Consuming research,producing policy?

The authors' 1990 article "Producing Health, Consuming Health Care" presented a conceptual framework for synthesizing a rapidly growing body of findings on the nonmedical determinants of health. The article received a very positive response, and here the authors reflect on what lessons might be learned from that response about the style or content of effective interdisciplinary communication. Much substantive knowledge has been accumulated since 1990, and a number of different frameworks have been developed before and since. The authors situate theirs within this literature and consider how they might have modified it if they "knew then what they know now." They ask what impact this article, and the much broader stream of research on the determinants of health, has had on public policy?     

Changing education,changing assessment,changing research?

BACKGROUND: In medical education, assessment of medical competence and performance, important changes have taken place in the last 5 decades. These changes have affected the basic concepts in all 3 domains. DEVELOPMENTS IN EDUCATION AND ASSESSMENT: In education constructivism has provided a completely new view on how students learn best. In assessment the change from trait-orientated to competency- or role-orientated thinking has given rise to a whole range of new approaches. Certain methods of education, such as problem-based learning (PBL), and assessment, however, are often seen as almost synonymous with the underlying concepts, and one tends to forget that it is the concept that is important and that a particular method is but 1 way of using a concept. When doing this, one runs the risk of confusing means and ends, which may hamper or slow down new developments. LESSONS FOR RESEARCH: A similar problem seems to occur often in research of medical education. Here too, methods--or, rather, methodologies--are confused with research questions. This may lead to an overemphasis on research that fits well known methodologies (e.g. the randomised controlled trial) and neglect of what are sometimes even more important research questions because they do not fit well known methodologies. CONCLUSION: In this paper we advocate a return to the underlying concepts and a careful reflection of their use in various situations.     

African Americans, democracy, and biomedical and behavioral research: contradictions or consensus in community-based participatory research?

Individualism, in both its political and attitudinal senses, reinforces societal and institutional racism in the United States. Because of individualism's dominant focus on self-interest and self-reliance, any application of "participatory democracy" in community-based biomedical and behavioral research is fraught with dilemmas similar to those that Gunnar Myrdal observed between American racism and democracy. The research establishment is overwhelmed by well-meaning non-minorities who recognize racism and its consequences in health, but only greater representation of people-of-color in the health establishment can ameliorate the inherent contradictions of "participatory democracy" which is so fundamental to the process of community-based participatory research.     

Games for health research—past,present, and future

Background

A substantial number of studies have been published on many games for diverse aspects of health. Despite the potential contributions of games for health (G4H), it has not been easy to obtain funding for research in this field.

Aim

This paper attempts to identify why there has been difficulty in obtaining funding for G4H research, create an awareness of the importance of evidence-based research, and provide recommendations to enhance research and understanding in this area.

Materials and methods

This article describes the past and current state of research in G4H and identifies implications for the future.

Results

The current state of research in the field of games does not match the criteria for good standards of research. The poor quality of studies limits what can be concluded about the effectiveness of G4H.

Conclusions

Outcomes research on G4H must make a quantum leap in quality to realistically assess the efficacy or effectiveness of G4H, and which aspects of G4H offer the most promise for change among which target groups. Research is also needed on the effectiveness of behavior change procedures and game mechanics within the context of games.

     

Outcomes research collaborations between third-party payers, academia, and pharmaceutical manufacturers: What can we learn from clinical research?

Research collaborations between academic researchers, regulatory agencies, and pharmaceutical manufacturers have made the drug development process more efficient and have frequently supported the successful documentation of quality, safety, and efficacy of pharmaceuticals (the so-called three hurdles). Over recent years issues of drug cost, access, and utilization have moved to center stage, giving rise to a "fourth hurdle approval" process by third-party payers. This requires new forms of collaborative research among new players. This contribution highlights the need for a "triangular" relationship in the field of outcomes research between scientists in academia, third-party payer institutions, and pharmaceutical manufacturers. We discuss, and illustrate by case studies, how successful models of collaboration from the drug development process might be relevant to research activities related to the fourth hurdle. Case studies which may provide useful models for collaborative outcomes research include the "International Conference on Harmonization" process, the voluntary consultation procedures established by drug regulatory agencies, and the Quebec experience in database sharing.     

Outcomes research: high hopes, low yield?

The bulk of the nation's health services research has been redirected toward patient outcomes research conducted by the U.S. Agency for Health Care Policy and Research. But those expecting dramatic changes from the agency's work are likely be disappointed. One reason is the tendency to seize upon clever new theories as solutions to intricate problems, such as the inflated expectation that managed care will reap huge cost-savings.     

