The Latin American Social Medicine Database: a resource for epidemiology
1 Departments of Sociology, Family & Community Medicine, and Internal Medicine, University of New Mexico, MSC 05 3080, Albuquerque, NM 87131-0001, USA.
2 Department of Family & Community Medicine, MSC09 5040, 1 University of New Mexico, Albuquerque, NM 87131-0001 USA.
3 Health Sciences Library and Informatics Center, MSC09 5100, 1 University of New Mexico, Albuquerque, NM 87131-0001 USA.
4 Department of Public Health, Health Sciences Center, University of Guadalajara, Apartado Postal 1-2044, Guadalajara, Mexico.
* Corresponding author: University of New Mexico, MSC 05 3080, 1070 Social Sciences Building, 1915 Roma NE, Room 1103, Albuquerque, NM 87131-0001 USA. E-mail: waitzkin{at}unm.edu
Accepted 17 June 2008
Latin American social medicine (LASM) has become a widely respected and influential field of research, teaching and clinical practice, yet its accomplishments remain little known in the English-speaking and -reading world.1–3 Important publications have not been translated from Spanish and Portuguese into English, and the majority of LASM journals are not indexed in MEDLINE or similar bibliographic databases. The field's development also suffers from technical difficulties of publication and distribution within Latin America.
In LASM, a perspective emphasizing the social origins of illness and early death has focused on sources of these problems in relations of economic and political power. This orientation has contributed to the analysis of inequity in health and to alternative proposals for change. For instance, LASM analyses critically some of the dominant reform strategies in public health systems, offers proposals for alternative health policies and fosters research on the micro- and macro-political processes that affect health and health services. Likewise, LASM focuses on economic production in studies of the labour conditions that affect workers’ health. LASM uses theories and methods that distinguish its efforts from those of public health. In particular, LASM emphasizes the social and historical context of health problems, social determinants and the linkages between research and the development of responsive political ‘praxis’. In these ways, LASM offers innovative approaches to some of the most important problems of our age.
Some Latin American medical and public health literature is indexed in Literatura Latinoamericana y del Caribe en Ciencias de Salud (LILACS, Latin American and Caribbean Literature in Health Sciences), an Internet-accessible database maintained by the Latin American regional library of medicine in Brazil, Biblioteca Regional de Medicina (BIREME, Regional Library of Medicine). Although the LILACS database, supported by the Pan American Health Organization (PAHO), has improved access to the Latin American biomedical and public health literature, several features limit this database's applicability to LASM. As examples, the LILACS database covers only about half of the key journals in LASM, does not include an abstract unless it appeared in the original publication, and usually does not provide translation of Spanish or Portuguese abstracts into English.
This project's overall objective is to develop and implement an Internet-based information system to maximize access to LASM literature and to facilitate continuing publication and distribution efforts in this important field. We have constructed the system to target investigators, educators, clinical practitioners, public health professionals, historians, social scientists, specialists in Latin American studies and professionals in library and information science. In particular, we have aimed to improve access to LASM for epidemiologists who focus on the social determinants of health outcomes. Although we have reported preliminary work on these efforts,4–7 this article provides an overview of the project as a whole and clarifies its relevance for epidemiology.
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Key activities and features of the information system |
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Phases
The effort to initiate the LASM database has spanned two phases. Phase I, which took place at the University of New Mexico (UNM) Health Sciences Library and Information Center (HSLIC), was funded by the National Library of Medicine (NLM) of the U. S. National Institutes of Health (NIH) from February 2000 through January 2004. Phase II of the project started in October 2005 as a collaboration between UNM and the Health Sciences Center (Centro Universitario de Ciencias de la Salud—CUCS) of the University of Guadalajara (Universidad de Guadalajara) in Mexico. Phase II is partially funded by the United States Department of Education. In addition, the Mexican team has received support from the Pan American Health Organization.
