treatment and follow-up. Child weight changes were correlated with parent weight changes at 12 and 24 months (r = 0.38 and 0.26; P < .001 and P = .03). CONCLUSIONS: Concurrently targeting preschool-aged overweight and obese youth and their parents in primary care with behavioral intervention results in greater decreases in child percent over BMI, z-BMI, and parent BMI compared with IC. The difference between Intervention and IC persists after 12 months of follow-up.
The full text may be available from PubMed
Entecavir plus adefovir combination therapy versus lamivudine add-on adefovir for lamivudine-resistant chronic hepatitis B: A meta-analysis.
To determine whether adefovir (ADV) in combination with entecavir (ETV) is more effective than with lamivudine (LAM) in patients with lamivudine-resistant chronic HBV infection, electronic databases were searched through May 10th, 2013 to obtain relevant trials which met the inclusion criteria. Meta-analysis was performed on randomized controlled trials (RCTs) and non-randomized studies. Four trials containing a total of 323 patients were included. Serum HBV DNA reductions after 3 and 6 months of treatment in the ETV + ADV group were greater than that of LAM + ADV group (mean difference (MD) = 0.90, 95% confidence interval (CI): 0.74-1.07, P < 0.00001; MD = 0.81, 95% CI: 0.57-1.06, P < 0.00001). The rate of 6 months HBV DNA undetectability with ETV and ADV was higher than that of LAM and ADV (relative risk (RR) = 1.63, 95% CI: 1.14-2.34, P < 0.007). There were higher rates of serum ALT normalization than those in LAM + ADV group after 6 months of treatment (RR = 1.40, 95% CI: 1.11-1.77, P < 0.005). The ETV + ADV group had lower viral breakthrough and genotypic mutation rates than LAM + ADV group after 12 months of treatment (RR = 0.24, 95% CI: 0.10-0.58, P = 0.002). The combination of ETV plus ADV is a more effective rescue therapy than LAM add-on ADV in patients with LAM-resistant HBV.
The full text may be available from PubMed
Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: a randomized clinical trial.
IMPORTANCE: Colorectal cancer is a major health burden. Screening is recommended in many countries. OBJECTIVE: To estimate the effectiveness of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality in a population-based trial. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial of 100,210 individuals aged 50 to 64 years, identified from the population of Oslo city and Telemark County, Norway. Screening was performed in 1999-2000 (55-64-year age group) and in 2001 (50-54-year age group), with follow-up ending December 31, 2011. Of those selected, 1415 were excluded due to prior colorectal cancer, emigration, or death, and 3 could not be traced in the population registry. INTERVENTIONS: Participants randomized to the screening group were invited to undergo screening. Within the screening group, participants were randomized 1:1 to receive once-only flexible sigmoidoscopy or combination of once-only flexible sigmoidoscopy and fecal occult blood testing (FOBT). Participants with positive screening test results (cancer, adenoma, polyp >/=10 mm, or positive FOBT) were offered colonoscopy. The control group received no intervention. MAIN OUTCOMES AND MEASURES: Colorectal cancer incidence and mortality. RESULTS: A total of 98,792 participants were included in the intention-to-screen analyses, of whom 78,220 comprised the control group and 20,572 comprised the screening group (10,283 randomized to receive a flexible sigmoidoscopy and 10,289 to receive flexible sigmoidoscopy and FOBT). Adherence with screening was 63%. After a median of 10.9 years, 71 participants died of colorectal cancer in the screening group vs 330 in the control group (31.4 vs 43.1 deaths per 100,000 person-years; absolute rate difference, 11.7 [95% CI, 3.0-20.4]; hazard ratio [HR], 0.73 [95% CI, 0.56-0.94]). Colorectal cancer was diagnosed in 253 participants in the screening group vs 1086 in the control group (112.6 vs 141.0 cases per 100,000 person-years; absolute rate difference, 28.4 [95% CI, 12.1-44.7]; HR, 0.80 [95% CI, 0.70-0.92]). Colorectal cancer incidence was reduced in both the 50- to 54-year age group (HR, 0.68; 95% CI, 0.49-0.94) and the 55- to 64-year age group (HR, 0.83; 95% CI, 0.71-0.96). There was no difference between the flexible sigmoidoscopy only vs the flexible sigmoidoscopy and FOBT screening groups. CONCLUSIONS AND RELEVANCE: In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence and mortality on a population level compared with no screening. Screening was effective both in the 50- to 54-year and the 55- to 64-year age groups. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00119912.
