Public Health Research Priority Research Articles

Research agenda for tackling inequalities related to migration and ethnicity in Europe

Reducing ethnic inequalities and inequities in health needs to become a higher priority for public health research. Active involvement of migrant and ethnic minority populations in European population health research is necessary, for data show important inequalities but evidence, particularly on effectiveness, is sparse and strategic overviews rarer still. Ethnically disaggregated health surveillance systems are developing slowly, and pragmatically, often using country of birth. The principles to adopt, given the gaps between the ideal and the current reality, need wider discussion. Ethics may provide both principles and impetus. Doing no harm, doing good, respecting the research participants' autonomy are good starting points. More emphasis is needed on justice, fairness and equality, participation and communicating effectively. Ethnic minority groups are willing participants in trials once linguistic and trust-related barriers are overcome, though recruitment costs are higher. Guidelines and strategies by European bodies with research funding or enforcement responsibilities are needed. The research community needs an infrastructure within which to collect and utilize evidence. Research can help migrant and ethnic minority groups to participate more fully in our multi-ethnic societies.

Diagnosis and Management of Cryptococcal Disease in Resource-Limited Settings

Cryptococcal meningitis is one of the most important fungal infections in the developing world, where deaths related to this disease are numerous. In resource-limited settings, mortality is high in large part because of difficulties in the diagnosis and management of this infection. This paper outlines many of the realities in many resource-limited settings, and describes priorities for public health action and research.

Public Health Research Priorities For The Future.

The last century of innovative public health discoveries has led most of the world’s population to lead longer, healthier lives. Yet, the future holds some of the greatest public health challenges in mankind’s history. Global disparities in health; medication safety; climate change; epidemics of obesity and diabetes; an aging world demographic; and emerging infections all represent problems requiring scientific solutions. The solutions to these problems, like the solutions to those in the last century that contributed so greatly to our quality of life, will require paradigm-shifting innovation.To maximize individual innovative potential, one strategy is formal instruction in the methods of innovative thinking. Teaching innovative thinking is rarely integrated into science training. However 40 years of accumulated evidence suggests that formal instruction results in improved thinking skills. I describe here some of the methods integrated into a course for graduate and professional health science students entitled Innovative Thinking. The curriculum consists of three components: recognizing and finding alternatives to habitual cognitive patterns; learning to use tools that enhance idea generation and originality; and harmonizing divergent thinking with the process of convergent thinking that is central to the scientific method.To build more innovative environments, institutions can promote team science, fund staged scientific designs that are heavy on early prototypes, reward and grow the training programs of past innovators, and become less risk averse.Although public health has accomplished much, it must continue to battle major, growing causes of disease and disability. Innovation is the engine of scientific discovery. Releasing the great potential for discovery in all of us must be central to forwarding health and prosperity in the world.

Comparing public-health research priorities in Europe

BackgroundDespite improving trends, countries in Europe continue to face public-health challenges. This study investigated the priorities of stakeholders for research to meet these challenges.MethodsPublic-health research includes population-level and health-system research, but not clinical or biomedical research. The study drew on data from three surveys undertaken through collaboration in SPHERE (Strengthening Public Health Research in Europe). There was participation of ministries in 18 of 28 (64% response) European countries, from 22 of 39 (56% response) member national associations of the European Public Health Association, and from 80 civil society health organisations (53% of members of the European Public Health Alliance)ResultsPublic-health research fields included disease control, health promotion and health services. Ministries of health, rather than ministries of science or education, mostly took responsibility for public-health research: they reported varied but well-defined areas for research in relation to national health plans and programmes. National public health associations reported research priorities across most fields of public health, although with some European regional differences. Civil society health organisations prioritised health promotion research nationally, but also health services research internationally. There was less research reported on methods, such as modelling and economic analysis, wider determinants of health, and public-health interventions.ConclusionSystematic collaboration between stakeholders across European countries would enhance knowledge and promote innovation to address contemporary public-health challenges.

