Lit Review Workshop

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Public health research literatures their coverage and gaps in Europe Measuring European public health research: what does the literature show? A SPHERE (Strengthening Public Health Research in Europe) workshop EUPHA conference, Montreux Thursday 16th November 2006 15.30 – 17.00

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Public health research literatures their coverage and gaps in Europe Methodology ‘Public Health Research’ definition for study: populations health determinants/context (genetic, environmental, social) interventions to improve health and reduce inequalities designed to produce generalisable knowledge rather than specific programmes of service delivery’

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Definition of topic area and relationship to ‘Public Health research’ Framework including list of sub-topics Search strategy/filter to interrogate electronic databases: to include all of EEA ten years: 01.07.95 - 30.06.05 peer-reviewed published research only original research only exclude: grey literature purely descriptive research Public health research literatures their coverage and gaps in Europe Methodology

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Presentation of results to include: numbers of publications/papers/references by key words and by country assessment by denominators: 1000s population GDP burden of disease measured in DALYs Public health research literatures their coverage and gaps in Europe Methodology

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210,433 publications found. Precision and recall 0.61 and 0.68 respectively EEA extremely important producer of public health research - an annual average 6862 (32,3%) compared to 9422 (44%), for the United States variations in output within the EEA. UK and Nordic countries relatively high producers GDP - overall strongest predictor of public health research Collaboration - smaller countries, lower producers collaborate more (Lithuania, Latvia, Portugal). UK and Finland collaborate less Public health research literatures their coverage and gaps in Europe English literature overview results

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relative under-investment in public health research by many European countries including France, Greece, Spain, Italy, Portugal, Germany, and many Eastern European countries, compared to the US and the UK We recommend: investigation of relative spend on public health research as a proportion of each country’s research expenditure assessment of relevance of public health research against health need English literature overview conclusions Public health research literatures their coverage and gaps in Europe

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~ 4000 ref from 7 PH journals indexed according to burden of diseases and to PH functions « Infectious diseases, perinatal and nutritional conditions » category received high level of attention, compared with « chronic diseases » and « injuries » « Monitoring » is the most frequent function, followed by « health services research » « Prevention » represents only 7% (14% at most) compared with 17% in a Canadian journal Public health research literatures their coverage and gaps in Europe French PH journals methods & results

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The focus of papers in French public health journals may reflect historical domains and data availability The relatively low proportion of papers focusing on prevention raises questions about funding and academic involvement in this field Research following comparable objectives but based on overall scientific public health research would be useful Public health research literatures their coverage and gaps in Europe French PH journals conclusions

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Public health research literatures Public health research literatures their coverage and gaps in Europe Environmental Health Research (1)   Environmental health research is carried out by a large number of research centres in EEA countries. 6329 references have been retrieved for the period 1995-2005 there are marked differences in the research potential between countries five top countries contributed 55% of all retrieved papers and ten top countries 81%

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Public health research literatures Public health research literatures their coverage and gaps in Europe Environmental Health Research (2) Main research focus: EEA countries have the same priority focus in environmental health research. 73% of the research effort concentrates on three areas: occupational health, environmental exposures and environmental illnesses. Envirogenomics opens new opportunities to enhance the understanding environmental etiology of diseases. Publication output in EEA is four times less than in USA only. Public health policy increasingly needs to be based on concepts of multicausality and complexity.

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Genetic Epidemiology research results Public health research literatures their coverage and gaps in Europe Research areas on genetic epidemiology in Europe and in the USA based on papers published between 1987-2004 EUROPE, n=160 USA, n=201

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growing PH importance of risk assessment genetic epidemiology research  genomics research array techniques research going to be shifted to clinical implication gene therapy more supportive policy needed towards EU+10 and non-EU countries PH network needs to be facilitated Genetic Epidemiology research conclusions Public health research literatures their coverage and gaps in Europe

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<7000 HP research publications found Strong relationship between HP publications and GDP 27% related to immunisation and screening In the remaining 73%: Focus on individual level interventions Focus on diet and physical activity, tobacco use and cardiovascular disease Very little on mental health, alcohol reduction or accidents and violence Public health research literatures their coverage and gaps in Europe Health promotion research results

