mars 2014 · Numéro 75
Dans ce bulletin :
- Examen approfondi de la série de vidéos du CCNMO : Comprendre les données probantes issues de la recherche
- Quoi de neuf dans Public Health +?
- Atelier du Canadian Centre for Evidence-Based Nursing (CCEBN) sur la prise de décisions fondée sur des données probantes
- Nouveauté «La santé publique a la parole» :
Examen approfondi de la série de vidéos du CCNMO : Comprendre les données probantes issues de la recherche
Cette semaine : L'importance de la signification clinique
Il est essentiel de prendre en compte la différence entre l’importance statistique et la signification clinique lorsqu’il s’agit de décider si le résultat d’une intervention justifie l’investissement requis.
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L'importance de la signification clinique prend l’exemple de la construction de pistes cyclables comme moyen d’augmenter l’activité physique. Une étude hypothétique révèle un résultat positif. Toutefois, l’intervalle de confiance démontre une assez large échelle d’augmentation de l’exercice.
Bien que cette augmentation soit toujours statistiquement significative, il faut décider si l’extrémité inférieure de l’échelle est cliniquement significative. Une faible augmentation de l’activité physique hebdomadaire influera-t-elle suffisamment sur la santé d’une personne? Vaut-elle l’investissement qu’exige la construction de pistes cyclables?
Votre décision sera fondée sur les données probantes issues de la recherche et sur un éventail d’autres éléments propres à la situation. Il s’agira essentiellement d’un jugement de valeur quant à la signification clinique.
À propos de la série
Ces courtes vidéos visent à expliquer certains termes importants sur lesquels vous pouvez tomber dans les données probantes issues de la recherche. Elles constituent une précieuse remise à niveau ou une introduction utile aux termes que les professionnels de la santé publique doivent connaître pour prendre de bonnes décisions à l’aide de données probantes issues de la recherche.
À l’heure actuelle, la série Comprendre les données probantes issues de la recherche compte quatre vidéos. Chacune dure moins de six minutes et explique des termes clés qui sont employés en analyse statistique. Les vidéos jettent un regard sur les « rapports de cotes », les « intervalles de confiance », « les graphiques en forêt » et « la signification clinique » et expliquent chaque terme en langage clair en fournissant des exemples réalistes en santé publique et des images stimulantes.
Nous sommes à créer d’autres vidéos pour cette série. Assurez-vous de surveiller le Résumé pour connaître les détails!
Regardez toutes les vidéos de la série!
Les vidéos sont offertes sur YouTube et sur le site Web du CCNMO (http://www.nccmt.ca/resources/multimedia-fra.html).
Elles font partie d’une série de produits et services offerts sur le site Web du CCNMO et dans le Centre d’apprentissage (http://www.nccmt.ca/learningcentre) et elles sont conçues pour vous aider à prendre de bonnes décisions en santé publique, en vous fondant sur les meilleures données probantes issues de la recherche qui soient.
Quoi de neuf dans Public Health +?
Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling.
BACKGROUND: Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. OBJECTIVE: To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). DESIGN: Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. SETTING: General population and genitourinary medicine clinic attenders. PARTICIPANTS: Heterosexual women and men. INTERVENTIONS: Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). MAIN OUTCOME MEASURES: Population prevalence; index case reinfection; and partners treated per index case. RESULTS: Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, >10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. CONCLUSIONS: There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. FUNDING: The National Institute for Health Research Health Technology Assessment programme.
The full text may be available from PubMed
Efficacy, safety, and immunogenicity of an enterovirus 71 vaccine in China.
BACKGROUND: Enterovirus 71 (EV71) is one of the major causative agents of outbreaks of hand, foot, and mouth disease or herpangina worldwide. This phase 3 trial was designed to evaluate the efficacy, safety, and immunogenicity of an EV71 vaccine. METHODS: We conducted a randomized, double-blind, placebo-controlled, multicenter trial in which 10,007 healthy infants and young children (6 to 35 months of age) were randomly assigned in a 1:1 ratio to receive two intramuscular doses of either EV71 vaccine or placebo, 28 days apart. The surveillance period was 12 months. The primary end point was the occurrence of EV71-associated hand, foot, and mouth disease or herpangina. RESULTS: During the 12-month surveillance period, EV71-associated disease was identified in 0.3% of vaccine recipients (13 of 5041 children) and 2.1% of placebo recipients (106 of 5028 children) in the intention-to-treat cohort. The vaccine efficacy against EV71-associated hand, foot, and mouth disease or herpangina was 94.8% (95% confidence interval [CI], 87.2 to 97.9; P<0.001) in this cohort. Vaccine efficacies against EV71-associated hospitalization (0 cases vs. 24 cases) and hand, foot, and mouth disease with neurologic complications (0 cases vs. 8 cases) were both 100% (95% CI, 83.7 to 100 and 42.6 to 100, respectively). Serious adverse events occurred in 111 of 5044 children in the vaccine group (2.2%) and 131 of 5033 children in the placebo group (2.6%). In the immunogenicity subgroup (1291 children), an anti-EV71 immune response was elicited by the two-dose vaccine series in 98.8% of participants at day 56. An anti-EV71 neutralizing antibody titer of 1:16 was associated with protection against EV71-associated hand, foot, and mouth disease or herpangina. CONCLUSIONS: The EV71 vaccine provided protection against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children. (Funded by Sinovac Biotech; ClinicalTrials.gov number, NCT01507857.).