Public Health Research Priorities in Europe Seen by Non-governmental Organizations

Public health research is concerned with population health, determinants of health, health systems research, health promotion, environmental health, health protection, disease prevention and research in other fields of public health. During the last decades, non-governmental organisations (NGOs) are more often entering the field of public health research. This paper presents results of work within SPHERE (Strengthening Public Health Research in Europe), a European Commission funded study aimed to gather information and produce knowledge on the state of public health research in Europe. A questionnaire survey was developed and conducted among NGOs enrolled in a database held by the European Public Health Alliance (EPHA). There were 80 replies, and the response rate for NGOs that were members of EPHA was 53%. There were no significant statistical differences in the responses when analysed for three European groups ['old' member states (EU 15), accession members states in 2004 (EU 10) and EU-associated countries]. The NGOs reported a relatively large international experience, expressed by participation in international public health research, and more often practice work. The main research priorities reported were general public health, environmental health, ADHD, obesity, nutrition, tobacco control. NGOs showed low correlation between their work field and their proposed public health research priorities. There are growing numbers of NGOs in Europe concerned with public health. This survey indicates their interest also in public health research priorities.

The Status of HIV-1 Resistance to Antiretroviral Drugs in Sub-Saharan Africa

Access to highly active antiretroviral therapy (HAART) for persons infected with HIV in sub-Saharan Africa has greatly improved over the past few years. However, data on long-term clinical outcomes of Africans receiving HAART, patterns of HIV resistance to antiretroviral drugs and implications of HIV type-1 (HIV-1) subtype diversity in Africa for resistance, are limited. In resource-limited settings, concerns have been raised that deficiencies in health systems could create the conditions for accelerated development of resistance. Coordinated surveillance systems are being established to assess the emergence of resistance and the factors associated with resistance development, and to create the possibility for adjusting treatment guidelines as necessary. The purpose of this report is to review the literature on HIV-1 resistance to antiretroviral drugs in sub-Saharan Africa, in relation to the drug regimens used in Africa, HIV-1 subtype diversity and overall prevalence of resistance. The report focuses on resistance associated with treatment, prevention of mother-to-child transmission and transmitted resistance. It also outlines priorities for public health action and research.

Development of joint European public health research priorities

Background A north-east to south-west European gradient in disease morbidity and mortality has been identified. Adjustments of public health policies and cooperative interventions of multi-disciplinary multi-national European teams, based on identified underlying reasons responsible for differences in regional disease incidence, reduce the populations health gradient in Europe. Methods Participants were invited by e-mail to attend a workshop to initiate a Pan-European public health network between researchers and public administration to identify and develop future public health research projects using de Bonos “six thinking hats” method. The workshop was hosted by the Institute of Social Medicine, Epidemiology and Health Economics in Berlin and financed by the German Federal Ministry of Education and Research. Results Following 170 invitations sent to 72 researchers, 78 public administrators, 18 civil society and 3 private sector representatives in 17 European countries, 27 participants from 12 European countries attended a 2.5 days workshop to discuss public health priorities of future public health importance under four major topics (non-infectious diseases, infectious diseases, substance abuse and disease prevention) and eight subtopics (coronary-heart disease, stroke, tuberculosis, HIV/AIDS, alcohol, tobacco, generic prevention and obesity prevention). Fourteen hours of workshop discussion were digitally recorded for further qualitative analysis. Conclusion De Bono's lateral thinking method allowed effective generation of new ideas, better communication and effective analysis of issues. A modern participatory approach in a workshop with partners from multiple European countries enabled structured discussion on major public health threats to populations in the EU for the preparation of future joint research projects.