In general, the database has grown by 50 structured abstracts in the three languages each year. The team in Guadalajara is responsible for selecting, writing and posting the abstracts to the database. The team in New Mexico participates in training the Guadalajara team, collaborating with quality control, administrating the website and publishing abstracts. Both teams have collaborated in design and evaluation.
Emphases
Partly due to the funding sources, the project devotes attention in particular to the following themes in LASM, which are emphases of the NIH: social, environmental and nutritional causes of infant and perinatal mortality; economic development, demographic change and ageing; 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.
Work process
As articles and books are obtained from Latin American publishers, a structured abstract is created for each source. Structured abstracts facilitate more precise bibliographic retrieval by offering more online access points (MeSH and text words) and enhance readers’ ability to appraise quickly and more accurately the applicability, importance and validity of findings.8,9 After extensive quality checks, the translated abstracts are entered into a database at the UNM HSLIC or the University of Guadalajara Health Sciences Center. Abstracts then are posted on the website (http://hsc.unm.edu/lasm). The website also provides links to other resources in social medicine.
We have worked with a Peer Selection Committee (PSC) to compile a list of approximately 25 landmark books in LASM; 50 book chapters from other esteemed Latin American works; and 100 key journal articles. These works covered the history of social medicine, national and international groups working in social medicine, health policy analysis, labour and environmental health, social class and health outcomes, gender issues, social epidemiology, mental health and educational reform. To facilitate communication with members of the PSC and other project partners, the investigators have held Internet-based conferences at least twice annually. In addition to the University of Guadalajara, investigators at four Latin American centres assisted in various components 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).
Format of abstracts and search capacity
The use of structured abstracts lends a commonality of format and content to each translated abstract. When appropriate, each abstract contains the following descriptive elements: objective, design, setting, subjects, intervention, main outcome measures, results and conclusions. In developing standards for the structured abstract, the team has considered the recommendations of major journals in the medical and public health literature. When the standards for conventional structured abstracts prove too restrictive (as is the case for certain LASM publications that undertake theoretical or policy analyses), an alternative format of structured abstract used for review articles and for social science articles is employed. In these instances, the following descriptive elements are used: objective, methodology, results and conclusions. Structured abstracts facilitate more precise bibliographic retrieval by offering more online access points (MeSH and text words) and enhance readers’ ability to appraise quickly and more accurately the applicability, importance and validity of findings.
The LASM website was designed to permit systematic searching of the trilingual abstracts through standard techniques. In searching the abstracts, investigators may use keywords, MeSH headings, journal title, volume and place or date of publication.
Online publishing of LASM journals
To develop and pilot an ongoing process for electronic publishing on the web, the PSC identified two LASM journals, to be published in their original languages, accompanied by structured abstracts in English, Spanish and Portuguese. In this pilot electronic publishing project, the UNM team developed a collaborative agreement with the institutional publishers of the two selected journals. The publishing activity included full-text of all articles from these journals, with translations of selected abstracts in the three languages. Although the full-text journals were published only in their original languages, the preparation of structured abstracts translated into all three pertinent languages facilitates the use of the online publications by a much larger group of readers. Standard web publishing software was used to produce the electronic journals, which were published on the LASM website.
Repository for LASM journals and books
The project also has developed and implemented a repository for key journals and books for physical or electronic access by researchers working in the same three languages. Approximately 20 classic Latin American texts have been added to the HSLIC's collection. Fifteen new journal subscriptions were added. Journals purchased as part of this project have been housed in HSLIC's regular journal collection. The books have been added to the circulating collection, arranged by NLM call number. As part of HSLIC's electronically accessible catalogue, the books, book chapters, seminal articles, journal subscriptions and structured abstracts are searchable through the Internet.
Evaluation
The project has incorporated several approaches to evaluation. For phase I, a formal evaluation process has been conducted annually, and a similar evaluation is planned for phase II. Feedback from users was incorporated into the evaluation design. A user study has guided the development and refinement of retrieval mechanisms most helpful for users of the databases. Users’ information needs and searching requirements have led to improvements in the database and website. Database use statistics have been generated through counters on the project's website.
