Research relationships between the South and the North: Cinderella and the ugly sisters?

There has been an increase in the size and range of North-South health research partnerships since the 1990s. Current literature tends to stress the need for partnership and associated principles, but recognises the difficult context of structural inequality and historical legacies. Critics point to continuing neo-colonialist attitudes to research, which are unhelpful for the development of mutually beneficial collaborations. Such dynamics have parallels with the European folktale of Cinderella and the Ugly Sisters, the latter using their advantage of wealth and position to exploit their step-sister. Little literature is available on how to address this situation for the principles of partnership to be integrated into project design, implementation and dissemination. This article examines processes and dynamics within North-South collaborations in health research through two different case studies presented from Northern perspectives. Each case study focuses on distinct aspects of research collaborations. The first, a North-South partnership project in Bangladesh, highlights issues of capacity building, use of data and publications. The second case, a Doctoral study in Thailand, examines the reliance on contributions by Southern partners, responsibility to the local setting and the practice of reciprocity. The article then turns to Southern researchers' reflections, explored in semi-structured interviews, on themes identified by Northern researchers as important concerns in research collaborations. The authors conclude that advantage should be taken of the fact that Southern and Northern colleagues often share similar values regarding research collaborations, but difficulties exist in implementation partly due to historically rooted and current inequalities. Practical arrangements are suggested which may help to address the commonly assumed roles of the North as 'provider' of funding and ideas, and of the South as 'receiver' in an environment with little scope for action.     

Uncovering the “Skeleton in the Closet”: The Issue of Bone and Joint Disorders in the Maldives and the Opportunities for Primary Prevention and Health Promotion

  Disorders of bones and joints are the most common cause of severe long-term pain and disability around the world yet receive inadequate attention in many countries. Bone/joint health is absent from current health policy and the primary prevention/health promotion agenda in Maldives and diagnostic and curative infrastructure is very limited. In 2004, tentative evidence emerged indicating that degenerative bone and joint conditions may impose a large burden on community health. A study was undertaken amongst a representative community sample of women aged 15–50 to further investigate the issue. One third reported bone/joint problems; very high proportions manifested a range of osteoporosis risk factors, and sizeable numbers appear to be at elevated risk of osteoarthritis. Bone/joint health knowledge was very limited. The findings suggest strong potential for primary prevention on modifiable risk factors, need for research with other population groups, and development of screening and curative care.Editors' Strategic Implications: The author provides important data on the burden of disorders of bones/joints on a “developing” community and presents recommendations for behavioral and educational prevention strategies that may prove useful across societies.     

The doctor and the literary text — potentials and pitfalls

Expectations are growing that literature may contribute to clinical skills. Narrative medicine is a quickly expanding area of research. However, many people remain sceptical to the idea of literature having a capacity to “save the life of medicine”. It is therefore urgent to scrutinize both the arguments in favour of and those against the potential of literature for increasing medical understanding. This article attempts to do this. It does in fact support the assertion that literature is important, but it stresses precisely its character of potential. There is no simple connection between acquaintance with literary texts and understanding of the different aspects of medical work. Much more need to be known about the conditions which allow the experiences residing in texts to be transformed into lived personal knowledge. This revised version was published online in July 2006 with corrections to the Cover Date.     

Dracunculiasis eradication and the legacy of the smallpox campaign: what's new and innovative? What's old and principled?

Coming on the heels the declaration of smallpox eradication in 1980 was the launch of the dracunculiasis (Guinea worm) eradication program, as a key outcome indicator of the success of the United Nations 1981-1990 International Drinking Water Supply and Sanitation Decade (IDWSSD). The dracunculiasis eradication campaign has carried on well beyond the close of the IDWSSD largely due to the efforts of President Jimmy Carter and The Carter Center, to assist the national Guinea Worm Eradication Programs in collaboration with partner organizations, including the Centers for Disease Control and Prevention (CDC), UNICEF, and the World Health Organization. Dracunculiasis eradication efforts have as primary tools health education, filter distribution for drinking water filtration, and case containment, all guided by rigorous village based surveillance. Additional tools are treatment of selected water sources with ABATE(R) (temephos) larvicide and provision of protected drinking water supplies. Village volunteers provide monthly reporting of cases (including reports of zero cases). The global campaign has made remarkable progress through both innovation and adherence to eradication principles. Annual cases of dracunculiasis have decreased from 3.5 million in 1986 to less than 2000 in 2010. The challenge is to reach zero cases. The task, so often faced by eradication programs, is to finish the 'final inch' in some of the most difficult places on earth to work. In the case of dracunculiasis, that is the new Republic of South Sudan.     

