In this issue 1 A message from the INCLEN Trust Chair
JANUARY 2001 VOLUME 22 NO. 1
INCLEN news
1 INCLEN Trust launched in Bangkok 3 Highlighting research networks at INCLEN Global Meeting XVII 4 The vision of Marcel Tanner 5 Mary Ann Lansang scores another First 6 Staff update at Executive Office 6 Looking back 7 Future opportunities for INCLEN 9 Reducing injuries in Uganda 11 ThaiCLEN’s study on global impact of INCLEN research publications 12 CanUSAClen soars aloft 13 Update from INCLEN-Africa 15 ThaiCLEN hosts Global Meeting XVII 16 IndiaCLEN’s move towards regionalization 16 New leadership at Nagpur CEU 17 ChinaCLEN’s headway in traditional medicine 17 High cancer mortality investigated 18 INCLEN-SEA welcomes Vietnam as its newest member 18 PhilCLEN’s collaborative efforts for physical examination guidelines
MESSA GE AG . . . from the Chair of the INCLEN Trust
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he last INCLEN News announced and described the process of the “quiet revolution” with the move towards the INCLEN Trust following the “Cuernavaca decision” in February 2000. At this stage, we were highly committed, but also anxious, as our aims were ambitious and the time was short.
Dr Marcel Tanner
At the end of this eventful year, we are very happy to report that the INCLEN Trust is not only launched as planned, but that it is in full swing. The Global Meeting in Bangkok in October 2000 allowed us to finalize the last details of the continued on page 4
The INCLEN Trust officially launched The 10 Original Founders of the INCLEN Trust International, Inc. gathered at the Montien Riverside Hotel in Bangkok, Thailand on October 15, 2000 to formally sign the Trust Deed. In the presence of 36 CEU directors and representatives, who are members of the INCLEN Trust’s Board of Governors and who witnessed the signing ceremonies, the INCLEN Trust was born and formally launched. continued on page 5
19 LatinCLEN holds VI Regional meeting 19 Tucuman CEU assists in ARI program 19 Activities at University of Cauca, Colombia 20 INCLEN-ChildNet group formed 21 Agreement between INCLEN and BMJ Publishing Group 22 Announcements 22 Message from Richard Heller 22 Global Research Forum in October
INCLEN Trustees hold up original copies of the signed Trust Deed during the launch of the Trust INCLEN NEWS JANUARY 2001 1
INCLEN Trust’s Goal We are dedicated to improving the health of the populations of the developing countries by promoting health care based on the best evidence of effectiveness and the efficient use of resources. We achieve this by building and sustaining institutional capacity for excellence and relevance in research and health professional education in developing countries.
INCLEN Executive Office Rodolfo J. Dennis, MD Senior Program Consultant Alan B. Fogel Director of Administration and Finance Tina Heiler Development & Grants Officer Sheeba Kakar Database Systems Supervisor Mary Ann D. Lansang, MD Executive Director Mila Montejo Administrative Officer Kate Christo Ciela P. Sarmiento Administrative Assistants
INCLEN Board of Trustees Chair Marcel Tanner, PhD Director, Swiss Tropical Institute Basel, Switzerland Claire Bombardier, MD, FRCPC Chair, Board of Directors, INCLEN, Inc. Professor of Medicine University of Toronto Toronto, Ontario, Canada
Nelson K. Sewankambo, MD, MSc MMed Dean, School of Medicine Makerere University Kampala, Uganda Francois Chapuis, MD, MPH, PhD INCLEN-Euro-Mediterranean President Lyon, France
Maniyalath Narendranathan, MD IndiaCLEN President India Patricia Clark, MD, MSc LatinCLEN President Mexico City, Mexico Suzanne W. Fletcher, MD, PhD CanUSACLEN President Boston, Massachusetts,
Wang Jialiang, MD, MSc. ChinaCLEN President Chengdu, China William M. Macharia, MD INCLEN-Africa Secretary General Nairobi, Kenya Pyatat Tatsanavivat, MD, MSc. INCLEN-Southeast Asia Coordinator Khon Kaen, Thailand
Editor’s Note The INCLEN Executive Office assumes full responsibility for editing and publishing the INCLEN Newsletter bi-annually.
INCLEN News is published bi-annually by the INCLEN Trust. All submissions, correspondence and address changes should be sent to:
The newsletter serves as a forum for exchanging information and current research among INCLEN faculty and associates and also introduces firsttime readers to INCLEN activities.
Editor, INCLEN Executive Office Section E, 5th floor, Ramon Magsaysay Center 1680 Roxas Blvd. Malate, Manila 1004 Philippines Phone: (632) 521-3166 up to 85 Local 159 Fax: (632) 400-4374 Email: inclen@inclen.org
This newsletter continues to enhance its focus on the research activities and training of the INCLEN faculty.
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Or to: 3600 Market Street, Suite 380 Philadelphia, PA, USA 19104 Phone: (1) (215) 222-7700 Fax: (1) (215) 222-7741 The INCLEN Executive office reserves the right to edit all submissions. A PDF file of this issue of INCLEN News is available on the Web: www.inclen.org
INCLEN Global Meeting XVII: Research Networks in the New Millennium: Developing Countries’ Contribution to Global Knowledge INCLEN XVII, held last October 15 – 18, 2000 was a conference of many firsts and new beginnings for the INCLEN community. Hosted by ThaiCLEN in collaboration with INCLEN - Southeast Asia, it is the first global meeting to be organized almost entirely by a regional CLEN. Attended by 401 delegates from 37 countries, it was held in tandem for the first time with the International Conference for Health Research and Development held on October 10 – 13. This presented an opportunity for interested members to participate and network in both conferences (see related story on page 7). The conference opened with a keynote speech by Dr. Adetokunbo O. Lucas of Nigeria, the Chair of the Foundation Council of the Global Forum on Health Research. Dr. Lucas highlighted the conference theme “Research Networks in the New Millennium: Developing Countries’ Contribution to Global Knowledge”. He emphasized the substantial inputs being given by developing researchers and their immense impact on the global health. Dr. Visanu Thamlikitkul and Dr. Chitr Sitthi-Amorn then presented the results of the ThaiCLEN study that evaluated the quality of INCLEN members’ publications and the extent to which these have contributed to global knowledge. Their conclusion was that INCLEN has produced publications of high quality and at par with the rest of the world. They also concluded that the published research studies were relevant to both local and international
health needs, but overall health impact assessment was beyond the scope of their study. The Global Meeting was preceded by workshops on four collaborative projects: Reproductive Health, Group A Streptococcal Pharyngitis (GRASP), Studies of Abuse and Family Environment (WorldSAFE Project), and Mental Health. These workshops began as early as October 13 and resumed or continued till October 19. Prior to the afternoon opening ceremonies on October 15, there were continuing education sessions on the following topics: multicenter data analysis, given by Dr. Shrikant Bangdiwala of the University of North Carolina, USA; economic evaluation by Dr. Alan Maynard of the University of York, UK; meta-analysis by Dr. Stephen Walter of McMaster University, Canada; and socio-cultural research on tobacco use by Dr. Mark Nichter of the University of Arizona, USA.
