Category: Interpersonal Communication

October is Domestic Violence Awareness Month

By: Aria Gray MPH: Maternal and Child Health candidate 2017

What is Domestic Violence? Domestic violence is the willful intimidation, physical assault, battery, sexual assault, or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. It can include physical violence, sexual violence, psychological violence, and emotional abuse. Domestic violence affects individuals in every community regardless of age, economic status, sexual orientation, gender, or other demographic factors. However, domestic violence is most commonly experienced by  women between the ages of 18-24.

Domestic violence is preventable. Part of domestic violence prevention includes talking about this issue and reducing the stigma associated with it as a community. While all of October is Domestic Violence Awareness Month, the National Network to End Domestic Violence is hosting a week of action from October 16-October 22.

Here are some ways that you can get involved during the week of action and throughout all of October. You can also search for events that may be happening in your community with local organizations.

  • Wear purple for #PurpleThursday on Thursday October 20
  • Speak Out: Talk with a friend, family member, or colleague about domestic violence to help eliminate stigma and show survivors that they are supported.
  • Follow the National Network to End Domestic Violence on social media (Facebook, Twitter, and Instagram and change

For anonymous, confidential help available 24/7, call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE) or 1-800-787-3224 (TTY) now.

Corporate Integrity Agreements

Throughout the summer I’ve dedicated several posts to the ways that medical and pharmaceutical publishing should be ethically conducted, according to established requirements and guidelines.

However, I’m sure it comes as no surprise that pharmaceutical companies have consistently failed to play by these rules. Headlines such as “GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data,” and “Bristol-Myers Squibb to Pay More Than $515 million to Resolve Illegal Drug Marketing and Pricing Allegations,” are proof that these companies are not always committed to high ethical standards of practice.

Although industry standards such as the ICMJE and GPP3 guidelines are almost universally accepted, they are not laws and are therefore not usually enforceable.

However, when pharmaceutical and biotech companies fall under Federal investigation, the Office of the Inspector General (OIG) can make them agree to abide by a Corporate Integrity Agreement (CIA) as part of their legal settlement.

These CIAs legally obligate companies to abide by many of the tenets of the previously mentioned guidelines and ensure ethical practice by imposing requirements such as:

  • hiring a compliance officer/appointing a compliance committee
  • developing written standards and policies
  • implementing a comprehensive employee training program
  • retaining an independent review organization (IRO) to conduct annual reviews
  • restricting employment of ineligible persons (people who have been flagged for unethical behavior)
  • providing an implementation report and annual reports to OIG on the status of compliance activities

If a company is non-compliant with their CIA, they risk having their product pulled from the list of products that can be reimbursed through Federal health care programs such as Medicare and Medicaid. This loss would be a crippling financial hit to most companies, making compliance with these agreements a high priority.
In this way, the industry can be kept in check and forced to behave in a more ethical manner.

Research Dissemination: Part 2

The most highly regarded place to publish medical research findings is in a peer-reviewed scholarly journal. However, journals are not all considered equal.


Most people have at least heard of the so-called “top-tier” journals including The Journal of the American Medical Association (JAMA), the British Medical Journal, and the New England Journal of Medicine. There are also mid-tier journals which are still respectable, but less competitive, and then there are lower quality journals whose standards and peer review process are much less rigorous (or non-existent) and consequently are taken much less seriously by the medical community.  

The dream is usually to have an article published in a top-tier journal, however, this is not always the best choice depending on the content and goal of a paper. If a paper does not present novel and/or ground-breaking findings, it is probably not worth an author’s’ time to submit it to a top journal and then wait, only to be rejected. Also, if authors’ want to get the results of a study published quickly so that the data is publicly available (for instance to help support an application for FDA approval), it is probably better to go with a less prestigious journal that has a higher acceptance rate or a less rigorous review process.

In addition to journal prestige, there are many other factors that must also be considered when deciding where to submit a manuscript. For example, medical specialty, target audience, impact factor, primary language or region, length limits, and allowance of figures and other supplementary materials are all potential considerations.

Due to the complexity of the factors that weigh into this decision, many medical publications agencies offer assistance with target journal selection by researching and compiling this information for authors so that they can more easily make a decision based on the variables that are most important to them for a particular manuscript.

 
Getting the right information in front of the right audience in a timely manner is critically important in fields such as medicine and pharmaceuticals since that information could potentially affect the lives and well-being of countless individuals.

Research Dissemination: Part 1

After a clinical trial or other medical study has been conducted and the researchers have planned out the ways in which they want to structure the results for disseminationthey next need to actually make that information public in the form of one or more medical publications. These publications typically take the form of posters, presentations, and journal manuscripts.

These publications all require a brief written summary known as an abstract. An abstract includes an overview of each relevant section of a medical publication including the study’s objectives, methods, results, and a discussion of the main conclusions.

