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Ahmad N, Kunicki ZJ, Tambor E, Epstein-Lubow G, Tremont G. Burden and Depression among Empirically-Derived Subgroups of Family Caregivers for Individuals With Dementia. J Geriatr Psychiatry Neurol 2024; 37:163-172. [PMID: 37551824 PMCID: PMC10840657 DOI: 10.1177/08919887231195217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Dementia caregiving experiences are not universal and different factors may influence the risk for burden and depression. This study examined factors such as the relationship with the care recipient, severity of dementia, and relationship satisfaction to uncover different types of caregiver burden profiles using baseline assessment for a telephone-based intervention study for dementia caregivers. Participants (n = 233) completed a battery of psychological and caregiving related surveys. The sample was predominantly White and female. Latent class analysis suggested four class models in subsamples of spousal caregivers and adult children caregivers. The results suggested four distinct classes among samples of spousal and adult child caregivers. Differences in burden emerged across both spouses and adult children, and differences in depression also emerged in the spousal sample. Our findings demonstrate the diversity of the caregiving experience and suggest that future psychosocial interventions may benefit from being tailored to the needs of caregiver subgroups.
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Affiliation(s)
- Nina Ahmad
- Department of Biology, Tufts University, Medford, MA, USA
| | - Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Gary Epstein-Lubow
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Education Development Center, Waltham, MA, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Neuropsychology Program, Rhode Island Hospital, Providence, RI, USA
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Tambor E, Robinson M, Hsu L, Chang HY, Al Naber J. coreSCD: multi-stakeholder consensus on core outcomes for sickle cell disease clinical trials. BMC Med Res Methodol 2021; 21:219. [PMID: 34666680 PMCID: PMC8524872 DOI: 10.1186/s12874-021-01413-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND With the dramatic increase in the pipeline for new sickle cell disease (SCD) therapies in recent years, the time is ripe to ensure a robust body of evidence is available for decision making by regulators, payers, clinicians, and patients. Harmonization of the outcomes selected across interventional trials enables optimal post-trial appraisal and decision making through valid pooled analyses and indirect comparisons. We employed a structured, multi-stakeholder consensus process to develop core outcome sets (COS) for use in clinical trials of SCD interventions. METHODS CoreSCD utilized a modified Delphi method adapted from the standards recommended by the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. An initial list of candidate outcomes was developed through a targeted literature review and input from an 11-member advisory committee. A 44-member multi-stakeholder Delphi Panel was established and included patients and family members, advocates, clinicians, researchers, payers, health technology assessors, representatives from government agencies, and industry representatives. Patients/advocates comprised 25% of the Delphi Panel and orientation and training was provided prior to the consensus process to ensure all were prepared to participate meaningfully. Panelists completed three rounds of an online survey to rate the importance of candidate outcomes for inclusion in the COS. Summary data was provided between each voting round and an in-person consensus meeting was held between the second and third round of voting. Consensus rules were applied following each round of voting to eliminate outcomes that did not meet predetermined criteria for retention. RESULTS Consensus was reached for two core outcome sets. The final COS for trials of disease-modifying therapies includes ten outcomes and the COS for trials of acute interventions includes six outcomes. Both core sets include clinical outcomes as well as outcomes related to functioning/quality of life, resource utilization, and survival/mortality. CONCLUSIONS Use of the COS in clinical development programs for SCD will help to ensure that relevant, consistent outcomes are available for decision making across the product lifecycle.
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Affiliation(s)
- Ellen Tambor
- Center for Medical Technology Policy, 401 E. Pratt St., Suite 631, Baltimore, MD, 21202, USA.
