Addiction research centres and the nurturing of creativity: Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University,Sweden

The Centre for Social Research on Alcohol and Drugs (SoRAD) was established as a national research centre and department within the Faculty of Social Science at Stockholm University in 1997, following a Government Report and with the aim to strengthen social alcohol and drug research. Initially, core funding came from the Swedish Council for Working Life and Social Research and from the Ministry of Health and Social Affairs for several long‐term projects. Today, SoRAD, with 25 senior and junior researchers, has core funding from the university but most of its funding comes from external national and international grants. Research is organized under three themes: consumption, problems and norms, alcohol and drug policy and societal reactions, treatment and recovery processes. SoRADs scientific approach, multi‐disciplinarity, a mix of qualitative and quantitative methods and international comparisons was established by the centre's first leader, Robin Room. Regular internal seminars are held and young researchers are encouraged to attend scientific meetings and take part in collaborative projects. SoRAD researchers produce government‐funded monthly statistics on alcohol consumption and purchase, and take part in various national government committees, but SoRADs research has no clear political or bureaucratic constraints. One of the future challenges for SoRAD will be the proposed system for university grants allocation, where applied social science will have difficulties competing with basic biomedical research if decisions are based on publication and citation measures.     

Setting research priorities in tobacco control: a stakeholder engagement project

Background and Aims

The Cochrane Tobacco Addiction Group (TAG) conducts systematic reviews of the evidence for tobacco cessation and prevention interventions. In 2016 TAG conducted a priority‐setting, stakeholder engagement project to identify where further research is needed in the areas of tobacco control and smoking cessation.

Design

The project comprised two surveys and a workshop. A range of stakeholders participated, including members of the public (smokers and ex‐smokers), clinicians, researchers, research funders, health‐care commissioners and public health organizations. The first survey phase identified unanswered research questions in the field of tobacco control. The second phase asked participants to rank these, with overall rankings calculated by combining scores across participants. The workshop allowed attendees to discuss prioritization of topics and questions in more depth. Workshop discussions were transcribed and analysed thematically, and a final voting activity at the close of the workshop allowed participants to choose topics to prioritize and to de‐prioritize.

Findings

A total of 304 stakeholders (researchers, health professionals, smokers and ex‐smokers, guideline developers, research funders and policymakers, representing 28 countries) identified 183 unanswered research questions. These were categorized into 15 research categories. A total of 175 participants prioritized categories and questions in the second survey phase, with ‘electronic cigarettes’; ‘addressing inequalities’; and ‘mental health and other substance abuse’ prioritized as the top three categories. Forty‐three stakeholders attended the workshop and discussed reasons for and against category prioritization. Prioritized research categories largely mirrored those in the survey stage, although ‘treatment delivery’ also emerged as a key category. Five cross‐cutting themes emerged: efficacy; relative efficacy; cost effectiveness; addressing inequalities; and different types of evidence.

Conclusions

There are many unanswered questions in the field of tobacco control. Stakeholders highlighted electronic cigarettes, addressing inequalities and mental health and other substance abuse as key areas for further research, and efficacy, relative efficacy, cost‐effectiveness and use of non‐randomized studies as important themes cutting across research areas. Future prioritization work would benefit from targeting non‐US and non‐UK stakeholders explicitly and from examining where priorities may differ based on stakeholder group.     

Applications of systems modelling in obesity research

Obesity is a complex system problem involving a broad spectrum of policy, social, economic, cultural, environmental, behavioural, and biological factors and the complex interrelated, cross‐sector, non‐linear, dynamic relationships among them. Systems modelling is an innovative approach with the potential for advancing obesity research. This study examined the applications of systems modelling in obesity research published between 2000 and 2017, examined how the systems models were developed and used in obesity studies and discussed related gaps in current research. We focused on the applications of two main systems modelling approaches: system dynamics modelling and agent‐based modelling. The past two decades have seen a growing body of systems modelling in obesity research. The research topics ranged from micro‐level to macro‐level energy‐balance‐related behaviours and policies (19 studies), population dynamics (five studies), policy effect simulations (eight studies), environmental (10 studies) and social influences (15 studies) and their effects on obesity rates. Overall, systems analysis in public health research is still in its early stages, with limitations linked to model validity, mixed findings and its actual use in guiding interventions. Challenges in theory and modelling practices need to be addressed to realize the full potential of systems modelling in future obesity research and interventions.     

