Category Archives: Research
A major theme at this year’s AcademyHealth Annual Research Meeting was the need to become more aggressive on translating and disseminating health research. Just last month, the Mailman School of Public Health at Columbia University announced that is was becoming the first school at the university and one of the first of U.S. schools of public health to adopt an open access resolution. The resolution calls for faculty and other researchers at the school to post their papers in openly available online repositories such as Columbia’s Academic Commons, where content is available free to the public, or in another open access repository, such as the National Institutes of Health’s PubMed Central.
“A wider dissemination of research and information has been a number one priority of our faculty, who are motivated by the belief that scientific knowledge belongs to everyone,” said Linda P. Fried, MD, MP, the dean at Mailman. “It is in the interest of all of us to take every measure possible to improve and simplify the process of gaining access to our research findings,” Fried said.
NewPublicHealth spoke with Bhaven N. Sampat, PhD, Assistant Professor of health policy and management at Mailman and a lead faculty member on the open access endeavor.
NewPublicHealth: Why haven’t many journals been open access before and what is making researchers, particularly in the field of public health, interested in more widely disseminating their research?
An anniversary session at the AcademyHealth Annual Resarch Meeting yesterday looked back at the organization’s thirty years of translating research into policy. It’s an important topic. A number of recent meetings focusing on public health, including last week’s public meeting of the Commission to Build a Healthier American, stressed the need for evidence in order to consider planning and community improvement decisions. The Affordable Care Act has a number of new initiatives that call on clinical and public health practitioners to seek and rely on an evidence base, including the Patient-Centered Outcomes Research Institute (PCORI), which is authorized by Congress to evaluate the best available evidence to help patients and their health care providers make more informed decisions.
Decades of research is beginning to pay off, according to the panelists. For example, according to Sherry Glied, PhD, professor of health policy and management at the Columbia University Mailman School of Public Health, the experts involved in crafting the Affordable Care Act drew on a body of research to inform the expected cost of implementing the law.
Gail Wilensky, senior fellow at Project HOPE, an international health foundation, who directed the Medicare and Medicaid programs from 1990 to 1992, pointed out that sometimes evidence has limitations. “Getting legislation passed also has to do with, among other things, the political mood of the country,” said Wilensky, who added that sometimes policy passes and sometimes it doesn’t, which is important for younger researchers to realize. “Important legislation has passed with minimal analysis including Medicaid and Medicare,” Wilensky pointed out.
NewPublicHealth is on the road this week at the AcademyHealth Annual Research Meeting in Baltimore, Maryland and the International Making Cities Livable Conference meeting in Portland, Oregon.
AcademyHealth is a key organization in the United States for the study of health services research—a discipline that looks at how people get access to health care, how much care costs and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance and deliver high-quality care; reduce medical errors; and improve patient safety.
An important focus of this week’s Annual Research Meeting is the translation and dissemination of research into health practice. The Public Health Systems Interest Group, AcademyHealth’s largest interest group with close to 3,000 members, is meeting this week as well and has a particular focus on translating and disseminating public health systems and services research to the public health practitioners who could benefit from practical findings.
NewPublicHealth recently spoke with Paul Erwin, MD, MPH, and head of the department of public health at the University of Tennessee School of Public Health, about the importance of having strong evidence available for public health practitioners.
NewPublicHealth: Why is the translation and dissemination of Public Health Services and Systems Research (PHSSR) so important?
Paul Erwin: Ultimately PHSSR is meant to go out into the practice community so that research can actually make a difference. I think historically that is part of what has set PHSSR apart from closely related research disciplines. PHSSR really is intended to help produce the kinds of evidence-based practices that are more effective with limited resources, and likely to move the needle on population health.
