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Patient-reported outcome measures (PROMs) are widely used in the United Kingdom (UK) and internationally to report and monitor patients’ subjective assessments of their symptoms and functional status and also their quality of life. Whilst the importance of involving the public in PROM development to increase the quality of the developed PROM has been highlighted this practice is not widespread. There is a lack of guidance on how public involvement (PI) could be embedded in the development of PROMs, where the roles can be more complex than in other types of research. This paper provides a timely review and sets out an emerging framework for fully incorporating PI into PROM development.

SummaryBackground American Indian (AI) youth are at high risk for type 2 diabetes. Objectives To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally sensitive behavioural intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study. Methods We enrolled 62 overweight/obese AI children (7–10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n = 29) attended 12 group classes and five individual sessions. Control participants (n = 33) attended three health and safety group sessions. We analysed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioural (physical activity and dietary self-efficacy) outcomes. Results Study retention was 97%, and intervention group attendance averaged 84%. We observed significant treatment effects (p = 0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg m−2, p

Background\ud To provide a model for Public involvement (PI) in instrument development and other research based on lessons learnt in the co-production of a recently developed mental health patient reported outcome measure called Recovering Quality of Life (ReQoL). While service users contributed to the project as research participants, this paper focuses on the role of expert service users as research partners, hence referred to as expert service users or PI.\ud \ud Methods\ud At every stage of the development, service users influenced the design, content and face validity of the measure, collaborating with other researchers, clinicians and stakeholders who were central to this research. Expert service users were integral to the Scientific Group which was the main decision-making body, and also provided advice through the Expert Service User Group.\ud \ud Results\ud During the theme and item generation phase (stage 1) expert service users affirmed the appropriateness of the seven domains of the Patient Reported Outcome Measure (activity, hope, belonging and relationships, self-perception, wellbeing, autonomy, and physical health). Expert service users added an extra 58 items to the pool of 180 items and commented on the results from the face and content validity testing (stage 2) of a refined pool of 88. In the item reduction and scale generation phase (stage 3), expert service users contributed to discussions concerning the ordering and clustering of the themes and items and finalised the measures. Expert service users were also involved in the implementation and dissemination of ReQoL (stage 4). Expert service users contributed to the interpretation of findings, provided inputs at every stage of the project and were key decision-makers. The challenges include additional work to make the technical materials accessible, extra time to the project timescales, including time to achieve consensus from different opinions, sometimes strongly held, and extra costs.\ud \ud Conclusion\ud This study demonstrates a successful example of how PI can be embedded in research, namely in instrument development. The rewards of doing so cannot be emphasised enough but there are challenges, albeit surmountable ones. Researchers should anticipate and address those challenges during the planning stage of the project.

While it is important to treat symptoms, there is growing recognition that in order to help people with mental health problems lead meaningful and fulfilling lives, it is crucial to capture the impact of their conditions on wider aspects of their social lives. We constructed two versions of the Recovering Quality of Life (ReQoL) measure&mdash, ReQoL-10 and ReQoL-20&mdash, for use in routine settings and clinical trials from a larger pool of items by combining qualitative and quantitative evidence covering six domains. Qualitative evidence was gathered through interviews and focus groups with over 76 service users, clinicians, and a translatability assessment. Psychometric evidence generated from data from over 6200 service users was obtained from confirmatory factor models and item response theory analyses. In this paper we present an approach based on a traffic light pictorial format that was developed to present qualitative and quantitative evidence to a group of service users, clinicians, and researchers to help to make the final selection. This work provides a pragmatic yet rigorous approach to combining qualitative and quantitative evidence to ensure that ReQoL is psychometrically robust and has high relevance to service users and clinicians. This approach can be extended to the development of patient reported outcome measures in general.

