Rural and remote health research: Does the investment match the need?

Objective

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014.

Design

This is a retrospective analysis of publicly available datasets.

Setting

National Health and Medical Research Council Rural and Remote Health Research 2000–2014.

Outcome measures

‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014.

Results

Of the 16 651 National Health and Medical Research Council‐funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented.

Conclusion

Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.     

How much are we spending? The estimation of research expenditures on cardiovascular disease in Canada

ABSTRACT: BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death in Canada and is a priority area for medical research. The research funding landscape in Canada has changed quite a bit over the last few decades, as have funding levels. Our objective was to estimate the magnitude of expenditure on CVD research for the public and charitable (not-for profit) sectors in Canada between 1975 and 2005. METHODS: To estimate research expenditures for the public and charitable sectors, we compiled a complete list of granting agencies in Canada, contacted each agency and the Canadian Institutes of Health Research (CIHR), and extracted data from the organizations' annual reports and the Reference Lists of health research in Canada. Two independent reviewers scanned all grant and fellowship/scholarship titles (and summary/key words, when available) of all research projects funded to determine their inclusion in our analysis; only grants and fellowships/scholarships that focused heart and peripheral vascular diseases were selected. RESULTS: Public/charitable sector funding increased 7.5 times, from close to $13 million (in constant dollars) in 1975 to almost $96 million (in constant dollars) in 2005 (base year). The Medical Research Council of Canada (MRCC)/CIHR and the Heart & Stroke Foundation of Canada have been the main founders of this type of research during our analysis period; the Alberta Heritage Foundation for Medical Research and the Fonds de la recherche en sante du Quebec have played major roles at the provincial level. The Indirect Costs Research Program and Canada Foundation for Innovation have played major roles in terms of funding in the last years of our analysis. CONCLUSION: Public/charitable-funded research expenditures devoted to CVD have increased substantially over the last three decades. By international standards, the evidence suggests Canada spends less on health-related research than the UK and the US, at least in absolute terms. However, this may not be too problematic as Canada is likely to free-ride from research undertaken elsewhere. Understanding these past trends in research funding may provide decision makers with important information for planning future research efforts. Future work in this area should include the use of our coding methods to obtain estimates of funded research for other diseases in Canada.     

健康教育在公共卫生工作中的应用

目的:通过分析1994~2004年间国内发表的健康教育相关文献,了解健康教育在我国公共卫生工作中的应用、研究现状及变化趋势,为今后的健康教育研究和工作提供参考。方法:从中国学术期刊全文数据库(CNKI)收集健康教育相关文献,按照既定的纳入方法和指标建立数据库,并对数据进行描述性统计分析。结果:健康教育相关文献发表量随时间呈递增趋势。文献研究对象主要为全人群、儿童青少年及妇女,占75.73%;文献研究的主要健康问题为传染病(28.2%)及卫生常识和卫生习惯(13.85%)。采取了健康教育干预的文献占39.69%,干预手段主要为文字传播、音像传播及人际传播,干预效果主要为知识提高(82.70%)。结论:健康教育将在艾滋病、慢性病的防治中发挥更大的作用,但同时应加强生殖健康、职业健康、心理健康等工作,并加强理论研究。     

An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction

CONTEXT: A fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes. OBJECTIVE: A content analysis of leading medical education journals was performed to determine the primary foci of medical education research, using a three- dimensional outcomes research framework based on the paradigm of health services outcomes research. DATA SOURCES: All articles in three medical education journals (Academic Medicine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Papers presented at the Research in Medical Education conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, were also analysed. STUDY SELECTION: Only data-driven articles were selected for analysis; thus editorials and abstracts were excluded. DATA EXTRACTION: Each article was categorized according to primary participant (i.e. trainee, faculty, provider and patient), outcome (performance, satisfaction, professionalism and cost), and level of analysis (geographic, system, institution and individual(s)). DATA SYNTHESIS: A total of 599 articles were analysed. Trainees were the most frequent participants studied (68.9%), followed by faculty (19.4%), providers (8.1%) and patients (3.5%). Performance was the most common outcome measured (49.4%), followed by satisfaction (34.1%). Cost was the focus of only 2.3% of articles and patient outcomes accounted for only 0.7% of articles. CONCLUSIONS: Medical education research is dominated by assessment of trainee performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of medical education, that is, provider performance and patient outcomes. The study of these medical education outcomes represents an important challenge to medical education researchers.     