The Status of HIV-1 Resistance to Antiretroviral drugs in Sub-Saharan Africa

Access to highly active antiretroviral therapy (HAART) for persons infected with HIV in sub-Saharan Africa has greatly improved over the past few years. However, data on long-term clinical outcomes of Africans receiving HAART, patterns of HIV resistance to antiretroviral drugs and implications of HIV type-1 (HIV-1) subtype diversity in Africa for resistance, are limited. In resource-limited settings, concerns have been raised that deficiencies in health systems could create the conditions for accelerated development of resistance. Coordinated surveillance systems are being established to assess the emergence of resistance and the factors associated with resistance development, and to create the possibility for adjusting treatment guidelines as necessary. The purpose of this report is to review the literature on HIV-1 resistance to antiretroviral drugs in sub-Saharan Africa, in relation to the drug regimens used in Africa, HIV-1 subtype diversity and overall prevalence of resistance. The report focuses on resistance associated with treatment, prevention of mother-to-child transmission and transmitted resistance. It also outlines priorities for public health action and research.

Priorities for public health research on craniosynostosis: Summary and recommendations from a Centers for Disease Control and Prevention‐sponsored meeting

On June 8-9, 2006, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention held a meeting entitled "Prioritizing a Public Health Research Agenda for Craniosynostosis". The meeting goals were to review current knowledge in the area, discuss research gaps, and identify future priorities for public health research. Participants with a broad range of expertise (including clinical and molecular genetics, cranial morphology, epidemiology, pediatrics, psychology, public health, and surgery) contributed to the development of the research agenda. Meeting participants were asked to consider public health significance and feasibility when identifying areas of priority for future public health research. Participants identified several priorities, including the need to better delineate the prevalence and phenotype of craniosynostosis (CS); to identify factors important in the causation of CS (including potentially modifiable environmental risk factors as well as genes involved in isolated CS and gene-gene and gene-environment interactions); and to better understand short- and long-term outcomes of CS (e.g., surgical, neurocognitive and neuropsychological outcomes, psychological adjustment, and social relationships) and issues related to clinical care that could affect those outcomes. The need for improved collaboration among clinical treatment centers and standardization of data collection to address these priorities was emphasized. These priorities will be used to guide future public health research on CS.

Exposure of the U.S. Population to Bisphenol A and 4- tertiary -Octylphenol: 2003–2004

BackgroundBisphenol A (BPA) and 4-tertiary-octylphenol (tOP) are industrial chemicals used in the manufacture of polycarbonate plastics and epoxy resins (BPA) and nonionic surfactants (tOP). These products are in widespread use in the United States.ObjectivesWe aimed to assess exposure to BPA and tOP in the U.S. general population.MethodsWe measured the total (free plus conjugated) urinary concentrations of BPA and tOP in 2,517 participants ≥ 6 years of age in the 2003–2004 National Health and Nutrition Examination Survey using automated solid-phase extraction coupled to isotope dilution–high-performance liquid chromatography–tandem mass spectrometry.ResultsBPA and tOP were detected in 92.6% and 57.4% of the persons, respectively. Least square geometric mean (LSGM) concentrations of BPA were significantly lower in Mexican Americans than in non-Hispanic blacks (p = 0.006) and non-Hispanic whites (p = 0.007); LSGM concentrations for non-Hispanic blacks and non-Hispanic whites were not statistically different (p = 0.21). Females had statistically higher BPA LSGM concentrations than males (p = 0.043). Children had higher concentrations than adolescents (p < 0.001), who in turn had higher concentrations than adults (p = 0.003). LSGM concentrations were lowest for participants in the high household income category (> $45,000/year).ConclusionsUrine concentrations of total BPA differed by race/ethnicity, age, sex, and household income. These first U.S. population representative concentration data for urinary BPA and tOP should help guide public health research priorities, including studies of exposure pathways, potential health effects, and risk assessment.