The plenary sessions revolved around cutting edge issues in the three stages of the research process: Research Planning and Research Architecture on Day 1, Effective Leadership and Management on Day 2, and Getting Research into Practice on Day 3. A special plenary session was devoted to the INCLEN Trust on the second day. The plenary sessions on the first day dealt with setting the research agenda. Dr. Nicholas White, of Oxford and Mahidol Universities, gave a historical perspective on communicable disease research, concluding with important messages on the need to develop interventions for emerging infections. Dr. Laura Sadowski, coordinator of the WorldSAFE Project, discussed the challenges of conducting research on family violence in various country and cultural settings, reviewed the processes and structures needed to carry out multi-center colcontinued on page10 INCLEN NEWS JANUARY 2001 3
Message from the Chair... (from page 1) Trust’s structure and functions, and to sign the Trust Deed during a moving ceremony. All of us who signed and those who followed this process from inside or outside of INCLEN realized that this is not only a great moment, but also the start of a new phase with new, important challenges. The new governance structure, the Trust, ensures our important principles of regionalization with autonomy and allows tailoring our activities to local and regional needs under a global umbrella of partnership. It is now up to us to fill these structures with life and good science. We are also very happy that Dr. Mary Ann Lansang has accepted the challenge of becoming our new executive director, most effectively assisted by our new senior program consultant, Dr. Rodolfo Dennis, with whom she has already assured the harmonious transition into the new INCLEN Trust. The Board is deeply grateful to both of them for having led the INCLEN community, ably assisted by the Executive Office and all CLENs and CEUs, into the new phase and the new millennium! Having sensed the spirit of Cuernavaca and Bangkok, looking at the excellent science generated by INCLEN members, seeing the highly experienced leadership and having had intensive contacts with many colleagues, the Board is convinced that the INCLEN community is committed to our goals and will be highly successful in reaching them. The Board has full confidence in the INCLEN community and offers unconditional assistance and support to pursue our common aims. All this would not have been possible without the great and special efforts of many colleagues and friends involved in this transition process, as well as the stimulating, critical and fruitful contributions and the generous support of our donors. It is impossible to thank them all individually, but we know that the efforts of each individual made the creation of the INCLEN Trust possible. Personally, I wish to thank the INCLEN community for having offered me the privilege to chair the new Board. I see this privilege as a great challenge and will try to assist with expertise and experience, but with the knowledge that when interacting with the INCLEN community, I always learn more than what I can give. On behalf of the Board of INCLEN Trust, I wish you all a happy and prosperous New Year and look forward to many more joint steps for the benefit of mutual learning for change and for worldwide health development. Marcel Tanner Basel, 20 December 2000 4
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Marcel Tanner, INCLEN’s new Chair of the Board: One Man’s Vision “A network of networks with autonomous regions drawing strength from individual CEUs and CERTCs, addressing local and regional health needs under a global umbrella of partnership” is the vision of the man who is now Chair of INCLEN’s Board of Trustees. Dr. Marcel Tanner, Professor of Epidemiology and Tropical Medicine, was born and educated in Switzerland but has, for more than 20 years now, worked in Africa and Asia, cultivating a developing country perspective that is at the heart of his plans for INCLEN. He has a diverse research experience, having started with basic parasitology in tropical medicine (onchocerciasis, schistosomiasis and filariasis) and continuing to community-based studies of communicable diseases (malaria and schistosomiasis), including health systems and health service management research in areas such as urbanization, health service utilization and decentralization. He has served in various capacities as researcher, educator, board member, writer, editor, or director of numerous Swiss and international groups and institutions such as the Swiss Agency for Development and Cooperation, the UNDP/ WB/WHO Special Programme on Research and Training in Tropical Diseases, the Ifakara Health Research & Development Center (Tanzania), the French and German governments’ commissions for the evaluation of researches in tropical medicine, the University of Queensland Medical School (Australia), Acta Tropica, and the World Bank, among many others. Dr. Tanner has been on the INCLEN, Inc. Board since 1998 and he has shared not just the richness of his research and academic work, but a warmth and ebullience that makes working with him a joyful learning experience. As INCLEN traverses uncharted waters this new millennium, we are fortunate to have him on board as captain.
A candid look at the INCLEN Trust launch new Executive Director The(from10 page1) Original Founders consist of 3 members of the Born 10th of 11 children in Baguio City, the Philippines, birth rank is arguably the only thing for which Mary Ann Lansang has not been first. First in class from grade school to medical school, she holds the distinction of being the first clinical Dr Mary Ann Lansang epidemiologist of the Philippines, creating a career path not usually taken, and making a difference in the process. Although “maverick” is not a term you would readily apply, given her quiet ways, her career is testimony to the unusual— from her days as a student activist to her rare combination of public health and clinical research work in infectious diseases.
Board of Directors of INCLEN, Inc. and the 7 presidents or coordinators of the regional clinical epidemiology networks (CLENs). Forever etched in the INCLEN annals are the following founders: · Dr. Claire Bombardier, Chair, INCLEN, Inc. · Dr. Marcel Tanner, Board member, INCLEN, Inc., who was elected Chair of the INCLEN Trust for a term of one year (see related story on page 4) · Dr. Nelson Sewankambo, Board member, INCLEN, Inc. · Dr. William Macharia, Secretary-General, INCLEN – Africa · Dr. Suzanne Fletcher, Secretary-General, CanUSACLEN, which was officially recognized as the newest CLEN (see related story on page 10) · Dr. Wang Jialiang, President, ChinaCLEN · Dr. Francois Chapuis, President, INCLEN – EuroMediterranean · Dr. M. Narendranathan, President, IndiaCLEN · Dr. Patricia Clark, President, LatinCLEN · Dr. Pyatat Tatsanavivat, Coordinator, INCLEN – Southeast Asia
As the first Executive Director of the INCLEN Trust, Mary Ann bears the pioneering spirit of being among INCLEN’s initial group of fellows, along with years of experience within and outside INCLEN as clinician, researcher, policy-maker, administrator, educator, editor and writer. She has served as a consultant, board or committee member or chair in several health organizations, such as the World Health Organization (WHO), the Council on Health Research for Development (COHRED), the Global Forum on Health Research, the Alliance on Health Policy & Systems Research, sharing her ideas and expertise while honing skills in coordination and negotiation at a global level. She has been described as uncompromising and unwavering in the things she believes in, while managing to stay on good terms with opposite thinkers. This, plus her single-minded devotion to work, are talents that will be fully harnessed as INCLEN breaks new ground— strengthening the regional CLENs and building collaborations. It is a challenge she is cautiously optimistic about, knowing well INCLEN’s strengths and potentials, yet realistic about the diversity of contexts in which the CLEN’s and individual members work in. But if Mary Ann’s life history is evidence, she has set a pattern of succeeding at being first. As INCLEN marks many firsts this millennium, we at INCLEN know we are in good hands. Cecilia Acuin CEU, University of the Philippines Manila
Memorable event: Signing of Trust deed in Bangkok The Board of Governors also approved the nomination of Dr. Mary Ann Lansang as the incoming Executive Director of the INCLEN Trust. Also on hand during the inauguration were Dr. Rodolfo Dennis, outgoing interim coexecutive director of INCLEN, Inc. and Mr. Alan Fogel, INCLEN director of administration and finance. In subsequent presentations of the INCLEN Trust at the INCLEN XVII Global Meeting, Drs. Bombardier, Tanner and Lansang presented the background and rationale for the creation of the Trust, the governance structure, the continued on following page INCLEN NEWS JANUARY 2001 5
INCLEN Trust launch from previous page processes and events leading to the Trust creation, and the relationship between INCLEN, Inc. and the INCLEN Trust. It was explained that INCLEN’s five-year strategic plan developed in June 1999 will continue to be implemented, in particular, the plans for regionalization and institutionalization of CEUs. The new program directions of the INCLEN Trust will serve to reinforce the process of regionalization, specifically: partnership building and networking, leadership and management training, more relevant and high-quality research at national, regional and global levels, and strengthened capacity building programs making use of new information and communications technology. Details of these presentations and an overview of the INCLEN Trust can be found at the INCLEN website: http://www.inclen.org.
New and familiar faces at the INCLEN Executive Office The new INCLEN Executive Office (IEO) was recently established in Manila, the Philippines, with virtual connections to Philadelphia, USA and Bogotá, Colombia. Dr. Mary Ann Lansang assumed the post of Executive Director last December 1, 2000 (see related story on page 1). Ending his short but productive term as Acting Co-Executive Director of INCLEN, Dr. Rodolfo Dennis will continue serving INCLEN as Senior Program Consultant, providing the Management Committee with technical advice and expertise on critical program areas. He will primarily operate from his Bogotá office, where he is concurrently Chair of the Dept. of Medicine at the Pontifica Universidad de Javeriana, but is virtually connected
Looking back… “Global health research and those involved in it have changed strikingly since INCLEN was established. With more and easier international exchange of expertise than before, the advantages of information technology, the cost efficiencies of networking, and the need for sustainability, INCLEN is rethinking its roles and organization. This network has the unique opportunity to demonstrate the advantages of leadership by professional workers living in countries with the greatest burdens of disease. We are convinced that, whatever new directions its members choose to take, INCLEN will continue to make a difference in the face of complex health transitions in the developing world.” — Macfarlane SBJ, Evans TG, Muli-Musiime FM, Prawl O, So AD Lancet 1999;353:503 And we have, indeed, taken some bold new steps. We are grateful to the Rockefeller Foundation for the core support it had given to INCLEN through the years. In December 2000, the INCLEN Trust received a grant of $2 million from RF for the Trust’s new programs in the next 5 years. We acknowledge the award with appreciation and full recognition of the challenges of organizational sustainability in the years ahead. — The INCLEN Trust 6
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to the IEO and with various CLENs, projects, and INCLEN partners. The IEO, which from hereon refers to the office in Manila, has new staff: Milagrosa Montejo— administrative officer, and Ciela Sarmiento—administrative assistant. They will be working with Mary Ann Lansang from the Manila base. The Philadelphia office has been considerably downsized but still has the following familiar faces: Alan Fogel—Director for Administration and Finance, Tina Heiler—Development & Grants Officer, and Sheeba Kakar—Database Systems Supervisor. Kate Christo recently joined the Philadelphia office as an administrative assistant. Further streamlining of staff will be determined by the INCLEN Board of Trustees in the coming year.
After the Bangkok meetings— opportunities for INCLEN Vic Neufeld and Chitr Sitthi-amorn
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he month of October 2000 will be remembered as a milestone for global health research, primarily because of the International Conference on Health Research for Development (ICHRD 2000), which was held in Bangkok from October 10-13. Like several other research groups, the INCLEN Global XVII meeting held last October 15-18, 2000 was scheduled in conjunction with the ICHRD, in order to achieve synergies between these two important events. What were (and are) these synergies—and what special opportunities for INCLEN emerged? After summarizing some key strategies that were put forward in both meetings, we will propose three particular opportunities for INCLEN: joining and strengthening national networks; rethinking the concept of “critical mass”; and providing pro-active leadership as coalition builders.