IntroductionPatient and public involvement (PPI) is inconsistently reported in health and social care research. Improving the quality of how PPI is reported is critical in developing a higher quality evidence base to gain a better insight into the methods and impact of PPI. This paper describes the methods used to develop and gain consensus on guidelines for reporting PPI in research studies (updated version of the Guidance for Reporting Patient and Public Involvement (GRIPP2)).MethodsThere were three key stages in the development of GRIPP2: identification of key items for the guideline from systematic review evidence of the impact of PPI on health research and health services, a three-phase online Delphi survey with a diverse sample of experts in PPI to gain consensus on included items and a face-to-face consensus meeting to finalise and reach definitive agreement on GRIPP2. Challenges and lessons learnt during the development of the reporting guidelines are reported.DiscussionThe process of reaching consensus is vital within the development of guidelines and policy directions, although debate around how best to reach consensus is still needed. This paper discusses the critical stages of consensus development as applied to the development of consensus for GRIPP2 and discusses the benefits and challenges of consensus development.

An enduring theme in the literature exploring patient and public involvement (PPI) in research has been the focus\ud on evaluating impact, defined usually in terms of participants’ practical contribution to enhancing research processes.\ud By contrast, there has been less emphasis on the perspectives and experiences of those involved in PPI. Drawing on\ud qualitative data with people involved in the National Cancer Research Network in the United Kingdom, we report\ud on what motivated participants to get involved and their experiences of involvement in this setting. We highlight how\ud those involved in PPI often espoused the notion of the “good citizen,” with PPI in research being a natural extension\ud of their wider civic interests. However, our findings also highlight how PPI was an important resource, utilized by\ud participants to make sense of living with chronic illness. We suggest that PPI in research also offers spaces for the\ud reconfiguration of self and identity.

The National Institute for Health Research (NIHR) Research Design Service (RDS) for Yorkshire and Humber has been running a public involvement funding scheme since 2008. This scheme awards researchers a small amount of money to help them get involvement from patients and/or the public. Involvement activities take place at the time when researchers are planning studies, and when they are completing application forms to request funding for a proposed research project. After the public involvement activities researchers are asked to write a report for the RDS describing what they did with the public involvement funding. This study analysed those reports using an approach which included members of a public involvement panel in the data analysis process. The aim of the work was to see what the views and experiences of researchers who received funding were, and what might be learned for the future of the scheme. Twenty five reports were analysed. Four main themes were identified, these described: the added value of public involvement; aspects to consider when planning and designing public involvement; different roles of public contributors; and aspects of valuing public member contributions. The group approach to analysis was successful in enabling involvement of a variety of individuals in the process. The findings of the study provide evidence of the value of public involvement during the development of applications for research funding. The results also indicate that researchers recognise the variety in potential roles for the public in research, and acknowledge how involvement adds value to studies. Background A regional Research Design Service, funded by the National Institute for Health Research, introduced a small grant in 2008, to support public involvement (often known as patient and public involvement [PPI]) activities during the development of applications for research funding. Successful applicants are requested to submit a report detailing how the grant money was used, including a description of the aims and outcomes of the public involvement activities. The purpose of this study was to analyse the content of these reports. We aimed to find out what researcher views and experiences of public involvement activities were, and what lessons might be learned. Methods We used an innovative method of data analysis, drawing on group participatory approaches, qualitative content analysis, and Framework Analysis to sort and label the content of the reports. We developed a framework of categories and sub-categories (or themes and sub-themes) from this process. Results Twenty five documents were analysed. Four main themes were identified in the data: the added value of public involvement; planning and designing involvement; the role of public members; and valuing public member contributions. Within these themes, sub-themes related to the timing of involvement (prior to the research study/intended during the research study), and also specific benefits of public involvement such as: validating ideas; ensuring appropriate outcomes; ensuring the acceptability of data collection methods/tools and advice regarding research processes. Other sub-themes related to: finding and approaching public members; timing of events; training/support; the format of sessions; setting up public involvement panels: use of public contributors in analysis and interpretation of data; and using public members to assist with dissemination and translation into practice. Conclusions The analysis of reports submitted by researchers following involvement events provides evidence of the value of public involvement during the development of applications for research funding, and details a method for involving members of the public in data analysis which could be of value to other researchers The findings of the analysis indicate recognition amongst researchers of the variety in potential roles for public members in research, and also an acknowledgement of how involvement adds value to studies.