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study

The community of health services researchers in general internal medicine has played an important role in affecting health policy at the national and state levels. Community-based participatory research (CBPR) offers health services researchers an opportunity to identify and address health policy questions at the local level. We present the following four mechanisms by which CBPR might increase the ability of health services researchers to impact health by informing local policy. CBPR benefits community partners by allowing them to participate directly in the research process, gives academic researchers access to local data, enhances interpretation of research findings through an understanding of local context, and provides a natural infrastructure for affecting local policy through its community partners. For each of these mechanisms, we describe one example from a CBPR project conducted by one of us (M.O.). Considering the challenges and opportunities of conducting CBPR, future efforts will help describe how this emerging research paradigm can complement traditional health services research to most effectively inform health policy at multiple levels.     

Development of a community care research agenda for Australia

Aim: The purpose of this study was to develop a Community Care Research Agenda to give direction to research across community‐based services for older people, for the next 3–5 years. Methods: This study used a four‐round Delphi method to verify, rate and rank research questions and issues identified by sector stakeholders. Thirty panellists were selected to represent all key stakeholder groups within community care. Results: The research agenda comprises the 30 questions/topics, in ranked order, considered by the panellists to be of the highest priority. The largest subgroups of issues pertain to approaches to care (30%), program outcomes and effectiveness (13%), funding (10%), and workforce (10%). Conclusion: Having a National Community Care Research Agenda will provide focus and direction for researchers, service providers and funders in developing and conducting high priority, high value research that can inform improvements in policy and practice in community care for older people.     

Addiction Research Centres and the Nurturing of Creativity

The Alcohol and Drug Abuse Research Unit (ADARU) was established at the South African Medical Research Council (MRC) at the beginning of 2001, although its origins lie in the activities of the Centre for Epidemiological Research in Southern Africa and other MRC entities. Initial challenges included attracting external funding, recruiting new staff, developing the skills of junior staff, publishing in international journals and building national and international collaborative networks. ADARU currently comprises a core staff of 33 members who work on 22 projects spanning substance use epidemiology and associated consequences, intervention studies with at‐risk populations and services research. A large component of this portfolio focuses on the link between alcohol and other drug use and human immunodeficiency virus (HIV) risk behaviour, with funding from the US Centers for Disease Control and Prevention. Junior staff members are encouraged to develop independent research interests and pursue PhD studies. Research outputs, such as the 20 papers that were published in 2010 and the 35 conference presentations from that year, form an important part of the unit's research translation activities. We engage actively with policy processes at the local, provincial, national and international levels, and have given particular attention to alcohol policy in recent years. The paper includes an analysis of major challenges currently facing the unit and how we are attempting to address them. It ends with some thoughts on what the unit intends doing to enhance the quality of its research, the capacity of its staff and its international standing.     

Improving communication of research findings: identifying the sources of information most important to national disease control officers in low‐ and middle‐income countries

Major global health initiatives have brought new opportunities and increased funding for health programmes in countries tackling diseases, such as malaria, tuberculosis (TB), and HIV/AIDS. However, to deploy these investments effectively, health programme managers need much better access to research that assesses the advantages and disadvantages of different strategies. Communicating key findings via the sources of information that health officials use and trust helps to maximise the impact of research on policy and practice. We contacted heads of communicable disease programmes in six countries to ask them about their most important and most frequently used sources of information, as well as the source of information behind their most recent policy change. African respondents particularly emphasised the importance of the World Health Organization (WHO) to influence policy, as well as some mention of international donors. Asian respondents, however, reported being guided much more by in‐country information and surveillance. ‘Most recent’ policy changes having to do with drug treatments (particularly for malaria, but also in one TB policy) were influenced by the WHO, while other TB and HIV policy changes drew on wider sources of information, depending on the nature of the policy change considered (e.g. service structure, treatment approach or populations targeted). Our approach illustrates a first step many researchers may wish to engage in to help guide dissemination strategies to maximise potential research uptake.     

Addiction research centres and the nurturing of creativity. The Korean Institute on Alcohol Problems (KIAP)

The aim of this paper is to provide an account of the history, current status and vision of the Korean Institute on Alcohol Problems (KIAP). In the context of increasing alcohol consumption, rising second‐hand effects and industry‐friendly government policy, the Korean College Alcohol Study (KCAS) was established in the Republic of Korea in 1999, and changed its name to the Korean Institute on Alcohol Problems (KIAP) in 2005. KIAP's mission is to decrease alcohol consumption and its related harms by promoting research, advocating policy, developing intervention programmes and preparing media communications. Since 1999, KIAP has published scientific papers and books in alcohol research and used the internet and other media for dissemination of specialized information to the general population. In the last decade, KIAP has trained front‐line alcohol researchers, and advanced domestic and international networks to promote evidence‐based alcohol control policy in Korea. The light of hope shines brightly as KIAP grows and establishes critical linkages to move forward in its mission.     