The ICHRD 2000 was designed to assess the achievements of the past decade, with particular reference to the recommendations of the landmark 1990 report of the Commission on Health Research for Development1. This report found a major “disequilibrium” between funding investment and the global disease burden—only 5% of the total funds ($US 30 billion in 1986) was spent on research that addressed the problems of the people of low-income countries who bore 93% of the burden of disease. The report also found that many countries had weak research capacity, and that efforts among international agencies were fragmented. The Commission made clear recommendations about how to turn this situation around—including the
use of the “essential national health res e a r c h ” (ENHR) strategy, the creation of international facilitating and monitoring support structures, and increased funding for research on the problems of the poor and disadvantaged. Preparations for the ICHRD 2000 were intensive. They included a series of national consultations and assessments in order to understand the realities at a country level. These analyses were synthesized at a regional level, and subsequently at a global level—resulting in a series of regional reports as well as a summary document (discussion paper) which was sent in advance to all 800 conference participants2. Expectations for the conference were further heightened by editorials and articles in international journals3,4. The conference itself was highly interactive (through working groups, workshops, a market place, and several “satellite” meetings). Many INCLEN colleagues contributed actively both in the preparatory process and in the conference itself. In the closing session of the conference, a declaration was adopted, and an “action framework” was presented, which highlighted five strategies for future international health research cooperation:
Knowledge: emphasizing that knowledge is a public good, and stressing the need for more effective knowledge management and use. Levels: with a particular emphasis on the importance of the country level, with regional and global mechanisms strengthening national mechanisms. Means: stressing capacity development as the core strategy for enhancing the production, management and use of health knowledge, particularly knowledge focused on reducing health inequities. Support: including better measurement of resource flows, increased actual funding from countries themselves as well as from international donors. Governance: the need for well-aligned global and regional structures, to support country initiatives through advocacy, monitoring and review mechanisms, and the development of “codes of good practice.” continued on following page INCLEN NEWS JANUARY 2001 7
opportunities . . . from previous page The annual INCLEN meeting that immediately followed the ICHRD, featured several plenary presentations describing INCLEN’s remarkable recent transition and putting forward the strategies which are to guide future actions. The new “vehicle”, of course, is the INCLEN Trust. The new program directions include: • regionalization and democratization • leadership development • research and capacity strengthening • partnership building and networking In reflecting upon the interactions between the strategies discussed at these two meetings, we see several synergies, which represent special opportunities for INCLEN. Three opportunities in particular are presented here. 1.
Joining and strengthening national networks:
A focus on country needs and priorities was a key element of the future vision for health research, both in the conference discussion document, and in the ICHRD itself. The history of INCLEN up to this point has featured the creation of academic units (CEUs) within academic institutions, regional networks of these units, and problemspecific international research groups (such as IBIS and WorldSAFE). We now urge the CEUs to more intentionally become part of the national system for health research. A good starting point would be to learn about ENHR efforts in a given country— perhaps by exploring the website of the Council on Health Research for Development (COHRED)5. By joining these national initiatives, INCLEN colleagues could contribute their special strengths such as knowledge about research design and measurement, familiarity with literature searching, links with colleagues and organizations internationally, and so on. 8
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In order to join and strengthen the networks, clear rules based on a long-term agenda for equity and health need to be set out through an open and transparent governance structure. Good governance is needed because not every partner has an equal influence on the creation and operation of a partnership; the intended beneficiaries usually have the least beneficiaries, while more influential partners can “hijack” the partnership. Some guidelines will be needed to develop successful partnerships. Representatives of governments, private sectors and civil society groups should be truly representative. Representation can be regularly reviewed in order to guarantee equitable participation of all parties, as well as legitimacy and accountability to the constituencies the partnership serves.
2
Promoting the new “critical mass”:
Within INCLEN circles, the term “critical mass” usually refers to the number and expertise mix of trained individuals who comprise a CEU. In the growing literature about the evolving “knowledge economy” a new kind of critical mass is being described6 . These new groupings are focused on a specific problem or challenge, which demands an inclusive approach to problem definition and solution. Both the producers and users of knowledge are included. And both research and intentional learning are included within the activities of these “research and learning coalitions”. In fact, some good examples of such coalitions were presented at the recent INCLEN Global Meeting. They include the work of Olive Kobusingye and her colleagues who are tackling the problem of inju-
ries in Uganda (see Box: Injury Control in Uganda), and the melioidosis story in Thailand as told by Visanu Thamlikitkul.
3.
Providing leadership as “coalition-builders”:
In assessing the performance of the global health research system over the past decade, it was evident in many of the documents and discussions that there still is an unacceptable degree of fragmentation and lack of coordination. This is true at all levels: institutional, national, regional and global. At the same time, it is encouraging to see an increased awareness of the need for management and leadership training for those responsible for health research. In fact, one of the planned new directions for INCLEN involves leadership development. We propose that “coalition building” be considered as an explicit competency within INCLEN’s leadership training program. It is an ability that is much needed at all levels of the health research system. INCLEN colleagues could provide an important leadership role as coalition builders. In conclusion, INCLEN as a network needs to define and invest in activities that will lead to the growth of the Network and respond to the needs of the ‘intended beneficiaries’. These activities can focus on documenting the added advantages of the ‘quality’ image of INCLEN, as well as the impact of the Network. Some initial discussions on benchmarks and criteria for
Chitr Sitthi-amorn: chitr@cph.chula.ac.th
opportunities . . . from previous page success might be needed as vehicles of communication with the stakeholders within and outside networks7,8. The criteria and benchmarks will help provide decisions and actions that are able to balance the dynamics between several approaches (top-down, bottom-up, outside-in and inside-out) as the Network moves closer towards its objectives. We welcome any comments and suggestions about these ideas, as we work and learn together within the new INCLEN Trust arrangement. We can be reached at the following e-mail addresses: Vic Neufeld: neufeld@mcmaster.ca
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3
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The Lancet 2000; 356:1043 5
Council on Health Research for Development: www.cohred.ch
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Documents related to the International Conference on Health Research for Development are available at www.conference2000.ch.
Gibbons M, Limoges C, Nowotny H, Schwartman S, Scott P, Trow M. The new production of knowledge: the dynamics of science and research in contemporary societies. Sage Publications, London, England; 1994
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Lee K, Mills A. Strengthening governance for health research BMJ 2000; 321:775-6
Buse K, Walt G. Global publicprivate partnerships: Part I – A new development in health? Bull WHO 2000; 78: 549-561.
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Buse K, Walt G. Global publicprivate partnerships: Part II – A new development in health? Bull WHO 2000; 78: 699-709.
Commission on Health Research for Development. Health Research: Essential link to equity and development. New York (NY) Oxford University Press; 1990
Editorial. Enabling research in developing countries.
Injury control in Uganda The story of Uganda’s Injury Control Centre (ICC-U) illustrates a new kind of “critical mass”. Dr. Olive Kobusingye, a trauma surgeon and epidemiologist, returned to Uganda in 1996 after some years of post-graduate training in the U.K. and U.S.A. She became interested in the problem of road traffic accidents, but realized that the evidence base for defining and managing this problem was weak. Her work began with the development of a hospital based trauma registry, and a monitoring tool—the Kampala Trauma Score. With some external support, Dr Kobusingye established the ICC-U in 1997. Working with colleagues in the CEU at Makerere University, she conducted further prevalence studies, as well as training sessions regarding the care of trauma victims. It soon became apparent that in order to reduce Uganda’s burden of illness due to trauma, a range of stakeholders needed to be included in the work of the ICC-U. And so various research
“user groups” became involved— planners from the police traffic division, members of the Uganda Road Safety Council, and policy makers from the Ministry of Health. The ICCU group also organized pedestrian safety campaigns, involving local schools (both teachers and students). With the Kampala City Council, a feasibility study was conducted about the state of the city’s ambulance services. All of this involved increasing experience in creating and managing effective inter-sectoral teams. Along with research, advocacy and action elements, the ICC-U has also become an important learning center. Postgraduate students from the University, serving as research associates, are conducting various studies related to the problem of injuries. Hospital personnel are being trained in the management of trauma victims. A specialized trauma library has been established. With some initial funding from INCLEN, the ICC-U played a leading
role in the creation of a problem-specific African coalition—the Injury Prevention Initiative of Africa (IPIFA). It now includes colleagues from eight African countries who are involved in various research, training and advocacy activities. Members of this group have also contributed to seminars and workshops related to injuries in other parts of the world. The ICC-U thus provides a good example of a “research and learning coalition”—the new form of “critical mass”. There is a specific focus (injury control). Both research producers and users are included in research and action coalitions. National policy has been influenced, with injury prevention and management now included as a high priority in Uganda’s new 5-year health strategy. Intentional learning is included in the range of activities. The Uganda team has demonstrated leadership in the creation of a regional injury control network.