2006-2011年荣县公共卫生六项专题调研成效分析

目的：对荣县2006-2011年的6项公共卫生专题调研成效进行分析解读,为做好农村县级疾控工作及调查研究成效评价提供依据。方法：按文献计量统计惯例对调研专题内容、成果形式构成、调研报告分类构成、调研人员基本情况等进行统计分析,对典型成果进行解读。结果：6项专题调研,首次上报专题报告5个,占11.36%,公开发表论文和文章10篇,占22.73%,获科研成果3项,占6.82%,应用成效26个,占59.09%;应用成效9类26个专题报告,其中疾控网络建设6个,居第一,占23.08%、卫生应急工作5个,居第二,占19.23%、免疫规划1个,居末位,占到3.85%。结论：对县级公共卫生调研成效进行研究与评价可提高调研成果的利用率和达到做好疾控工作的本原目的。     

基于META分析的肺结核患者按病种支付方式实施效果研究

目的:收集近20年来国内外学者发表的按病种支付方式下肺结核患者补偿情况的研究,并进行循证医学分析,探寻支付方式对肺结核患者疾病经济负担的作用效果.方法:以"肺结核/结核病"和"支付方式"为关键词,从中国知网、PubMed等数据库检索文献,根据纳入排除标准,利用NoteExpress软件对文献进行筛选,采用RevMan5...     

Strange bedfellows: bridging the worlds of academia,public health and the sex industry to improve sexual health outcomes

Background

There is increasing interest in building the capacity of researchers in low and middle income countries (LMIC) to address their national priority health and health policy problems. However, the number and variety of partnerships and funding arrangements can create management problems for LMIC research institutes. This paper aims to identify problems faced by a health research institute in Bangladesh, describe two strategies developed to address these problems, and identify the results after three years of implementation.

Methods

This paper uses a mixture of quantitative and qualitative data collected during independent annual reviews of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) between 2006 and 2010. Quantitative data includes the number of research activities according to strategic priority areas, revenues collected and expenditure. Qualitative data includes interviews of researchers and management of ICDDR,B, and of research users and key donors. Data in a Monitoring and Evaluation Framework (MEF) were assessed against agreed indicators.

Results

The key problems faced by ICDDR,B in 2006 were insufficient core funds to build research capacity and supporting infrastructure, and an inability to direct research funds towards the identified research priorities in its strategic plan. Two strategies were developed to address these problems: a group of donors agreed to provide unearmarked pooled core funding, and accept a single common report based on an agreed MEF. On review after three years, there had been significant increases in total revenue, and the ability to allocate greater amounts of money on capacity building and infrastructure. The MEF demonstrated progress against strategic objectives, and better alignment of research against strategic priorities. There had also been changes in the sense of ownership and collaboration between ICDDR,B's management and its core donors.

Conclusions

The changes made to funding relationships supported and monitored by an effective MEF enabled the organisation to better align funding with research priorities and to invest in capacity building. This paper identified key issues for capacity building for health research in low and middle income countries. The findings have relevance to other research institutes in similar contexts to advocate and support research capacity strengthening efforts.     

Funding for rural health research from the Australian Research Council: A missed opportunity?

