University of New Mexico Health Sciences Center
This project traces the development of current perspectives in Latin American social medicine, a field little known to North American researchers. The Principal Investigator (Dr. Waitzkin), working with a Peer Selection Committee (PSC), is compiling a list of approximately twenty landmark books that deal with Latin American social medicine; fifty book chapters from other esteemed Latin American works; and one hundred key journal articles which also support this field. These works cover the history of social medicine, national and international groups working in social medicine, health policy analysis, labor and environmental health, social class and health outcomes, gender issues, social epidemiology, mental health, and educational reform. Particular attention is devoted to themes whose health-related applications are NIH emphases: social, environmental, and nutritional causes of infant and perinatal mortality; economic development, demographic change, and aging; socioeconomic barriers to cancer prevention; determinants of mental illness in race or ethnic background, social class, gender, and social violence; and policy research on managed care, primary care innovations, and preventive services.
The co-PI (Dr. Buchanan), as Director of the UNM HSC Library, works closely with the PI in coordinating those project activities based at the Library. The chief of collection development at the UNM HSC Library (Dr. Eldredge) and the Latin American curator at the UNM General Library (Dr. Davidson) are responsible for providing current bibliographic data and for ensuring communication with vendors. Dr. Iriart, together with the Latin American teams, prepares structured abstracts of the works selected in English, Spanish, and Portuguese and, with the PI, is responsible for monitoring and coordinating communication between UNM and the Latin American teams. Dr. Iriart further coordinates the activities of the different project units, monitors progress on the project.
The chief of collection development and the PI quality check the abstracts, which are then entered into the HSC Library's database. Using existing technology, the abstracts are subsequently mounted on the HSC Library's Web page by systems personnel, with links established to various organizational entities within and outside UNM. Links include those to the UNM General and Parish (business) libraries, which both employ Latin American subject librarians; the UNM Latin American & Iberian Institute; and the University of Texas Latin American Network Information Center (UT-LANIC) and the University of Texas at Austin Benson Latin American Collection. These institutions and programs are also requested to provide links from their Web pages to this project's database and Web page.
The project is under the day-to-day coordination of the project coordinator who ensures that the project fulfills the Library's policies and expectations. The coordinator monitors all project activities, including work flow, monthly production rates, on-line database use, and acquisition of new materials.
The coordinator meets weekly with the PI and biweekly with the UNM project team: the PI and co-PI, chief of collection development, Latin American curator, HSC Library systems coordinator, and cataloging, collection management, and document delivery personnel. In addition, the manager will provide monthly written reports on the project's progress to the PI and the co-PI. She will thus ensure that all facets of the plan of operation, as set forth in this proposal, are carried out and that the project goals are achieved.
The PI assumes responsibility for the coordination of the international team. As already established by the prior projects on social medicine and managed care in Latin America, the coordination includes the development of common protocols and procedures for article and book selection, publication of subsequent works on the Web site, and quality control for abstracts. Coordination also includes trips for work with each national group, for the purpose of integrating the project's activities. Via electronic mail, the PI maintains weekly contact with each national group to help coordinate the international team.
Four Latin American centers participate in all aspects of the project: the Institute for the Study of State and Participation (Argentina), the University of Campinas (Brazil), the Social Medicine Research and Training Group (Chile), and the Health Research and Advisory Center (Ecuador).
To assure broad participation in the selection of seminal books, chapters, and articles, a Peer Selection Committee (PSC), whose membership is voluntary and unpaid, has been created. The Committee communicates on a bimonthly basis via electronic mail and twice-annually through real-time online conferencing. Its members include prominent figures in the field of Latin American social medicine.
The PSC's first task was to develop systematic selection criteria, which the PI and other members of the UNM team will in turn apply to choose the seminal books, chapters, and articles for inclusion in the database.
In 1996, the chief of collection development created the HSC Library's first Collection Development Policy Manual, which has received recognition for its quality and comprehensiveness.
The PSC's selection criteria assigned priority to publications that have subject or methodological relevance for broader regional or transcultural communities. At their bimonthly meetings, the committee members review the application of the selection criteria to structured abstracts prepared for books, chapters, and articles during the prior two months. The committee members have the opportunity, in these meetings, to suggest new materials for inclusion and to revise the selection criteria if deemed appropriate. Members of the PSC also take part in the annual and final evaluations of the overall project.
