Clinical Research: Where is the "laboratory" and what are the methods? - [abstract]

Clinical research is obviously necessary if medical care for patients is to improve. Over the last several decades, however, there has been a tendency to marginalize this branch of science. The reasons for this trend are obvious enough - lack of scientific training of investigators, pressure of clinical responsibilities, substitution of product testing (eg drugs, devices) for sciences, etc - but the solution is not. Clinican scientist control two unique resources - access to patients and an understanding of clinical problems - that should translate into control, if not a monopoly, over the clinical research enterprise. Unfortunately, this resource if squandered. In this presentation, a perspective on clinical research at the present time, at least from the North American perspective, will be offered. It will be argued that medicine has responded very ineffectively to changes in the academic environment. As a result, clinicans are deeply confused about where the appropriate "laboratory" is situated and what constitutes the method of enquiry for clinical research. In conclusion, a view on what might constitute the elements of a programme to restore that balance will also be presented.(Au)

Knowledge, attitudes and practices of professionals who investigate child sexual abuse cases in Kingston and St. Andrew, Jamaica

OBJECTIVE: To determine the influence of personal childhood experiences, such as sexual experience, onthe knowledge, attitudes and practices of professionals investigating paediatric sexual abuse cases. DESIGN AND METHODS: A cross-sectional study was done in February, 1999. All members of three separate professionals employed as child sexual abuse investigators in three public institutions within the Corporate area of Kingston and St Andrew were included. The data wee collected using a self-administered questionnaire. RESULTS: The results established that there were significant relationships between sexual experiences in childhood of the investigators and their knowledge of child sexual abuse issues. The most significant findings were related to experiences as victims and knowledge of close friends or family who suffered sexual abuse as children. Victims of childhood sexual abuse who admitted their experiences had statistically significant differences in knowledge score compared with the other investigators who denied any such experience (p=0.0041). Furthermore, the ackowledgers (8/26) had significantly higher knowledge scores than the minimizers (18/26) (p<0.0003). The professionals who knew of a family or close childhood friend who suffered sexual abuse had statistically significant differences in knowledge scores than their colleagues who did not (p=0.015. The high prevalence (68 percent) childhood sexual abuse among this group of professionals futher supports the social importance of this problem. CONCLUSIONS: A significant number (68 percent) of investigators are survivor of childhood sexual abuse and are positively attracted to their current position. Their superior knowledge of the issue of child sexual abuse represents a positive out-come from an extremely negative situation. (Au)

The role of applied research in donor-supported public health programmes in developing countries - abstract

The basic goal of scientific inquiry, whether in individual patient care or in health practice, is to replace intuitive thinking or ad hoc decision-making with methodological tools for appropriate decision-making. Two objectives of the USAID-supported African Child Survival Initiative - Combatting Childhood Communicable Disease (ACSI-CCCD) have been to provide data necessary for programmatic needs and to develop indigenous research capability among African counterparts and institutions. The twelve-year experience of applied research in ACSI-CCCD was reviewed through project documents, research reports and proposals, and focus groups, individual interviews and on-site visits with African investigators and programme managers. Research undertaken with CCCD support was compared to the typology of Feachem et al which classifies the priorities for developing country research in hiearchical fashion. Particular attention was paid to evaluating programme or policy impact or research findings, benefits to local institutions or individual researchers, and perceived value of the research proces or results to local, national or regional health objectives. Over 250 research activities in 18 countries received CCCD support from the project's inception. Significant accomplishments were achieved in strengthening research capacity as well as advancing programmatic objectives, despite the conflicting nature of these goals. Identified strengths of the CCCD research component were its close links to local programmes and programme managers, responsiveness to local priorities, availability of local review and funding mechanisms, policy relevance, and flexibility in the face of changing circumstances. Skills transfer and availability of technical assistance were also highlighted. Weaknesses identified included inadequate monitoring and supervision of research activities (particularly in remote or widespread geographical locations), absence of a clear agenda or priorities for indigenous research, sometimes conflicting objectives of donors and local programme managers, and relatively small achievements in institutional strengthening. Long-term benefits in donor-sponsored applied research will require acknowledging a clear distinction between "promoting research" and "developing researchers". Both short-term training, such as workshops and mentoring relationships, and formal postgraduate training are necessary to establish an acceptable and sustainable research infrastructure for health services in developing countries (AU)

Tracking research at the Faculty of Medical Sciences, U.W.I. Mona - abstract

The research output of the Faculty of Medical Sciences UWI, for the academic year 1990 - 1991 was quantified, based on the Departmental Reports published by the University of the West Indies. One hundred and forty-three members of the academic staff employed by the Faculty of Medical Sciences published 103 articles in scientific journals, a rate per staff member of 0.72 publications per year, of which fewer than one-third were peer review publications. More than half of the publications came from only 4 of the 13 Departments (p

Research in health sciences: the Caribbean issue

Research is an integral part of our growth and development in the context of transfer of technology, human resource development and international competitiveness. We as Caribbean scientists have the responsibility of ensuring that the appropriate impetus is given to this vital activity (Summary)