NIH: $12.7M in Grants to Explore New Uses for Existing Compounds
Approximately $12.7 million in National Institutes of Health (NIH) grants will go toward helping academic research groups explore new treatments in eight disease areas. They include Alzheimer’s disease, Duchenne muscular dystrophy and schizophrenia. The “Discovering New Therapeutic Uses for Existing Molecules” hopes that, by finding new uses for existing compounds, new treatments can advance to clinical trials more quickly. “Innovative, collaborative approaches that improve the therapeutic pipeline are crucial for success,” said NIH Director Francis S. Collins, MD, PhD. “This unique collaboration between academia and industry holds the promise of trimming years from the long and expensive process of drug development.” Read more on research.
Emergency Contraception Officially Available to All Women Without a Prescription
The U.S. Food and Drug Administration (FDA) has officially followed through on its plan to make the Plan B One-step emergency contraceptive available to all women regardless of age and without a prescription. It was previously available over-the-counter only to women age 17 or older and with a prescription for women who were younger than 17. Earlier this year it the nonprescription age was lowered to 15, but a U.S. District Court ruling ordered it be made to all women and girls without a prescription, at the time calling the FDA’s decision to reject a citizen petition related to the restrictions "arbitrary, capricious and unreasonable." Read more on sexual health.
Study: Listening to Music While Driving Doesn’t Negatively Impact Response Time
Listening to music while driving does not have the same negative effective on response time as other actions marked as distractions, and in fact might even improve focus under certain conditions, according to a new study. "Speaking on a cellphone or listening to passengers talking is quite different than listening to music, as the former types are examples of a more engaging listening situation," said study author Ayca Berfu Unal, an environmental and traffic psychologist. "Listening to music, however, is not necessarily engaging all the time, and it seems like music or the radio might stay in the background, especially when the driving task needs full attention of the driver.” The study looked at college-aged drivers, finding that louder music actually improved the response time to changes in the speed of cars ahead of the driver. Approximately nine people are killed and more than 1,000 are injured each day in the United States because of distracted driving, according to the U.S. Centers for Disease Control and Prevention. Read more on safety.
American Institute of Architects, Others Launch Ideas Competition to Rebuild Sustainable Communities
The American Institute of Architects (AIA), Make It Right, St. Bernard Project and Architecture for Humanity have launched a new “Designing Recovery” ideas competition to help rebuild sustainable, resilient communities in areas hit by natural disasters. The announcement came at the annual Commitment to Action at CGI America. "The cities of New Orleans, New York and Joplin are all stark reminders of the emerging threat of severe-weather disasters brought on by a changing climate,” said Eric Cesal, Director of Reconstruction and Resiliency at Architecture for Humanity. “Every city can learn from the successes and failures of these three cities and their response to disaster. Designers and architects have a responsibility to do more — and to do better. We hope this competition will draw out the best and brightest new ideas for a world of new risks." Read more on disasters.
On World Blood Donor Day, HHS Highlights Need for More Resources
Today is World Blood Donor Day. The United States is one of only 62 countries that collect 100 percent of their blood from voluntary, unpaid donors; the World Health Organization has this goal for all countries by the year 2020. About 8 million people donate blood in the United States each year. While this number is substantial, the U.S. Department of Health and Human Services (HHS) says even more donations are needed to help surgical patients, cancer patients, victims of natural disasters and people who suffer battlefield injuries.
According to HHS:
- Forty or more units of blood may be needed for a single trauma victim
- Eight units of platelets may be required daily by leukemia patients undergoing treatment
- A single pint of blood can sustain a premature infant’s life for two weeks
Read more on global health.
Supreme Court Rules Naturally Occurring Human Genes Cannot be Patented
In a unanimous decision, the U.S. Supreme Court ruled that naturally occurring human genes cannot be patented, although synthetically produced genetic material can be. The ruling struck down Myriad Genetics Inc.’s patents on the BRCA1 and BRCA2 genes linked to breast and ovarian cancer. Robert Darnell, MD, president and scientific director of the New York Genome Center, said the ruling "sets a fair and level playing field for open and responsible use of genetic information" and that “it does not preclude the opportunity for innovation in the genetic world." Read more on research.
New funding by the National Institutes of Health (NIH) is aimed at improving treatment for bacterial infections, treating alcohol dependence and determining effective drugs for long-term diabetes treatment.