Although social medicine has become a widely respected field of research, teaching, and clinical practice in Latin America, the accomplishments of this field remain little known in the English-speaking world. This gap in knowledge derives partly from the fact that important publications remain not translated from Spanish or Portuguese into English. In addition, the field's development suffers from technical difficulties of publication and distribution within Latin America.
To address these problems, the proposed project is developing an information system that uses innovative database construction techniques and Internet capabilities to assist in the publication, distribution, and storage of key journals and books in this important field. The project builds on prior investigations of Latin American social medicine, supported by the Fulbright Program and the Fogarty International Center of the National Institutes of Health (NIH), that have facilitated a network of educational and research centers in Latin America. This effort also capitalizes on previous National Library of Medicine (NLM)-funded projects at the University of New Mexico (UNM) Health Sciences Center (HSC) Library that have created an infrastructure for information systems and a database structure that will facilitate the work proposed here. Other UNM libraries and academic units that focus on Latin America, social medicine, and public health will make key contributions.
This project devotes attention in particular to a defined range of themes, whose health-related applications have become the emphases of institutes at NIH: social, environmental, and nutritional causes of infant and perinatal mortality (NICHHD); economic development, demographic change, and aging (NIA); socioeconomic barriers to cancer prevention (NCI); determinants of mental illness in race or ethnic background, social class, gender, and social violence (NIMH); and policy research on managed care, primary care innovations, and preventive services (AHCPR). Targeted users in the U.S. and other countries where English is spoken and read include health professionals, specialists in Latin American studies, and professionals in library and information sciences.
The development of this new information system will lead to an important new capability for investigators throughout the United States to access Latin American research in several key arenas that previously have been very difficult to access. In addition, the project will enhance the capabilities of Latin American investigators to disseminate their work in a context that makes continuity of publication and distribution of research findings extremely challenging.
To develop and implement an Internet mechanism access previously published seminal journal articles and books in Latin American social medicine, to be made available in English, Spanish, and Portuguese.
Seminal books. Based on criteria developed with the PSC, the PI and the Project Coordinator (PC) selected a list of twenty-five landmark books that deal with Latin American social medicine. Current ordering information is then produced for each title by the chief of collection development and the Latin American curator, who also determine whether the respective titles are in or out-of-print. The Latin American curator identifies appropriate sources of both in-print and out-of-print titles, selects and maintains correspondence with vendors within the respective Latin American countries, ensures the timely receipt of materials, and otherwise resolves any problems associated with the ordering and acquisition of these materials. Vendors and out-of-print dealers specializing in Latin American or Spanish language books are used as needed. Those books which cannot be purchased will be borrowed on interlibrary loan. Books unavailable through any of these channels, yet needed for the project, will be made available from the personal collections of the PI and PC. The project is initially focusing on twenty-five core titles, with the expectation of adding them to the UNM HSC Library's permanent monographic collection.
The HSC Library will set up separate purchasing accounts and processing records to handle acquisitions for this special collection. Each of the books received is processed and cataloged at the Library; it is expected that the majority will require original cataloging. After processing, the books will be incorporated into the library's collection and checked out to the PC, who writes the structured abstracts in the three languages.
While the books were on order, the PC was trained in writing structured abstracts by the chief of collection development The use of structured abstracts lends a commonality of format and content to each translated abstract, as each will contain the following descriptive elements: objective, design, setting, subjects, intervention, main outcome measures, results and conclusions. When the standards for conventional structured abstracts prove too restrictive (as is the case for certain Latin American social medicine publications), the alternative form of structured abstract used for review articles, and for social science articles, will be employed. In these instances, the following descriptive elements will be used: objective, methodology, results, and conclusions. Alternatively, the standards developed by Hartley may offer other adaptations of the structured abstract. Structured abstracts will facilitate more precise bibliographic retrieval by offering more online access points (MeSH and text words), and will enhance readers' ability to appraise the applicability, importance, and validity of findings.
After reading each book, the PC writes a structured abstract in English, Spanish, and Portuguese. The chief of collection development and the PI then check each abstract for quality, including assessment of structure and clarity. The revised abstracts are entered into the database, at which point additional changes or corrections are made, as necessary. The HSC Library systems unit will transfer each completed abstract to the Internet site created by the project.