The full text may be available from PubMed
The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial.
OBJECTIVE: To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)(2) at increased risk of colorectal cancer and other obesity related comorbidities. DESIGN: Multicentre, parallel group, randomised controlled trial. SETTING: Four Scottish National Health Service health boards. PARTICIPANTS: 329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control. INTERVENTION: Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change. MAIN OUTCOME MEASURES: The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption. RESULTS: At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation. CONCLUSIONS: Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53033856.
The full text may be available from PubMed
Effects of exercise programs on depressive symptoms, quality of life and self-esteem in older people: A systematic review of randomized controlled trials.
OBJECTIVE: This study attempted to show evidence of exercise programs as intervention to decrease depressive symptoms and to improve quality of life and self-esteem in older people. DESIGN: Systematic review of randomized controlled trials. DATA SOURCES: Electronic databases of KoreaMed, Korea Scientific and Technological Intelligence Center, Korean Society of Nursing Science, Korean Academy of Psychiatric Mental Health Nursing, Ovid-Medline and Embase were searched up to May 25th, 2012 for relevant articles. REVIEW: We searched studies of randomized controlled trials involving exercise programs administered to participants aged 65years or over. Of 461 publications identified, 18 met the inclusion criteria for the meta-analysis. Quality assessment of the studies utilized Cochrane`s Risk of Bias. RESULTS: Exercise therapy in older people was effective, as evidenced by a decrease in depressive symptoms [standardized mean difference (SMD) -0.36; 95% confidence interval (CI) -0.64, -0.08], and improvements in quality of life (SMD 0.86; 95% CI 0.11, 1.62) and self-esteem (SMD 0.49; 95% CI 0.09, 0.88). The changes were significant statistically, with no heterogeneity. CONCLUSIONS: Exercise programs in older people are effective in improving depressive symptoms, quality of life and self-esteem. Development and efficient use of tailored exercise programs for elderly people is a prudent strategy.
The full text may be available from PubMed
A Randomized Trial of a Standard Dose of Edmonston-Zagreb Measles Vaccine Given at 4.5 Months of Age: Effect on Total Hospital Admissions.
Observational studies and trials from low-income countries indicate that measles vaccine has beneficial nonspecific effects, protecting against non-measles-related mortality. It is not known whether measles vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis vaccine were randomly assigned to receive measles vaccine at 4.5 months or no measles vaccine; all children were offered measles vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for measles vaccine versus no measles vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the measles vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52-.95), with a ratio of 0.53 (95% CI, .32-.86) for girls and 0.86 (95% CI, .58-1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34-.84), with an effect of 0.30 (95% CI, .13-.70) for girls and 0.73 (95% CI, .42-1.28) for boys (P = .08, interaction test). The reduction in admissions was separately significant for measles infection (admission HRR, 0 [95% CI, 0-.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16-.89]). Early measles vaccine may have major benefits for infant morbidity patterns and healthcare costs.Clinical trials registration. NCT00168558.
The full text may be available from PubMed
Atelier du Canadian Centre for Evidence-Based Nursing (CCEBN) sur la prise de décisions fondée sur des données probantes
Cours intensif d’une semaine
du 5 au 9 mai 2014
à l’Université McMaster, Hamilton (Ontario)
- Améliorez vos compétences en évaluation critique des comptes rendus de recherche.
- Apprenez des stratégies pour appliquer des décisions fondées sur des données probantes.
- Séances en groupes restreints ou importants animées par des membres du corps enseignant de l’Université
Groupes de travaux dirigés pour les professionnels, les administrateurs, les gestionnaires et les responsables de l’élaboration de politiques en matière de santé qui souhaitent recourir à la prise de décisions fondée sur des données probantes dans leur discipline.
Afin d’en savoir plus à propos de l’atelier sur la PDFDP et de vous y inscrire, allez sur le site du CCEBN au http://www.ccebn.ca.
Pour de plus amples renseignements, communiquez avec Jennifer Yost à l’adresse ccebn@mcmaster.ca.
Nouveauté «La santé publique a la parole» :
la tuberculose et les déterminants sociaux de la santé
Le Centre de collaboration nationale des déterminants de la santé (CCNDS) et le Centre de collaboration nationale des maladies infectieuses a réuni un groupe de praticiennes de la santé publique afin de connaître leurs points de vue quant aux rôles, aux interventions et aux stratégies possibles pour réduire les iniquités associées aux maladies infectieuses. En utilisant la tuberculose comme exemple, les praticiennes parlent des moyens que peut employer la santé publique pour agir sur les déterminants sociaux de la santé.