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Need for targeted research commissioning: national and policy levels as opposed to individual /local levels wider range of topics, particularly: accidents and violence alcohol use reduction mental health promotion Health promotion research conclusions Public health research literatures their coverage and gaps in Europe

Health services research (1): 

Health services research (1) Health services research is: A large and growing domain of research (over 30,000 publications found); HSR is strongly developed in the Nordic countries, Estonia, Ireland, the United Kindom, the Netherlands; Topics addressed follow political agenda’s / health system characteristics. Public health research literatures their coverage and gaps in Europe

Health services research (2): 

Health services research (2) Problems addressed in HSR are: Efficiency of health services and quality improvement (56%)  doing things right; Organisation of care, cohesion between parts of the systems, and arrangement of services (27%)  doing the right things; Inequalities in health care utilization and distribution of services of the population/ country (10%)  for the right people. Public health research literatures their coverage and gaps in Europe

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MAIN TOPIC (whole of Infectious Diseases) : 1201 articles found: France, Germany, Italy, Netherlands, Spain, Sweden, Switzerland and UK most prolific actors by 1000 population: Denmark, Luxemburg, Netherlands, Sweden & Switzerland most productive by GDP: Estonia, Hungary, Lithuania, Netherlands, Slovakia, Slovenia, Sweden & Switzerland most productive SUBTOPICS (from Centre for Diseases Control and Prevention classification): 9321 published papers found, significantly higher than for main topic areas (paradoxical” result) Main fields: STDs, Drug Resistant Infections, Emerging Infectious Diseases and Insects or Arthropod-Related Diseases 4613 papers on subtopic STDs MAIN DISEASES and NEW SUBTOPICS: 4922 articles on HIV 6243 papers on Vaccine preventable Diseases Infectious Diseases research results Public health research literatures their coverage and gaps in Europe

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Literature production shows a progressive increase Wide heterogeneity concerning overall scientific production on IDs in Europe Sexually Transmitted Diseases, Drug Resistant Infections, Emerging Infectious Diseases, Insects or Arthropod-Related Diseases & Vaccine are the main fields of scientific research Research on subtopics Bioterrorism, Occupational Risk in Healthcare & Food related Diseases needs to be significantly improved First priority: to cooperate to help States with no scientific production and harmonize research in Europe Need for further studies to better focus the real state of the art of the research on IDs in EU, with a more analytic approach Infectious Diseases Research Conclusions Public health research literatures their coverage and gaps in Europe

Health Management Research Results: 

Public health management not a well defined discipline – its focus is broad and on health improvement; not to be confused with health services research 1,047 journal articles initially selected from which 63 were identified as relevant Strong relationship between health management research publications and GDP with heavy bias towards UK Majority of articles focus on chronic disease/long term conditions management Very few focus on mainstream management issues affecting the public’s health Public health research literatures their coverage and gaps in Europe Health Management Research Results

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There exists a paucity of public health management research aimed at strengthening the evidence base for effective interventions There is a lack of research capacity in public health management as a result of underinvestment and weak infrastructure More support is needed to foster multidisciplinary research links More research needed on partnerships, cross-sectoral working, governance, change management, leadership Health management is an underdeveloped research area throughout Europe Health Management Research Conclusions Public health research literatures their coverage and gaps in Europe

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The EEA is an important producer of public health research Public health research does not appear to: Be proportionate to health needs at a geographical level focus on important health needs at the health topic level focus on inequalities afford enough prominence to an active interventional approach Common Themes Public health research literatures their coverage and gaps in Europe

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Achieve a more informed picture of the realities and challenges facing public health researchers by surveying and/or interviewing researchers across Europe “Evidence-based research commissioning” - with a greater stress on interventional research on a wider range of topics, more related to health need   More emphasis in research on higher (national & policy) levels, less on the individual   Research into GAPS in understanding of and response to health needs, and the ability to tackle inequalities for each country   Consideration of the generalisability of already available research Next stage recommendations Public health research literatures their coverage and gaps in Europe

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EUPHA Conference Montreux EUPHA Workshop Germany EUPHA Conference Helsinki Study Set up DESCRIBE CONSULT REVIEWS: Literature Strategy PRELIMINARY ASSESSMENT Consultation FINAL REPORT Stakeholders European public health science and policy communities National and European political and administrative organisations International scientific bodies and institutions