Can reflexivity be learned? An experience with tobacco control practitioners in Canada.

Summary: To explore an example of a reflexive intervention with health professionals working in tobacco control (TC). This study reports the perceived intervention effects regarding: (i) participants' understanding of reflexivity and personal learning and (ii) conditions needed in order to integrate reflexivity into professional and organizational practices. This is a qualitative study using an interpretative evaluation framework to assess the perceived effects of a reflexive intervention in Montréal, Québec. Semi-structured qualitative interviews (n = 8) gathered data. Data analysis began deductively, guided by the broad categories found in research questions. Sub-categories to populate these broad categories captured the inhibitors and facilitators through an inductive thematic analysis. Our study reveals that, following the intervention, most participants had a generally good understanding of reflexivity and described concrete learning in association with the intervention. Main facilitators and inhibitors to conducting a reflexive workshop pertained to the organizational context as well as to the professional and individual characteristics of the participants. Some participants implemented sustainable changes as a result of the intervention, such as creating a tool, reviewing work plans and developing new mechanisms to integrate the voice of their clientele in the planning process. The need and interest for dialogue among health professionals about how TC intervention activities may inadvertently contribute to social inequalities in smoking is apparent. While there appears to be potential for reflexive practice, the integration of reflexivity into practice is reliant upon the organizational context (financial and time constraints, culture, support, and climate) and the reflexivity concept itself (intangibility, complexity and fuzziness).

[Participatory Quality Development: Engaging Community Members in All Phases of Project Planning and Implementation]. / Partizipative Qualitätsentwicklung: Zielgruppen in alle Phasen der Projektgestaltung einbeziehen.

Community participation, recognised as a central feature of successful health promotion and prevention, is often difficult to implement. In this research project internationally recognised methods of participatory health research were applied to demonstrate ways in which community members can be engaged. Participatory health research is characterised by a close collaboration between academic researchers, practitioners and community members in order to generate common knowledge. It is not a question of translating knowledge from research into practice, but rather a question of promoting a collective learning process on the part of all participants for the purpose of developing solutions which address the interests and needs of local people. The result of the project is a new approach for strengthening the quality of prevention and health promotion interventions: participatory quality development (PQD).

[Practice-based evidence in prevention and health promotion among socially disadvantaged communities]. / Praxisbasierte Evidenz in der Prävention und Gesundheitsförderung bei sozial Benachteiligten.

In recent years numerous health promotion and prevention efforts have been created for socially disadvantaged communities. There is a broad consensus that such measures should be scientifically sound; however, the criteria for evidence-based medicine (EBM) have been shown to have limited applicability in this area. It is widely debated which scientific approaches are most appropriate. Several authors have called for the production of "practice-based evidence"(PBE) as an alternative, focusing on ways to produce evidence based directly on practical experience. Implied is a variety of methodological and epistemological approaches for generating knowledge about the effectiveness of interventions. In contrast to the usual means of generating evidence, PBE suggests that practitioners instead of researchers take on the leading role in the generation and interpretation of intervention data. To date, PBE is an idea in need of further definition, both in terms of theory and practice. On the basis of recent research the authors present a definition for PBE and a model for how it could be generated. The authors propose an "Evidence Cycle" which would synthesize the findings from local evaluations for the purpose of generating practice guidelines (Good Practice Criteria) which can be developed in an ongoing way as new data becomes available. In this way local theories of disease causation and development and local evidence for intervention effectiveness could be drawn together to produce empirically-based, generalizable statements about effective health promotion and prevention for disadvantaged communities.

[Quality in prevention and health promotion. Developing a common framework for quality development for members of the Federal Association for Prevention and Health Promotion in Germany]. / Qualität in Prävention und Gesundheitsförderung. Entwicklung eines gemeinsamen Handlungsrahmens in der Qualitätsentwicklung für die Mitglieder der Bundesvereinigung Prävention und Gesundheitsförderung e.V.

Following the principles of participatory health research, a collaborative study was conducted by the German Federal Association for Prevention and Health Promotion (BVPG) and the Institute for Social Health at the Catholic University of Applied Sciences Berlin (KHSB). The purpose of the study was to create a framework for the members of the BVPG for taking joint action on developing the quality of health promotion and prevention measures. The 129 members of the BVPG are mainly nongovernmental organizations responsible for the implementation and coordination of prevention and health promotion interventions at the state and national levels. One of the explicit goals of the BVPG is to support the development of quality in prevention and health promotion. A theoretical sample was drawn of 14 member organizations to participate in individual interviews and a Delphi process to gather data on their current quality development practice, their need for further support, and their ideas for a common framework. Selected results from the interviews and the proposed framework are presented here.

Replicate DNA metabarcoding can discriminate seasonal and spatial abundance shifts in river macroinvertebrate assemblages.

The delivery of consistent and accurate fine-resolution data on biodiversity using metabarcoding promises to improve environmental assessment and research. Whilst this approach is a substantial improvement upon traditional techniques, critics note that metabarcoding data are suitable for establishing taxon occurrence, but not abundance. We propose a novel hierarchical approach to recovering abundance information from metabarcoding, and demonstrate this technique using benthic macroinvertebrates. To sample a range of abundance structures without introducing additional changes in composition, we combined seasonal surveys with fish-exclusion experiments at Catamaran Brook in northern New Brunswick, Canada. Five monthly surveys collected 31 benthic samples for DNA metabarcoding divided between caged and control treatments. A further six samples per survey were processed using traditional morphological identification for comparison. By estimating the probability of detecting a single individual, multispecies abundance models infer changes in abundance based on changes in detection frequency. Using replicate detections of 184 genera (and 318 species) from metabarcoding samples, our analysis identified changes in abundance arising from both seasonal dynamics and the exclusion of fish predators. Counts obtained from morphological samples were highly variable, a feature that limited the opportunity for more robust comparison, and emphasizing the difficulty standard methods also face to detect changes in abundance. Our approach is the first to demonstrate how quantitative estimates of abundance can be made using metabarcoding, both among species within sites as well as within species among sites. Many samples are required to capture true abundance patterns, particularly in streams where counts are highly variable, but few studies can afford to process entire samples. Our approach allows study of responses across whole communities, and at fine taxonomic resolution. We discuss how ecological studies can use additional sampling to capture changes in abundance at fine resolution, and how this can complement broad-scale biomonitoring using DNA metabarcoding.

[Participation in the cooperation between target group, project and sponsor]. / Partizipation in der Zusammenarbeit zwischen Zielgruppe, Projekt und Geldgeber.

The intrinsic connection between empowerment and participation is apparent in the Ottawa Charter on Health Promotion. In order for citizens to reach a higher degree of autonomy and control over health-related factors (empowerment) they need to have an active role in the decision-making processes affecting their lives and the environment in which they live (participation). This implies that many decisions are made affecting the health of citizens over which they have no influence. The question is: Who has the power to make such decisions and how can this power be shared more equitably? This question can be raised not only at the highest political level, but also locally in the context of the collaboration between various stake-holders. The local level plays a key role in deciding which health promotion measures are developed and funded, thus contributing in an important way to strengthening communities. In this article the method "Circles of Decision-Making" is presented as a tool for assisting those working at the local level in determining to what degree the active participation of the various stake-holders has been achieved and in what ways the participation of those "on the outside" of decision-making processes can be strengthened. This method is based on the concept of Participatory Quality Development (PQD) created by the authors and their community partners. PQD uses methods from community-based research to address issues of quality in community-level health promotion and prevention.

Endomorphin-like immunoreactivity in the rat dorsal horn and inhibition of substantia gelatinosa neurons in vitro.

Endomorphin 1 and 2 are two tetrapeptides recently isolated from bovine as well as human brains and proposed to be the endogenous ligand for the mu-opiate receptor. Opioid compounds expressing mu-receptor preference are generally potent analgesics. The spinal cord dorsal horn is considered to be an important site for the processing of sensory information including pain. The discovery that endomorphins produced greater analgesia in mice upon intrathecal as compared to intracerebroventricular injections raises the possibility that dorsal horn neurons may represent the anatomic site upon which endomorphins exert their analgesic effects. We report here the detection of endomorphin 2-immunuoreactive fiber-like elements in superficial layers of the rat dorsal horn by immunohistochemical techniques. Whole-cell patch recordings from substantia gelatinosa neurons of cervical spinal cord slices revealed two conspicuous effects of exogenously applied endomorphin 1 and 2: (i) depression of excitatory postsynaptic potentials evoked by stimulation of dorsal root entry zone, and (ii) hyperpolarization of substantia gelatinosa neurons. These effects were reversed by the selective mu-opiate receptor antagonist beta-funaltrexamine. Collectively, the detection of endomorphin-like immunoreactivity in nerve fibers of the superficial layers and the inhibitory action of endomorphins on substantia gelatinosa neurons provide further support for a potential role of these two peptides in spinal nociception.

A flexible digit with tactile feedback for invasive clinical applications.

This paper describes research on measurement of tactile sense using a flexible digit appropriate to endoscopy and minimal access surgery. It is envisaged that the sensing method will facilitate the navigation of flexible invasive devices, such as endoscopes, and also aid diagnosis using tactile perception as well as visual observation. The proposed master-slave digit system incorporates the application of the distributive sensing method applied to tactile sensing in order to discriminate different contact conditions of the flexible digit. The paper concentrates on the description of the application of this method and places this in the context of the user and the integrated system. The approach to sensing is able to discriminate the position, magnitude, distributed profile and width of the applied contacting load by using only four sensing points. Values to describe these parameters are evaluated to an accuracy greater than 93 per cent.

The old problem of adherence: research on treatment adherence and its relevance for HIV/AIDS.

The international published research on patient adherence was selectively reviewed with the goal of determining its relevance for the treatment of HIV/AIDS. Results show that not adhering to treatment regimes is so widespread that no combination of sociodemographic variables is reliably predictive of patients' not following doctors' orders. Achieving 100% adherence for any treatment or patient group does not appear to be realistic. Characteristics of the patient's situation, of the given therapy, and of the disease itself affect adherence. In addition, the patient-doctor relationship and the context of the treatment are important. Often overlooked are the existential dimensions of meaning, self-determination and quality of life which are particularly important for the chronically ill. Treatment needs to be negotiated individually with each patient on the basis of an open therapeutic relationship and with the help of multidimensional interventions. Lessons from the discourse on safer sex can steer adherence research and practice away from a behavioural and reductionist approach toward the context and meaning of treatment.

Defining the elements of a successful volunteer program in the provision of AIDS services.

Volunteerism has been the cornerstone of HIV/AIDS services since the founding of the first AIDS service organizations (ASOs) in the early 1980s. The work of volunteers continues to be an integral part of care in the face of limited resources and the spreading epidemic. As existing ASOs seek to improve and expand services, and communities seek to establish new organizations to combat the disease, guidelines for practice are necessary to facilitate the implementation of effective, efficient, and successful volunteer programs. This article provides a synthesis of a diverse literature base on the subject and describes the current practical experience at three large American ASOs.