Members of the PSC have taken part in the project's annual evaluations. This phase of the evaluation has focused on committee members’ views of the team's success in choosing representative seminal books, chapters and articles, based on the committee's specified selection criteria.
A summative evaluation for Phase I included pre- and post-project surveys of the potential and actual audience for the project's products. A questionnaire employed gap analysis and measured key service attributes (e.g. tangible product, reliability, responsiveness, access, communication and credibility).
The evaluation process also has included collecting use data on journal titles that are most frequently searched via the structured abstracts. Web tracking software has identified frequently searched subjects via the structured abstracts. The team has reported frequently used journal titles or subjects to NLM's Literature Selection Technical Review Committee (LSTRC). Providing this information has assisted the LSTRC in assessing the potential value of indexing the LASM journals.
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Specific accomplishments |
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TopKey activities and features...Specific accomplishmentsDiscussionAcknowledgementsReferences |
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Trilingual structured abstracts
The LASM website contains approximately 360 structured abstracts of classical and contemporary books, chapters and articles. All abstracts are available in English, Spanish and Portuguese. They are fully searchable through standard techniques. Table 1 presents the scope of the abstracts’ coverage.
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Journals abstracted
The project regularly has produced abstracts from articles in 12 LASM journals (Table 2). So far, NLM has indexed two of these journals.
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Online publishing of LASM journals
The two journals selected for publication in electronic form, Saúde em Debate (Health in Debate, Brazil) and Boletín SaluCO (Bulletin of Collective Health, a publication of the Cuban Network of Gender and Collective Health, Cuba), are notable for their contributions to LASM. One of these journals (Boletín SaluCO) subsequently has developed its own independent electronic publication procedures.
Evaluation
Assessment of the project and the working relationships of the team members revealed substantial accomplishments, as well as certain challenges (Table 3).
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Discussion |
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The LASM database provides Spanish, Portuguese and English structured abstracts summarizing classic and contemporary works in LASM. A website offers access to the abstracts in a searchable format. The LASM literature available through these resources provides important information about the social, economic and cultural determinants of health, and the organized responses to confront the problems. Such information can become increasingly helpful in the field of epidemiology. Originally, this information circulated mostly within professional networks and among other health and community workers located in Latin America. Through the LASM website, we expect to enhance access to this information within Latin America and other regions worldwide.
This effort has led to several substantial outcomes. The database and website have created access to a largely unknown literature that addresses problems relevant to current medicine, public health and epidemiology and health care delivery. This work has expanded the knowledge base about the mechanics and efficacy of structured abstracts as a means for accessing pertinent medical literature. The project has provided models for librarian-health care provider collaboration and new roles for health sciences librarians. Finally, we have communicated important lessons about the challenges of such collaborative, interdisciplinary work.
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Acknowledgements |
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Phase I of the project was funded by the National Library of Medicine of the U. S. National Institutes of Health (Grant Number 1 G08 LM06688 01A1) through the University of New Mexico in the United States from February 2000 through January 2004. Phase II is partially funded by the United States Department of Education, Title VI, through a research program ‘Technological Innovation and Cooperation for Foreign Information Access’ (TICFIA), managed by the Latin American and Iberian Institute (LAII) of the University of New Mexico (Grant # P337A050005). The Mexican team received support from the Pan American Health Organization during the first months of the second phase, and both teams have obtained financial and logistic support from the UNM Health Sciences Center and the Health Sciences Center of the University of Guadalajara. Luis Eduardo Hernández Ibarra, Elizabeth C. Alcántara Hernández and Margaret Schroeder have participated in the Guadalajara team. We thank our colleagues in LASM for their inspiring and dedicated efforts. In recognition of his remarkable contributions to LASM, we dedicate this article to the memory of Edmundo Granda.
Conflict of interest: None declared.
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References |
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