Background People with intellectual disabilities (ID) have unequal access to health care. While systemic efforts are addressing health inequalities, there remains a need to demonstrate that persons with ID can increase their health self-advocacy skills. Method A randomised control design with up to 6-month follow-up was used to evaluate the 3Rs (Rights, Respect and Responsibility) health self-advocacy training program for persons with ID (n = 31). Training involved teaching participants to recognise and redress health rights violations in the context of respect and responsibility. Training materials included PowerPoint slides and interactive video scenarios illustrating health rights, respect and responsibility problem and non-problems. Two-hour training sessions were conducted twice a week in a group format where participants played a game and answered questions. Results The health rights training group made significantly more correct responses on post training and follow-up tests than the control group. Training effects generalised to untrained scenarios and in situ health interviews. Conclusions The results of this study suggest that persons with ID can learn complex skills related to health self-advocacy. More research is needed to improve in situ generalisation.

Contemporary health policy in England places increasing emphasis on patient and public involvement (PPI) in health and health research. With regard to the latter, it has been suggested that PPI brings ‘different’ perspectives to research decision-making spaces, based on what has been referred to as ‘experiential expertise’. This article presents findings from a qualitative study of PPI in cancer research settings in England. We argue that participants highlighted specific forms of expertise in their accounts about involvement, above and beyond experiential expertise, which they felt legitimated their claims to be credible participants within cancer research settings. We report here on the various strategies by which participants sought to accomplish this and highlight, in particular, a concomitant process of ‘professionalization’ of some within our group of participants. We discuss the significance of these findings in the context of recent debates around the status of experiential expertise.

We developed a modern methodology to retrieve water (H2O) and deuterated water (HDO) in planetary and cometary atmospheres, and constructed an accurate spectral database that combines theoretical and empirical results. On the basis of a greatly expanded set of spectroscopic parameters, we built a full non-resonance cascade fluorescence model and computed fluorescence efficiencies for H2O (500 million lines) and HDO (700 million lines). The new line list was also integrated into an advanced terrestrial radiative transfer code (LBLRTM) and adapted to the CO2 rich atmosphere of Mars, for which we adopted the complex Robert–Bonamy formalism for line shapes. We retrieved water and D/H in the atmospheres of Mars, comet C/2007 W1 (Boattini), and Earth by applying the new formalism to spectra obtained with the high-resolution spectrograph NIRSPEC/Keck II atop Mauna Kea (Hawaii). The new model accurately describes the complex morphology of the water bands and greatly increases the accuracy of the retrieved abundances (and the D/H ratio in water) with respect to previously available models. The new model provides improved agreement of predicted and measured intensities for many H2O lines already identified in comets, and it identifies several unassigned cometary emission lines as new emission lines of H2O. The improved spectral accuracy permits retrieval of more accurate rotational temperatures and production rates for cometary water.

As service user involvement in health and social care research has become more firmly embedded in health policies, both in the UK and internationally, there is increasing interest in evaluating its potential benefits and outcomes. Impact studies have highlighted a range of different types of service user involvement, using diverse research methods, within various research topics and involving different stakeholders. Potential benefits to research, researchers and the service users actively involved in research have been identified, along with the possibility of some negative consequences. Many impact studies have been criticized for being based on informal retrospective accounts of researchers and service users working together. Few have been underpinned by conceptual models, and there is a paucity of detailed accounts of the process of involvement that would enable replication. This paper reports an account of a prospective, qualitative exploration of service user involvement within a study, where the aims of the evaluation were agreed beforehand. Reflective discussions about the process and progress of service user involvement at different stages of the study were recorded, transcribed and analysed. The qualitative analysis identified perceived benefits to research, researchers and service user researchers that endorsed previous findings. The analysis also highlighted subjective and interpersonal aspects of service user involvement that have seldom been reported. This evaluation demonstrates the benefits of allowing time for structured reflection and adds to the understanding of the process and meaning of service user involvement in research.