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Global Meeting ... from page3 laborative studies, and stressed the imperative to proceed to interventions that are appropriate to the local context. On the second day, Dr. Nelson Sewankambo of Makerere University, Uganda and Dr. Visanu Thamlikitkul of Mahidol University, Thailand talked about leadership and management issues in conducting research on a global health problem (HIV/ AIDS) and a local and regional priority concern (melioidosis). Though the two problems were entirely different in scope and nature of interventions, the management concerns on initiating, advocating and sustaining research efforts were remarkably similar. First World experiences on disseminating research results were shared by Dr. Carolyn Clancy of the Agency for Healthcare Research and Quality (AHRQ, USA) and Dr. Alan Maynard of the University of York, UK on Day 3. Both discussed varying approaches in the utilization of practice guidelines in a highly privatized setting such as the US and in a more socialized system like the UK, as well as the challenges presented by rapidly changing social, political and technological environments. The AHRQ supported four workshops during the conference that tackled various perspectives in providing quality in health care. In the first workshop, Drs. Henry Glick of the University of Pennsylvania and Kameshwar Prasad of the All India Institute of Medical Sciences, New Delhi talked about methodological and measurement issues, as well as key differences between clinical and
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outcomes research that need to be considered when looking at quality of care. Workshop 2 on the opportunities offered by information technology was given by Dr. Helen Burstin of AHRQ and Jim McCord, INCLEN,
Inc. Board director, who, despite his absence, provided state-of-the-art information on I.T. via a coordinated audiotape and slide presentation. Dr. Juan Gabriel Ruiz of Pontificia Universidad Javeriana, Bogota, Colombia then illustrated I.T. use in a developing country setting through the Kangaroo Mother Care Program. The last two workshops discussed patient outcomes from the perspectives of research, program, policy and consumers. Given by Drs. Antonio Dans of the University of the Philippines, Paul Garner of the University of Liverpool, Tessa Tan-Torres Edejer of WHO, and AHRQ’s Helen Burstin and Carolyn Clancy, the concluding workshops emphasized the needs, difficulties and tips on changing health policy and practice, and the need to see how people’s lives are being improved by what is accomplished through research. The 64 oral and 54 poster presentations, almost all of which were presented by researchers from Third World countries, illustrate the breadth and depth of developing country par-
ticipation in INCLEN. The range of topics, stakeholder perspectives and settings covered the following: from methodology to outcomes, laboratory to community, hospitals and clinics to public health centers, health provider and client to policy-maker. This broad spectrum is testament to the many concerns in which INCLEN researchers have become immersed. The authorship citations show a growing number of northsouth and south-south partnerships and collaborations that affirm INCLEN’s vision and continuing advocacy for indigenous health care research. Afternoons were devoted to CLEN discussions and meetings, highlighting the important role that the regions will now play in INCLEN’s work. Each of the regional CLENs (INCLEN - Africa, ChinaCLEN, IndiaCLEN, LatinCLEN, INCLEN-SEA, INCLEN Euro-Mediterranean, as well as the newly created CanUSACLEN) presented ongoing activities and plans for collaboration. At present, only a couple of the CLENs (LatinCLEN on breastfeeding and IndiaCLEN on family violence) have region-wide ongoing research initiatives. IndiaCLEN organized two workshops on the IndiaSAFE project and on Program Evaluation and Qualitative Methods for INCLEN XVII. The conference’s closing program featured intriguing dance presentations sponsored by the ThaiCLEN hosts, and representing each of the regional CLENs. The ThaiCLEN Organizing Committee, headed by Dr. Visanu Thamlikitkul and the INCLEN - SEA Coordinating Committee headed by Dr. Pyatat Tatsanavivat along with the Secretariat, the Advisory Committee and all the Global Meeting XVII’s participants can take pride in this first conference for the millennium.
Epidemiology of Research Publications of INCLEN Members* Thai Clinical Epidemiology Network In its 20 years of existence as a network, the leadership and constituents of the International Clinical Epidemiology Network (INCLEN) evaluated its activities and directions along the lines of its mission of improving the health of the people. Among its specific objectives is to attain excellence and relevance in research. One of the indicators of the achievement of this objective is the quantity and quality of research publications by the INCLEN members. It is in this light that in 2000, the Thai Clinical Epidemiology Network conducted a study to (1) evaluate the quality of the publications of INCLEN members; and (2) determine the extent to which these publications have contributed to global knowledge. Methods. The project team asked the directors of 50 CEUs in the Network to collect and submit reprints of research publications of their members. Twenty-nine CEU members in Thailand participated as evaluators. This study was done in two parts. Part I determined the characteristics of research publications. All eligible publications were sent to the evaluators for review using a standardized evaluation form. Part II was done to determine the extent to which the publications contributed to global knowledge. Fifty full publications published in the international MEDLINE-indexed journals were randomly selected from the indexed journals submitted by the CEUs. These publications were designated as “Index Papers”. All full publications which appeared in the issues where the “Index Papers” were published were studied; and the affiliation of the main investigators
were determined. In addition, one full publication from each issue was randomly selected; and these were designated as “Control Papers”. These papers were assessed for quality using the standardized evaluation form. Another issue of the same journal and volume as the “Index Papers” were studied. The affiliation of the main investigators were determined for all the full publications in these issues. The latter methodology was done using the publications in Thailand. Highlights of findings in the study are described below. Results Characteristics of the publications of INCLEN members. A total of 196 INCLEN members from 31 CEUs participated in the study. There were 1,045 eligible publications generated from these members. Majority (940, 90%) of the publications were full publications of the research results. Others were abstracts and reports of research results. Of the 940 full publications, 42% were published in international journals and 58 % were in local journals. Fifty four percent of the full publications were published in journals indexed in MEDLINE and 28% were in journals with known impact factors. Of the 1,045 eligible publications, 93% dealt with applied research while 7% were on basic research. Seventy-two percent of the results were considered to be applicable to the target setting. Collaborative research was the general trend among INCLEN faculty. Most of the publications (95%) had multiple authors. In 58% of the publications, INCLEN members were the primary author. Multidisciplinary re-
Dr. Visanu Thamlikitkul search was noted in 60% of the papers, and 78% were from single institutions. Multi-country collaboration was reported in 13% of the publications. Publications of INCLEN members in MEDLINE-indexed journals. There were 718 publications in the 50 issues that contained the “Index Papers”. The main investigators of 119 papers (17%, 95% CI: 14%-19%) were from developing countries. INCLEN members authored 42% of these publications. Moreover, INCLEN members were the only authors from developing countries in 36% of the 50 selected journal issues. There were 703 publications in the other issues of the same journal and volume of the 50 issues that had the “index papers”. Investigators from developing countries authored 77 papers (11%, 95% CI: 9%-13%). None of them were INCLEN fellows. The quality of the publications in terms of type of research, study design and methods, sampling and sample size, intervention, outcome continued on page 14
INCLEN NEWS JANUARY 2001 11
INCLEN’s Newest CLEN: CanUSACLEN
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t its inaugural meeting in Bangkok, the INCLEN Trust added a new regional network, the CanUSACLEN, as a member of the Board of Trustees. This action came about at the request of a group of long-time INCLEN members from Canada and the United States. The rationale for the request was the evolution of INCLEN into a “global network of regional networks of physicians, statisticians, social scientists and health research professionals dedicated to improving the health and development of populations of developing countries by promoting health care based on the best evidence of effectiveness and the efficient use of resources.” Regional CLENS were already in place for most regions of the world, with INCLEN - Africa, ChinaCLEN, INCLEN - EuroMediterranean, IndiaCLEN, LatinCLEN, and INCLEN Southeast Asia. These CLENs will play an important role in the governance structure of the new INCLEN Trust.