Seminal book chapters. Working with the PSC, the PI and PC selected 50 chapters from an additional group of renowned works on Latin American social medicine. The chief of collection development in conjunction with the Latin American curator will utilize the same procedures outlined above to obtain these works.
Each of the relevant chapters will be assigned a unique accession number for inventory and entry into the InnoPac system. The PC will then write a structured abstract of each chapter in English, Spanish, and Portuguese and will input these into the project database. The same procedures used for books, governing their entry into the database and onto the internet site, will also be used for the seminal chapters.
Seminal articles. The PSC, PI and PC identified 100 articles of critical importance that have previously been published, including the correct bibliographic citation for each. The chief of collection development and the Latin American curator are determining the availability of each article.
Articles that are not found locally will be obtained through interlibrary loan, or from the personal collections of the PI and PC. The same procedures used for books and book chapters, controlling their accession into the database and onto the internet site, will be used for the articles.
Contemporary print journal literature. Employing the selection criteria developed by the PSC, articles are also being identified within the contemporary social medicine journal literature. This activity will continue to be carried out in the future. The PSC, PI, and PC have provided needed bibliographic information for a group of core journals that have contributed to the development and articulation of social medicine in Latin America. The chief of collection development and the Latin American curator are verifying the relevant data for each journal and subsequently entering subscriptions. The journals are received directly in the Health Sciences Center Library, where completed volumes are bound and kept.
Titles that have been selected and for which subscriptions have been entered are:
In the original proposal, several journals were included that have now ceased publication:
Published issues of Salud y Cambio and of Salud y Trabajo were sent to the Health Sciences Center Library by the Chilean and Ecuadorian teams, who participate in the project and who also published these journals.
As new issues of the journals are received, they are added to the HSC Library collection and then given to the PC, who creates the structured abstracts of the selected articles in the three languages. It is estimated that three articles per issue from each of the above-listed 15 core journals will need to be represented through structured abstracts. This requires that approximately 175 structured abstracts need to be written annually. Moreover, for each article the translator will need approximately five hours to read, translate, and write a structured abstract in the three languages. The same process will be used, as noted above for books, book chapters, and classic articles, to ensure full quality control on these abstracts up to and through their entry into the database and internet site.
To develop and pilot an ongoing process for electronic publishing on the Web of at least two Latin American social medicine journals in their original languages, with structured abstracts published in English, Spanish and Portuguese.
Because of technical and financial limitations and difficulties in mail distribution within Latin America, the editors of the key social medicine journals face continuing insecurity about the continuity of publication in hard copy form. For this reason, the project will provide an opportunity for publishing through an Internet mechanism. During the second year of the project, training in Internet and desktop publishing for Latin American colleagues will be undertaken. This training process will facilitate the Latin American colleagues' potential ability to enter new publications directly into the UNM Internet site.
The PI, PSC, and PC will identify two core journals, notable for their contributions to the development and articulation of social medicine in Latin America, for publication in electronic form. The UNM team will develop a collaborative agreement with the institutional publishers to participate in this pilot electronic publishing project. Existing copyright statements found in most Latin American social medicine journals currently encourage readers to reproduce the texts of articles from these journals. This pilot publishing activity will include the full-text of the articles, with translations of selected abstracts in the three languages (using selection criteria, processes, and personnel described under Specific Aim 1). A standard Web publishing software application (Microsoft Front Page) will be used to produce the electronic journals, which will be published on the UNM HSC Web server. Based on the length and frequency of issues for these journals, it is anticipated that the preparation and mounting of full-texts can be accomplished within the budgets and timelines projected for UNM and the participating Latin American centers. The journals will be mounted to facilitate access by users with full-fledged Web browsers (which currently are available at all the major social medicine centers and are rapidly becoming available much more widely in Latin America). The full-text versions will be accessible to users via links from the structured abstracts.
Project staff at UNM and the collaborating centers will train institutional publishers in Latin America to use Web software in preparing full-text for publication on the Web (including text, tables, and figures). HSC Library staff responsible for UNM HSC Web site administration will provide general technical oversight of the Web-based publication. Although the full-text journals will be published only in their original languages, the preparation of structured abstracts translated into all three pertinent languages will facilitate the use of the online publications by a much larger group of readers. Operational procedures and training for UNM staff and Latin American partners will include: a) development of policies and procedures for Web-based publishing; b) preparation of manuscripts with html coding appropriate for mounting articles on the Web; and c) transmission of electronic manuscripts to UNM for linking to HSC Web pages.