| | | | - Lewis Hsu
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Hsing-Yuan Chang
- Center for Medical Technology Policy, 401 E. Pratt St., Suite 631, Baltimore, MD, 21202, USA
| | - Jennifer Al Naber
- Center for Medical Technology Policy, 401 E. Pratt St., Suite 631, Baltimore, MD, 21202, USA
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Tambor E, Moloney R, Greene SM. One size does not fit all: Insights for engaging front-line clinicians in pragmatic clinical trials. Learn Health Syst 2021; 5:e10248. [PMID: 34667873 PMCID: PMC8512724 DOI: 10.1002/lrh2.10248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Despite the proliferation of pragmatic clinical trials (PCTs) conducted in health care delivery settings, we know relatively little about how practicing clinicians perceive their potential roles in such research. Empirical evidence and practical guidance concerning clinician engagement in research is needed to inform the design and successful implementation of PCTs. METHODS We conducted a two-phase qualitative study to better understand how and to what extent practicing clinicians should be involved in PCTs and to develop guidance for researchers on engaging front-line clinicians in PCTs. In phase one, clinicians who spend the majority of their time providing direct patient care participated in 90-min focus groups. In phase two, we conducted key informant interviews with PCT research teams and clinicians participating in the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) trial. RESULTS Thirty-four physicians, nurses, and other care providers from four health care delivery organizations participated in focus groups. Focus group participants stressed the importance of engaging clinicians early in the PCT planning process to identify clinically relevant study questions, provide input on study design, and customize study protocols to fit unique clinic workflows. We conducted 18 interviews with principal investigators, project managers, and clinicians involved in the ADAPTABLE trial across six clinical data research networks. Study team members described trying multiple approaches to optimize in-clinic recruitment and enrollment of eligible patients. Successful strategies involved several key factors related to research team interactions with eligible patients, clinicians, and clinic staff. CONCLUSIONS More active involvement by a range of clinical stakeholders in PCT planning may help researchers avoid common barriers to trial implementation. We propose a "medium-touch" approach to involving clinicians in PCT recruitment and enrollment that focuses clinician effort where it is most critical-to reassure eligible patients that trial participation is a safe alternative for them.
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Affiliation(s)
- Ellen Tambor
- Center for Medical Technology PolicyBaltimoreMarylandUSA
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Harrison J, Maslow K, Tambor E, Phillips L, Frank L, Herndon L, Epstein-Lubow G. Engaging Stakeholders in the Design and Conduct of Embedded Pragmatic Clinical Trials for Alzheimer's Disease and Alzheimer's Disease-Related Dementias. J Am Geriatr Soc 2021; 68 Suppl 2:S62-S67. [PMID: 32589275 PMCID: PMC7375262 DOI: 10.1111/jgs.16630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/01/2022]
Abstract
Embedded pragmatic clinical trials (ePCTs) of nondrug interventions for Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are conducted in real-world clinical settings and designed to generate an evidence base to inform clinical and policy decisions about care for this vulnerable population. The ePCTs exist within a complex ecosystem of relationships between researchers, payors, policymakers, healthcare systems, direct care staff, advocacy groups, families, caregivers, and people living with dementia (PLWD). Because the rapid increase of the number of Americans with AD/ADRD outpaces curative treatments, there is an urgent need to mobilize the power of these relationships to improve dementia care and address a mounting public health crisis. Stakeholder engagement in ePCTs is essential to generate research questions, establish the relevancy of trials to the intended end users, and understand the factors that influence dissemination and implementation in real-world clinical settings. The process of including stakeholders in ePCTs for dementia is similar to stakeholder engagement in ePCTs for other diseases and conditions; however, the unique nature of embedded research, prevalence of caregiver and provider burden, and the progressive worsening of cognitive impairment in PLWD must be approached with additional strategies. This article presents key considerations of stakeholder engagement for ePCTs in AD/ADRD and main activities of the stakeholder engagement team in the National Institute on Aging IMPACT Collaboratory to move the field forward. J Am Geriatr Soc 68:S62-S67, 2020.
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Affiliation(s)
- Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Katie Maslow
- The Gerontological Society of America, Washington, DC, USA
| | - Ellen Tambor
- Center for Medical Technology Policy, Baltimore, Maryland, USA
| | - Louise Phillips
- Person Living with Dementia, NIA IMPACT Collaboratory Stakeholder Engagement Team, USA
| | | | - Laurie Herndon
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Gary Epstein-Lubow
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.,Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Butler Hospital, Providence, Rhode Island, USA
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Chang H, Tran A, Al Naber J, Tambor E, Moloney R. P226 AMPLIFYING PATIENT VOICES IN RESEARCH: PATIENT ENGAGEMENT IN CORE OUTCOME SET DEVELOPMENT FOR ASTHMA TRIALS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tambor E, Moloney R. Improving Clinician Engagement in Patient‐Centered Outcomes Research. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- E. Tambor
- Center for Medical Technology Policy Baltimore MD United States
| | - R. Moloney
- Center for Medical Technology Policy Baltimore MD United States
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Tambor E, Shalowitz M, Harrington JM, Hull K, Watson N, Sital S, Al Naber J, Miller D. Engaging patients, clinicians, and the community in a Clinical Data Research Network: Lessons learned from the CAPriCORN CDRN. Learn Health Syst 2019; 3:e10079. [PMID: 31245603 PMCID: PMC6508783 DOI: 10.1002/lrh2.10079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/08/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022] Open
Abstract
Engaging patients, clinicians, and community members in the development of a research network creates opportunities and challenges beyond engagement in discrete learning activities. This paper describes our experiences establishing and maintaining a stakeholder engagement infrastructure for the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) and highlights important lessons learned over the first 4 years. During this time, the CAPriCORN Patient and Community Advisory Committee (PCAC) appointed patient, clinician, and community representatives to governance and advisory groups throughout the network, developed a process and criteria for patient- and clinician-centered review of research proposals, and evolved from a large, diverse group to a smaller yet still diverse, more actively engaged group with connections to the broader community. Key challenges faced by the PCAC have included determining the optimal size and composition of the group, understanding the complex structure of the network as a whole, coordinating with other network entities and functions, and integrating the patient and community voice into the research review process. Efforts to engage stakeholders in clinical data research networks should anticipate and develop solutions to address these challenges.