In these and other medical institutions throughout Canada and the US are departments and divisions engaged in capacity building for clinical epidemiology, biostatistics, health social sciences and related disciplines, and research in health and health services. Many already conduct collaborative research with colleagues in INCLEN’s CEUs and CERTCs around the world. Others are eager to do so. Many also conduct health services research aimed at improving the health and health care of underserved populations in the US and Canada, and are thereby doing similar work with mem-
Historically, INCLEN involved several training centers Dr. Suzanne Fletcher (CERTCs) in Canada and the USA: bers of CLENs in other parts of the McMaster University, the University globe. of North Carolina, the University of Pennsylvania, and the University of With this history and this potentially Toronto. Clinical epidemiologists, rich resource for the new INCLEN statisticians, and social scientists Trust, the formation of a CLEN to repfrom other institutions such as Johns resent this region of the world seemed Hopkins, Harvard, Cook County Hosappropriate. Thus, CanUSACLEN pital in Chicago, and the University was born. of Washington were also involved in INCLEN activities. Therefore, a group The overriding mission of the new of academic medical centers exists in CLEN is to be a regional network of Canada and the US with a long hisinstitutions in Canada and the US deditory of involvement in INCLEN and cated to contributing to the goals of with faculty who are dedicated to the the INCLEN Trust, i.e., to improving principles of the organization and eathe health and development of popuger to remain a part of it. lations of developing countries 12
INCLEN NEWS JANUARY 2001
around the globe. We are further dedicated to improving the health and health care of underserved populations in our own region, as we are convinced that many of the challenges facing health and health care of populations in developing countries are similar to those facing underserved populations in our own countries. We expect to work towards these objectives in two ways: 1) through capacity building for clinical epidemiology, biostatistics, and health sciences in our own region and in collaboration with other CLENs as possibilities occur, and 2) through bilateral collaborative research with colleagues in other regional CLENs on health problems that are global as well as regional. We expect that the mission and objectives of the new CLEN will evolve over time, but a strong international focus will persist. Because of the many other groups in Canada and the United States that are involved to some extent in clinical epidemiology education and health research, it is important that we coordinate the efforts of CanUSACLEN with these groups in due time. However, none of these groups has an international emphasis nor the combination of objectives outlined above. We are just beginning to develop the structure of CanUSACLEN. The CLEN’s organization includes a Secretary General who will be responsible for the day-to-day management of the CLEN and will represent the CLEN on the INCLEN Board of Trustees. An Executive Committee is the policy-making body until a more formal structure is developed. The Executive Committee will decide on CanUSACLEN committees, membership, dues, and other Continued on page 14
INCLEN - Africa applauds the launch of the INCLEN TRUST
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t was indeed a joyful moment for those of us who were for tunate enough to attend the INCLEN XVII meeting at the Montien Riverside Hotel in Bangkok. Like the rest of the regional CLENs, INCLEN – Africa (IA) had, over the years, shared the feeling that the voice of the “foot soldiers” within the network had not been adequately heard previously. Although there was the Program Committee in which a selected representative from AfriCLEN used to participate, the INCLEN Board of Directors had no legal obligations to implement the recommendations of the Committee. Now, at long last, we have a Board in which all the CLENs are represented and which has carved out an admirable relationship with the re-organized INCLEN, Inc. Board. Marcel Tanner brings in a wealth of experience to the new Trust; and is, in our view, fortunate to have Claire Bombardier as the Chair of INCLEN, Inc.Claire has so ably handled the transition that her name will rest in the INCLEN archives forever! We now all join hands with our brothers and sisters in other continents in supporting Mary Ann Lansang in reshaping this esteemed global organization through our actions – as the persons on the ground who determine how “bright the sun shines”. The ball is now in our court. Long live the INCLEN Trust! INCLEN – AFRICA IN THE YEAR 2000 Africa has not been left behind by the new winds of change, which have been
sweeping through the INCLEN world. For us, the turning point was during our annual scientific meeting in Addis Ababa in October 1997. At the general meeting, those in attendance expressed an overwhelming desire to have a better-organized regional network coordination system, which has now been translated into the “regionalization” concept. After about one year, the IEO supported a meeting to draw a Strategic Plan for INCLEN - Africa. We have since realized that the implementation phase is really the most difficult part of actualizing our vision. Although we have a humble budget dedicated to capacity building in the region, it has become necessary to agree on a regional system of governance before tangible outputs can be realized. Africa is a large continent with substantial language and communication technology barriers. Time is needed to cultivate a sense of mutual ownership of the regional network and to develop undivided commitment amid many other challenges for individual survival in such an economically harsh terrain. From July 1999, INCLEN - Africa has been maintaining an interim coordinating office at the University of Nairobi, even as the membership
Dr. William Macharia
continues to discuss and develop a constitution and network registration. The Council of Directors will be meeting in Nairobi in mid-February 2001 and finalize the proposed “memorandum of understanding”. They will also clearly outline projected guidelines for future research and capacity building for the region. It is hoped that this will be followed by re-dedication of the leadership towards rejuvenation of continental research and training activities. Even in this interim self-rediscovering period, a number of initiatives have been launched with variable successes. Dr James Hakim (Zimbabwe) has, over the last few months, been coordinating a malaria research interest group with participants from Cameroon, Kenya, Zimbabwe, and Ethiopia. One group is looking into treatment options for severe malaria in children while the other group is interested in malaria in pregnancy. Dr Sileshi Lulseged (Addis Ababa) is steering a group that has deContinued on page 14 INCLEN NEWS JANUARY 2001 13
CanUSACLEN . . .
INCLEN - Africa
from page 12
from page 12
CLEN procedures until by-laws are written and approved by the membership.
veloped a proposal on Invasive Bacterial Infections. Their proposal has been submitted to the BurroughsWellcome Trust. This initiative has participants from a number of African countries and hopes to emulate the work done by IndiaCLEN. On another front, an Injury Research Cluster has already completed pilot studies on surveillance systems in Uganda, Kenya, and Egypt. They hope to prepare combined research publications in 2001.
I am serving as the temporary Secretary General; with the temporary Executive Committee consisting of Bob Fletcher, Charlie Goldsmith, Des Runyan, Laura Sadowski, Peter Tugwell and myself, all in a voluntary capacity. Terms for the regular Secretary General and members of the Executive Committee will be determined, as well as the manner of their selection, when by-laws for the organization are written. The Executive Committee will ultimately include both a Secretary General-Elect and Immediate Past Secretary General. The CLEN is currently composed of four CERTCs (McMaster, Toronto, University of Pennsylvania, and University of North Carolina) and one CEU (Cook County Hospital, Chicago). We expect the number of institutional members to grow over time as new applications are submitted to the Board of Trustees of the INCLEN Trust. Institutional members will be eligible for membership on INCLEN’s Board of Governors. In addition, we must develop a mechanism for dealing with the large numbers of individuals in this region who have had experience in INCLEN over the last two decades but have since moved away from their original CEUs or CERTCs. If anyone wishes more information, or to give suggestions, please contact me at suzanne_fletcher@hms.harvard.edu. We are excited to continue to be part of the INCLEN family and are look forward to hearing from you! Suzanne Fletcher Secretary General CanUSACLEN
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INCLEN NEWS JANUARY 2001
Through the initiatives outlined above, coordinators are starting to accumulate a wealth of understanding on difficulties involved in getting meaningful multi-centre research going. They all acknowledge that most collaborators do not usually respond as quickly as they should even when
communication technology is available. Availability of relevant expertise is, at times, not available within the Network; and there is dire need to invite collaborators outside INCLEN. The problem of time competition with other equally deserving professional and social activities will need to be openly addressed with a view to developing lasting solutions. We will continue to learn from our experiences and those of colleagues from other regions. Over time, INCLEN will no doubt start harvesting the fruits of its re-organization and new vision. This will necessitate patience and understanding among the leaders and the membership. William Macharia Secretary-General, INCLEN-Africa
Epidemiology of Research Publications from page 11 measurement and data analysis, research results, research output and research outcome and impact between the “Index Papers” and “Control Papers” were similar.
* This study was presented at the opening plenary session of the INCLEN Global Meeting XVII held in Bangkok, Thailand on October 15, 2000.
Summary. The publications voluntarily provided by INCLEN members for review were of similar quality to the publications of other authors from both the developing and the developed world with regard to the papers accepted for publication in the international MEDLINE-indexed journals. They were assessed to be relevant to the health needs of the local and international communities and they contributed to global knowledge. However, whether the productivity of INCLEN members in terms of research publications is worth the long-term investment is beyond the scope of this study to determine.
The Thai Clinical Epidemiology Network would like to thank the INCLEN Research Subcommittee for funding this study, the CEU directors and the CEU members who sent us their publications For the full results or other inquiries, please write to: Visanu Thamlikitkul, Project Coordinator, Director, Mahidol CEU Siriraj Hospital, Bangkok 10700, Thailand Tel. (662) 412-5994 Fax. (662) 412-5994 E-mail Address: sivth@mahidol.ac.th
INCLEN and the BMJ Publishing Group . . . from page22 more appropriate as a tool in different environments. As authors: CE commissions topics to authors with content expertise, knowledge of evidence-based medicine and expertise in critical appraisal of biomedical literature. INCLEN is a key network of such people.
opportunity of access to the latest developments of science and provides a reliable source of clinical questions that need to be answered. In addition to this, its authors and peer reviewers are mostly top-rated and active researchers. All these characteristics provide a seedbed for networking, doing relevant research and answering the hottest clinical questions.
CE is keen to have increased international participation. An open “call for contributors” has been made to researchers with content knowledge and skillsincriticalappraisalandevidence-basedmedicine. One of CE’s clinical editors was invited as a speaker to the INCLEN Global Meeting XVII. At this meeting, INCLEN members were invited to become contributors to CE. CD’s of CE issue 3 were provided to all CEUs.
Provide feedback: CE is a dynamic project in continuous development and improvement. It uses feedback from readers to improve its contents and its form. Feedback has been useful to detect flawed or misleading studies and to alert readers on issues related to internal and external validity. CE is keen to have comments on how to make its contents and formats more appropriate and accessible for people working in different environments.
In addition to inviting INCLEN members, CE has launched other efforts to improve its quality and global perspective: The Cochrane Collaboration has been a leading group in developing systematic reviews and registers of clinical trial trials and systematic reviews. CE uses the Cochrane Library as a source of evidenceandCochranecollaboratorsarevaluablecontributors to CE.
CE is being produced in different formats and is now in other languages. During 2000, a German edition was launched. Currently negotiations are being done to produce CE in other languages. In 2000 the Internet version was introduced. To suit the need of healthcare providers in different regions and different specialties, new formats are also under development.