Isolation of health services research from practice and policy: the example of chronic heart failure management

This study examined how health services research connects with practice and policy, first by investigating whether successful research projects continued in their test settings and engendered replication and then by examining whether a coherent body of research helped shape public policy. Chronic heart failure (CHF) was studied because randomized, controlled trials of posthospital CHF disease management have repeatedly demonstrated patient benefits and reduced costs, yet this practice has not become standard in the United States. Literature review produced 30 randomized, controlled trials of multidisciplinary outpatient CHF management, generally yielding improved patient outcomes. An e-mail survey of first authors (97% response rate) showed that practices proven to be effective in U.S. studies generally did not continue or expand (13 of 15 studies), mostly attributed to financial constraints (11 of 13), whereas similar projects in other countries often became permanent (7 of 13). U.S. respondents generally rated current quality of clinical care as good, whereas those elsewhere mostly rated it as excellent. Recent Medicare reforms implemented a model of CHF management substantially different from those studied in health services research. The Congressional hearings leading to these Medicare reforms, and the statute itself, mostly evidence the model used by commercial disease-management firms. Policy-makers, health service researchers, and funding agencies could develop more-effective methods for translating proven models of healthcare delivery into routine practice. Reforms that might improve the effectiveness of the linkages between research, policy, and practice are suggested.     

Strategies for Promoting Organizational and Practice Change by Advancing Implementation Research

BACKGROUND: The persistence of a large quality gap between what we know about how to produce high quality clinical care and what the public receives has prompted interest in developing more effective methods to get evidence into practice. Implementation research aims to supply such methods.
PURPOSE: This article proposes a set of recommendations aimed at establishing a common understanding of what implementation research is, and how to foster its development.
METHODS: We developed the recommendations in the context of a translation research conference hosted by the VA for VA and non-VA health services researchers.
IMPACTS: Health care organizations, journals, researchers and academic institutions can use these recommendations to advance the field of implementation science and thus increase the impact of clinical and health services research on the health and health care of the public.     

Diagnostic and prognostic biomarkers in cholangiocarcinoma

The high mortality rate of cholangiocarcinoma (CCA) is due, in part, to the lack of non‐invasive approaches able to accurately detect this silent tumour at early stages, when therapeutic options can be potentially curative or may at least increase the overall survival of patients. The fact that the majority of CCA tumours are not linked to any known aetiological factor highly compromises the monitoring of patients at risk for tumour development and also their early diagnosis. Combination of clinical/biochemical features, imaging techniques and analysis of non‐specific tumour biomarkers in serum are commonly used to help in the diagnosis of CCA, but tumour biopsy is usually required to confirm the diagnosis. Moreover, no prognostic biomarkers are currently used in the clinical setting, deserving more innovative research, and international validation and consensus. Important efforts have been made in the last few years to identify accurate non‐invasive biomarkers, by using innovative techniques and high‐throughput omics technologies. This review summarizes and discusses the advances in the investigation of novel diagnostic and prognostic biomarkers in CCA and envisions the future directions in this field of research.     

Strategies for applied research

The need of increasing the amount and quality of applied research in the health field es emphasized. The social and economical determinants of health and health care services require a multidisciplinary approach. The most important issue is the utilization of research results in the definition of policies and in the decision making process. Some of the barriers and obstacles to implement research results are discussed as well as the strategies that can be put forward to overcome the former. It is suggested tah participatory research could be an innovative methodology to improve the application of research results. Participative research is a collaborative effort that involves different actors of the health arena including administrators, health personnel, community members, and the researchers themselves. This type of research carries out diagnostic and intervention activities from the very beginning of the studies; its main strength is that decision made and the community members are active participants, impinging a scientific approach to their daily work and so the application of results is facilitated through out the process.     

Addiction Research Centres and the Nurturing of CreativityThe Chinese National Institute on Drug Dependence,Peking University: past,present and future

In the 25 years since drug abuse re‐emerged in China in the 1980s, the National Institute of Drug Dependence (NIDD) has made many contributions to China's antidrug campaign. This present paper offers an account of the history, current status and future of drug dependence research at NIDD. NIDD was originally a research centre at Beijing Medical University, founded by the Chinese Ministry of Health to address the rapid spread of drug abuse in China. Originally, the main task of NIDD was to complete the commissions assigned by the government and university. Further developments transformed NIDD into a national research institute in the field of drug addiction that began to conduct its own research. NIDD has now created a professional team spread across several independent departments involved in neurobiological mechanisms, epidemiological surveys and monitoring, pre‐clinical and clinical evaluation of new drugs (mainly analgesic drugs and detoxification drugs) and informatics and data analysis. As a university‐based research institute, NIDD's funding derives mainly from grants provided by the government and financial support from international organizations. Its past and present research has a gained NIDD a reputation with both practitioners and policy makers in the field of drug addiction. In the future, NIDD will continue to engage in various aspects of drug addiction research and will enter the field of brain function.     