Multidisciplinary, interdisciplinary, or dysfunctional? Team working in mixed-methods research

Combining qualitative and quantitative methods in a single study-otherwise known as mixed-methods research-is common. In health research these projects can be delivered by research teams. A typical scenario, for example, involves medical sociologists delivering qualitative components and researchers from medicine or health economics delivering quantitative components. We undertook semistructured interviews with 20 researchers who had worked on mixed-methods studies in health services research to explore the facilitators of and barriers to exploiting the potential of this approach. Team working emerged as a key issue, with three models of team working apparent: multidisciplinary, interdisciplinary, and dysfunctional. Interdisciplinary research was associated with integration of data or findings from the qualitative and quantitative components in both the final reports and the peer-reviewed publications. Methodological respect between team members and a principal investigator who valued integration emerged as essential to achieving integrated research outcomes.     

"Omics" research, monetization of intellectual property and fragmentation of knowledge: can clinical epidemiology strengthen integrative research?

An analysis of the contributions of "omics technologies" to human health and clinical care needs to address the relationships between internal issues (e.g., methodological shortcomings in "omics" research and clinical biology) and external influences. Among the latter, monetization of intellectual property (IP) appears to be a powerful force favoring methodological limitations and an excessive reductionism and fragmentation of biological knowledge. Following economic successes in other industries (semiconductors, software, and "dot-coms"), monetization of IP tries to market small fragments of big research "puzzles"; the strategy seems partly responsible for the biotech industry having underperformed methodological, clinical, and economic expectations. Hence, internal, purely scientific reasons can hardly explain failures in the application of long-proven principles of clinical epidemiology to the discovery and validation of diagnostic and prognostic tests. Nevertheless, this paper also sketches methodological proposals that may help integrate microbiological, clinical, and environmental evidence. Clinical and epidemiological reasoning, knowledge, and methods need to be applied on a much wider scale than until now by "omics" studies that aim at making inferences relevant for human beings. Rather than adopting the values and norms of "science business," "omics research" could apply a diversity of clinicoepidemiological models favoring integrative research.     

What is dialogical research, and why should we do it?

Social scientists have explored the writing of Russian literary philosopher Bakhtin from a variety of perspectives, but little attempt has been made to apply Bakhtin's conception of dialogue to the conduct of research and the production of research reports. The author's questions relate to what dialogical research would look like and the ethical imperative of dialogical research.     

Ethical aspects of genome diversity research: genome research into cultural diversity or cultural diversity in genome research?

The goal of the Human Genome Diversity Project (HGDP) was to reconstruct the history of human evolution and the historical and geographical distribution of populations with the help of scientific research. Through this kind of research, the entire spectrum of genetic diversity to be found in the human species was to be explored with the hope of generating a better understanding of the history of humankind. An important part of this genome diversity research consists in taking blood and tissue samples from indigenous populations. For various reasons, it has not been possible to execute this project in the planned scope and form to date. Nevertheless, genomic diversity research addresses complex issues which prove to be highly relevant from the perspective of research ethics, transcultural medical ethics, and cultural philosophy. In the article at hand, we discuss these ethical issues as illustrated by the HGDP. This investigation focuses on the confrontation of culturally diverse images of humans and their cosmologies within the framework of genome diversity research and the ethical questions it raises. We argue that in addition to complex questions pertaining to research ethics such as informed consent and autonomy of probands, genome diversity research also has a cultural–philosophical, meta-ethical, and phenomenological dimension which must be taken into account in ethical discourses. Acknowledging this fact, we attempt to show the limits of current guidelines used in international genome diversity studies, following this up by a formulation of theses designed to facilitate an appropriate inquiry and ethical evaluation of intercultural dimensions of genome research.     

Enterprising or altruistic selves? Making up research subjects in genetics research

The emergence of direct-to-consumer (DTC) personal genomics companies in 2007 was accompanied by considerable media attention and criticism from clinical geneticists and other health professionals, regulators, policy advisors, and ethicists. As well as offering genetic testing services, some firms are also engaged in building their own databases and conducting research with the data obtained from their customers. In this paper, we examine how one of these companies, 23andMe, is creating a certain kind of 'research subject' in opposition to that constituted in conventional forms of disease research. Drawing on debates about neoliberalism, contemporary health discourses and subjectivity, we consider two kinds of subjectivities produced through the discursive and material practices of 23andMe and UK Biobank, namely, 'enterprising' and 'altruistic' selves. We argue that the 23andMe model promotes the idea that curiosity about one's genome on the one hand, and participation in research on the other, are not only compatible but complementary aspects of being an entrepreneurial subject of contemporary health and medicine framed by the technologies of web 2.0.     