For conferences, abstracts are typically developed and submitted as a first step in the acceptance process. The conference committee will then use the submitted abstract to decide whether or not to include a poster or presentation about that study as part of the conference. Once an abstract has been accepted to the conference, the authors can then create a poster or slide deck to present.

Because researchers want to get the maximum bang for their buck when it comes to their study data, most research findings will be presented as a poster or an oral presentation at a medical conference first, then be expanded into a full manuscript for publication in an academic journal.
Manuscripts allow researchers to provide a more detailed description of a study’s results and implications and are also able to reach a wider audience. We’ll talk more about manuscripts in next week’s post so be sure to check back on Monday.

Publication Planning: You have the data, now what?

Research, in any field, tends to be time-consuming and expensive. This is especially true of large-scale medical research trials. Therefore physicians and pharmaceutical companies, just like researchers in other fields, want to make optimal use of their research activities by producing as many publications from the resulting data as possible.

There are limits to how far these boundaries can be pushed, however. For example, duplicate publications are generally not permissible. This “double-dipping” includes publishing or presenting an identical work in multiple journals or at multiple conferences, but it also bars researchers from reworking a published piece in a way that does not contribute any new knowledge or insights to the results that were originally published.

One study usually measures a large number of variables and can therefore still be broken down into countless publications without violating sanctions against duplicate publications. For a clinical trial of a particular drug, for example, publications could focus on different outcome measures, such as the mechanism of action, safety, efficacy, economic considerations, administration, adherence, etc. Different publications could also examine these variable in various subgroups, such as pregnant women, the elderly, patients with certain co-morbidities, etc.   

In order to balance the desire for publication volume with the need to be ethically responsible by only publishing works that have scientific value, it is essential that large organizations and companies engage in publication planning activities. By convening a group of stakeholders at a publication planning meeting, an organization or company can lay out all of their available study data and determine what can and should be published from it.

In addition, gap analyses can be conducted to determine the topics or types of information that are missing in the current body of literature which can then serve as basis for future research studies intended to produce that information.

In this way, the cycle of medical research and publishing is continually pushed forward to produce new and valuable knowledge, both for the research community and for healthcare providers.

Authorship of Medical Publications

Last week I briefly introduced the concept of professional medical writers. These individuals are hired to write or create medical publications (such as abstracts, journal articles, and conference posters or presentations) on behalf of, or in collaboration with the actual researchers. Medical writers are often used because researchers do not have the time, interest, or the writing expertise to create high quality, publishable work in a timely manner. However, the listed authors still need to be involved in the writing process, and have specific obligations to fulfil in order to qualify as an author.

The International Committee of Medical Journal Editors (ICMJE) recommends that authorship be based on the following 4 criteria: http://www.icmje.org/icmje-recommendations.pdf

  1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND
  2. Drafting the work or revising it critically for important intellectual content; AND
  3. Final approval of the version to be published; AND
  4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Authorship is one of the major ways in which researchers get credit for the work that they do, which in turn often leads to professional and financial benefits. However, being designated as an author also carries a level of responsibility, as it serves as a public acknowledgement that an individual is willing and able to vouch for a publication and field any questions or critiques that may arise after publication of the work. Therefore, it is important that ethical authorship practices continue to be upheld, and that medical writers are used appropriately.

STI or STD: What Is The Difference?

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If your work involves talking to people about sexual health, you must be talking to them about STDs. Or STIs. Or both. Right?

As the great STD-STI terminology challenge continues, just about everyone has had to choose one term or the other. Well, everyone except for the people who use both interchangeably to mean the same thing. Or those folks who use each in distinct ways to mean different things.

Many well-informed experts make absolutely no distinction between STI and STD. Others feel the distinctions are real and important.

For those who make a distinction, most would say STD describes a condition with visible signs and describable symptoms—a drip, an itch, a bump, fatigue. STI encompasses the broader spectrum of conditions both with and without symptoms.

There was some idea that using STI would make it clear to everyone that sexually transmitted conditions often have no symptoms. It might also lessen the stigma people frequently feel about having these conditions, making them more amenable to testing and treatment.

In actual practice, I’m not at all sure that’s happened. We now have reports that many young people believe STD refers to illnesses that can’t be cured, and STI refers to illnesses that can be.

There are sound reasons for choosing either term, or both. Which is working for you right now? Why is it best for your purposes? We’d love to hear your thoughts.

Marcia Quackenbush, MS, MFT, MCHES, is Senior Editor at ETR. You can view this article in its entirety at http://www.etr.org/blog/my-take-std-sti/

RESEARCH SPOTLIGHT: MIKE NEWTON-WARD

Mike Newton-Ward, MSW, MPH, of the Gillings School of Global Public Health, at the University of North Carolina at Chapel Hill (UNC), spoke with the Upstream writing team recently to share his lifelong experiences working with social marketing and how this form of communication is effective in public health.