Alcohol marketing research: the need for a new agenda

Aims This paper aims to contribute to a rethink of marketing research priorities to address policy makers' evidence needs in relation to alcohol marketing. Method Discussion paper reviewing evidence gaps identified during an appraisal of policy options to restrict alcohol marketing. Findings Evidence requirements can be categorized as follows: (i) the size of marketing effects for the whole population and for policy‐relevant population subgroups, (ii) the balance between immediate and long‐term effects and the time lag, duration and cumulative build‐up of effects and (iii) comparative effects of partial versus comprehensive marketing restrictions on consumption and harm. These knowledge gaps impede the appraisal and evaluation of existing and new interventions, because without understanding the size and timing of expected effects, researchers may choose inadequate time‐frames, samples or sample sizes. To date, research has tended to rely on simplified models of marketing and has focused disproportionately on youth populations. The effects of cumulative exposure across multiple marketing channels, targeting of messages at certain population groups and indirect effects of advertising on consumption remain unclear. Conclusion It is essential that studies into marketing effect sizes are geared towards informing policy decision‐makers, anchored strongly in theory, use measures of effect that are well‐justified and recognize fully the complexities of alcohol marketing efforts.     

ESC Working Group on Myocardial Function Position Paper: how to study the right ventricle in experimental models

The right ventricle has become an increasing focus in cardiovascular research. In this position paper, we give a brief overview of the specific pathophysiological features of the right ventricle, with particular emphasis on functional and molecular modifications as well as therapeutic strategies in chronic overload, highlighting the differences from the left ventricle. Importantly, we put together recommendations on promising topics of research in the field, experimental study design, and functional evaluation of the right ventricle in experimental models, from non‐invasive methodologies to haemodynamic evaluation and ex vivo set‐ups.     

Complex systems for evaluation of public health interventions: a critical review

Background

There has been a growth in interest in applying systems thinking to public health research, including greater consideration of the complex and changing nature of real-world environments where public health interventions take place. We aimed to assess how a systems approach could be applied in the context of public health evaluation.

Developing an effective intervention for IDU women: a harm reduction approach to collaboration.

Harm reduction is fundamentally a movement intended to empower the patient and consumer of health services. This project applied harm reduction theory as a strategy to empower collaborating community partners and researchers to overcome their preconceptions about each other in order to create a successful HIV prevention intervention and evaluation study for injection drug using women. The Women's Options for Risk Reduction through Knowledge of Self (WORKS) intervention program offered a series of four HIV prevention workshops, in conjunction with sexually transmitted infection (STI) and HIV counseling and testing to female injection drug users (IDUs) or the partners of IDUs. This community collaboration was to integrate the strengths of researchers and service providers in a comprehensive approach to prevention evaluation. In this collaborative research context, capacity building meant developing the long-term goal, explicit commitment to and integration of evaluation into the overall operation of a HIV prevention service delivery organization. The WORKS Intervention collaboration's aim was to improve the capacity of community-based organizations (CBOs) to use research-based data on HIV risk taking behavior and prevention strategies to provide effective interventions and services and effectively evaluate their efforts. Barriers to successful planning, implementation, and evaluation are presented with the strategies used to overcome them. Intervention effectiveness results from the process evaluation are presented in the context of prevention and research capacity development in CBOs.     

Research needs for an improved primary care response to chronic non‐communicable diseases in Africa

With non‐communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub‐Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub‐Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case‐finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa.     

Addiction research centres and the nurturing of creativity. The Centre for Alcohol and Drug Research: social science alcohol and drug research in Denmark

Aims The purpose of this paper is to introduce the social science alcohol and drug research undertaken by the Centre for Alcohol and Drug Research (CRF) and at the same time offer an insight into the development in Danish alcohol and drug research throughout the past 15–20 years. Method A review of articles, books and reports published by researcher from CRF from the mid‐1990s until today and an analysis of the policy‐making in the Danish substance use and misuse area. Results CRF is a result of the discussions surrounding social, health and allocation policy questions since the mid‐1980s. Among other things, these discussions led to the formal establishment of the Centre in 1991 under the Aarhus University, the Faculty of Social Science. Since 2001 the Centre has received a permanent basic allocation, which has made it possible to appoint tenured senior researchers; to work under a more long‐term research strategy; to function as a milieu for educating PhD students; and to diversify from commissioned research tasks to initiating projects involving more fundamental research. Research at the Centre is today pivoted around four core areas: consumption, policy, prevention and treatment. Conclusion The emergence, continuation, financing and character of the research taking place at CRF can be linked closely to the specific Danish drug and alcohol discourse and to the division of the responsibility for alcohol and drug research into separate Ministries.