How can PhD research contribute to the global health research agenda?

We propose that PhD and post-doctoral researchers are a strong, untapped resource with the potential to make a real contribution to global health research (GHR). However, we raise some ethical, institutional and funding issues which either discourage new researchers from entering the field or diminish their capacity to contribute. We offer a number of recommendations to Canadian academic and non-academic institutions and funders, and aim to generate discussion among them about how to overcome these constraints. We need changes in the way graduate research is organized and funded, to create opportunities to work collaboratively within established low- and middle-income country (LMIC)/Canadian research partnerships. We urge changes in the way institutions fund, recognize, value and support GHR, so established researchers are encouraged to develop long-term LMIC relationships and mentor new Canadian/LMIC researchers. We ask funders to reconsider additional GHR activities for support, including strategic training initiatives and dissemination of research results. We also encourage the development of alternative institutions that can provide training and mentoring opportunities. GHR per se faces many challenges. If we address those that reduce our potential to contribute, we can become real partners in GHR, working towards equitable global health and solutions to priority health issues.     

Caffeine withdrawal, sleepiness, and driving performance: what does the research really tell us?

As a psychostimulant, caffeine is thought to reduce road accidents by keeping drivers alert and wakeful. Studies have found that caffeine can improve performance on vigilance tasks and in driving simulators under normal sleeping conditions and after sleep restriction or deprivation. However, there is increasing evidence that these beneficial effects of caffeine are due to withdrawal reversal. Studies comparing the effects of caffeine versus placebo on driving performance have tested habitual caffeine consumers deprived of caffeine from the evening before the test day. The conclusion from this review is, therefore, that improvements in driving performance and alertness after caffeine are likely to represent withdrawal reversal rather than a net beneficial effect of caffeine. Further research using designs that control for caffeine withdrawal are necessary and, accordingly, advice given to the public on use of caffeine as an antidote to tiredness and impaired performance should be reviewed.     

Accelerating measles and rubella elimination through research and innovation – Findings from the Measles & Rubella Initiative research prioritization process, 2016

The Measles & Rubella Initiative (M&RI) identified five key strategies to achieve measles and rubella elimination, including research and innovation to support cost-effective operations and improve vaccination and diagnostic tools. In 2016, the M&RI Research and Innovation Working Group (R&IWG) completed a research prioritization process to identify key research questions and update the global research agenda. The R&IWG reviewed meeting reports and strategic planning documents and solicited programmatic inputs from vaccination experts at the program operational level through a web survey, to identify previous research priorities and new research questions. The R&IWG then convened a meeting of experts to prioritize the identified research questions in four strategic areas: (1) epidemiology and economics, (2) surveillance and laboratory, (3) immunization strategies, and (4) demand creation and communications. The experts identified 19 priority research questions in the four strategic areas to address key areas of work necessary to further progress toward elimination. Future commitments from partners will be needed to develop a platform for improved coordination with adequate and predictable resources for research implementation and innovation to address these identified priorities.     

What do Swedish occupational therapists feel about research? A survey of perceptions, attitudes, intentions, and engagement

The aim of this study was to identify Swedish occupational therapists' perceptions and attitudes to research-related activities as well as the therapists' present engagement in future plans for research. A follow up design was used, and the study was undertaken between 1997 and 2003. A total of 425 and 442 Swedish occupational therapists responded to a postal questionnaire (response rate 74.4% and 70.4%). Questions regarding research-related activities were measured on a Likert-type scale, whereas questions referring to attitudes towards research used a semantic differential scale. There were small differences between the two surveys. The result showed that occupational therapists considered research-related activities to be an important part of their development of the professional role and status. Reading research literature to update knowledge was the most important research activity and the second most important activity was applying research findings to improve occupational therapy practice. High workload and lack of time were the most commonly mentioned barriers to participation in research- related activities. Occupational therapists read a large variety of journals, preferably in Swedish. The barriers to participation in research-related activities did not change from 1997 to 2003. The fact that occupational therapists reported reading research as rating highly gives hope for the future development of the occupational therapy profession and practice.