Interdisciplinarity in health services research: dreams and nightmares, maladies and remedies

Interdisciplinarity has become popular in health services research. Advocates suggest that interdisciplinary approaches may produce more accessible, applicable, exciting and realistic knowledge than traditional disciplinary approaches. To date, there has been surprisingly little analysis of the institutional and intellectual demands of interdisciplinarity as a methodology or practice. This paper (1) identifies some basic intellectual and institutional features of interdisciplinary research, (2) describes typical interdisciplinary 'dreams' and corresponding 'nightmares' that researchers might encounter in practice, (3) highlights maladies of interdisciplinary research careers and suggests practical remedies, and (4) discusses implications for health research policy. Individual researchers can avoid pitfalls of interdisciplinarity through strategies that include selective collaboration, cross-training, sustained relationships, good humour, participation in peer review, declaring the place of one's work, and balancing dissemination of research between peer and other audiences. Interdisciplinary activities span institutional boundaries and make novel demands on academic resources and allegiances. Research organizations can improve their hospitality to interdisciplinary work by encouraging straightforward communication, recognising interdisciplinary productivity, making allowances for the higher time and energy costs of interdisciplinary liaisons, and providing the necessary institutional support and stability to cultivate projects to fruition. Alongside the creation of large new interdisciplinary networks and organizations, we should invest in the highly valuable contributions of small and enduring interdisciplinary teams, modest interdisciplinary stretches and evolving interdisciplinary creatures.     

Sexuality in adolescence: a bibliographic study

This is a bibliographical study that aimed at pointing out the history of sexuality as well as its cultural, social and religious influences. The goals were to find out in literature the causes of the difficulties faced by the actual men to approach themes related to sexuality mainly with their adolescent children that need this orientation in order to live a safer and healthier sexuality.     

Scientific production in public health and the international bibliographic data bases

This study begins by briefly situating the development of indexing procedures in the scientific literature, dating to the latter half of the 19th century. Next, taking public health in Latin America as its reference, it analyzes the current use of indexing for the evaluation of scientific production, and thus that of scientific periodicals. The argument is that for various reasons, international indexing should not be used as the only parameter for evaluating the impact of Latin American scientific production in public health. Criteria other than impact indices should be developed to promote a broader understanding of the dynamics of scientific production in the Latin America public health field.     

Meanings of risk in pregnancy according to obstetrics: bibliographic study

This study analyzes the meaning of high-risk pregnancy in articles published by a representative Brazilian journal in the field of Obstetrics in the 1990s. The methodological approach includes the quantitative and qualitative analysis of 40 articles, which reveals a diversity of meanings attributed to high-risk pregnancy and a reduced discussion on the theme. The conclusion shows the need to include an interdisciplinary approach to the theme by taking into account the complexity of the aspects involving women's participation in pregnancy care.     

The impact of papers in Sociology of Health and Illness: a bibliographic study

Abstract This paper examines the citation counts of papers published in the first 25 years of the Sociology of Health and Illness. According to this measure only a small number of papers have made a major impact on the discipline of sociology of health and illness and an analysis of these select papers identifies some common themes. In particular, ‘successful’ papers have provided important theoretical constructs for the field while exploration of aspects of identity has been a recurrent focus.     

Interdisciplinarity in nursing diploma programs: an evolving process

Diploma Programs in Nursing with disciplinary curricula cope with the need to be reorganized to conform to the new guidelines. In this way the study aimed at characterizing the incorporation of the interdisciplinarity in tree undergraduate courses, in the municipality of S?o Paulo. Documents and interviews were collected and then analyzed in a qualitative approach. The study detected efforts on the part of the coordination of the courses to establish an integrated curriculum. Aside limiting factors pointed out, the projects in the community appear as facilitators of incorporation of the interdisciplinarity in the curricula.     

Assessment of fatigue in chronic disease: a bibliographic study of fatigue measurement scales

A large number of fatigue scales exist and there is no consensus on which fatigue measuring scales that are most appropriate for use in assessment of fatigue in different diseases. We aimed to describe the use of fatigue scales in studies of disease-related fatigue during the last three decades. We searched databases from 1975 to 2004 for original studies reporting on disease-related fatigue and extracted information on method used to assess fatigue, diseases under study and year of publication. A total of 2285 papers reported measures of fatigue in chronic non-acute diseases of which 80% were published during the last decade. We identified 252 different ways to measure fatigue, of which 150 were use only once. Multi-symptom scales (n = 156) were used in 670 studies, while 71 scales specifically designed to measure fatigue were applied in 416 studies. The majority of these studies used scales with a multidimensional approach to fatigue, and most studies used scales that were disease-specific or only applied to few different diseases. Research in disease-related fatigue has increased exponentially during the last three decades, even if we adjust for the general increase in publishing activity. The number of scales has also increased and the majority of scales were developed for specific diseases. There is need for measure instruments with different sizes and dimensionality, and due to ceiling and floor effects, the same scale may not be useful for patients with different severity of fatigue. However, since fatigue is an unspecific symptom there should not be need for adopting disease specific fatigue scales for each individual disease. There may be differences in characteristics of fatigue between diseases and generic measurement instruments may facilitate documentation of such differences, which may be of clinical importance.     