Although these activities are not openly offeredtopeoplewithexpertiseinevidence-based medicine, CE recognizes that INCLEN brings together a valuable group of scientists with knowledge and international perspectives, and provides opportunities for multi-center and multi-country collaboration. Being a synthesis of the available evidence, CE offers the
CE is searching for evidence in databases that are committed to the reduction of publication bias, such as those available in the Cochrane Library. Databasesandnewmeta-registersarebeingevaluated as sources of evidence. Authors are considering evidence regardless of the publication language. CE is now supporting translation processes to facilitate inclusion of such evidence.
To become a contributor to Clinical Evidence, you may contact the contributors’ site in the web page (http://www.clinicalevidence.org), where you will find a detailed explanation of the methods, requirements, terms and conditions. For further queries you may contact Luis Gabriel Cuervo (http://lgcuervo@bmjgroup.com), clinical editor for CE and an INCLEN member.
ThaiCLEN Hosts the INCLEN Global Annual Meeting XVII ThaiCLEN, together with INCLENSoutheast Asia, successfully hosted the INCLEN Global Meeting XVII in Bangkok, Thailand. It is the first global meeting organized almost entirely by a regional CLEN. The preparations were indeed enormous and challenging since this meeting was a turning point in INCLEN’s history. The INCLEN Trust, the new identity of the Network, was launched in this meeting. Hats off to our Thai colleagues especially to the Chairs of the Committees namely, Dr. Visanu Thamlikitkul (Organizing Committee
& Scientific Program), Dr. Somjai Wangsuphachart (Registration, Accommodation and Transport). Dr. Montchai Chalaprawat (Publication and Audio-visuals), Dr. Sompop Limpongsanurak (Finance), Dr. Sompon Tassniyom (Social Activity and Public Relations) and Ms. Herminia Mekanandha (Secretariat). Special mention is also given to the Organizing Committee. Amidst the business of these preparations, the Thai Clinical Epidemiology Resource Training Consortium (Thai CERTC), offers its 2-year international master’s degree
program in Health Development (Clinical Epidemiology) and the master’s degree program in Biostatistics. Since its inception in 1992, the Thai consortium has accepted 80 full-time fellows and 6 part-time students. Sixty-one fellows have already graduated. Details of these graduate programs are available at the Secretariat Office through inquiries at these e-mail addresses: smedtmk@md2.chula.ac.th or mhermini@chula.ac.th. Dr. Montchai Chalaprawat CEU Director, Chulalongkorn University INCLEN NEWS JANUARY 2001 15
IndiaCLEN Marches Towards Regionalization
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ndiaCLEN leads the march to wards regionalization in its various research and teaching activities. The IndiaCLEN In fectious Disease Initiative, on its third year of operation, has upgraded the microbiology laboratories of 6 participating CEUs. The Department of Microbiology of the Christian Medical College and Hospital in Vellore is the reference laboratory. IndiaCLEN has completed a number of nationwide program evaluations. Dr. Narendra Arora has coordinated the evaluation of the Pulse Polio Program (PPP) and the Family Health Awareness Week Program (FHAWP). PPP is a health program initiated by the government of India to combat polio. The FHAWP is another government program that aims to scale up the public’s awareness of sexually transmitted diseases (STDs) and reproductive tract infections (RTIs). The IndiaSAFE (Survey of Abuse in the Family Environment) project was another major endeavor. This project did not only provide opportunity for multi-disciplinary collaboration but also was able to confirm the problem of abuse in the fam-
ily environment in India. It also showed the need to develop sustainable and culturally acceptable intervention strategies. IndiaCLEN continues to offer training in clinical epidemiology and biostatistics. Among its graduate programs are the M. Phil. in Clinical Epidemiology at the Medical College in Trivandrum and the M.Sc. Epidemiology at the Christian Medical College (CMC) in Vellore. CMC, through the Biostatistics Resource and Training Centre, also offers M.Sc and PhD courses in biostatistics. IndiaCLEN holds office in ChennaiMadras Medical University. Inaugurated on July 29, 2000, this office serves as the nodal point of the activities of the network. Dr. Shuba Kumar is the IndiaCLEN office manager. Another milestone is the creation of the Institutional Review Board (IRB) in 1999. Dr. Ravi Korula, Dean of CMC, is the chairperson of the IRB which has representatives from all the CEUs and from the public sector. The IRB is responsible for technical and ethical review of all research proposals.
Still another major regional accomplishment of the network was the establishment of the Indian Journal of Clinical Epidemiology. Launched in 1999, the journal is the official publication of the network. It is available online at this website: http:// education.vsnl.com/certc/ Journal.htm. IndiaCLEN welcomes contributions from INCLEN members. IndiaCLEN has also formed three subcommittees for research, capacity building and public relations. The chairpersons are Kurien Thomas, Shally Awasthi, and Narendra Arora respectively. M. Narendranathan President, IndiaCLEN
GMC-CEU in Nagpur, India has a new sponsor and director Doctor R.K. Ayachit, MS (Ophthalmology) is the New Dean and Sponsor of the CEU at Government Medical College, Nagpur. Dr. Ayachit is a renowned ophthalmogist and a thorough academician with strong research background. Dr. Prashant Joshi, internist-cardiologist, also recently took over as the CEU director, taking over from Dr. A.K. Niswade. In addition to the collaborative research activities under the IndiaCLEN Infectious Disease Initiative (IIDI) and INCLENfunded projects, Nagpur CEU
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INCLEN NEWS JANUARY 2001
ChinaCLEN strengthening capacity in trad med
Pictured above are the 26 trainees and key members of research in traditional medicine who came from main traditional medicine universities nationwide to discuss the feasibility of organizing countrywide multi-center studies. faculty have also forged national and global collaborative research partnerships with different agencies. Among them are: (1) Dr. Joshi—collaborative cardiovascular disease research along with the All India Institute of Medical Sciences (Dr. K. Srinath Reddy), involving the Government of India, the World Health Organization, McMaster University (Prof. Salim Yusuf ‘The InterHeart Study’, ‘The CREATE Study’); involvement in a task force project of the Indian Council on Medical Research (ICMR) on ‘Control of Hypertension’ in the community; (2) Dr. Purwar—a multinational collaborative research on maternal health sponsored by WHO, and another on reproductive health; (3) Dr. Dipty Jain— multicenter ICMR project on sickle cell disease; (4) Dr. S. P. Zodpey—multicenter survey on drug abuse survey; (5) Dr. S.N. Ughade—spontaneous abortion study; and (6) Dr. C. Sarodey—a com-
Conference on EvidenceBased-Medicine - 131 health
External reviewer, Evaluation Committee of the 95th national prior-
officers from 30 provinces in China participated in the EBM conference on November 27-29, 2000 in Chengdu. Drs. Wang Jialiang, Wang Juesheng and Li Jing from the Chengdu CERTC gave lectures on the relationship between EBM and development of clinical medicine, health technology evaluation, and healthpolicy making.
ity health researches—Dr. Wang Jialiang, representing ChinaCLEN, participated in the meeting of the Evaluation Committee in Beijing on November 1 – 14, 2000.
National continuing education workshop on clinical research methods - This focused on strengthening research capacity and improving research quality of traditional medicine. It was held at the CERTC of the West China University of Medical Sciences in Chengdu on November 1 - 17, 2000. munity-based study on abortion and family planning practices sponsored by the International Center for Research on Women. In the area of capacity building, two workshops from CEU Nagpur, proposed by Dr. SN Ughade and Dr. Sanjay Zodpey, have been approved by Capacity Building Subcommittee of IndiaCLEN for support: (1) a workshop on relevant statistical methods for categorical data analysis and non parametric methods in the context of IIDI projects, and (2) a workshop on health program evaluation in the context of IIDI projects. A two-day workshop on research methodology will be conducted at the Medical College, Sawangi Meghe, Wardha for the faculty and postgraduate students. Prashant P. Joshi CEU Director, Government Medical College, Nagpur, India
Wang Jialiang, MD President, ChinaCLEN and Huang Jiuyi and Xu Dezhong, CEU Deputy Director and Director, FMMU
Cancer investigation of the CEU at FMMU Tthe newly created CEU of the Fourth Military Medical University, headed by Drs. Xu Dezhong and Huang Jiuyi, spearheaded a baseline epidemiologic investigation in Longling Village at Shan’xi Province in China. This aimed to investigate the unusually high cancer mortality rates observed in the village. A review of records revealed that the population decreased from 150 residents in 1974 to 95 at the present time. The mortality rate attributed to neoplasms was 917.4/100,000 personyears, which accounted for 63.8% of the overall causes of mortality. Mortality rates from esophageal cancer, hepatoma, bladder cancer, gastric carcinoma, and rectal and lung cancer were also calculated. More deaths were observed among residents born in the village compared to migrants into the village. Compared to the surrounding villages, the mortality rates from neoplasm in Longling Village were much higher. Existence of environmental factors inherent to the village is hypothesized to be contributory to the increased risk of mortality from neoplasms. This will be the thrust of further investigations by the CEU INCLEN NEWS JANUARY 2001 17
INCLEN-SEA meets at INCLEN XVII in Bangkok, Thailand, Vietnam joins as the 14th member
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embers of INCLEN – Southeast Asia (INCLEN-SEA) met at the INCLEN Global Meeting XVII in Bangkok, Thailand to discuss organizational matters, research and capacity building. Dr. Pyatat Tatsanavivat, INCLEN-SEA Coordinator, led the discussion which centered on the review of the missionvision and the leadership structure of the network, the improvement of communications in the region, setting up the INCLEN-SEA office in Thailand, and the development of a work plan for the Network for the next three years. With regard to communications in the region, the membership agreed to set up an electronic discussion group. This e-group will help the INCLENSEA members form collaborative research groups, tap experts for their
teaching and research needs, and exchange information. Dr. Mario Festin is the current e-group moderator. INCLEN-SEA welcomed Hanoi Medical School, Vietnam as the 14th member of the Network. Vietnam, represented by Dr. Tan That Bach and Dr. Luu Ngoc Hoat, expressed the need of their CEU, being the youngest member of the network, for capacity building activities. Further expansion of INCLEN – SEA membership was also discussed. In view of its past contributions and collaboration as well as future joint initiatives, INCLEN-SEA agreed to invite the University of Newcastle in Australia to join the Network. INCLEN-SEA has a board of coordinators composed of country representatives, namely: Dr. Tonny Sadjimin and Dr. Osman Sianipar for
Indonesia; Dr. Joselito Acuin and Prof. Cynthia Cordero for the Philippines; and Dr. Monchai Chalaprawat and Pyatat Tatsanavivat for Thailand. Vietnam has yet to name its country representative. There were three Subcommittees created by INCLEN-SEA during its regional meeting held in Manila in February 2000, namely: the Capacity Building Subcommittee (CBS), headed by Dr. Osman Sianipar; the Capacity Strengthening Subcommittee (CSS), tasked with continuing education for existing INCLEN-SEA faculty and headed by Dr. Monchai Chalaprawat; and the Collaborative Research Subcommittee (CRS), headed by Dr. Joselito Acuin. At the same time, the coordinator designated the following staff from the Khon Kaen University to assist the Subcommittees: Jadsada Tinkamrop for CBS, Sanguansak for CRS, and Suchada Paileaklee for CSS.