Editorial: Scale‐up of antiretroviral therapy in sub‐Saharan Africa – priorities for public health research

1 London School of Hygiene and Tropical Medicine, London, UK 2 Uganda Virus Research Institute, Entebbe, Uganda 3 Department for International Development, Kampala, Uganda 4 The AIDS Support Organisation, Kampala, Uganda 5 Wakiso District Council, Entebbe, Uganda 6 HIV Division, World Health Organisation, Geneva, Switzerland 7 Centre for Sexual Health & HIV Research, University College London, London, UK

Priorities for Future Public Health Research in Orofacial Clefts

The National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention conducted a workshop in January 2006, entitled "Prioritizing a Research Agenda for Orofacial Clefts." The goals of the meeting were to review existing research on orofacial clefts (OFCs), identify gaps in knowledge that need additional public health research, and develop a prioritized research agenda that can help guide future public health research. Experts in the field of epidemiology, public health, genetics, psychology, speech pathology, dentistry, and health economics participated to create the research agenda. Research gaps identified by the participants for additional public health research included: the roles of maternal nutrition, obesity, and diabetes in the etiology of OFCs; psychosocial outcomes for children with OFCs; the quality of life for families and children with OFCs; and the health care costs of OFCs. To create the research agenda, the participants prioritized the research gaps by public health importance, feasibility, and outcomes of interest. This report summarizes the workshop.

Ageing societies—new priority for public health research?

Population ageing, caused by longer life spans and low fertility rates, has changed the demographics in Europe and around the world. Older people not only are becoming a larger portion of the population, but also face a prolonged period of life in which a majority is relatively healthy, especially so in the ‘third age’ that ranges typically from the mid-50s to the early 80s. Nevertheless, ageing is associated with increased risks of chronic disease and impaired functioning. This fact results in challenges to health-care systems, prevention activities and social policy regulations. In this context, fresh evidence derived from public health research on the maintenance and promotion of health in older populations is clearly needed. But why should this research be given special priority? At least three reasons deserve attention. The first reason concerns early retirement and its major determinants. Although large variations in workforce participation rates are observed …

Antiretroviral treatment in resource‐poor settings: public health research priorities

Many countries in Africa are planning to provide highly active antiretroviral therapy (HAART) to millions of people with acquired immune deficiency syndrome. This will be a highly complex therapy programme. Physician-based models of care adapted from industrialized countries will not succeed in providing treatment to the majority of those who need it in resource-constrained settings. A high priority is to identify care models for Africa that will increase coverage of HAART safely and effectively: key issues are (i) whether nursing staff or non-clinically qualified staff can take the major role in the treatment programme and reduce the workload of physicians, (ii) whether treatment and monitoring can be delivered through peripheral health centres or through home visits and achieve better adherence and be more cost-effective than delivery at hospitals and (iii) which clinical algorithms used by nursing or non-clinically qualified staff will be effective for screening, diagnosing and managing treatment-related side-effects and medical problems being incurred. Many current ART support programmes are making little or no investment in research, but answering important questions on delivery of HAART will be essential if HAART programmes are to be successful in African nations with a high burden of human immunodeficiency virus infection.

An Overview of the Environmental Genome Project

Understanding the causes of common diseases such as cancer, asthma, diabetes, hypertension, and atherosclerosis, which have high population prevalence, is a significant priority for public health research and a major goal in biomedical studies. The influences on susceptibility to common disease are thought to arise from multiple factors, each conferring a low level of relative risk for disease. These low levels of disease risk probably reflect interactions between genotypes at multiple loci (epistasis), interactions between genotypes and environment, and more stochastic epigenetic events such as methylation (Belinsky 2004; Berwick 2000; Hayward 2003; Hegele 1997). Because the risk of any given effect is small (Lander and Schork 1994; Moffatt and Cookson 1999; Pritchard and Cox 2002; Reich and Lander 2001; Risch and Merikangas 1996), detecting these influences will require larger sample sizes, making populationbased association studies more practical for tracing the underlying genetic risks (Risch and Merikangas 1996). Association studies will also be key for exploring genetic links to environmental exposures (Bell and Taylor 1997). In 1997 Dr. Kenneth Olden, director of the National Institute of Environmental Health Sciences (NIEHS), convened a historic conference titled “The Environmental Genome Project” held 17–18 October 1997 in Bethesda, Maryland. This symposium explored the feasibility of the Environmental Genome Project (EGP) and generated significant discussion. The EGP is designed to explore the relationship between common genetic polymorphisms and environmentally induced disease in human populations E s s a y o n The Environmental Genome Project

Vitamin A deficiency and xerophthalmia among school-aged children in Southeastern Asia.