Accidents in childhood and adolescence: a bibliographic review

This study aims at reviewing the literature on accidents among young under the age of 15. Throughout Brazil, lesions and poisonings are responsible for 5 to 6 percent of total internments by the National Health System (SUS), generating 8 percent of the total hospital internment expenses. Sweden and Italy are the countries that have the lowest mortality rates related to external causes among youngsters under the age of 15. The rates of Denmark, Germany and Japan are regarded as intermediate. France, Belgium, Austria and Canada are regarded as countries with high mortality rates related to external causes among youngsters under the age of 15. Brazil together with the United States, Portugal, Mexico and Korea are considered countries with very high mortality rates related to childhood accidents, needing preventive actions. Furthermore, studies reinforce the importance of recognizing the nature and reality of childhood accidents in order to form a diagnosis that helps elaborate and accomplish specific prevention policies.     

Nutrition of children with cleft lip and cleft palate, a bibliographic study

The present study aimed at describing the children with congenital lip-palate malformation, emphasizing their alimentation, such as the difficulties and alternative methods to feed these children and nursing care in this process. The bibliographic review showed that there are many aspects in the alimentation care to fissured children, involving complex affective, social, economic and cultural relations that influence in mother-child relationship, in social discrimination of the fissured children and in mothers' difficulty to feed and give care to the child. Authors found the need to implement breast feeding, pointing out the physiological, psychological and social limitations that involve the child and the family as well as the importance of alimentation to physical and emotional development, favouring the surgical correction of lips and/or palate fissures as well as the rehabilitation process.     

Reflexive education in post-modernity: a bibliographic review

This is a bibliographical review that aimed at considering teaching at the actual historical moment, denominated post-modernity, and that has resulted in a pragmatic change in all levels of human being understanding. Thus, authors rescued and presented the presuppositions for a post-modern education, emphasizing among them the reflexive education proposed by Donald A. Sh?n, that is based on practical learning centered in "reflexion-in-action", as an alternative for the formation of a reflexive professional.     

Unconditioned logistic regression and sample size: a bibliographic review

Unconditioned logistic regression is a highly useful risk prediction method in epidemiology. This article reviews the different solutions provided by different authors concerning the interface between the calculation of the sample size and the use of logistics regression. Based on the knowledge of the information initially provided, a review is made of the customized regression and predictive constriction phenomenon, the design of an ordinal exposition with a binary output, the event of interest per variable concept, the indicator variables, the classic Freeman equation, etc. Some skeptical ideas regarding this subject are also included.     

Searching bibliographic databases effectively

The ability to search bibliographic databases effectively is now an essential skill for anyone undertaking research in health. This article discusses the way in which databases are constructed and some of the important steps in planning and carrying out a search. Consideration is given to some of the advantages and limitations of searching using both thesaurus and natural language (textword) terms. A selected list of databases in health and medicine is included.     

The experience of mastectomized woman: a bibliographic research

This study aimed at knowing the scientific production concerning the care to the mastectomized woman, focusing the revealed feelings, the difficulties faced and the care strategies adopted by the nursing, a bibliographical search was carried out with 23 published articles since 1990, in national periodics. Using the proposed methodology by Salvador, the main women's feelings identified was fear, rejection, guilty and loss; amongst the difficulties, stand out the auto-image acceptance, the confrontation of the prejudice and the collateral effect of chemotherapeutic treatment, specially the alopecia, the pain and the physical difficulties. As main care strategy, it was identified the group activities, aiming at promotin the mastectomized woman self-esteem and to contribute for her quality of life.     

Posttraumatic stress disorder and health status: the veterans health study

This article examines the association between self-reported prevalence of posttraumatic stress disorder (PTSD) and health status in a sample of 2425 male Department of Veterans Affairs (VA) ambulatory care patients who participated in the Veterans Health Study. Participants were recruited at 1 of 4 VA outpatient clinics in the Boston area. They completed self-report measures of PTSD (using the PTSD Checklist and measures of exposure to traumatic events), depression (using the Center for Epidemiologic Studies--Depression scale), and health status (using the Short-Form-36) and a medical history interview assessing 22 conditions and a history of psychiatric treatment. The screening prevalence of PTSD was 20.2% among all patients (24.3% among those exposed to traumatic events); another 15.5% met the criteria for depression but not PTSD. The health status of patients with either PTSD or depression was significantly worse than that of patients with neither disorder, even after controlling for age, education, and number of comorbid medical conditions. Patients with PTSD reported more medical conditions than did other patients. Patients with PTSD currently in mental health treatment had worse health status than did those who reported no treatment; the health status of patients who reported past mental health treatment was generally comparable to that of those with no treatment. The prevalence and comorbidity of PTSD among this sample of VA ambulatory care patients were higher than previously reported among samples of community-residing adults. The association of PTSD with health status was substantial, suggesting that the burden of PTSD is at least comparable to, and may be worse than, that of depression. Mental health treatment alleviated some of this burden. The potential impact of PTSD on health status should be more widely recognized.