Objective:  To determine the number of projects, and level of funding, for rural health research from the Australian Research Council (ARC).
Design:  Analyses of ARC searchable datasets of completed, and new and ongoing projects from 2001 to 2008.
Main outcome measures:  Number of rural health research projects as a proportion of total funding; level of funding for rural health research projects as a proportion of total funding.
Results:  Only 46 of 6498 ARC completed projects were classified as rural health research projects. This represents 0.7% of the total number of projects, and 0.39% of the total funding allocated. Only 25 of 4659 ARC new and ongoing projects were classified as rural health research projects. This represents 0.54% of the total number of projects, and 0.27% of the total funding allocated. None of the 832 completed fellowships were classified as rural health. Only five (0.52%) of the 953 new and ongoing fellowships were classified as rural health.
Conclusions:  The level of under-funding for rural health research could be partially addressed by directing applications towards the ARC, in addition to the National Health and Medical Research Council. With a few exceptions, rural health researchers are not yet competitive in the national funding arena.     

职业队列的方法与在中国的应用

目的 本文主要针对队列研究的原理方法与目前国内主要职业人群队列研究开展情况进行综述，旨在为新建职业人群队列研究的随访方案设计提供建议和思路。方法 采用“职业+队列”“职业+随访”“工人+队列”“工人+随访”检索式，在中国知识资源数据库、万方数据知识服务平台、中华医学期刊全文数据库中检索自收录日期为始直至2022年6月已发表文献的职业人群队列。结果 本次检索出结果记录3 129条，符合纳入标准的275篇研究文献，对所纳入文献进行数据提取以及归纳，最终确定了127个针对职业人群的队列研究。结论 我国现已开展了许多大型职业人群队列研究，取得了丰富的成果，随着技术的发展与更加深入的研究需要，对职业环境因素健康效应的进一步探索以及开展相应生物标志物的监测是很有必要的。     

Peer support in type 2 diabetes: a randomised controlled trial in primary care with parallel economic and qualitative analyses: pilot study and protocol

Background

General practitioners and other primary health care professionals are often the first point of contact for patients requiring health care. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary health care professionals are trained in research or have research experience. With the aim of enhancing research skills and developing a research culture in primary health care, University Departments of General Practice and Rural Health have been supported since 2000 by the Australian Government funded 'Primary Health Care Research Evaluation and Development (PHCRED) Strategy'. A small grant funding scheme to support primary health care practitioners was implemented through the PHCRED program at Flinders University in South Australia between 2002 and 2005. The scheme incorporated academic mentors and three types of funding support: bursaries, writing grants and research fellowships. This article describes outcomes of the funding scheme and contributes to the debate surrounding the effectiveness of funding schemes as a means of building research capacity.

Methods

Funding recipients who had completed their research were invited to participate in a semi-structured 40-minute telephone interview. Feedback was sought on acquisition of research skills, publication outcomes, development of research capacity, confidence and interest in research, and perception of research. Data were also collected on demographics, research topics, and time needed to complete planned activities.

Results

The funding scheme supported 24 bursaries, 11 writing grants, and three research fellows. Nearly half (47%) of all grant recipients were allied health professionals, followed by general practitioners (21%). The majority (70%) were novice and early career researchers. Eighty-nine percent of the grant recipients were interviewed. Capacity, confidence, and level of research skills in ten core areas were generally considered to have improved as a result of the award. More than half (53%) had presented their research and 32% had published or submitted an article in a peer-reviewed journal.

Conclusion

A small grant and mentoring scheme through a University Department can effectively enhance research skills, confidence, output, and interest in research of primary health care practitioners.     

Outcomes from NHMRC public health research project grants awarded in 1993

AIMS: In 1987, the Public Health Research and Development Committee (PHRDC) was established by the NHMRC as one mechanism to fund public health research in Australia. In 1993, it awarded 32 new and 31 continuing project grants. Given increasing interest in research accountability in Australia, we designed an audit to determine outcomes from this investment. We also explored grant recipients' views about sources of research funding and strategies to enhance research dissemination. METHOD: Self-administered survey, July 1999. MAIN RESULTS: We obtained a 69% response fraction. The majority of projects already had been completed with peer-reviewed articles the most common outputs. More than half (58%) of respondents 'strongly agreed' or 'agreed' that their research had influenced policy to improve public health and 69% that it had influenced practice. Study design was significantly associated with peer-reviewed output, whether self-reported (p=0.002) or corroborated by us (p=0.004). With respect to research funding, significantly more agreed that the NHMRC should enhance program grants for public health research than mechanisms through the Strategic Research Development Committee (p=0.013). The most highly rated strategy to enhance dissemination was greater demand for research results among policy makers. CONCLUSION: A pleasing proportion of projects funded by PHRDC in 1993 generated peer-reviewed publications and provided research training. Recipients perceive their research has influenced policy and practice. Recipients' views about strategies to increase funding for public health research are consistent with current reforms within the NHMRC. Policy makers emerge as a key target for training in research transfer.     