While patient and public involvement (PPI) in health and social care research has progressed successfully in the last decade, a range of difficulties with the evidence base exist, including poor understanding of the concept of impact, limited theorization and an absence of quantitative impact measurement. In this paper, we argue that a paradigm change towards robust measurement of the impact of involvement in research is needed to complement qualitative explorations. We argue that service users should be collaboratively involved in the conceptualization, theorization and development of instruments to measure PPI impact. We consider the key advantages measurement would bring in strengthening the PPI evidence base through a greater understanding of what works, for whom, in what circumstances and why.

Objectives: The aim of this study was to develop the GRIPP (Guidance for Reporting Involvement of Patients and Public) checklist to enhance the quality of PPI reporting.Methods: Thematic analysis was used to synthesize key issues relating to patient and public involvement (PPI) identified in the PIRICOM and PAPIRIS systematic reviews. These issues informed the development of the GRIPP checklist.Results: The key issues identified included limited conceptualization of PPI, poor quality of methods reporting, unclear content validity of studies, poor reporting of context and process, enormous variability in the way impact is reported, little formal evaluation of the quality of involvement, limited focus on negative impacts, and little robust measurement of impact. The GRIPP checklist addresses these key issues.Conclusion: The reporting of patient and public involvement in health research needs significant enhancement. The GRIPP checklist represents the first international attempt to enhance the quality of PPI reporting. Better reporting will strengthen the PPI evidence-base and so enable more effective evaluation of what PPI works, for whom, in what circumstances and why.

A recently-recorded set [Hargreaves et al., Astrophys. J., in press] of Fourier transform emission spectra of hot ammonia is analyzed using a variational line list. Approximately 3350 lines are newly assigned to mainly hot bands from vibrational states as high as v2 = 2. 431 new energy levels of these states are experimentally determined, considerably extending the range of known rotationally-excited states. Comparisons with a recent study of high J levels in the ground and first vibrational states [Yu et al., J. Chem. Phys., 133 (2010) 174317] suggests that while the line assignments presented in that work are correct, their energy level predictions suffer from problems associated with the use of very high-order perturbation series in the effective Hamiltonian. It is suggested that variational calculations provide a more stable method for analyzing spectra involving highly-excited states of ammonia.

Background. Little is known about service users’ views of measures used to evaluate treatments in mental health. Aims. To identify the views of people with psychosis and affective disorder about the relevance and acceptability of commonly used outcome measures. Methods. Twenty-four widely used outcome measures were presented to expert groups of service users. Nominal group methods were used to develop consensus about the appropriateness of each measure. Comments made by service users about how outcomes should be assessed were also recorded. Results. Group members expressed concern about the ability of some outcome measures to capture their experiences. Patient-rated measures were assessed as more relevant and appropriate than staffrated measures, and the need to examine negative as well as the positive effects of treatments was emphasised. Specific concerns were raised about some widely used measures including the Global Assessment of Functioning and the European Quality of Life scale. Conclusions. We consider it essential that service users’ views are taken into account when selecting measures to evaluate treatment outcomes. Providing insight into views of users of mental health services, our findings serve as a starting point for discussion.