How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions

Purpose  

To assess and compare content, validity, and specificity of the QuickDASH (Disability of the arm, shoulder and hand questionnaire) as compared to the full-length DASH and other instruments to give a recommendation for its use depending on a specific clinical situation.     

Retinol-binding protein (RBP), retinol and β-carotene in the bovine uterus and plasma during the oestrous cycle and the relationship between systemic progesterone and RBP on day 7

In the dairy cow, low systemic concentrations of progesterone are known to be a major factor associated with early embryo loss. Endometrial expression of the gene encoding retinol-binding protein (RBP) is sensitive to small changes in progesterone on day 7 of the oestrous cycle. The objectives of the present study were to measure RBP concentrations in bovine uterine flushings and plasma across different days of the oestrous cycle and to examine the relationship between uterine RBP and systemic concentrations of progesterone. Uterine flushings and plasma were collected from cows on days 3, 7, 11 and 15 of the oestrous cycle. Uterine RBP concentrations were five- to 15-fold higher (P < 0.001) on day 15 compared with the other days and twofold higher (P < 0.001) in the uterine horn ipsilateral to the corpus luteum on day 15. RBP concentrations were similar in flushings and plasma across days 3-11; however, day 15 RBP concentrations were six- to 15-fold higher (P < 0.001) in uterine flushings. No significant relationship was found between the concentration of systemic progesterone and RBP concentrations on day 7. Overall, the results of the present study indicate a local controlling mechanism operating at the level of the endometrium to regulate RBP secretion, most likely progesterone.     

Promote the general welfare to ourselves and our posterity: the founding documents of the United States and the nation’s health care debate

A recent on-line discussion asked whether healthcare for Americans is a constitutional right or a privilege. One can debate whether one can extract a legal right to healthcare from the Declaration of Independence depending on whether one sees it is a philosophical or as a legal document. The Constitution of the United States of America lists “promote the general welfare” and protect “ourselves and our posterity” as some of its aims. Perhaps this would demand the inclusion of certain basic health services such as immunizations and antimicrobial therapy for every citizen; even for illegal immigrants, in order to protect the public. America must decide whether health care is a privilege or a right! If it is a privilege, one must accept the exclusion of some individuals and the unintended consequences of epidemics. If it is a constitutional right, one must accept paying for that right with increased taxes and the unintended consequences on the economy. But who should pay, how much and for what?     

Are the Kihon Checklist and the Kaigo-Yobo Checklist Compatible With the Frailty Index?

Objectives

To explore comparability of Kihon Checklist (KCL) and Kaigo-Yobo Checklist (KYCL) to Frailty Index (FI) in predicting risks of long-term care insurance (LTCI) certification and/or mortality over 3 years.

Transparency and the Food and Drug Administration—A Quantitative Study

In Europe and North America, there is increasing political pressure being put on health regulatory agencies to become more transparent. To date, however, there has been little academic evaluation—let alone analysis—of these transparency initiatives from a risk communication perspective. This review examines whether the U.S. Food and Drug Administration's Adverse Event Reporting System quarterly signal postings, put in place after the passage of the Food and Drug Administration Amendments Act 2007, will assist patients and doctors in their decision-making processes, on the basis of results of a quantitative Internet survey of 433 physicians and 1,000 American adults. The results indicate that there is significant disagreement between physicians and the public about when medical safety issues should be communicated in the first place, with physicians opposed to early signal postings while the public in general is in favor. In addition the findings show that if the public were to find their drugs listed on the Adverse Event Reporting System signals web postings, more than a quarter would stop taking their medicine. Going forward, the Food and Drug Administration needs to work to a greater degree with social scientists in developing scientific-based communication strategies, rather than developing transparency initiatives on the basis of stakeholder consultations.     

Advanced nurse practitioners and physician assistants: what is the difference? Comparing the USA and UK

With the reduction in junior doctors' hours and fewer doctors being trained in the UK, there is a need for other types of health-care practitioners to fill the gap. This article describes some of the background to the present situation and delineates two types of roles, the advanced nurse practitioner and the physician assistant, for consideration as alternatives to address the present and growing shortage of doctors.     

Going with the grain? General practitioners and the new NHS

A number of policy initiatives over the last few years have encouraged general practitioners (GPs) to participate in commissioning, as opposed to simply purchasing, health care. This role was reinforced in the white paper, The New NHS. A qualitative study of GPs in two health authorities uncovered not only concerns about the reforms which have since emerged in the medical and general press, but other issues which have been less frequently articulated. There was also evidence of goodwill towards professional colleagues, including those in social services departments. The preference for professional, as opposed to market relationships may help to secure the collaborative ethos desired by government. However, if the concerns the study uncovered are indicative of a more widespread response to the white paper, they suggest the need for careful support of developing Primary Care Groups (PCGs).