The PI, PSC, and PC will identify approximately three articles per issue, using the same selection criteria, of the full-text versions of these two online journals for the abstractor/ translator to write structured abstracts in the three languages. It is estimated that this activity will produce 12 structured abstracts per journal, resulting in approximately 24 structured abstracts per year for both on-line full-text journals. The same quality assurance procedures will be used for assessing these online structured abstracts as were used for print counterparts.
To develop and implement a repository for key journals and books for physical or electronic access by researchers working in the same three languages.
As described above, approximately twenty classic Latin American texts will be added to the HSC Library's collection; in addition, abstracts of fifty book chapters and one hundred noteworthy journal articles will be written. Fifteen new journal subscriptions will be added, the sources of articles totaling approximately 175 structured abstracts per year. Access to the contents of these materials will be via the World Wide Web through the HSC home page, or through Oracle or another searchable database, by using searchable keywords, MeSH headings, journal title, volume, number, or by city, country, year, or month of publication.
Journals purchased as part of this project will be housed in the regular journal collection of the HSC Library. The books will be added to the circulating collection, arranged by NLM call number. Each book, book chapter, or seminal article will be assigned a unique accession number, which will appear in a Web or database search. The books, book chapters, seminal articles, journal subscriptions, and structured abstracts will all appear in Innopac, and the contents of the books and journal articles will be searchable through the Web.
The development of operational procedures and the training and supervision of the Latin American teams will be conducted via existing electronic mail communication, and Web-enabled tele-conferencing. Online ordering of materials will be possible, and their delivery facilitated by the document delivery department. Charging mechanisms for affiliated and unaffiliated users already exist, and these same procedures will be followed when users request material from the Latin American collection.
This phase of the project will build upon experience gained from an existing Internet-based communications network linking UNM with more than 50 universities and research centers across Latin America and Spain. UNM was the founding member and continues to house the secretariat of the Ibero-American Science and Technology Education Consortium (ISTEC), whose "Library Linkages" program has helped pioneer rapid document delivery of journal articles, technical reports, conference papers, books, etc. to ISTEC members in Latin America via Ariel (scanning), RandeX, and, increasingly, Web-based systems. During 1997, the Library Linkages initiative delivered 1,478 articles, comprising 15,588 pages, to researchers affiliated with eleven Latin American universities.
Training for the preparation of structured abstracts; quality assurance. The HSC Library chief of collection development was responsible for training the PC in this activity. Such training included a thorough introduction to the purposes and conventions of writing structured abstracts and continued until the PC satisfied quality assurance standards set for the project. These are based upon the previously cited literature on structured abstracts. The completed abstracts will be checked for content accuracy, ease of use by clinicians, and quality and consistency. The efficacy of existing structured abstract conventions for summarizing this type of literature, the consistency of the abstracts across publications, and editorial quality will be continually evaluated during the project.
Throughout this three year project we envision an ongoing dialogue among the project participants to ensure quality and the appropriate adaptability of structured abstract practices to this new application involving the Latin American social medicine literature. This dialogue will enhance the rapid communication of any problems or previously unrecognized opportunities. Adaptation of the structured format conventions will occur as the result of an initial piloting of 20 actual abstracts of Latin American social medicine publications and receiving feedback on the database from members of the PSC. The database also will include posted reminders to users to suggest ways in which the structured abstracts might be improved. The PC will keep detailed records of this ongoing dialogue so that lessons learned can be synthesized for publication at a later date in the appropriate professional literature.
In quality assurance activities, we will continue to apply evolving standards for structured abstracts. We anticipate that the structured abstract conventions designed for clinical medicine in the United States will evolve to describe important aspects of the Latin American social medicine literature. This process will resemble efforts by British researchers to improve upon existing structured abstracts conventions. The existing conventions proposed by the Ad Hoc Working Group for Critical Appraisal of the Medical Literature offer flexibility with their eight standard headings: Objective, Design, Setting, Patients or Participants, Interventions, Main Outcome Measures, Results, and Conclusions. The Ad Hoc Group has offered conventions for structured abstracts to summarize review articles, which provides additional flexibility. The methodological terms created by the Ad Hoc Group also lend a great deal of flexibility. These conventions modify and expand upon the ANSI standards.
