September 2014 · Issue 97
In this issue:
- Highlight from the Registry of Methods and Tools
- New from Public Health+
- Population Mental Health needs assessment survey
- Upcoming conferences and events:
Highlight from the Registry of Methods and Tools
What's getting in the way of your using evidence-based policy in practice?
This SUPPORT tool can help identify barriers to change!
So you have introduced a new policy that is based on evidence but staff seen reluctant to adopt it. What’s the problem?
Developed by the SUPporting POlicy relevant Reviews and Trials (SUPPORT) Project, this SUPPORT tool provides five questions to help decision makers implement an evidence-based policy in practice. The questions guide the process of identifying barriers to implementation, and then tailoring the implementation strategies to address identified barriers and facilitators:
- What are the potential barriers to the successful implementation of a new policy?
- What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes among healthcare recipients and citizens?
- What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes in healthcare professionals?
- What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary organisational changes?
- What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary systems changes?
For more info, check out SUPPORT tool for using research evidence in policy implementation, our summary of this tool http://www.nccmt.ca/registry/view/eng/155.html
New from Public Health+
Increasing provision of adolescent vaccines in primary care: a randomized controlled trial.
OBJECTIVES: To assess the effectiveness of in-person and webinar-delivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage. METHODS: We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX consultation. We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011. The state`s immunization registry provided vaccine coverage data for younger patients (ages 11-12 years) and older patients (ages 13-18 years) for 3 adolescent vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); meningococcal; and human papillomavirus (HPV) vaccines (>/=1 dose, females only). RESULTS: At the 5-month follow-up, AFIX consultations increased vaccine coverage among younger adolescents. Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap (3.4% [95% confidence interval (CI): 2.2 to 4.6]), meningococcal (4.7% [95% CI: 2.3 to 7.2], and HPV (1.5% [95% CI: 0.3 to 2.7]) vaccines. Patients in the webinar versus control arm also experienced larger changes for these vaccines. AFIX did little to improve coverage among older adolescents. At 1 year, the 3 arms showed similar coverage changes. The effectiveness of in-person and webinar consultations was not statistically different at either time point (all, P >.05). CONCLUSIONS: Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents. AFIX consultations for adolescents need improvement to have a stronger and more durable impact, especially for HPV vaccine.
The full text may be available from PubMed
Effect of a quadrivalent meningococcal ACWY glycoconjugate or a serogroup B meningococcal vaccine on meningococcal carriage: an observer-blind, phase 3 randomised clinical trial.
BACKGROUND: Meningococcal conjugate vaccines protect individuals directly, but can also confer herd protection by interrupting carriage transmission. We assessed the effects of meningococcal quadrivalent glycoconjugate (MenACWY-CRM) or serogroup B (4CMenB) vaccination on meningococcal carriage rates in 18-24-year-olds. METHODS: In this phase 3, observer-blind, randomised controlled trial, university students aged 18-24 years from ten sites in England were randomly assigned (1:1:1, block size of three) to receive two doses 1 month apart of Japanese Encephalitis vaccine (controls), 4CMenB, or one dose of MenACWY-CRM then placebo. Participants were randomised with a validated computer-generated random allocation list. Participants and outcome-assessors were masked to the treatment group. Meningococci were isolated from oropharyngeal swabs collected before vaccination and at five scheduled intervals over 1 year. Primary outcomes were cross-sectional carriage 1 month after each vaccine course. Secondary outcomes included comparisons of carriage at any timepoint after primary analysis until study termination. Reactogenicity and adverse events were monitored throughout the study. Analysis was done on the modified intention-to-treat population, which included all enrolled participants who received a study vaccination and provided at least one assessable swab after baseline. This trial is registered with ClinicalTrials.gov, registration number NCT01214850. FINDINGS: Between Sept 21 and Dec 21, 2010, 2954 participants were randomly assigned (987 assigned to control [984 analysed], 979 assigned to 4CMenB [974 analysed], 988 assigned to MenACWY-CRM [983 analysed]); 33% of the 4CMenB group, 34% of the MenACWY-CRM group, and 31% of the control group were positive for meningococcal carriage at study entry. By 1 month, there was no significant difference in carriage between controls and 4CMenB (odds ratio 1.2, 95% CI 0.8-1.7) or MenACWY-CRM (0.9, [0.6-1.3]) groups. From 3 months after dose two, 4CMenB vaccination resulted in significantly lower carriage of any meningococcal strain (18.2% [95% CI 3.4-30.8] carriage reduction), capsular groups BCWY (26.6% [10.5-39.9] carriage reduction), capsular groups CWY (29.6% [8.1-46.0] carriage reduction), and serogroups CWY (28.5% [2.8-47.5] carriage reduction) compared with control vaccination. Significantly lower carriage rates were also noted in the MenACWY-CRM group compared with controls: 39.0% (95% CI 17.3-55.0) carriage reduction for serogroup Y and 36.2% (15.6-51.7) carriage reduction for serogroup CWY. Study vaccines were generally well tolerated, with increased rates of transient local injection pain and myalgia in the 4CMenB group. No safety concerns were identified. INTERPRETATION: Although we detected no significant difference between groups at 1 month after vaccine course, MenACWY-CRM and 4CMenB vaccines reduced meningococcal carriage rates during 12 months after vaccination and therefore might affect transmission when widely implemented. FUNDING: Novartis Vaccines.