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Affiliation(s)
- Ellen Tambor
- Center for Medical Technology PolicyBaltimoreMDUSA
| | | | | | - Kevin Hull
- West Side Institute for Science and Education, at the Jesse Brown VA Medical CenterChicagoILUSA
| | - Natalie Watson
- Center for Community Health and VitalityUniversity of Chicago MedicineChicagoILUSA
| | - Shelly Sital
- Chicago Area Patient‐Centered Outcomes Research Network (CAPriCORN)ChicagoILUSA
| | | | - Doriane Miller
- Center for Community Health and VitalityUniversity of Chicago MedicineChicagoILUSA
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Concannon TW, Grant S, Welch V, Petkovic J, Selby J, Crowe S, Synnot A, Greer-Smith R, Mayo-Wilson E, Tambor E, Tugwell P. Practical Guidance for Involving Stakeholders in Health Research. J Gen Intern Med 2019; 34:458-463. [PMID: 30565151 PMCID: PMC6420667 DOI: 10.1007/s11606-018-4738-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/30/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022]
Abstract
Stakeholder engagement is increasingly common in health research, with protocols for engaging multiple stakeholder groups becoming normative in patient-centered outcomes research. Previous work has focused on identifying relevant stakeholder groups with whom to work and on working with stakeholders in evidence implementation. This paper draws on the expertise of a team from four countries-Canada, Australia, the UK, and the USA-to provide researchers with practical guidance for carrying out multi-stakeholder-engaged projects: we present a list of questions to assist in selecting appropriate roles and modes of engagement; we introduce a matrix to help summarize engagement activities; and we provide a list of online resources. This guidance, matrix, and list of resources can assist researchers to consider more systematically which stakeholder groups to involve, in what study roles, and by what modes of engagement. By documenting how stakeholders are paired up with specific roles, the matrix also provides a potential structure for evaluating the impact of stakeholder engagement.
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Affiliation(s)
- Thomas W Concannon
- The RAND Corporation, Boston, MA, USA.
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.
| | - Sean Grant
- The RAND Corporation, Santa Monica, CA, USA
| | - Vivian Welch
- University of Ottawa Centre for Global Health, Ottawa, ON, Canada
| | | | - Joseph Selby
- Patient Centered Outcomes Research Institute, Washington, DC, USA
| | | | - Anneliese Synnot
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Evan Mayo-Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ellen Tambor
- Center for Medical Technology Policy, Baltimore, MD, USA
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, ON, Canada
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Morain SR, Tambor E, Moloney R, Kass NE, Tunis S, Hallez K, Faden RR. Stakeholder perspectives regarding alternate approaches to informed consent for comparative effectiveness research. Learn Health Syst 2018; 2:e10047. [PMID: 31245580 PMCID: PMC6508784 DOI: 10.1002/lrh2.10047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/22/2017] [Accepted: 11/02/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Traditional informed consent approaches, involving separate discussions and lengthy consent forms, may be an imperfect fit for comparative effectiveness research (CER) that is integrated into usual care and compares non-investigational treatments. However, systematic efforts to collect broad stakeholder perspectives about alternative streamlined approaches to disclosure and consent in this context have been limited. METHODS We used a deliberative engagement method to solicit the views of a multi-stakeholder group regarding 3 alternative models of disclosure, consent, and authorization in CER studies: Opt-In, Opt-Out, and "General Approval". Participants considered the acceptability of these 3 models for observational and randomized CER studies of hypertension medications and for alternative treatments for spinal stenosis, all conducted in the context of a learning health care system. RESULTS Fifty-eight stakeholders participated in the all-day deliberative engagement session. Following deliberation, a majority of stakeholders (67%) liked the General Approval model for the observational hypertension study, more than the number who reported liking Opt-Out or Opt-In (45% and 36%, respectively). Support was lower for General Approval model in the context of a randomized hypertension study, with 80% liking a traditional Opt-In approach, compared with 54% liking Opt-Out, and 11% liking General Approval. Similarly, for the spinal stenosis CER studies, while most stakeholders preferred a streamlined Opt-Out approach for the observational design, most preferred a traditional Opt-In approach for the randomized version. CONCLUSIONS This multi-stakeholder group was more favorable towards streamlined models for disclosure and authorization for observational CER than randomized designs. These findings are consistent with arguments that informed consent requirements should be tailored to the context of the research design, rather than a standard "one size fits all" approach.
