Barriers and enablers to optimal consumer involvement in research: the perspectives of health and medical researchers in the UK

Numerous reasons exist for involving consumers in research, falling mainly into three categories: moral/ethical, methodological, and political. The moral and ethical reasons for involving consumers in research centre on concepts of rights, citizenship and democracy, specifically related to publicly funded research whereby the word ‘consumer’ is seen as a synonym for ‘taxpayer’. The methodological reasons focus on the potential benefits that consumer involvement may have on the research process, including increasing its relevance, credibility, dissemination and transferability of research findings. The political imperative is centred on current policy directives in addition to requirements by research funding agencies, research governance organisations, and research ethics committees (RECs)

A case for reorienting health systems and investing in primary health care in Australia

In recent times, many developing countries have been going through a process of re-orienting health policy and services towards early detection and prevention, rather than solely on the treatment and on-going management, of illness and disease. For example, in the UK, the fundamental philosophy underpinning the approach to funding primary healthcare is analogous to the adage ‘prevention is better than cure’, with the NHS Improvement Plan stating that “If England is to secure world-class standards of health, the enormous human, financial and physical resources available to the NHS need to be focussed on the prevention of disease and not just its treatment”. Within Australia, there are similar shifts in thinking and policy, with the development of the National Preventative Health Taskforce, which has been tasked with developing a National Preventative Health Strategy

The alcohol industry, neo-liberalism and the political economy of health

Writing in the Australasian Medical Journal Bond, Daube, & Chikritzhs present a fascinating analysis of previously confidential, internal industry documents. The documents became available due to the 1998 Master Settlement Agreement, which was originally initiated to allow public access to internal tobacco industry documents, but since some alcohol companies are controlled by tobacco companies (in this case, Phillip Morris), the internal documents of the alcohol companies (in this case, Miller Brewing Company) became available. It is also interesting to note that Kraft foods is also controlled by Phillip Morris, which means that researchers interested in food policy, marketing and regulation can now access potentially useful documentation on the underlying intentions of a particular food company. The paper presented an analysis of a vast array of alcohol industry documents, and the authors discuss a number of key areas with which the alcohol industry stated their concerns. Within this Editorial, I wish to highlight the implications of many of these concerns within two areas of social and political thought: the political economy of health, and the impact of neo-liberalism

HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention

Will the need for effective communication between doctors redefine primary care?

The medical profession differentiated into specialities decades ago. Most doctors are no longer able to serve everyone who might seek medical advice. Put simply surgeons are not expert in psychiatry. Therefore all doctors regularly refer patients to colleagues in other specialties. Geography and logistic considerations determine that doctors seldom ‘talk’ to one another when seeking opinions or advice. To date the main medium of communication between doctors is the traditional ‘letter’. There are numerous studies reporting the impact of this communication and most conclude that doctors often fail to pen enough information when they write to each other. Why articulate people don’t seem to communicate ‘effectively’ on paper, and increasingly online, is the subject of this editorial

340 years of atmospheric circulation characteristics reconstructed from an eastern Antarctic Peninsula ice core

Copyright @ 2006 American Geophysical Union (AGU)Precipitation delivery mechanisms for Dolleman Island (DI), located off the east coast of the Antarctic Peninsula, are investigated using reanalysis and back trajectory data. The Southern Annular Mode (SAM) and ENSO are both shown to influence precipitation delivery and event size. Precipitation delivery variability is compared against the interannual variation of chemical data from two DI ice cores. Nitrate concentration in the cores is strongly linked with the ratio of easterly to westerly back trajectories arriving at DI, as described by a Cross-Peninsula Index (CPI) defined in this paper. This CPI is used subsequently to reconstruct the atmospheric circulation characteristics for the 340-year ice core record. The analysis highlights a period of increased easterlies during 1720–1780 and an increase in westerlies for 1950–1980, the latter concomitant with a positive SAM trend and western Peninsula warming. The reconstruction also reveals periods when polynyas may have been present in the Weddell Sea

Do your patients trust you? A sociological understanding of the implications of patient mistrust in healthcare professionals

The trust that patients invest in healthcare professionals and their advice has been shown to facilitate positive clinical outcomes, although there is evidence that patient trust in expertise, including healthcare professionals, has been declining over the years. Questions about whether or not to trust healthcare professionals have been raised recently in international media by Australian pop icon Kylie Minogue, who spoke of her alleged initial misdiagnosis with breast cancer and went on to tell women that they should ‘follow their intuition’ rather than placing unquestioning trust in doctors or medical advice. Given the power of the media in shaping public opinion, there is a potential for such stories to further impact on the already potentially friable doctor-patient relationships, with questions of trust taking centre-stage. Therefore, an understanding of the nature of trust, in addition to the reasons for the decline in patient trust, is exceedingly important for health professionals. This paper presents an overview of social theories of trust that provide a lens through which we can analyse the development of mistrust in healthcare, and identifies ways in which healthcare professionals may aim to facilitate and sustain patient trust

Reworking the sociology of trust: making a semantic distinction between trust and dependence

Trust, as a sociological construct, has become increasingly important in recent times but an agreed definition is yet to be found. A potentially useful way of ‘defining’ trust is by distinguishing it from other semantically similar concepts. Niklas Luhmann has provided semantic distinctions between trust and familiarity, and trust and confidence. The purpose of this paper is to provide empirical evidence of a further semantic distinction between trust and dependence. This distinction allows us to further define trust and also to investigate the difference between ‘trust’ and ‘dependence’

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

Communicating effectively with patients who have advanced cancer is one of the greatest challenges facing physicians today. Whilst guiding the patient through complex diagnostic and staging techniques, treatment regimens and trials, the physician must translate often imprecise or conflicting data into meaningful personalized information that empowers the patient to make decisions about their life and body. This requires understanding, compassion, patience, and skill. This narrative literature review explores current communication practices, information preferences of oncology patients and their families, and communication strategies that may assist in these delicate interactions. Overwhelmingly, the literature suggests that whilst the majority of patients with advanced cancer do want to know their diagnosis and receive detailed prognostic information, this varies not only between individuals but also for a given individual over time. Barriers to the delivery and understanding of information exist on both sides of the physician–patient relationship, and family dynamics are also influential. Despite identifiable trends, the information preferences of a particular patient cannot be reliably predicted by demographic, cultural, or cancer-specific factors. Therefore, our primary recommendation is that the physician regularly asks the patient what information they would like to know, who else should be given the information and be involved in decision making, and how that information should be presented