PhilCLEN launches its first nationwide collaborative project
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plinary nature of the Network and to form partnerships with government and non-government health organizations in the country.
PHEX aims to develop national guidelines on periodic health examinations for Filipinos. This research project provides PhilCLEN with an opportunity to tap the multi-disci-
Periodic health examinations cover a variety of disease conditions. In the PHEX project, subgroups were formulated according to these disease conditions; namely cardiovascular diseases, neoplasmic diseases, metabolic, nutritional and environmental disorders, infectious diseases, vision and hearing, prenatal disorders, childhood and developmental disorders, musculo-skeletal disorders, mental disorders, and substance abuse and renal disorders. Being a network of clinical epidemiologists with various clinical specialties and sub-specialties, biostatisticians, economists and social scientists, PHILCLEN was able to form working groups for the
he Philippine Clinical Epide miology Network (PhilCLEN) is a network of clinical epidemiology units (CEUs) in the different medical schools all over the Philippines. It was established in 1994 to foster collaboration in the research and teaching activities among the CEUs. PhilCLEN launched the Development of Philippine Guidelines on Periodic Health Examination Project (PHEX) on May 13, 2000, in collaboration with the Philippine College of Physicians in coordination with the Department of Health, the Philippine Medical Association, and the various medical specialty societies in the Philippines.
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above disease categories. PHEX also hopes to address the problem of commercialization of the health maintenance packages. The PHEX convenors are Dr. Mario Festin and Dr. Antonio Dans. PHEX is funded by the Philippine Council for Health Research and Development, Metrobank Foundation and the Department of Health. Cynthia P. Cordero CEU Director, U.P. Manila
LatinCLEN holds VI Regional Meeting After the historical INCLEN Global Meeting XVII in Thailand, LatinCLEN held its VI Regional Meeting last November 5-8, 2000. This was hosted by the Temuco CERT “CIGES” in Villarica, Región IX, Chile with the support of the following: INCLEN, Pan-American Health Organization (PAHO), the Health Minister of Chile, The Council on Health Research for Development(COHRED)andtheSociedadMédica Cautín. There were over 60 participants, consisting of LatinCLEN members as well as representatives from the government of Chile, PAHO, COHRED and funding agencies. The meeting programcoveredabroadrange,withseveralworkshops and free paper presentations. Dr. Patricia Clark from Mexico, current LatinCLEN president, will be finishing her term as president in March 2001. Dr. Sergio Muñoz from Temuco, Chile will be the next president, and will assume responsibility until 2003. An executive committee was nominated to work with Dr. Muñoz during this period. The members are: Dr. Juan Manuel Lozano as vice-president, Dr. Evelina Chapman from Argentina, Dr. Eddy Rios from Bolivia, and Dr. Antonio Da Cunha from Brazil.
The CLEN has been very active in creating a scientific organizational structure that would facilitate networking across the region. During the regional meeting a full governing body was thus nominated to look after the legal, administrative and organizational aspects of the regional network.
LatinCLEN has also joined COHRED’s initiative to determine essential needs in health in Latin-Americancountries,reviewresearchachievements in the region and health programs and teaching by LatinCLEN during the last decade in the region.
A LatinCLEN workplan is already in place and implementation started in November 1999. The ExecutiveCommitteeiscurrentlydraftingthedocument that will guide LatinCLEN on administrative and academic issues, as well as the legal aspects of the CLEN organization in the different countries. Preparations for the web page and communication system are ongoing as the CEU in Temuco takes over.
We wish every CLEN the best for 2001.
In the field of research, there are two interest groups working on regional and international collaborative initiatives. Pediatricians have formed one group and Dr. Antonio da Cunha presented the research projects of this group at the Global Meeting XVII. The other recently formed group is composed of gynecologists and health professionals interested in women health issues headed by Dr. Carlos Vallejos.
ARI Research to Policy: A Report from the Tucuman CEU in Argentina Acute respiratory infections, particularly obstructive bronchial syndrome and pneumonia, are the leading causes of preventable postneonatal mortality in Argentina. The Provincial Program on Acute Respiratory Infections (ARI) in children was launched in April 1998, one of the significant activities of the CEU in Tucuman, Argentina. This program was first initiated in the community level through a non-government organization before it was adopted officially by the health organization of the province of Tucuman. In the light of success during the initial stage, the CEU director, Dr Evelina Chapman, was appointed by the Ministry of Health of Argentina to advise on the project with the aim of
extending this program to other regions of Argentina. Based on an algorithm, the intervention employed for the treatment of obstructive bronchial syndrome (OBS) in children is the use of an inhalator and aerochamber for a brief and intensive period. The parents are also educated and trained on how to use the intervention at home. For the past three years 12,000 children have been included in the program with very good outcomes. The CEU will assist in extending this program to other areas of the country. Evelina Chapman CEU Director, University of Tucuman, Argentina
Patricia Clark LatinCLEN President
Update from CEU, University of Cauca, Colombia The year 2000 saw many CEU activities, the highlights of which were the following: EBM workshop for academicians coordinated by Dr. Juan Manuel Lozano, CERTC director at Javeriana University in Bogota, Colombia; workshops on the methodology of epidemiologic investigations; presentation of an intervention study in Guambian Indian Community of the Cauca Department; and active participation at the LatinCLEN VI Regional Meeting. In 2001, the ongoing research projects are: prevalence of hypertension in the Department of Cauca; development of a predictive tool for neonatal mortality in collaboration with the Department of Mathematics, University of Cauca; and risk factors for chronic diseases in school-age children. Due to intensification of the armed conflict in the region, we ask for your solidarity and support in anticipation of the difficult period that lies ahead for southwest Colombia. Mario F. Delgado CEU Director, University of Cauca, Colombia INCLEN NEWS JANUARY 2001 19
INCLEN – ChildNet is Created
A
t least 25% of the trained INCLEN faculty are pediatri cians or work in the area of child health. In their respective countries, they do meaningful research and clinical work on child health. As such, the INCLEN – ChildNet group was established during the INCLEN Global Meeting XVII. The primary aim of INCLEN – ChildNet is to conduct research on high priority areas in child and maternal health, using the collaborative multi-disciplinary and multi-site approach of the INCLEN network. The objectives of this group are: (a) to have a centralized directory of pediatricians and related professionals within the INCLEN network and link it with their research work; (b) create an extended network of pediatricians and related professionals interested in participation in the conduct, dissemination and implementation of research work and results within various countries where INCLEN has established units; (c) maintain a core group of trained researchers who can identify and deal with the issues raised in the “unfinished agenda of maternal and child health”; (d) establish linkages with groups working on maternal health; (e) through linkages with the INCLEN Trust, assist researchers from the developing countries to make and foster work relationships with established persons in the specific interests identified in order to facilitate research; and (f) assist researchers to identify potential sources of funding through the parent organization, the INCLEN Trust. The coordinator for the INCLEN – Childnet group is Dr. Shally Awasthi 20
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from IndiaClen and the Lucknow CEU. Each regional CLEN has its representative in the INCLEN – ChildNet working committee. These are as follows: IndiaCLEN: Dr. Manjula Dutta (manjulad@yahoo.com); AfricaCLEN: Dr. Hesham Fathey ElSayed (heshamel@gega.net); LatinClen: Dr. Antonia J Ledo Alves Da Cunha (acunha@ufrj.br); SeaClen: Dr. Tonny Sadjimin (tsadjimin@yogya.wasantara.net.id); ChinaClen: to be identified
up projects of common interest was emphasized and was thought to be a strategy for coherence of the group. The representatives agreed to start an e-mail discussion group on important topics within their region. For example, Dr. da Cunha volunteered to share the experience and the protocol of a LatinCLEN project on feeding practices.