Newton-Ward, an adjunct professor, received both a Masters in Social Work and a Masters in Public Health from UNC, and spent many years working with the N.C. Division of Public Health and the N.C. Department of Health and Human Services helping to create and implement various social marketing campaigns aimed at populations across the state. He retired in 2015 and is now an independent consultant with RTI International.

He spoke to the class to highlight the importance of social marketing campaigns in public health and discussed what steps are needed to ensure optimal effectiveness with selected target audiences.

One of the most valuable aspects of social marketing is that it takes feedback generated from the target audience (the group the campaign is intended for) and uses that data to help determine the layout of the campaign itself. Using this approach is key for garnering participant interest and ensuring improved outcomes.

Newton-Ward also discussed other aspects of social marketing, such as its interdisciplinary approach, and how the input of several fields is effective at campaign development, as well social marketing’s unique ability to influence behaviors in all directions. Since public health is primarily geared toward prevention at the population level, social marketing can be used to influence behaviors upstream through social or policy change. Likewise, it can also be used to produce changes downstream (hence, the name of our blog!), by treating or educating populations to change negative behaviors. Finally, social marketing can work sidestream, by allowing partner organizations to collaborate for promoting the best environment possible to ensure a continuum of positive outcomes.

Newton-Ward concluded his talk by answering questions from the audience and discussing the “simplified elicitation methodology,” a strategy used in many public health campaigns, which seeks to identify determinants of behavior by asking three pairs of questions, including:

  • “What makes a behavior harder or easier to do?”
  • “What are the good things and bad things that happen when one does the behavior?”
  • “Who would approve or disapprove of the behavior?”

 The answers generated from these questions are strong indicators for discovering and learning about target audience reactions, and are key drivers for developing successful campaigns.

How do you tell someone when you have an STI?

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1 in 2 people will contract an STI by the time they reach 25 and 20 million people in the United States contract an STI each year (and those are only the ones that get reported). So what happens when YOU get one?

Step 1: Take care of your own health

Go see your medical provider and get the care that you need. Many STIs (like chlamydia and gonorrhea) are easy to test for and are curable especially if you catch them early. So don’t be afraid of making an appointment to get help.

Step 2: Share the news

All STIs are more dangerous if you don’t know about them, so it is very important to tell anyone who may have been exposed. You can tell them directly in person or over the phone, or via email or text. If you are having a hard time telling your sexual partners directly, you can use these resources.

  • So They Can Know: This website helps alert sexual partners about potential STI exposure and provides additional resources. You can send an email anonymously send an email or you can also use tools on the website to support you when you tell someone in person.
  • inSPOT: This website lets you send e-cards about STI exposure either with a short personal message or anonymously. You can even email up to six people anonymously to let them know that they should get tested.
  • Don’t Spread It: This website lets you anonymously email or text a sexual partner with information about the STI they may have been exposed to. You will need to create an account but don’t need to include any personal information or contact information.

Remember, that STIs can happen to anybody. Learn more at the STD Project. The website and all those listed above have all sorts of useful resources like where to get tested and what will happen during testing and have answers to any questions that you could possibly have about STIs.

What can healthcare learn from Uber?

Reports and news stories about the wastefulness of the U.S. healthcare system abound, but the healthcare industry may be able to combat some of that waste by embracing the growing trend of collaborative consumption or a shared economy. This new economic model is rapidly gaining traction in other industries, especially the travel and hospitality industries, where companies like Uber, Lyft, and Airbnb are changing the way that people think about consumption by tapping into unused resources and creating peer-to-peer sharing networks.

In the Robert Wood Johnson Foundation’s Pioneering Ideas podcast, Rachel Botsman, coauthor of the book What’s Mine Is Yours: The Rise of Collaborative Consumption, explained the concept of a collaborative economy and identified the potential future role it could play in the healthcare industry.

Botsman posits that the growing waste, broken trust, unnecessary complexity, and redundancy in the medical field could be mitigated by a shared economy model. Some other unused or underused resources that could be tapped into with a sharing economy model include things like excess food, unused gym memberships, and the skills and knowledge of retired health care workers.

In addition, some hospitals have already created peer-to-peer networks in which expensive medical equipment can be shared with or rented to other hospitals that need them.  Because each hospital does not need to invest the hundreds of thousands of dollars to purchase their own device, it removes waste from the system and allows new technology to be adopted and utilized more quickly and efficiently, which can mean better and more affordable care for patients.

Botsman attributes the growing popularity of collaborative consumption to the rise in peer trust that is beginning to surpass the trust people have in traditional companies, as well as people’s increasing expectation and demand for two-way interactions. These ideas echo some of the underlying principles in the growing healthcare trends of patient empowerment and shared decision making.

 

What are some health or healthcare issues that you think could be addressed by a shared economy system? Share your thoughts in the comments!