Background Public involvement is central to health and social research policies, yet few systematic evaluations of its impact have been carried out, raising questions about the feasibility of evaluating the impact of public involvement. Objective To investigate whether it is feasible to evaluate the impact of public involvement on health and social research. Methods Mixed methods including a two-round Delphi study with pre-specified 80% consensus criterion, with follow-up interviews. UK and international panellists came from different settings, including universities, health and social care institutions and charitable organizations. They comprised researchers, members of the public, research managers, commissioners and policy makers, self-selected as having knowledge and ⁄ or experience of public involvement in health and ⁄ or social research; 124 completed both rounds of the Delphi process. A purposive sample of 14 panellists was interviewed. Results Consensus was reached that it is feasible to evaluate the impact of public involvement on 5 of 16 impact issues: identifying and prioritizing research topics, disseminating research findings and on key stakeholders. Qualitative analysis revealed the complexities of evaluating a process that is subjective and socially constructed. While many panellists believed that it is morally right to involve the public in research, they also considered that it is appropriate to evaluate the impact of public involvement. Conclusions This study found consensus among panellists that it is feasible to evaluate the impact of public involvement on some research processes, outcomes and on key stakeholders. The value of public involvement and the importance of evaluating its impact were

The hot Jupiter HD 209458b was observed during primary transit at 3.6, 4.5, 5.8 and 8.0 microns using the Infrared Array Camera (IRAC) on the Spitzer Space Telescope. We detail here the procedures we adopted to correct for the systematic trends present in the IRAC data. The light curves were fitted including limb darkening effects and fitted using Markov Chain Monte Carlo and prayer-bead Monte Carlo techniques, finding almost identical results. The final depth measurements obtained by a combined Markov Chain Monte Carlo fit are at 3.6 microns, 1.469 +- 0.013 % and 1.448 +- 0.013 %; at 4.5 microns, 1.478 +- 0.017 % ; at 5.8 microns, 1.549 +- 0.015 % and at 8.0 microns 1.535 +- 0.011 %. Our results clearly indicate the presence of water in the planetary atmosphere. Our broad band photometric measurements with IRAC prevent us from determining the additional presence of other other molecules such as CO, CO2 and methane for which spectroscopy is needed. While water vapour with a mixing ratio of 10^-4-10^-3 combined with thermal profiles retrieved from the day-side may provide a very good fit to our observations, this data set alone is unable to resolve completely the degeneracy between water abundance and atmospheric thermal profile.

Researchers in the area of health and social care (both in Australia and internationally) are encouraged to involve consumers throughout the research process, often on ethical, political and methodological grounds, or simply as ‘good practice’. This article presents findings from a qualitative study in the UK of researchers’ experiences and views of consumer involvement in health research. Two main themes are presented. First, we explore the ‘know—do gap’ which relates to the tensions between researchers’ perceptions of the potential benefits of, and their actual practices in relation to, consumer involvement. Second, we focus on one of the reasons for this ‘know—do gap’, namely epistemological dissonance. Findings are linked to issues around consumerism in research, lay/professional knowledges, the (re)production of professional and consumer identities and the maintenance of boundaries between consumers and researchers.

Objectives: To investigate how far and in what way consumers are involved in NHS research. Background: There is guidance from the UK Department of Health on involving consumers in research, but it is not known how these policies have been implemented. Design: A national postal survey was conducted of 884 researchers selected randomly from the National Research Register, 16 researchers registered on the INVOLVE database and 15 consumers nominated by researchers who collaborated in the same research projects. Setting: The survey participants were drawn from diverse settings including NHS organizations and universities. Participants: Researchers and consumers collaborating in the same projects. Main outcome measures: Details of how consumers were involved and the number of projects that met previously developed consensus-derived indicators of successful consumer involvement in NHS research. Results: Of the 900 researchers who were sent a postal questionnaire, 518 responded, giving a response rate of 58%. Nine of the 15 consumers responded. Eighty-eight (17%) researchers reported involving consumers, mainly as members of a project steering group, designing research instruments and/or planning or designing the research methods. Most projects met between one and four indicators. Conclusions: This national survey revealed that only a small proportion of NHS researchers were actively involving consumers. This study provides a useful marker of how far the Department of Health's policy on consumer involvement in NHS research has been implemented and in what way.

