Suchergebnisse

ABSTRACT
ObjectivesTo describe the design of a privacy-preserving protocol to support transient and purpose-specific data linkages between defined organisations in the health domain, to discuss how the specific technical and governance constraints of each organisation shaped the design of the protocol, and to propose approaches to reduce the costs associated with the use of privacy-preserving protocols for such linkages.
ApproachPrivacy-preserving protocols enable individual-level data to be linked across organisations without any requirement for direct identifiers to be released outside of organisational boundaries. Such protocols can reduce the risk that data released by organisations can be associated with an identifiable subject. Use of these protocols in practical scenarios requires that their computational and communication steps are mutually acceptable to each participating organisation from a technical and governance perspective. For transient and purpose-specific linkages, organisations may have no previous experience of participation in a privacy-preserving protocol and therefore no established set of mutually acceptable steps. We describe the design of a privacy-preserving protocol for a national health research project - in which specific health data from local and national organisations is to be linked to construct longitudinal patient records for analysis - and discuss how the design of the protocol was shaped by the specific technical and governance constraints of each organisation.
ResultsOrganisations are subject to varied technical constraints, such as expertise and infrastructure, and varied governance constraints, such as policies and procedures. Therefore, different computational and communication steps may be acceptable to different organisations. Design of a privacy-preserving protocol requires interaction with each organisation to determine their specific constraints and to understand the space of mutually acceptable steps from which a protocol can be composed. Initial costs for the design of a privacy-preserving protocol can therefore be significant. However, once mutually acceptable steps have been established between certain organisations, ongoing costs for subsequent linkages should be reduced. To reduce both initial and ongoing costs, different approaches can used to support coordination of organisations on technical and governance matters. Such approaches could include: (i) education and training, (ii) tooling and accreditation, and (iii) published best practice.
ConclusionUse of privacy-preserving protocols for transient and purpose-specific data linkages requires coordination between organisations, which can be initially costly to establish. Reduction in initial and ongoing costs can be achieved through approaches that support both initial and ongoing coordination.

Transferring healthcare research into policy and practice is a messy and complex process that both policy makers and researchers can struggle with. A potential solution is to use individuals or organisations as knowledge brokers. Using a range of literature, this paper explains the theory behind knowledge brokering, identifies three models of brokering and explores the challenges of brokering. We suggest that clarifying these factors is a significant step towards planning well-designed and rigorously evaluated brokering interventions. We also suggest that a clearly defined theoretical framework could help us to find out more about how brokering works and its effectiveness.

"A presentation of the main facts about social media, and research about the relationship between social media use and mental health, to examine both the positive and negative effects. Useful to anybody working in education, social care or mental health. It will also appeal to an educated general readership"--

BACKGROUND: In Ghana, rates of self-harm in young people are as high as they are in high income countries. Self-reported interpersonal, familial and societal stressors form the most important background, and self-harm is seen by young people as a way of responding to that stress. In the present study, we obtained the views of key adult informants about self-harm among adolescents in Ghana – what they thought as possible reasons for self-harm in young people and what actions might be needed at an individual or population level to respond to the problem. METHODS: We interviewed face-to-face 11 adults, using a semi-structured interview guide. We used an experiential thematic analysis technique to analyse the transcribed interviews. RESULTS: The analysis identified five themes: "underestimating the prevalence of self-harm in adolescents", "life on the streets makes self-harm less likely", "self-harm in adolescents is socially and psychologically understandable", "ambivalence about responding to adolescent self-harm", and "few immediate opportunities for self-harm prevention in Ghana". Adolescent self-harm was acknowledged but its scale was underestimated. The participants offered explanations for adolescent self-harm in social and psychological terms that are recognisable from accounts in high income countries. Low rates among street-connected young people were explained by their overarching orientation for survival. Participants agreed that identification was important, but they expressed a sense of inadequacy in identifying and supporting adolescents at risk of self-harm. Again, the participants agreed that self-harm in adolescents should be prevented, but they recognised that relevant policies were not in place or if there were policies they were not implemented – mental health and self-harm were not high on public or political priorities. CONCLUSIONS: The adults we interviewed about young people who self-harm see themselves as having a role in identifying adolescents at risk of self-harm and see the ...

Background
In the UK managers from multiple organisations are commonly tasked with collectively devising and implementing local health and wellbeing policies as a way of addressing increasing demand for healthcare. This requires them to create knowledge together but relatively little is known about how this occurs. This paper reports the results of research into how managers collectively create knowledge in order to address local health and wellbeing challenges.


Methods
We undertook a case study in three sites in England. Using statistical network modelling we identified clusters of actors and interviewed managers from heterogeneous clusters about their collective activities. We used interview and documentary data to construct accounts of collective knowledge creation.


Findings
Managers simultaneously work across stable bureaucratic networks and temporary taskforces in order to create and implement local health and wellbeing policy. They collectively create knowledge by enacting networks of relationships which enable them to share and build on routines and discourses and to reach out for new evidence, perspectives and skills. When creating knowledge, managers' ability to draw on and harmonise alternative programmes of action and their willingness to collectively negotiate is more important than their managerial status or position.


Conclusions
Managers should be encouraged to examine and discuss their alternative programmes of action and to see these as a catalyst for rather than barrier to collectively creating and implementing local health and wellbeing policies, and should be supported and valued for their ability to harmonise conflicting programmes of action.

Researchers are being strongly encouraged to incorporate knowledge translation strategies into their research applications, but there is relatively little clear guidance for them about precisely what this means or how they can achieve it. A previous paper published in this journal addressed those assessing research applications, but there is still a need for guidance aimed at researchers themselves. This paper sets out a proposed guide, which could help to fill this gap. The guide is based on a coherent and empirically based conceptualisation of the knowledge translation process. It encourages researchers to embed knowledge translation early in their research planning process rather than adding it on later. Because the framework sets out a number of considerations rather than 'rules', it affords researchers the flexibility, autonomy and creativity to produce a personally useful, coherent and workable knowledge translation strategy.

As primary care practitioners are the health professionals closest to patients' everyday lives, they are most likely to experience the impact of policies that support the patient choice agenda. The government's approach to increasing patient choice has been subject to criticism by those sceptical of its politics and by those concerned with its influence on health providers and some patient groups. A perspective missing from the debate is one informed by research on the psychology of choice. Some psychologists have argued that a seemingly inbuilt preference for choice can adversely affect the decision-making process and that presenting healthcare decisions as choices may result in less reasoned decision making. It is important that GPs encourage patients to make reasoned healthcare decisions that are informed by an evaluation of the options rather than by a simple preference for choice. Patients are likely to be less satisfied with, and experience more regret about, choices made without reasoning.