To determine provisional estimates of the extent of vitamin A (VA) deficiency and xerophthalmia among school-aged children. Literature search of published, unpublished and website-based population survey and study reports, with country-specific imputation of prevalence rates and numbers of children affected by: (1) VA deficiency based on measured or imputed distributions of serum retinol concentration < 0.70 micromol/l (equivalent to < 20 microg/dl) and (2) xerophthalmia, by country. Countries within the WHO South-East Asian Region. The target group for estimation was children 5-15 y of age. None. The estimated prevalence of VA deficiency is 23.4%, suggesting that there are approximately 83 million VA-deficient school-aged children in the region, of whom 10.9% (9 million, at an overall prevalence of 2.6%) have mild xerophthalmia (night blindness or Bitot's spot). Potentially blinding corneal xerophthalmia appears to be negligible at this age. VA deficiency, including mild xerophthalmia, appears to affect large numbers of school-aged children in South-East Asia. However, nationally representative data on the prevalence, risk factors and health consequences of VA deficiency among school-aged children are lacking within the region and globally, representing a future public health research priority.

Classification, disability and the public health agenda.

Depression is a common and disabling illness. For some time the disability has been relatively neglected by those interested in public health. Public health priorities have largely been determined by statistics on mortality. The World Health Organization has argued for some time that public health should be concerned with 'adding life to years' as well as 'adding years to life'. This article will argue that depression should be a key priority for public health research.

Relationships among family characteristics and violent behavior by black and white male adolescents

Understanding why violence occurs disproportionately among black male adolescents has become a public health research priority due to recent increases in the rates of homicide and other violent crime in this population. This study examined independent, mediating, and moderating effects of family structure, attachment to parents, and family stress and conflict on self-reported fighting behavior. Subjects were black (n=163) and white (n=397) male 7th and 8th graders. Compared to white males, blacks were exposed to an excess of risk factors for violent behavior, including living in a single-parent household and higher levels of family stress and conflict. Although both groups reported similar levels of past-year fighting, black youth were more likely than whites to report attacking someone or being attacked by someone at school during the prior month. Controlling for age, area of residence, and other family characteristics, logistic regression analyses indicated that living in a nonintact family was a significant risk factor for violent behavior among black male youth, while attachment to parents was a significant protective factor for white males. Family stress and conflict was a risk factor for violent behavior cimmon to both groups of adolescents.

Methods for a population-based study of eye disease: the Melbourne Visual Impairment Project.

The methodology of the Melbourne Visual Impairment Project, a major population-based survey of eye disease on 3,500 randomly selected individuals aged 40 years of age and over in the Melbourne metropolitan region, is presented. The aims of the study are to determine the distribution and determinants of eye disease in an urban population; the impact of eye disease on visual function and the activities of daily living; and the accessibility of eye health care services in the community. All procedures are conducted according to a standardised protocol to allow for comparison with other population-based studies, both in Australia and overseas. Information collected from this study will be employed in the development of recommendations related to eye health care service delivery and establishment of priorities for future public education programmes and health research.

Alcohol Consumption and Hypertension—The Evidence from Hazardous Drinking and Alcoholic Populations

To provide an enhanced perspective to observations of an association between moderate alcohol consumption and hypertension, information on the frequency of hypertension in heavy drinking and alcoholic populations was reviewed. Hypertension was found more often in ambulatory heavy drinkers and alcoholics than in more moderate drinkers and abstainers. This hypertensive state appeared to be at least partially reversible upon cessation of drinking. Additional investigation is needed to define the level of consumption associated with an increased risk of hypertension, the dose response pattern, and the determinants of irreversibility. Alcohol-related hypertension may constitute a risk factor for cardiovascular disease, thus contributing to the excess mortality experienced by heavy drinking populations. In view of the steady increase in per capita alcohol consumption which characterizes many affluent societies further clarification of this relationship is an urgent public health research priority.