Water hot-band lines were detected in comets C/1999 H1 (Lee), C/1999 S4 (LINEAR), and C/2001 A2 (LINEAR) in the 2.9 � m spectral region using high-dispersion (k=� k � 2 ; 10 4 ) infrared spectroscopy with NIRSPEC at the W. M. Keck Observatory. The density of H2O emissions in this spectral region, the spectral coverage and resolution of NIRSPEC, and fluorescence models developed for these hot bands enabled the determination of H2O production rates, rotational temperatures, and ortho-to-para ratios (OPRs) in these comets. Previous studies revealed clear diversity in the volatile organic chemistries of these comets, suggesting that they may have formed in different regions of the early solar nebula. The nuclear spin temperature of H2O as derived from its OPR is another possible indicator of cometary formation temperature and region. Nuclear spin temperatures for H2O were derived on one date in comet S4 and two dates in Lee and A2. Derived spin temperatures for H2O in these comets are � 30, 30 þ15 � 6 ,a nd 23 þ4 � 3 K for S4, Lee, and A2, respectively. Measurements are consistent with a possible link between nuclear spin temperatures and volatile abundances, but studies of more comets and continued improvements in water hot-band fluorescence models are needed to more stringently test this. Subject headingg comets: general — comets: individual (C/1999 S4, C/2001 A2, Lee (C/1999 H1)) — infrared: solar system — techniques: spectroscopic

A revised rotation-vibration line list for the combined hydrogen cyanide (HCN) / hydrogen isocyanide (HNC) system is presented. The line list uses {\it ab initio} transition intensities calculated previously (Harris et al., ApJ, 2002, 578, 657) and extensive datasets of recently measured experimental energy levels (Mellau, J. Chem. Phys. and J. Mol. Spectrosc. 2010-2011). The resulting line list has significantly more accurate wavelengths than previous ones for these systems. An improved value for the separation between HCN and HNC is adopted leading to an approximately 25%\ lower predicted thermal population of HNC as a function of temperature in the key 2000 to 3000 K region. Temperature-dependent partition functions and equilibrium constants are presented. The line lists are validated by comparison with laboratory spectra and are presented in full as supplementary data to the article and at \url{www.exomol.com}., Comment: MNRAS, in press

Since 1986, the MCH International Public Health Internship Program (IPHI Program) at the Center for Population and Family Health at Columbia University has provided short-term technical assistance to MCH/FP agencies in Latin America and the Caribbean while at the same time offering substantive field experience to masters level public health students. Agencies submit project proposals in the area of utilization of health and family services, reproductive health education, AIDS prevention and education and the status of women. IPHI Program faculty visit agencies and selected interns are matched to agency needs. Interns participate in a one-week orientation and training prior to their six-week field assignment; the program provides round-trip transportation and a modest per diem. They are supervised in data analysis and report writing for agencies. Interns collaborate with agency personnel to submit abstracts for presentation at professional meetings. Agencies, interns and faculty evaluate the program favorably.

Objective To investigate health researchers’ attitudes to involving the public in research. Background Public involvement in research is encouraged by the Department of Health in the UK. Despite this, the number of health researchers actively involving the public in research appears to be limited. There is little research specifically addressing the attitudes of health researchers towards involving the public: how they interpret the policy, what motivates and de-motivates them and what their experiences have been to date. Design A qualitative research design, using semi-structured telephone interviews. Setting and participants Fifteen purposively sampled UK-based University health researchers were the participants. Interviews were conducted over the telephone. Findings The participants suggested varying constructions of public involvement in research. Arguments based on moral and political principles and consequentialist arguments for involving the public in research were offered and most participants highlighted the potential benefits of involving the public. However, feelings of apprehension expressed by some participants imply that a number of researchers may still be uncomfortable with involving the public, as it presents a different way of working.