The full text may be available from PubMed
Randomized controlled trial lifestyle interventions for Asian Americans: A systematic review.
OBJECTIVE: Asian Americans are the fastest-growing race in the United States. However, they are largely underrepresented in health research, particularly in lifestyle interventions. A systematic review was conducted to analyze the characteristics and quality of lifestyle intervention literature promoting changes in physical activity (PA), diet, and/or weight management targeting Asian Americans. METHOD: A systematic electronic database search identified randomized controlled clinical trials (RCTs), involving lifestyle interventions for Asian Americans, published from 1995 to 2013 conducted in the US. Data extraction was conducted from August through December 2013. RESULTS: Seven RCTs met the review criteria. Cross-study comparisons were difficult due to diversity in: RCT intervention designs, cultural appropriateness, outcome measures, sample size, and race/ethnic groups. Overall, risk of bias and cultural appropriateness scores were moderate to low. Five out of seven RCTs showed significant between group differences for PA, diet, and weight. In general, sample sizes were small or lacked sufficient power to fully analyze intervention efficacy. CONCLUSION: Evidence of the efficacy for lifestyle interventions among Asian Americans was mixed. Recommendations include: more rigorous RCT designs, more objective measures, larger Asian American sample sizes, culturally appropriate interventions, individual tailoring, maintenance phase with support, and providing education and modeling of lifestyle behaviors.
The full text may be available from PubMed
Exercise for people with high cardiovascular risk.
BACKGROUND: When two or more cardiovascular risk factors occur in one individual, they may interact in a multiplicative way promoting cardiovascular disease. Exercise has proven to be effective in controlling individual risk factors but its effect on overall cardiovascular risk remains uncertain. OBJECTIVES: To assess the effects of exercise training in people with increased cardiovascular risk but without a concurrent cardiovascular disease on general cardiovascular mortality, incidence of cardiovascular events, and total cardiovascular risk. SEARCH METHODS: A search was conducted in CENTRAL (The Cochrane Library 2013, Issue 10 of 12), Ovid MEDLINE (1946 to week 2 November 2013), EMBASE Classic + EMBASE via Ovid (1947 to Week 47 2013), CINAHL Plus with Full Text via EBSCO (to November 2013), Science Citation Index Expanded (SCI-EXPANDED) (1970 to 22 November 2013), and Conference Proceedings Citation Index - Science (CPCI-S) (1990 to 22 November 2013) on Web of Science (Thomson Reuters). We did not apply any date or language restrictions. SELECTION CRITERIA: Randomized clinical trials comparing aerobic or resistance exercise training versus no exercise or any standard approach that does not include exercise. Participants had to be 18 years of age or older with an average 10-year Framingham risk score of 10% for cardiovascular disease over 10 years, or with two or more cardiovascular risk factors, and no history of cardiovascular disease. DATA COLLECTION AND ANALYSIS: The selection of studies and subsequent data collection process were conducted by two independent authors. Disagreements were solved by consensus. The results were reported descriptively. It was not possible to conduct a meta-analysis because of the high heterogeneity and high risk of bias in the included studies. MAIN RESULTS: A total of four studies were included that involved 823 participants, 412 in the exercise group and 411 in the control group. Follow-up of participants ranged from 16 weeks to 6 months. Overall, the included studies had a high risk of selection, detection, and attrition bias. Meta-analysis was not possible because the interventions (setting, type and intensity of exercise) and outcome measurements were not comparable, and the risk of bias in the identified studies was high. No study assessed cardiovascular or allcause mortality or cardiovascular events as individual outcomes. One or more of the studies reported on total cardiovascular risk, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, blood pressure, body mass index, exercise capacity, and health-related quality of life but the available evidence was not sufficient to determine the effectiveness of exercise. Adverse events and smoking cessation were not assessed in the included studies. AUTHORS` CONCLUSIONS: Evidence to date is entirely limited to small studies with regard to sample size, short-term follow-up, and high risk of methodological bias, which makes it difficult to derive any conclusions on the efficacy or safety of aerobic or resistance exercise on groups with increased cardiovascular risk or in individuals with two or more coexisting risk factors. Further randomized clinical trials assessing controlled exercise programmes on total cardiovascular risk in individuals are warranted.
The full text may be available from PubMed