- Antibiotic Resistance: Duke University has been awarded $2 million by the NIH for a clinical research network focused on antibacterial resistance. Funding could rise to close to $70 million by 2019. According to the NIH, bacterial infections resistant to antibiotic drugs were first reported more than 60 years ago and since then have become more common in both health care and community settings. In some cases, no effective antibiotics exist. The funding will be used to conduct clinical trials on new drugs, optimizing use of existing ones; testing diagnostics and conducting research on best practices for infection control.
- Alcohol Dependence: A new study funded by the NIH and published in the Journal of Addiction Medicine finds that the smoking-cessation drug varenicline (brand name Chantix), significantly reduced alcohol consumption and craving among people who are alcohol-dependent. “Current medications for alcohol dependence are effective for some, but not all, patients. New medications are needed to provide effective therapy to a broader spectrum of alcohol dependent individuals,” said says Kenneth R. Warren, PhD, acting director of the National Institute on Alcohol Abuse and Alcoholism, part of NIH. Participants who took varenicline, compared with those taking a placebo, decreased their heavy drinking days per week by nearly 22 percent.
- Diabetes: The NIH is currently recruiting volunteers for a study to compare the long-term benefits and risks of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes. The study is important because if doctors find that metformin is not effective enough to help manage type 2 diabetes, they often add another drug to lower blood glucose levels. However, there have been no long-term studies on which of the add-on drugs are most effective and have fewest side effects. The study will compare drug effects on glucose levels, adverse effects, diabetes complications and quality of life over an average of nearly five years and will enroll about 5,000 patients at 37 study sites.
Do we need an endgame strategy to finally end the devastating hold tobacco has on its users? Scholars, scientists and policy experts grapple with endgame proposals in a special supplement to the journal Tobacco Control. Some of the articles are based on a workshop held last year at the University of Michigan, with financial support from the Robert Wood Johnson Foundation and the American Legacy Foundation. The workshop was hosted by Kenneth Warner, PhD, a former dean at the University of Michigan School of Public Health and now a professor at the School.
Although smoking has declined significantly in most developed nations in the last half-century, due to policy changes and increased education about the health hazards, says Warner, too many people continue to die from the most preventable cause of premature death and illness. It's estimated that worldwide six million people a year die from illnesses caused by cigarettes, including more than 400,000 in the U.S. alone."There is a newfound interest in discussing the idea of an endgame strategy. The fact that we can talk about it openly reflects a sea change,” says Warner.
>>Read the articles in the tobacco endgame supplement.
Some of the strategies in the supplement include:
- Requiring manufacturers to reduce nicotine content sufficiently to make cigarettes nonaddictive.
- A "sinking lid" strategy that would call for quotas on sales and imports of tobacco, which would reduce supply and drive up price to deter tobacco purchases.
- A "tobacco-free generation" proposal calling for laws that would prevent the sale of tobacco to those born after a given year, usually cited as 2000, to keep young people from starting to smoke; or ban the sale of cigarettes altogether.
"What we are doing today is not enough," says Warner. "Even if we do very well with tobacco control, as we have for several decades now, we'll have a huge number of smokers for years to come, and smoking will continue to cause millions of deaths.”
NewPublicHealth recently spoke with Dr. Warner about some of the strategies proposed for ending tobacco use.
NewPublicHealth: Why is there a need for novel, even radical, endgame strategy?
Ken Warner: While a lot of people have quit smoking, if you look at the rate at which people are quitting in the United States, in the last few years it may actually have declined. In Canada, there is some concern that their very low rates of smoking may actually have gone up. In Singapore, which had the lowest smoking prevalence among developed nations, the smoking rate went up from 12.6 percent to 14.3 percent between 2004 and 2010. So what we're observing is that in some of the countries that have had pretty good success with tobacco control, smoking is now being reduced somewhat more slowly, or possibly even increasing. And if we stay at the current rate of smoking, or even if the smoking rate continues to decline slowly, smoking will remain the leading cause of preventable premature death for many years to come.
NPH: What are some of the reasons that we’re seeing a plateau in the reduction of tobacco use?