Breastfeeding has regained more popularity in the US since 1970, but there has been a definite disparity in its resurgence among minority, poor, and less educated mothers. This article outlines the history of breastfeeding prevalence in the US and New York City as an introduction to explaining the design and implementation of New York City's breastfeeding promotion program. In 1982, the Steering Committee to Promote Breastfeeding in New York City was generated and it designed task forces to address each of their defined barriers to breastfeeding promotion (e.g. lack of relevant data, centralized compilation, data analysis, health care professional education, inhibitory practices by hospitals and ambulatory services, public misinformation, and unsupportive public policy). The Research Task Force, Professional Education Task Force, Hospital Practices Task Group, Policy and Legislation Task Group, and Public Information Task Group were outlined and some policies, strategies, and practices they have enacted were described. Some of their accomplishments include: educational kits on breastfeeding for health care professionals, guidelines for work-site health and nutrition programs for pregnant and lactating workers, research on the economics of breastfeeding, breastfeeding information posters on the subway, and establishment in 1984 of a breastfeeding coordinator in each municipal hospital. These strategies demonstrate a successful model for breastfeeding promotion in large urban areas as seen by the rise in breastfeeding at the time of newborn discharge from New York City hospitals.

著者人数: 209名, Accepted: 2005-09-01, 資料番号: SA1004082000

Consumer involvement in NHS research is Department of Health policy within the UK. Despite the existence of policy directives and guidance, until recently there has been no consensus among consumers and researchers about what it means to involve consumers successfully in NHS research. This paper discusses the value of consensus research in this policy area, and presents the detailed findings of a Delphi study carried out to reach consensus on principles and indicators of successful consumer involvement in NHS research. Study participants, comprising consumers, researchers and consumer–researchers, were identified using a purposive sampling strategy. Consensus was reached on eight clear and valid principles of successful consumer involvement in NHS research, with each principle having at least one clear and valid indicator. Subgroup analysis revealed few significant differences in how consumers, researchers and consumer–researchers rated the principles and indicators. The implications and limitations of the study are discussed. Further research is needed to assess: (1) the usefulness of the principles and indicators for differing models of consumer involvement, health research methodologies, and subject areas within health research; and (2) the impact of ‘successful’ consumer involvement on health research processes and outcomes.

Ab initio vibration-rotation energy levels are summed to estimate a partition function for the total HCN system. By assigning individual levels to HCN and HNC, separate partition functions are obtained for the isomers. These are used to give a temperature dependent equilibrium constant which suggests that at temperatures typical of cool carbon stars, about 20% of the HCN system is actually HNC. Errors in the partition functions and equilibrium constant are estimated. (C) 2002 American Institute of Physics.

In 1988, a new Constitution was adopted in Brazil in which guidelines for community participation in the development and implementation of the national health system were delineated. The health and welfare of women and children were given priority. Implementation of these guidelines presents a major challenge in a city such as Sao Paulo with a population of 15 million, of which an estimated 5.8 million are women of childbearing age. In order to determine the extent to which community organizations are actively participating in planning health services for women and children in Sao Paulo, a study was undertaken to examine the experience of community and professional organizations in public health advocacy. This paper describes a sample of these organizations, their constituents, membership, history, funding, advocacy objectives, and strategies used and results obtained. The information gathered indicates that the community organizations are involved in activities that include major efforts to improve access to health care by providing specialized courses in women's health, including the status of women's work, sexuality, discrimination, family planning, and the politics of health; publishing newsletters; producing radio programs; engaging in legal action; and using petitions, demonstrations, and public meetings to garner public support on specific issues.

Recent statistics provide strong evidence that more American women are entering and remaining in the work force. The majority of these working women are of prime childbearing age and choose to work during pregnancy and after childbirth. This labor force trend, coupled with the increasing interest in worksite health promotion programs, raises the issue of pregnancy, lactation and the nutritional needs of working women, and how worksite health promotion programs can best respond to these needs. This article aims to provide a framework for developing worksite maternal nutrition education programs for this population.