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Affiliation(s)
- Stephanie R. Morain
- Center for Medical Ethics and Health PolicyBaylor College of MedicineHoustonTexas
| | - Ellen Tambor
- Center for Medical Technology PolicyWorld Trade Center BaltimoreBaltimoreMaryland
| | - Rachael Moloney
- Center for Medical Technology PolicyWorld Trade Center BaltimoreBaltimoreMaryland
| | - Nancy E. Kass
- Johns Hopkins Berman Institute of BioethicsBaltimoreMaryland
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Sean Tunis
- Center for Medical Technology PolicyWorld Trade Center BaltimoreBaltimoreMaryland
| | - Kristina Hallez
- Johns Hopkins Berman Institute of BioethicsBaltimoreMaryland
| | - Ruth R. Faden
- Johns Hopkins Berman Institute of BioethicsBaltimoreMaryland
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Schaffer SK, Messner D, Mestre-Ferrandiz J, Tambor E, Towse A. Paying for Cures: Perspectives on Solutions to the "Affordability Issue". Value Health 2018; 21:276-279. [PMID: 29566833 DOI: 10.1016/j.jval.2017.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 06/08/2023]
Abstract
Curative therapies and other medicines considered "game-changing" in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems-the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature. This included a small number of semistructured interviews. We conclude that there is a mismatch between the enthusiasm in the academic literature for developing new approaches and the scepticism of payers that they can work or are necessary. For the foreseeable future, affordability pressures will continue to be handled by aggressive price bargaining, high co-pays (in systems in which this is possible), and restricting access to subgroups of patients. Of the mechanisms we explored, outcomes-based payments were of most interest to payers, but the costs associated with operating such schemes, together with implementation challenges, did not make them an attractive option for managing affordability.
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Affiliation(s)
| | - Donna Messner
- Center for Medical Technology Policy, Baltimore, MD, USA
| | | | - Ellen Tambor
- Center for Medical Technology Policy, Baltimore, MD, USA
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Holtzman NA, Bernhardt BA, Mountcastle-Shah E, Rodgers JE, Tambor E, Geller G. The quality of media reports on discoveries related to human genetic diseases. Public Health Genomics 2006; 8:133-44. [PMID: 16113530 DOI: 10.1159/000086756] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To examine (1) the quality of media reports (newspapers, television and public radio) of genetic discoveries with medical relevance and (2) factors related to the completeness and balance of the stories. METHODS Analysis of the accuracy, balance, and completeness of 228 media stories reporting 24 genetic discoveries between 1996 and 2000 using a previously validated instrument. RESULTS Although usually accurate, the stories contained only 45.5 +/- 13.8% (mean +/- SD) of relevant items. Stories appearing on television and stories reporting discoveries of genes for rare diseases were the least complete. Stories in non-US English-speaking newspapers included more content items per word than US stories. Less balanced stories exaggerated the benefits of discoveries, ignored possible risks, and did not present a range of expert opinion. Scientists were sometimes the source of exaggeration. CONCLUSIONS To increase the quality of media reports about genetic discoveries, stories should include more relevant items and be written by journalists skilled in science writing. Scientists will have to resist the tendency to exaggerate. These conclusions may apply to media stories of other discoveries as well.