During opening remarks at this year’s Keeneland Conference, hosted by the National Coordinating Center for Public Health Systems and Services Research (PHSSR) based at the University of Kentucky in Lexington, Professor Douglas Scutchfield, director of the Center, proudly announced that three of the first health departments to be accredited by the Public Health Accreditation Board (PHAB) earlier this year were in Kentucky. Accreditation had its own track during the conference scientific sessions, including a presentation from Jessica Kronstadt, MPP, PHAB’s director of research and evaluation.
NewPublicHealth caught up with Kronstadt to talk about her presentation on some very early findings from an internal evaluation of the accreditation process.
>>Read more on national public health department accreditation.
NewPublicHealth: What information is PHAB seeking to gain from an evaluation of the accreditation process?
Jessica Kronstadt: Just as we’re asking health departments to engage in quality improvement, PHAB is very much committed to engaging in quality improvement of the accreditation program. So these evaluation efforts will really help us understand what is working well in our accreditation program, and what the experience was like from the perspective of the health departments and the site visitors. This evaluation will allow us to continue to improve the accreditation process.
The last session of the Keeneland Conference focused on translation and dissemination of public health systems and services research, with the critical goal of more efficient and effective delivery of public health services and improving population health. NewPublicHealth spoke with Ross Brownson, PhD, of the Prevention Research Center at Washington University in St. Louis. Dr. Brownson has received funding from the Robert Wood Johnson Foundation to explore evidence-based decision making at local health departments.
NewPublicHealth: How far back does evidence-based public health go?
Ross Brownson: The formal underpinnings of evidence-based public health were developed in the late 1990s, so at least the formal literature has been around for probably about 15 years. Of course, research on effective interventions has been around for many more decades. The newer field of public health services and systems research is much newer, just within the last five years or so, and these different bodies of research are now converging.
The early research focused a lot on identifying evidence-based interventions. The newer research is more on the process of evidence-based public health—regardless of the intervention, how do you develop and implement an evidence-based health department?
We identified five domains that are really important:
- leadership of the agency;
- ability to develop, formalize and maintain good partnerships within the community;
- workforce training and development;
- focus on organizational climate and culture; and
- effective financial and budgeting processes.
The ultimate goal is to make the population healthier and we know that the way to improve the overall health of the public is largely through state and local governmental public health. To reach that ultimate goal you want to have the most effective health department possible and also make the most efficient use of resources. We’re always in a time of tight resources, but probably now more than ever. That calls on us to be as effective and efficient as we can be in the delivery of public health services.
NPH: How will you disseminate these best practices and this evidence base to state and local public health officials?
Today’s plenary speaker at the 2013 Keeneland Conference is William Roper, MD, MPH, dean of the school of medicine, vice chancellor for medical affairs and CEO of the UNC Health Care System at the University of North Carolina at Chapel Hill. Earlier in his career, Dr. Roper was senior vice president of Prudential HealthCare, president of the Prudential Center for Health Care Research, director of the Centers for Disease Control and Prevention and administrator of the Health Care Financing System, the precursor to the Center for Medicare and Medicaid Services.
NewPublicHealth spoke with Dr. Roper on his way to the Keeneland Conference about the drive to better use data, instead of anecdotes and personal beliefs, to drive decision-making.
NewPublicHealth: What were some of the early efforts you were involved in that set the stage for the field of public health services and systems research we know today?
Dr. Roper: I didn’t do this by myself; I did it with a lot of other people, but one of the critical early efforts was the publication of Medicare mortality information on all American hospitals beginning in 1986 and continuing for a number of years thereafter. Another was creation of the Agency for Healthcare Policy and Research in 1989, which has since been renamed the Agency for Healthcare Research and Quality. Another was the launching of the Prevention Effectiveness Initiative at CDC in the early 90s. And then subsequently, work that I’ve done at the University of North Carolina, first at the School of Public Health and then at the School of Medicine using the tools of health services research broadly in health care and in public health.
NPH: What are some of the fruits of those efforts?