Methods of synthesizing qualitative research studies for health technology assessment

OBJECTIVES Synthesizing qualitative research is an important means of ensuring the needs, preferences, and experiences of patients are taken into account by service providers and policy makers, but the range of methods available can appear confusing. This study presents the methods for synthesizing qualitative research most used in health research to-date and, specifically those with a potential role in health technology assessment. METHODS To identify reviews conducted using the eight main methods for synthesizing qualitative studies, nine electronic databases were searched using key terms including meta-ethnography and synthesis. A summary table groups the identified reviews by their use of the eight methods, highlighting the methods used most generally and specifically in relation to health technology assessment topics. RESULTS Although there is debate about how best to identify and quality appraise qualitative research for synthesis, 107 reviews were identified using one of the eight main methods. Four methods (meta-ethnography, meta-study, meta-summary, and thematic synthesis) have been most widely used and have a role within health technology assessment. Meta-ethnography is the leading method for synthesizing qualitative health research. Thematic synthesis is also useful for integrating qualitative and quantitative findings. Four other methods (critical interpretive synthesis, grounded theory synthesis, meta-interpretation, and cross-case analysis) have been under-used in health research and their potential in health technology assessments is currently under-developed. CONCLUSIONS Synthesizing individual qualitative studies has becoming increasingly common in recent years. Although this is still an emerging research discipline such an approach is one means of promoting the patient-centeredness of health technology assessments

Disentangling Genetic, Environmental, and Rater Effects on Internalizing and Externalizing Problem Behavior in 10-year-old Twins

Previous studies have emphasized the importance of rater issues in studying the etiology of variation in internalizing and externalizing problems in children. Earlier results indicate only moderate agreement between parents, and assume that parents assess a specific aspect of their child’s behavior. In comparable samples of younger children, additive genetic effects are the main factor explaining individual differences in both internalizing and externalizing behavior. It is unknown whether this pattern of rater influences and variance decomposition will be consistent in older children. Child Behavior Checklists (Achenbach, 1991), completed by both parents, were collected in a sample of 2956 Dutch 10-year-old twin pairs. The etiology of individual differences in internalizin

Heritability of Educational Achievement in 12-year-olds . . .

tional test of educational achievement (CITO), administered around age 12, in order to determine high school entrance level. The results of the test are often used as an independent judgment, besides the teachers ' opin ion, i n advising the parents on the future educational level of their child. So the CITO is used as an aid in choosing the most appropriate type of high school (e.g., academic versus technical). From a historical perspective, this attention for "independent" testing has to do with the possibilities for selection. The establisher of the CITO (Eindtoets Basisonderwijs, 2002) emphasized that this national test of educational achievement has put the effect of education in a particular school to the test besides measuring possible learning potential or cognitive abilities in children (Geldermans, 2001). It was hypothesized that success in scholastic achievement depended on the quality of the elementary school. A large number of articles in Dutch daily newspapers were dedic

A Study of Parent Ratings of Internalizing and Externalizing Problem Behavior in 12-Year-Old Twins

Objective: Studies on 3-, 7-, and 10-year-old twins' internalizing and externalizing problems have emphasized the importance of understanding sources of agreement and disagreement between maternal and paternal ratings. A psychometric model that assumes that each parent assesses rater-specific aspects of the child's behavior provided the best explanation for parental disagreement. This study investigates two models that have been used to explain the agreement and disagreement between mothers and fathers in the ratings of their children. Method: Child Behavior Checklists filled in by mothers and fathers were collected for a sample of 1,481 twelve-year-old twin pairs. Genetic and environmental influences on internalizing and externalizing problems were estimated using models that corrected for rater bias, rater-specific effects, and unreliability. Results: The psychometric model fitted the data significantly better than a rater bias model. Significant influences of genetic, shared, and nonshared environmental factors were found for internalizing and externalizing behavior. Parent-specific views, rater bias, and unreliability were significant. Conclusions: The best-fitting model implies that disagreement between parents is due to the fact that mothers and fathers provide information from their own perspective. This information should be seen as important and adding to the diagnostic formulation rather than as a point of disagreement. The finding that internalizing and externalizing problems are influenced by genetic and environmental factors fosters the understanding that it is the interaction of nature and nurture that puts children at risk for common behavioral disorders. J. Am. Acad. Child Adolesc. Psychiatry, 2003, 42(11):1351--1359

Transmission of SARS-CoV-2 on mink farms between humans and mink and back to humans

Animal experiments have shown that non-human primates, cats, ferrets, hamsters, rabbits and bats can be infected by SARS-CoV-2. In addition, SARS-CoV-2 RNA has been detected in felids, mink and dogs in the field. Here, we describe an in-depth investigation using whole genome sequencing of outbreaks on 16 mink farms and the humans living or working on these farms. We conclude that the virus was initially introduced from humans and has since evolved, most likely reflecting widespread circulation among mink in the beginning of the infection period several weeks prior to detection. Despite enhanced biosecurity, early warning surveillance and immediate culling of infected farms, transmission occurred between mink farms in three big transmission clusters with unknown modes of transmission. Sixty-eight percent (68%) of the tested mink farm residents, employees and/or contacts had evidence of SARS-CoV-2 infection. Where whole genomes were available, these persons were infected with strains with an animal sequence signature, providing evidence of animal to human transmission of SARS-CoV-2 within mink farms

Transmission of SARS-CoV-2 on mink farms between humans and mink and back to humans

Animal experiments have shown that non-human primates, cats, ferrets, hamsters, rabbits and bats can be infected by SARS-CoV-2. In addition, SARS-CoV-2 RNA has been detected in felids, mink and dogs in the field. Here, we describe an in-depth investigation using whole genome sequencing of outbreaks on 16 mink farms and the humans living or working on these farms. We conclude that the virus was initially introduced from humans and has since evolved, most likely reflecting widespread circulation among mink in the beginning of the infection period several weeks prior to detection. Despite enhanced biosecurity, early warning surveillance and immediate culling of infected farms, transmission occurred between mink farms in three big transmission clusters with unknown modes of transmission. Sixty-eight percent (68%) of the tested mink farm residents, employees and/or contacts had evidence of SARS-CoV-2 infection. Where whole genomes were available, these persons were infected with strains with an animal sequence signature, providing evidence of animal to human transmission of SARS-CoV-2 within mink farms