The challenge in designing professional continuing education programs lies in balancing the need to provide a new knowledge base with the need to engage the interest of the adult learner. This article reports on the use and evaluation of an experiential and innovative educational approach using adult learning techniques in a continuing education program for nurses in a cross-cultural setting.

Growing attention to the issue of breastfeeding and the working mother can be attributed, in part, to the growing numbers of women entering and remaining in the labor force. Current labor statistics show that 41% of mothers who participate in the labor force have children under one year of age. As more mothers of young children elect to work, the need for more receptive policies at the worksite concerning the health needs of these women and their children becomes evident. This paper discusses the role that the occupational health nurse can play in making breastfeeding feasible for working mothers.

Over half of all women in the United States currently participate in the labor force, and 41% of mothers in the labor force have children under one year of age. As more and more mothers of young children work outside the home, the need for more supportive breastfeeding policies at the worksite becomes quite evident. The American Academy of Pediatrics and the World Health Organization have noted that the work environment, in both policy and structure, is often not supportive of women who choose to breastfeed. This paper examines logistical, social, and political barriers to breastfeeding at the workplace. These include: insufficiently comprehensive maternity leave policies, lack of child care at or near the workplace, rigid time schedules that do not allow for nursing breaks, lack of a location providing privacy for breast-pumping, and no facilities for refrigeration of pumped breastmilk. Short and long-term solutions to help employers address each of these issues are outlined.

This paper was written partially on the basis of an occupational health clinical study in Spain conducted by the authors in September 1982. The information discussed in this paper was obtained through site visits to factories and their medical services departments, to hospitals contracted by the social security system, and to a university school of nursing. In addition, we had the opportunity to observe contruction and agricultural workers. Our observations during the visit were limited to sites in central and southern Spain. A review of the literature provided background information on the Spanish labor force, work and living conditions of Spanish workers, political events influencing industrial relations and economic development, and some case examples of epidemiological studies in occupational health.

Background: Self-help approaches for mental health problems are a research and service development priority within the UK. \ud \ud Aim: To engage service users in the research process through a consultation exercise, seek their views on the strategies they use to manage their lives and priorities for research into self-help. \ud \ud Method: Service users were involved in planning and conducting a consultation event and in analysing, interpreting and disseminating the findings. Forty nine service users attended the consultation event. Notes and key points from focus groups discussions were analysed to identify main themes. \ud \ud Results: Five themes for service user self-help strategies were identified; managing and structuring the day; empowerment; engaging others to help yourself; physical health and well being; and spirituality. Four research priority areas in self-help were identified: the importance of user-led research; research into self-help strategies to improve physical health and well being; mapping of available services and self-help approaches; and what works and why. \ud \ud Conclusions: Self-help research and developments should take account of these service users' views of research priorities and the strategies they use to manage their lives. \ud \ud Declaration of interest: The project was initiated by Psychological Therapies Network North (PsyReNN). Funding for the venue and service user expenses was provided by the NIMHE Regional Development Centre, North East, Yorkshire and Humberside and by the Tees and North East Yorkshire Mental Health and Learning Disabilities NHS Trust.

The available evidence supports an important role for public health in reducing both morbidity and mortality due to child abuse. In recent years, there has been a major effort to coordinate the activities of the diverse sectors of Federal Government, including the Departments of Health and Human Services, Education, Justice, and Defense. The value and contribution of the National Center for Child Abuse and Neglect is recognized; however, it is hoped that coordination between and among these national agencies at the Federal level will be maintained and improved. While more study of problems related to child abuse and the effects of efforts to prevent the problem may help resolve our current dilemmas, it is imperative that a combination of educational interventions, provision of comprehensive health and human services, coordination of prevention efforts, and other measures which have shown positive results be undertaken at this time.