The full text may be available from PubMed
Exercise interventions for smoking cessation.
BACKGROUND: Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. OBJECTIVES: To determine whether exercise-based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2014, and searched MEDLINE, EMBASE, PsycINFO, and CINAHL Plus in May 2014. SELECTION CRITERIA: We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme (which we considered the control in this review). Studies were required to recruit smokers or recent quitters and have a follow-up of six months or more. Studies that did not meet the full inclusion criteria because they only assessed the acute effects of exercise on smoking behaviour, or because the outcome was smoking reduction, are summarised but not formally included. DATA COLLECTION AND ANALYSIS: We extracted data on study characteristics and smoking outcomes. Because of differences between studies in the characteristics of the interventions used we summarized the results narratively, making no attempt at meta-analysis. We assessed risk of selection and attrition bias using standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We identified 20 trials with a total of 5,870 participants. The largest study was an internet trial with 2,318 participants, and eight trials had fewer than 30 people in each treatment arm. Studies varied in the timing and intensity of the smoking cessation and exercise programmes offered. Only one included study was judged to be at low risk of bias across all domains assessed. Four studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow-up and a benefit for exercise of borderline significance (p = 0.05) at the 12-month follow-up. Another study reported significantly higher abstinence rates at six month follow-up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow-up but not at the end of treatment or 12-month follow-up. The other studies showed no significant effect for exercise on abstinence. AUTHORS` CONCLUSIONS: Only two of the 20 trials offered evidence for exercise aiding smoking cessation in the long term. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which may not have been sufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions in terms of both exercise intensity and intensity of support being provided, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups.
The full text may be available from PubMed
Population Mental Health needs assessment survey
The National Collaborating Centres for Public Health are trying to assess the needs in the field of population mental health through a survey.
Your participation in this survey will help to inform the subjects that will be addressed in the future.
To complete the survey, please click here: http://inspq.fluidsurveys.com/s/NCCPHneed/
Upcoming conferences and events:
22nd Cochrane Colloquium
Maureen Dobbins, Scientific Director of NCCMT, and Director of Health Evidence, will speak at the 22nd Cochrane Colloquium in Hyderabad, India this month. Join her for her discussion, “Supporting evidence-informed health care decision making: Challenging? Yes, but definitely worth the effort”, during the closing plenary on Friday September 26.
For more information on Colloquium sessions and abstracts, or to register to attend, visit https://colloquium.cochrane.org/.
Aboriginal Nurses Association of Canada 2014 National Forum
We’ll be in Winnipeg to offer a one-day pre-conference workshop in partnership with the NCCs for Aboriginal Health and Infectious Diseases on Infectious Diseases and Public Health: Sorting Through the Evidence for registered participants on October 3.
For more information on the conference or our workshop, check out the ANAC website: http://anac.on.ca/national-conference/.
3rd International Society of Evidence-Based Health Care (ISEHC) Conference
Maureen Dobbins will attend the ISECH conference in Taipei, Taiwan. On November 7, she will deliver a presentation on Accessing and Applying Knowledge Translation Methods and Tools in Public Health Practice.