Evaluation of the project will take place at several stages and will incorporate various types of evaluation. A formal evaluation process will be identified, conducted, and reported annually. In addition, a summative evaluation component is included in the project design. A detailed evaluation plan, including identification of outcomes and methods of measuring them, will be the responsibility of the evaluation team, comprised of the chief of collection development (serving as evaluation coordinator), the PI, the co-PI, the Latin American curator, and a representative from the Latin American partners.
Feedback from users will be incorporated into the evaluation design. A user study will guide the development of retrieval mechanisms that are anticipated to be most helpful for the users of the databases. This study will aid in determining users’ information needs and searching requirements and will serve as a basis for continuing evaluation.
Evaluation by users of the created products will be conducted in several ways. As an example, actual database use statistics will be possible through "counters" on the project's Web pages. An online user form will be created to solicit feedback on the usefulness of the products created by the project and to solicit suggestions for improvement.
An evaluation by project partners will recognize their diversity, both geographical and disciplinary. This part of the evaluation offers an opportunity to assess the project's management itself. Monthly assessments (e.g., of project communication and training; maintenance of project schedule) will be incorporated into routine monthly reports to the PI. Desktop conferencing and e-mail mechanisms will be used to support ongoing evaluation by project partners.
Members of the PSC will also be asked to take part in the project's annual and final evaluations. This phase of the evaluation will focus on committee members' views of the UNM team's success in choosing representative seminal books, chapters, and articles, based on the committee's specified selection criteria.
Evaluation components are also incorporated into the various design stages of the project. As an example, suggestions from the PSC will be used to create and evaluate format conventions for structured abstracts. The summative evaluation will include pre- and post-project surveys of the potential and actual audience for the project’s products. Dr. Buchanan will work with Dr. Eldredge to design and test this summative instrument. It is anticipated that a questionnaire designed around the concept of gap analysis and measuring key service attributes (e.g., tangible product, reliability, responsiveness, access, communication, and credibility) will be used.
The evaluation process will include collecting use data on which journal titles are most frequently searched via the structured abstracts. Web tracking software also will help identify frequently searched subjects via the structured abstracts. The chief of collection development will analyze these data as part of the evaluation process. He will report any frequently used journal titles or subjects to the National Library of Medicine’s Literature Selection Technical Review Committee (LSTRC). Providing this analyzed project evaluation information will alert the LSTRC to the potential value of indexing these Latin American social medicine journals and the potential value of tracking these popular subjects.
Given the development of a successful product, the project team believes there is high likelihood for sustaining the project beyond the grant period through various sources of funding. To assess the financial and operational viability of ongoing production, Dr. Waitzkin will work with the Latin American partners to determine their ability to migrate from current publishing practices to electronic publishing.
A business plan will be prepared to assess the viability of various funding sources to sustain an ongoing product. Funding sources that have the potential for sustaining continued development of the resources and database include the following: a) Professional societies whose members benefit from the project will underwrite abstracting and publishing costs (this option will be pursued by the PI and Co-PI). b) Fees will be charged for database access. c) Fee-for-service document delivery will be incorporated into existing HSC Library services.
At a minimum, resources collected during the project period will be retained by the UNM HSC Library, according to its collection retention policies. The project database will be maintained and available online via the Web for five years. The UNM Division of Community Medicine will commit itself to continued support of the repository by underwriting, through clinically generated revenue, the Library’s purchase of key journal subscriptions and books. In addition, the above-mentioned "Library Linkages" program, linking UNM with more than 50 universities and research centers across Latin America and Spain, will be used for rapid document delivery via the Internet.
This policy articulates the selection criteria for classic and contemporary materials to be summarized through structured abstracts in English, Spanish, and Portuguese to be posted on the project website. The selection criteria for these materials generally indicates that any particular posted item has relevance for social medicine researchers and practitioners beyond any specific historical phase or geographic area described by the classic or contemporary publication.
General subjects covered by this project include but are not limited to the following areas:
Specific subjects covered by this project include but are not limited to the following areas:
Classic materials will be selected if they fulfill the aforementioned global criteria described under the "purpose" section and the subject scope guidelines, plus one or more of the following criteria:
Contemporary LASM materials will be selected if they fulfill the aforementioned global criteria plus all of the following criteria (Prerequisites):
Other factors to consider: