Developing and Testing an Evaluation Framework for Collaborative Mental Health Services in Primary Care Systems in Latin America.

To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed.

Ethics and Privacy Implications of Using the Internet and Social Media to Recruit Participants for Health Research: A Privacy-by-Design Framework for Online Recruitment.

BACKGROUND: The Internet and social media offer promising ways to improve the reach, efficiency, and effectiveness of recruitment efforts at a reasonable cost, but raise unique ethical dilemmas. We describe how we used social media to recruit cancer patients and family caregivers for a research study, the ethical issues we encountered, and the strategies we developed to address them. OBJECTIVE: Drawing on the principles of Privacy by Design (PbD), a globally recognized standard for privacy protection, we aimed to develop a PbD framework for online health research recruitment. METHODS: We proposed a focus group study on the dietary behaviors of cancer patients and their families, and the role of Web-based dietary self-management tools. Using an established blog on our hospital website, we proposed publishing a recruitment post and sharing the link on our Twitter and Facebook pages. The Research Ethics Board (REB) raised concern about the privacy risks associated with our recruitment strategy; by clicking on a recruitment post, an individual could inadvertently disclose personal health information to third-party companies engaged in tracking online behavior. The REB asked us to revise our social media recruitment strategy with the following questions in mind: (1) How will you inform users about the potential for privacy breaches and their implications? and (2) How will you protect users from privacy breaches or inadvertently sharing potentially identifying information about themselves? RESULTS: Ethical guidelines recommend a proportionate approach to ethics assessment, which advocates for risk mitigation strategies that are proportional to the magnitude and probability of risks. We revised our social media recruitment strategy to inform users about privacy risks and to protect their privacy, while at the same time meeting our recruitment objectives. We provide a critical reflection of the perceived privacy risks associated with our social media recruitment strategy and the appropriateness of the risk mitigation strategies that we employed by assessing their alignment with PbD and by discussing the following: (1) What are the potential risks and who is at risk? (2) Is cancer considered "sensitive" personal information? (3) What is the probability of online disclosure of a cancer diagnosis in everyday life? and (4) What are the public's expectations for privacy online and their views about online tracking, profiling, and targeting? We conclude with a PbD framework for online health research recruitment. CONCLUSIONS: Researchers, REBs, ethicists, students, and potential study participants are often unaware of the privacy risks of social media research recruitment and there is no official guidance. Our PbD framework for online health research recruitment is a resource for these wide audiences.

Collaborative mental health services in primary care systems in Latin America: contextualized evaluation needs and opportunities.

AIM: This study examined Latin American evaluation needs regarding the development of a collaborative mental health care (CMHC) evaluation framework as seen by local key health-care leaders and professionals. Potential implementation challenges and opportunities were also identified. METHODS: This multisite research study used an embedded mixed methods approach in three public health networks in Mexico, Nicaragua and Chile. Local stakeholders participated: decision-makers in key informant interviews, front-line clinicians in focus groups and other stakeholders through a survey. The analysis was conducted within site and then across sites. RESULTS: A total of 22 semi-structured interviews, three focus groups and 27 questionnaires (52% response rate) were conducted. Participants recognized a strong need to evaluate different areas of CMHC in Latin America, including access, types and quality of services, human resources and outcomes related to mental disorders, including addiction. A priority was to evaluate collaboration within the health system, including the referral system. Issues of feasibility, including the weaknesses of information systems, were also identified. CONCLUSION: Local stakeholders strongly supported the development of a comprehensive evaluation framework for CMHC in Latin America and cited several dimensions and contextual factors critical for inclusion. Implementation must allow flexibility and adaptation to the local context.

What makes public health studies ethical? Dissolving the boundary between research and practice.

BACKGROUND: The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary - whether on grounds of primary purpose, temporality, underlying legal authority, departure from usual practice, or direct benefits to participants - have been unsatisfactory.Public Health Ontario has eschewed this distinction between research and other evaluative activities, choosing to adopt a common framework and process to guide ethical reflection on all public health evaluative projects throughout their lifecycle - from initial planning through to knowledge exchange. DISCUSSION: The Public Health Ontario framework was developed by a working group of public health and ethics professionals and scholars, in consultation with individuals representing a wide range of public health roles. The first part of the framework interprets the existing Canadian research ethics policy statement (commonly known as the TCPS 2) through a public health lens. The second part consists of ten questions that guide the investigator in the application of the core ethical principles to public health initiatives.The framework is intended for use by those designing and executing public health evaluations, as well as those charged with ethics review of projects. The goal is to move toward a culture of ethical integrity among investigators, reviewers and decision-makers, rather than mere compliance with rules. The framework is consonant with the perspective of the learning organization and is generalizable to other public health organizations, to health services organizations, and beyond. SUMMARY: Public Health Ontario has developed an ethics framework that is applicable to any evidence-generating activity, regardless of whether it is labelled research. While developed in a public health context, it is readily adaptable to other health services organizations and beyond.

Online communities for breast cancer survivors: a review and analysis of their characteristics and levels of use.

PURPOSE: Online communities have been heralded as one of the most promising health resources on the Internet. The purpose of this study was to identify the characteristics and levels of use of online communities for breast cancer survivors. METHODS: Using Google, we identified websites with a string of computer-mediated communication terms and individual queries of three to five words of online community terms. This was complemented by a review of website resource lists and personal libraries. Two reviewers independently extracted information on their general characteristics and number of members and message board posts. A coding scheme guided content analysis. RESULTS: We found 111 websites. Most sites (n = 64, 65.8 %) had a broad focus (e.g., health, cancer, or general). One third (n = 38, 34.2 %) were exclusive to breast cancer and 11 catered to specific disease characteristics. The majority were American (n = 79, 75.2 %), nonprofit (55.0 %), and moderated (69.5 %). Most moderators (85.7 %) were staff or community members; eight sites were moderated by health professionals. Greater than one-third of sites (n = 40, 36 %) were initiated by breast cancer survivors or loved ones. Breast cancer-specific sites contained a total of 4,186,275 posts. One-third (n = 10) contained 93.4 % of posts, displaying over 100,000 posts each. As of April 3, 2012, eight sites were discontinued. CONCLUSIONS: There is a wide range of online communities available for breast cancer survivors with extensive archives of personal illness experiences. Future efforts should focus on identifying the factors that determine their success and effectiveness.

Chatbots, generative AI, and scholarly manuscripts: WAME recommendations on chatbots and generative artificial intelligence in relation to scholarly publications.

This statement revises our earlier "WAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications" (January 20, 2023). The revision reflects the proliferation of chatbots and their expanding use in scholarly publishing over the last few months, as well as emerging concerns regarding lack of authenticity of content when using chatbots. These recommendations are intended to inform editors and help them develop policies for the use of chatbots in papers published in their journals. They aim to help authors and reviewers understand how best to attribute the use of chatbots in their work and to address the need for all journal editors to have access to manuscript screening tools. In this rapidly evolving field, we will continue to modify these recommendations as the software and its applications develop.

Esta declaración revisa las anteriores "Recomendaciones de WAME sobre ChatGPT y Chatbots en Relation to Scholarly Publications" (20 de enero de 2023). La revisión refleja la proliferación de chatbots y su creciente uso en las publicaciones académicas en los últimos meses, así como la preocupación por la falta de autenticidad de los contenidos cuando se utilizan chatbots. Estas recomendaciones pretenden informar a los editores y ayudarles a desarrollar políticas para el uso de chatbots en los artículos sometidos en sus revistas. Su objetivo es ayudar a autores y revisores a entender cuál es la mejor manera de atribuir el uso de chatbots en su trabajo y a la necesidad de que todos los editores de revistas tengan acceso a herramientas de selección de manuscritos. En este campo en rápida evolución, seguiremos modificando estas recomendaciones a medida que se desarrollen el software y sus aplicaciones.

An ecological process model of systems change.

In June 2007 the American Journal of Community Psychology published a special issue focused on theories, methods and interventions for systems change which included calls from the editors and authors for theoretical advancement in this field. We propose a conceptual model of systems change that integrates familiar and fundamental community psychology principles (succession, interdependence, cycling of resources, adaptation) and accentuates a process orientation. To situate our framework we offer a definition of systems change and a brief review of the ecological perspective and principles. The Ecological Process Model of Systems Change is depicted, described and applied to a case example of policy driven systems level change in publicly funded social programs. We conclude by identifying salient implications for thinking and action which flow from the Model.

Patients' rights a case for a Charter of Participant Rights in Pre-Market Drug Trials: the next evolution.

Since the first publication of Medicine and Law thirty years ago, there have been significant international advances in patient rights and participant protections in clinical trials. Despite such advances, there are still alarming reports of actual or perceived breaches in ethical standards by Institutions, Investigators and Sponsors of pre-market drug clinical trials. This is particularly disturbing as these trials involve participants in the testing of an investigational drug before its full safety, effectiveness, and clinical outcomes are understood. Moreover, the study design may randomize participants (recruited because they have specific diseases or conditions) into a group receiving a placebo or comparator drug versus a group receiving the investigational drug. The proposed Charter of Participant Rights in Pre-Market Drug Trials reflects the growing trend towards a participant-centred approach to the implementation and enforcement of participant rights. The development and adoption of the Charter is the next natural step towards the guarantee of rights in pre-market clinical drug trials.

National evaluation of policies on individual financial conflicts of interest in Canadian academic health science centers.

BACKGROUND: Conflicts of interest (COI) in research are an important emerging topic of investigation and are frequently cited as a serious threat to the integrity of human participant research. OBJECTIVE: To study financial conflicts of interest (FCOI) policies for individual investigators working in Canadian academic health centers. DESIGN: Survey instrument containing 61 items related to FCOI. SETTING: All Canadian academic health science centers (universities with faculties of medicine, faculties of medicine and teaching hospitals) were requested to provide their three primary FCOI policies. MEASUREMENTS: Number of all centers and teaching hospitals with policies addressing each of the 61 items related to FCOI. MAIN RESULTS: Only one item was addressed by all 74 centers. Thirteen items were present in fewer than 25% of centers. Fewer than one-quarter of hospitals required researchers to disclose FCOI to research participants. The role of research ethics boards (REBs) in hospitals was marginal. LIMITATIONS: Asking centers to identify only three policies may not have inclusively identified all FCOI policies in use. Additionally, policies at other levels might apply. For instance, all institutions receiving federal grant money must comply with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. CONCLUSIONS: Canadian centers within the same level (for instance, teaching hospitals) differ significantly in the areas that their policies address and these policies differ widely in their coverage. Presently, no single policy in any Canadian center informs researchers about the broad range of individual FCOI issues. Canadian investigators need to understand the environment surrounding FCOI, be able to access and follow the relevant policies and be confident that they can avoid entering into a FCOI.

What patients with cancer want to know about pain: a qualitative study.

Research indicates that patients feel more satisfied and obtain better health outcomes when they are able to discuss their questions with their health professionals. A better understanding of cancer patients' questions may help guide interventions to address their information needs and improve pain management. This study sought to explore and describe the questions that women with breast cancer have about pain related to cancer. Semistructured interviews were conducted with women with pain related to breast cancer or its treatment, recruited from a large teaching hospital in Toronto, Canada. Interviews were audio recorded and fully transcribed. Data saturation was reached after 18 participants were interviewed. Analysis involved the identification of themes and the development of a taxonomy of questions about pain. In total, over 200 questions concerning seven main themes were identified: (1) understanding cancer pain, (2) knowing what to expect, (3) options for pain control, (4) coping with cancer pain, (5) talking with others with cancer pain, (6) finding help managing cancer pain, and (7) describing pain. The information collected suggests that formulating and articulating questions about pain is a context-dependent, time-intensive process that requires reflection, knowledge, and a good use of language. Patients have numerous and diverse questions about pain and its treatment, which may be difficult to address within the context of a typical consultation. To manage pain adequately, innovative efforts are needed to enable patients and health professionals to recognize, articulate, and answer such questions. Internet-based tools could provide some of these solutions.

Chatbots, generative AI, and scholarly manuscripts: WAME recommendations on chatbots and generative artificial intelligence in relation to scholarly publications

This statement revises our earlier "WAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications" (January 20, 2023). The revision reflects the proliferation of chatbots and their expanding use in scholarly publishing over the last few months, as well as emerging concerns regarding lack of authenticity of content when using chatbots. These recommendations are intended to inform editors and help them develop policies for the use of chatbots in papers published in their journals. They aim to help authors and reviewers understand how best to attribute the use of chatbots in their work and to address the need for all journal editors to have access to manuscript screening tools. In this rapidly evolving field, we will continue to modify these recommendations as the software and its applications develop.

