We sought theories (we use the term theory to collectively refer to published models, theories, and frameworks) that facilitate translation of research findings into practice, primarily within the healthcare sector. Greenhalgh et al.'s synthesis of nearly 500 published sources across 13 fields of research culminated in their 'Conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization' [8] and this was our starting point for the CFIR. We used a snowball sampling approach to identify new articles through colleagues engaged in implementation research and theories that cited Greenhalgh et al.'s synthesis, or that have been used in multiple published studies in health services research (e.g., the Promoting Action on Research Implementation in Health Services (PARiHS) framework [9]). We included theories related to dissemination, innovation, organizational change, implementation, knowledge translation, and research uptake that have been published in peer reviewed journals (one exception to this is Fixsen et al.'s review published by the National Implementation Research Network because of its scope and depth [10]). We did not include practice models such as the Chronic Care Model (CCM) because this describes a care delivery system, not a model for implementation [11]. The CFIR can be used to guide implementation of interventions that target specific components of the CCM.
Salivary cortisol and immunoglobulin A (IgA) concentrations are established stress markers that are utilized in various scientific fields; however, few investigations have applied these indices to field studies involving a large number of subjects over a specific period of time. In our field studies, we have clarified that cortisol concentration is significantly lower in subjects exposed to a forest environment than in those exposed to an urban environment [10]. However, the results for IgA concentration were not consistent. IgA concentration is known to decrease under severe chronic stress [13], whereas it has been reported to increase in response to acute stress [14]. Interestingly, however, it has also been demonstrated that the levels of IgA in individuals engaged in stressful jobs are significantly higher than those in individuals who are not engaged in comparable activity [15]. It is thus believed that the use of IgA concentration as a stress marker should be re-evaluated by investigating the relationship between its change and the types and continuity of emotional stress.
The Source Field Investigations Epub
Upon establishing this initial list in PubMed, we conducted the second stage of article selection by thoroughly reviewing the title and abstract (and in some instances where the abstract lacked the required information, the full article) according to the following inclusion criteria: (a) subjects of the article were refugees (not aid workers, clinicians, etc.); (b) primary topic was health-related; and (c) investigators directly interacted with the refugees included in the analysis (primary data sources). The last criterion consequently excluded investigations that solely used surveillance data, refugee databases, or chart reviews (secondary data sources). Review articles, systematic reviews, meta-analyses, notes from the field, letters to the editor, methodological papers, and policy papers were also excluded.
From our assessment, we found that the extent to which ethics principles were reported varied greatly across the refugee health literature we examined. Our findings highlight the need for a current understanding of ethics and the application of ethics principles in refugee health investigations. Moreover, there is still likely room for improvements to the investigation and review processes regarding ethics within the field of refugee health research. Additionally, the refugee context changes over time, as does critical thinking on research best practices, highlighting the need to repeat such analyses periodically to ensure research practices as they relate to refugees evolve accordingly. Although our current analysis provides important information regarding the present context and circumstances of refugees, the implementation of ethics principles in refugee health research should be revisited along with the changing landscape.
In conclusion, our analysis identified a number of complex ethical challenges in conducting refugee health-related investigations and found evidence of room for improvement in adherence to ethics principles and their documentation in resulting publications. Most importantly, we have described the unique characteristics of refugee populations that suggest a need for greater emphasis on particular ethics principles and warrant the development of a refugee-specific ethics framework to aid investigators in the field. Scientifically valid investigations with ethically collected data provide the foundation for policy and interventions, and therefore, investigators should make the fullest effort to ensure respect and safety for refugee participants and their communities. 2ff7e9595c
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