Child health has always been recognized as an important area within the INCLEN network. In the past INCLEN global meetings, interested individuals were convened by Dr. Alan Cross from the University of North Carolina. The INCLEN – ChildNet, however, was officially formed during its organizational meetings held on October 15-
Since the group is in its infancy, inputs are very welcome. These can be addressed to the coordinator, the regional representative and/or Dr. Rodolfo Dennis of the INCLEN Trust, who is assisting us in this endeavor. I look forward to receiving the nominee for the ChinaCLEN representative for the group. We all hope that the INCLEN – ChildNet will go a long way in conducting and disseminating policy-relevant work for the benefit of the underprivileged children.
16, 2000. Meeting participants were INCLEN pediatricians, Dr. Ruth Frischer (USAID, USA), Dr. Robert Black and Dr. Mark Steinhoff (Johns Hopkins School of Public Health, USA) and Dr. Dora Warren (USAID, India).
Shally Awasthi Coordinator: INCLEN – ChildNet E-mail: sawasthi@lw1.vsnl.net.in Address: Professor of Pediatrics, King George Medical College, Lucknow
During these meetings, the global coordinator and regional CLEN representatives were selected. The need to take
(UP) India- 226003
INCLEN and the BMJ Publishing Group: a logical partnership initiative Rodolfo J Dennis and Luis G Cuervo The INCLEN and the British Medical Journal (BMJ) Editorial Group share a common link in their respective Missions: to promote health care based on the best evidence of effectiveness. INCLEN strives to achieve this by building and sustaining institutional capacity for excellence and relevance in health research and health professional education in developing countries. The BMJ Editorial Group is keen to provide rigorous, evidence-based information to help doctors in their practice as well as to influence international health care. A little over six months ago, Dr. Luis Gabriel Cuervo, an INCLEN faculty from Colombia, joined the Editorial Staff at the BMJ. Since then, both institutions have tried to workmorecloselytowardsthesuccessfulachievement of a joint initiative and build on their strengths. There are two major areas where both INCLEN and the BMJ Editorial group can benefit from a common initiative. One has to do with the BMJ and the second with Clinical Evidence. With respect to the BMJ, INCLEN members should be aware that it is interested in considering papers from INCLEN on subjects likely to be of interest to a broad readership. Articles sent to the BMJ need not be in perfect English; the BMJ has put a substantial amount of resources into editing for language. The key elements are that the study is methodologically sound and suitable to a broad readership. The BMJ is essentially an international journal, hence no a priori bias is expected on what should or should not be suitable material. Although the BMJ only publishes about 10% of all manuscripts sent, a major reason for the relatively small numberofpapersfromdevelopingcountriespublished in the BMJ is that few papers are sent for evaluation. If in doubt of the suitability of a particular topic, the author is encouraged to contact the BMJ Editorial Group before sending in the manuscript. The BMJ also welcomes suggestions from INCLEN faculty on drawing attention to impor-
tant ongoing highquality research that may be relevant to the BMJ readership. Dependingonthenatureoftheresearchthe BMJ would encourage submission of a paper, or, if better suited for publication elsewhere, an editorial comment could be commissioned on the topic. The BMJ also welcomes news in advance from INCLEN about key initiatives, conferences or events, so that they can attend the event and commission news items or editorials. Clinical Evidence (CE) is a compendiumofthebestavailable evidence on health interventions. Several INCLEN Reprinted with permission of the BMJ Pubmembers have been lishing Group (BMJ 2000; 321 October cover) involved in its development. CE began as an effort of the National During the last semester of 2000, the editorial Health Services and the BMJ publishing group to team of CE approached INCLEN with a proposal provide a pocket-sized compendium of the best to establish links that would enhance the particiavailable evidence on interventions for health care pationofINCLENmembersinnewdevelopments. providers. Because of its initial development stratCE is keen to have a broader direct participation of egy, it is strongly influenced by British and North INCLEN members in different ways: Americanprioritiesandsourcesofevidence.However, it has grown rapidly and is becoming an Peer-review: reviewing the content and validity of influential tool for healthcare providers globally. different topics and commenting on original studTherefore it should offer a global perspective of ies. As section advisors: suggesting appropriate health problems. The editorial team is fully comways of approaching sections, topics and estabmitted to generate new questions with a global lishing links to candidate authors and peer reviewperspective, to use broader sources of evidence, ers; providing novel information on how proband to draw participation from people from differlems may be approached; and how to make CE ent regions. Continued on page 15 INCLEN NEWS JANUARY 2001 21
BULLETIN BOARD
ANNOUNCEMENTS Dr Julio Frenk, former board member of INCLEN, Inc., recently assumed the post of Minister of Health, Mexico. Rodolfo J. Dennis, MD, who is currently the Chairman of Medicineat Javeriana University, Columbia, was awarded the Prize for Research in Internal Medicine by the Columbian Association of Internal Medicine during its bi-annual meeting on October 2000. This award was given in recognition of Dr. Dennis’s valuable role in training clinical researchers during his term as director of the Javeriana Regional Clinical Epidemiology Research and Training Center, and having twice won the National Academy of Medicine Award for the best clinical research study in the country. The Cochrane Collaboration Kenneth Warren Prize was awarded to the systematic review on Intravenous Immunoglobulin for Treating Sepsis and Septic Shock authored by Drs. Marissa M. Alejandria, Mary Ann D. Lansang, Leonila F. Dans, and Jacinto
Global Research Forum Forum 5 The 10/90 gap: Assessing the progress 9-12 October 2001, Geneva, Switzerland Less than 10% of global investment in health research addresses 90% of the world’s health problems. Three years after the creation of the Global Forum for Health Research, what progress has been made in correcting this 10/90 gap? Participants in Forum 5 will be able to: · review advances in the major initiatives supported by the Forum in key areas of health research · get an update on analytical work for priority-setting (application of the methodological framework, burden of disease, cost-effectiveness analysis, 22
INCLEN NEWS JANUARY 2001
Blas V. Mantaring III from the Philippines. The award was given for the first time at the 8th International Cochrane Colloquium held at Cape Town, South Africa on October 28, 2000. This is in recognition of systematic reviews done by a national living in a developing country, published electronically, and judged to be of high methodological quality and relevant to health problems in the third world. The other award went to Dr. Anelise Lima, from Brazil, principal author of the systematic review on the effects of carbamazepine on cocaine dependence. Maniyalath Narendranathan, MD, from the Medical College, Trivandrum, Kerala, India is the new president of IndiaCLEN replacing A. M. Cherian, MD. Suzanne W. Fletcher, MD, from the Harvard Medical School, Boston, Massachusetts is now the secretary general of the newly formed CanUSACLEN. monitoring of resource flows) · become involved in existing and proposed projects · evaluate, one year after the International Conference in Bangkok, the new agenda for better collaboration in health research · help identify steps in correcting
Leonila F. Dans, MD, director of the masteral program of the Department of Clinical Epidemiology, University of the Philippines Manila, is this year’s recipient of the Outstanding Researcher Award from the University of the Philippines Manila. R.K. Ayachit, MD is the new dean of the Government Medical College (GMC) and new sponsor of the CEU of GMC in Nagpur, Maharashtra, India replacing H. Nagrale, MD. Professor Cynthia P. Cordero is the new director of the Institute of Clinical Epidemiology and new chairperson of the Department of Clinical Epidemiology, University of the Philippines-Manila replacing Mario Festin, MD. Dr Marian Jacobs, former board member of INCLEN, Inc., has been elected as the new Chair of the Board of the Council on Health Research for Development (COHRED).
the 10/90 gap Note the dates now. Information on program and on-line registration will be on our website as of February 2001: www.globalforumhealth.org. For further details, contact info@globalforumhealth.org
Message from Professor Richard Heller “Having been personally deeply committed to INCLEN for so many years, I am delighted to hear of the new developments for INCLEN. I have moved to the UK, where I am professor of Public Health at the University of Manchester (Dick.Heller@man.ac.uk). My mission here is to develop a public health counterpart to Evidence-
Based Medicine (which I am calling Evidence for Population Health). This is to move clinical epidemiology further into the population, a route I hope that might find some resonance among the INCLEN members. I wish INCLEN well and would be happy to contribute in any way I can, and to keep in touch with INCLEN members into the future.”
INCLEN NEWS JANUARY 2001 23
INCLEN Trust Clinical Epidemiology Units (CEUs) and Clinical Epidemiology Resource and Training Centers (CERTCs)
Section E, 5th floor, Ramon Magsaysay Center 1680 Roxas Blvd. Malate, Manila 1004 Philippines Phone: (632) 521-3166 up to 85 Local 159 Fax: (632) 400-4374
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INCLEN NEWS JANUARY 2001