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Affiliation(s)
- Neil A Holtzman
- Genetics and Public Policy Studies, Institute of Genetic Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD 21209, USA.
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Rebok G, Riley A, Forrest C, Starfield B, Green B, Robertson J, Tambor E. Elementary school-aged children's reports of their health: a cognitive interviewing study. Qual Life Res 2001; 10:59-70. [PMID: 11508476 DOI: 10.1023/a:1016693417166] [Citation(s) in RCA: 225] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There are no standard methods for assessing the quality of young children's perceptions of their health and well-being and their ability to comprehend the tasks involved in reporting their health. This research involved three cross-sectional studies using cognitive interviews of 5-11-year-old children (N = 114) to determine their ability to respond to various presentations of pictorially illustrated questions about their health. The samples had a predominance of children in the 5-7-year-old range and families of lower and middle socio-economic status. The research questions in Study 1 involved children's ability to convert their health experiences into scaled responses and relate them to illustrated items (n = 35); Study 2 focused on the type of response format most effectively used by children (n = 19); and Study 3 involved testing children's understanding of health-related terms and use of a specific recall period (n = 60). The results of Study 1 showed that children identified with the cartoon drawing of a child depicted in the illustrated items, typically responding that the child was at or near their own age and of the same gender, with no differences related to race. Study 2 results indicated that children responded effectively to circles of graduated sizes to indicate their response and preferred them to same-size circles or a visual analogue scale. Tests of three-, four-, and five-point response formats demonstrated that children could use them all without confusion. In Study 3, expected age-related differences in understanding were obtained. In fact, the 5-year-old children were unable to understand a sufficient number of items to adequately describe their health. Virtually all children 8 years of age and older were able to fully understand the key terms and presentation of items, used the full five-point range of response options, and accurately used a 4-week recall period. Six- and seven-year-olds were more likely than older children to use only the extreme and middle responses on a five-point scale. No pattern of gender differences in understanding or in use of response options was found. We conclude that children as young as eight are able to report on all aspects of their health experiences and can use a five-point response format. Children aged 6-7 had difficulty with some health-related terms and tended to use extreme responses, but they understood the basic task requirements and were able to report on their health experiences. These results provide the guidance needed to develop and test a pediatric health status questionnaire for children 6-11 years old.
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Affiliation(s)
- G Rebok
- Department of Mental Hygiene, School of Public Health, School of Arts and Sciences, The Johns Hopkins University, Baltimore, USA.
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Forrest CB, Tambor E, Riley AW, Ensminger ME, Starfield B. The health profile of incarcerated male youths. Pediatrics 2000; 105:286-91. [PMID: 10617737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE To identify the health needs of adolescent males incarcerated in a juvenile justice facility and to compare their health profiles with those of male adolescents in the community. METHODS Cross-sectional surveys were conducted of incarcerated (N = 202) and school (N = 379) samples of male youths. Questionnaires were self-administered and completed before admission health screens (incarcerated youth) or in classrooms (school sample). Health status was assessed by the Child Health and Illness Profile, Adolescent Edition, using scale and item means and by categorizing each youth's pattern of health into 1 of 13 mutually exclusive health profile types. RESULTS Compared with school counterparts, incarcerated male youths had significantly worse health status as demonstrated by poorer health and functioning scores in perceived well being, self-esteem, physical discomfort, acute, chronic, and psychosocial disorders, family involvement, physical activity, interpersonal problem-solving, risk behaviors, and academic performance. Three profile types-High Risks, High Risks/Low Resilience, and Worst Health-accounted for patterns of health for 69.8% of incarcerated youth versus 37.3% of an age-matched school sample. Just 6.4% of incarcerated males were in the Excellent/Good Health profile types, which contrasted with 34.2% of the age-matched school sample. CONCLUSIONS The health profiles of incarcerated male youths were worse than those of male youths in school. Our results indicate that rehabilitation programs will need to address incarcerated youth's basic health needs as well as modifying their risk and antisocial behaviors.
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Affiliation(s)
- C B Forrest
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
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Morton E, Tambor E, Rimer BK, Tessaro I, Farrell D, Siegler IC. Impact of National Cancer Institute revised mammography screening guidelines on women 40-49. Womens Health Issues 1996; 6:246-54. [PMID: 8870503 DOI: 10.1016/1049-3867(96)00036-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- E Morton
- Duke University Medical Center, Comprehensive Cancer Center, Durham, North Carolina, USA
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