Esta declaración revisa las anteriores "Recomendaciones de WAME sobre ChatGPT y Chatbots en Relation to Scholarly Publications" (20 de enero de 2023). La revisión refleja la proliferación de chatbots y su creciente uso en las publicaciones académicas en los últimos meses, así como la preocupación por la falta de autenticidad de los contenidos cuando se utilizan chatbots. Estas recomendaciones pretenden informar a los editores y ayudarles a desarrollar políticas para el uso de chatbots en los artículos sometidos en sus revistas. Su objetivo es ayudar a autores y revisores a entender cuál es la mejor manera de atribuir el uso de chatbots en su trabajo y a la necesidad de que todos los editores de revistas tengan acceso a herramientas de selección de manuscritos. En este campo en rápida evolución, seguiremos modificando estas recomendaciones a medida que se desarrollen el software y sus aplicaciones.

Adopting health behavior change theory throughout the clinical practice guideline process.

Adopting a theoretical framework throughout the clinical practice guideline (CPG) process (development, dissemination, implementation, and evaluation) can be useful in systematically identifying, addressing, and explaining behavioral influences impacting CPG uptake and effectiveness. This article argues that using a theoretical framework should increase the utility and probably the implementation of a CPG. A hypothetical scenario is provided using the theory of planned behavior (TPB) to aid in our explanation. While other theories may be viable, the TPB is chosen because it accounts for a wide spectrum of behavioral factors known to influence physician behavior, and because its flexibility allows it to be used for different populations (e.g., specialists), behaviors, and contexts (e.g., hospital, private clinic). In addition, evidence has indicated that the TPB can influence physician behavior. Empirical research examining whether CPG utility can be significantly improved by appropriately selecting and implementing theory throughout the CPG process is warranted.

Ethical issues in publishing in predatory journals.

Predatory journals, or journals that charge an article processing charge (APC) to authors, yet do not have the hallmarks of legitimate scholarly journals such as peer review and editing, Editorial Boards, editorial offices, and other editorial standards, pose a number of new ethical issues in journal publishing. This paper discusses ethical issues around predatory journals and publishing in them. These issues include misrepresentation; lack of editorial and publishing standards and practices; academic deception; research and funding wasted; lack of archived content; and undermining confidence in research literature. It is important that the scholarly community, including authors, institutions, editors, and publishers, support the legitimate scholarly research enterprise, and avoid supporting predatory journals by not publishing in them, serving as their editors or on the Editorial Boards, or permitting faculty to knowingly publish in them without consequences.

Erratum: Ethical issues in publishing in predatory journals.

[This corrects the article DOI: 10.11613/BM.2017.030.].

Predictors of completion status in a remedial program for male convicted drinking drivers.

OBJECTIVE: Rates of attrition in alcohol and drug treatment programs are often greater than 50%, and completion of treatment has been shown to be a potent predictor of posttreatment outcome. The current study examined both rates and predictors of completion among male participants in a remedial measures program for convicted drinking drivers. METHOD: Male individuals (n = 5,409) convicted of a drinking driving offense in Ontario between October 2000 and December 2002 who did and did not complete a mandatory rehabilitation program were described in terms of demographic, drug use and legal variables collected at time of assessment. RESULTS: The program completion rate was extremely high (97.3%). In multivariate analyses, noncompleters-relative to completers-were younger; drank more frequently; were less likely to own a home; and were more likely to live in urban centers, have two or more lifetime impaired driving convictions and have experienced more than one adverse consequence of substance use. CONCLUSIONS: Ontario's remedial measures program for convicted drinking drivers, in which the return of a suspended license after the period of mandatory suspension is contingent on the completion of the program, demonstrates a very low level of client attrition. Individuals who do not complete the program bear many similarities to those at high risk for persistent drink-drive behavior and its associated negative health consequences.

Promoting Global Health.

The Editor-in-Chief of the International Journal of MCH and AIDS (IJMA) is a member of the World Association of Medical Editors (WAME). The Editorial Board of IJMA believes it is important that the statement on promoting global health and this accompanying editorial is brought to the attention of our readers. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.