Twenty years of public health research: inclusion of lesbian,gay, bisexual,and transgender populations

OBJECTIVES: This study determined to what extent lesbian, gay, bisexual, and transgender (LGBT) populations have been studied over the past 20 years of public health research. METHODS: From MEDLINE English-language articles on human subjects published between 1980 and 1999, I identified articles that included LGBT individuals. The abstracts were analyzed with a coding procedure that categorized the content by topic, sexual orientation, and race/ethnicity. RESULTS: LGBT issues were addressed by 3777 articles, or 0.1% of all Medline articles; 61% of the articles were disease-specific, and 85% omitted reference to race/ethnicity. Research unrelated to sexually transmitted diseases addressed lesbians and gay men with similar frequency, whereas bisexual persons were less frequently considered, and the least amount of research focused on transgender individuals. CONCLUSIONS: Findings supported that LGBT issues have been neglected by public health research and that research unrelated to sexually transmitted diseases is lacking.     

Asbestos-related disease in Bangladeshi ship breakers: a pilot study

A pilot study tested the feasibility of conducting occupational health research in Bangladesh while examining prevalence of asbestos-related diseases including asbestosis, work-related respiratory symptoms, and attitudes to occupational health and safety among a group of internal migrant ship breakers. Data was collected on clinical and work history, respiratory symptoms, and occupational health and safety practices in Bengali. A B-reader read all postero-anterior chest x-rays. In the 104 male ship breakers studied, prevalence of asbestos-related disease was 12%, of which asbestosis accounted for 6%. Knowledge of asbestos and occupational health and safety measures were almost nonexistent. The prevalence of asbestos-related diseases is low compared to studies in shipbuilders and repairers, but a risk underestimate could have resulted from challenges identified during study design and implementation including: industry noncooperation and a culture of corruption; technological and language barriers; and a regional lack of physician knowledge and research on occupational diseases.     

农村卫生服务质量评价指标体系研究进展

目的:分析农村卫生服务质量评价指标体系的研究现状,为探索适合我国农村地区的卫生服务质量评价指标体系提供参考。方法:检索中外文数据库及卫生政策研究的相关网站,检索时间为2016年4月,纳入农村卫生服务质量评价指标体系的相关研究文献,利用End Note X7与Excel 2007对纳入文献进行筛选管理和数据分析。结果:初步检索获得相关文献5 374篇,依据纳入排除标准筛选最终纳入63篇:第一篇文献发表于1988年,2009年发表文献量最多(11篇,17.5%),2010—2015年间发表文献44篇(69.8%);纳入文献中9篇(14.3%)发表在科学引文索引期刊,7篇(11.1%)发表在中国核心期刊,8篇(12.6%)发表在普通期刊,37篇(58.7%)为学位论文;54篇(85.7%)观察性研究中,横断面研究达52篇(82.5%)。文献涉及21种农村卫生服务质量评价指标体系,其指标选择主要采用文献研究法(49%);指标权重确定主要应用经验赋值法(47.4%);指标评价方法以综合评价法(36.8%)为主。结论:农村卫生服务质量评价指标体系研究多以横断面调查为主,涉及指标体系虽多,但方法尚不完善,内容针对性不强,且缺乏实践验证。所以,建立符合我国实际的农村卫生服务质量评价指标体系十分重要。     

Assessment of diagnostic tests to inform policy decisions--visual electrodiagnosis

