41 research outputs found

    Lost in Translation: Piloting a Novel Framework to Assess the Challenges in Translating Scientific Uncertainty From Empirical Findings to WHO Policy Statements

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    Background Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. Methods We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. Results WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or “background” evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or “indirectness” was uniformly neglected, with little explicit consideration of study settings or subgroups. Conclusion In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to uncertainty regarding recommendations were neglected, including the state of evidence informing background questions (prevalence, mechanisms, or burden or distributions of health problems) and little assessment of generalizability, alternate interventions, and additional outcomes not captured by systematic review. These other factors often form a basis for providing policy recommendations, particularly in the absence of a strong evidence base for intervention effects. Consequently, they should also be subject to stringent and systematic evaluation criteria. We suggest that more effort is needed to systematically acknowledge (1) when evidence is missing, conflicting, or equivocal, (2) what normative considerations were also employed, and (3) how additional evidence may be accrued

    Minor or adult? Introducing decision analysis in forensic age estimation

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    Nowadays, forensic age estimation takes an important role in worldwide forensic and medico-legal institutes that are solicited by judicial or administrative authorities for providing an expert report on the age of individuals. The authorities’ ultimate issue of interest is often the probability that the person is younger or older than a given age threshold, which is usually the age of majority. Such information is fundamental for deciding whether a person being judged falls under the legal category of an adult. This is a decision that may have important consequences for the individual, depending on the legal framework in which the decision is made. The aim of this paper is to introduce a normative approach for assisting the authority in the decision-making process given knowledge from available findings reported by means of probabilities. The normative approach proposed here has been acknowledged in the forensic framework, and represents a promising structure for reasoning that can support the decision-making process in forensic age estimation. The paper introduces the fundamental elements of decision theory applied to the specific case of age estimation, and provides some examples to illustrate its practical application

    Bagaimana Keterlibatan Orang Tua dalam Terapi Wicara Anak Down Syndrome?

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    Terapi wicara merupakan salah satu cara orang tua untuk mengembangkan perkembangan bahasa anak down syndrome. Penelitian ini bertujuan untuk mendeskripsikan bagaimana keterlibatan orang tua dalam melakukan terapi wicara anak down syndrome. Penelitian ini menggunakan pendekatan kualitatif dengan metode fenomenologi. Subjek dalam penelitian ini sebanyak 3 orang tua. Penelitian ini mengungkap alasan orang tua melibatkan dirinya untuk melakukan terapi wicara pada anak down syndrome, begitu juga dalam memilih tempat terapi, terapist, melakukan tindak lanjut dirumah dan penggunaan media pendukung dalam terapi wicara anak down syndrome. Terapi wicara memiliki peranan yang penting untuk anak penyandang down syndrome untuk perkembangan bahasanya. Anak juga menjadi lebih fokus, proses tumbuh kembang terarah dan peningkatan fungsi bicara yang baik
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