OBJECTIVES: To conduct a systematic review of the evidence for the effectiveness of five visual electrodiagnostic tests to inform the Medical Services Advisory Committee (MSAC) of the Department of Health and Ageing (Australia) in its decision in allocating public funding for new technologies. METHODS: We searched the biomedical literature to identify English-language articles published from 1966 to September 2000. We assessed validity of methodology of included studies against the following criteria: investigators (i) compared test with an appropriate reference test; (ii) tested an appropriate spectrum of patients; (iii) masked assessment of study and reference tests; (iv) measured the study test independently of clinical information; and (v) measured the reference test before any interventions. RESULTS: Sixty-one articles met inclusion criteria for critical appraisal: nineteen were cross-sectional studies that compared a study test with another test, thirty-four were case-control studies that compared a test in a group of patients with an eye disease to a group of subjects without eye disease, and eight studies were case series. None of the included studies met all of the validity criteria. Only four studies provided enough information to calculate diagnostic characteristics but were flawed due to inclusion of patients already diagnosed with disease or lack of an appropriate reference test and, thus, overestimated test accuracy. CONCLUSIONS: Identified studies did not provide sufficient valid evidence of the clinical value of the five visual tests in diagnosing diseases of the retina or optic nerve. Thus, MSAC recommended that the tests not be supported by public funding.     

From clinical activities to didactics and research in occupational medicine

BACKGROUND: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained. OBJECTIVES: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research. METHODS: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance. RESULTS: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%). CONCLUSIONS: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.     

Research on health education and promotion in Spanish nursery and primary schools. A systematic review of studies published between 1995 and 2005

OBJECTIVE: To identify the characteristics of health education and promotion interventions in Spanish nursery and primary schools, through the studies published in scientific journals. METHOD: We performed a review of studies on health education and promotion interventions in Spanish nursery and primary schools, published from 1995 to 2005. The information sources were Medline (through Pubmed), Cinhal, Eric, Sociological Abstracts, Science Citation Index, and Isooc (CSIC). Studies performed in Spanish nursery and primary schools that incorporated health education and promotion interventions were selected. The studies' general features, main subject and aims, methodology, the kind of intervention described, and compliance with the criteria for Healthy Schools were analyzed. RESULTS: Only 26 of the 346 articles identified met the inclusion criteria. Health education programs focussed more on disease prevention than on health promotion and only a few studies were performed in nursery and primary schools. The criteria for health promotion in schools were included in 5 articles (19.2%). The importance of health institutions (n = 7; 26.9%) and universities (n = 8; 30.8%) as promoters of programs was notable. The most frequent subject was smoking (n = 11; 42.3%). CONCLUSIONS: Teachers play a lesser role in health promotion in schools than health institutions in the implementation and dissemination of health programs. Research into health promotion in nursery and primary schools is scarce.     

Searching the Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) database improves systematic reviews

BACKGROUND: An unbiased systematic review (SR) should analyse as many articles as possible in order to provide the best evidence available. However, many SR use only databases with high English-language content as sources for articles. Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) indexes 670 journals from the Latin American and Caribbean health literature but is seldom used in these SR. Our objective is to evaluate if LILACS should be used as a routine source of articles for SR. METHODS: First we identified SR published in 1997 in five medical journals with a high impact factor. Then we searched LILACS for articles that could match the inclusion criteria of these SR. We also checked if the authors had already identified these articles located in LILACS. RESULTS: In all, 64 SR were identified. Two had already searched LILACS and were excluded. In 39 of 62 (63%) SR a LILACS search identified articles that matched the inclusion criteria. In 5 (8%) our search was inconclusive and in 18 (29%) no articles were found in LILACS. Therefore, in 71% (44/72) of cases, a LILACS search could have been useful to the authors. This proportion remains the same if we consider only the 37 SR that performed a meta-analysis. In only one case had the article identified in LILACS already been located elsewhere by the authors' strategy. CONCLUSION: LILACS is an under-explored and unique source of articles whose use can improve the quality of systematic reviews. This database should be used as a routine source to identify studies for systematic reviews.