Flagship and Research

• Surasak Taneepanichskul MD. MPH.FRTCOG. LLB.

• Dean College of Public Health Sciences

• Chulalongkorn University

Two Flagships of DDC

• 1. Public Health Emergency Management

• 2. Behavioral Change Intervention Development

“Well begun is half done" --Aristotle,

quoting an old proverb

Where do research questions come from?

• One of the most common sources of research ideas is the experience of practical problems in the field.

• Many researchers are directly engaged in social, health or human service program implementation and come up with their ideas based on what they see happening around them.

• Other source for research ideas is the literature in your specific field.

• Many researchers get ideas for research by reading the literature and thinking of ways to extend or refine previous research.

• Another type of literature that acts as a source of good research ideas is the Requests For Proposals (RFPs) that are published by government agencies and some companies.

• These RFPs describe some problem that the agency would like researchers to address -- they are virtually handing the researcher an idea.

• Many researchers simply think up their research topic on their own.

• The ideas you come up with on your own are influenced by your background, culture, education and experiences.

Process of Discovery Research Questions

• Plausible: interesting idea

• Important: is it worthy of further consideration ?

• Acceptable: do we have a testable theory, can we create an hypothesis for experimental confrontation?

• Justifiable: amenable to evaluation, defense, confirmation ?

• Asking Questions

• Asking questions + systematic process to obtain valid answers.

• Make the question clear

• Hypothesis should be consistent with questions

• Statement of the problem

• Types of Questions

• Description

• Relationships

• Descriptive-Comparative

• Causality

• Causality-Comparative

The Literature Review

• One of the most important early steps in a research project is the conducting of the literature review.

• This is also one of the most humbling experiences you're likely to have.

• Some tips about conducting the literature review.

• First, concentrate your efforts on the scientific literature.

• Try to determine what the most credible research journals are in your topical area and start with those.

• Put the greatest emphasis on research journals that use a blind review system.

• Second, do the review early in the research process.

• You are likely to learn a lot in the literature review that will help you in making the tradeoffs you'll need to face.

• After all, previous researchers also had to face tradeoff decisions.

• What should you look for in the literature review?

• First, you might be able to find a study that is quite similar to the one you are thinking of doing.

• Since all credible research studies have to review the literature themselves, you can check their literature review to get a quick-start on your own.

• Second, prior research will help assure that you include all of the major relevant constructs in your study.

• You may find that other similar studies routinely look at an outcome that you might not have included.

• If you did your study without that construct, it would not be judged credible if it ignored a major construct.

• Third, the literature review will help you to find and select appropriate measurement instruments.

• You will readily see what measurement instruments researchers use themselves in contexts similar to yours.

• Finally, the literature review will help you to anticipate common problems in your research context.

• You can use the prior experiences of other to avoid common traps and pitfalls.

The feasibility of the study• Very soon after you get a research

question for a study, reality begins to kick in and you begin to think about whether the study is feasible at all.

• There are several major considerations that come into concentration.

• Many of these involve making tradeoffs between rigor and practicality

Typical Process in Research

Design

study

Generate hypotheses

Develop tentative new

theories

Analyze & interpret

findings

Collect information

Purpose

• What is main purpose of research? Ask questions and find answers!

• Have you ever conducted a study and not been able to reach conclusions about the results?

• Did you plan...

Goals of Study Design

• To formulate research question, choose specimens, plan measurements, plan analysis

• Maximize ability to infer from findings in study to truth in world

Drawing Conclusions

• Internal validity: Validity of conclusions drawn within study as based on actual finding

Generalizing

• External validity: Validity of inferences drawn from study to world outside study

(also called Generalization)

Consideration of validity in design

• Maximizing validity should be considered in all parts of study design, implementation, and analysis

• Be a skeptic; look for and minimize sources of error

Steps in Study Design

• Formulate research question

• Identify subjects/specimens and plan technique for obtaining them

• Identify variables and plan measurements

• Formulate testable hypothesis and plan statistical approach

Observation/Experiment

• Observational study: Investigator observes uncontrolled events, measures variables without altering them

• Experimental study: Investigator controls an intervention or imposes a treatment

Selecting Subjects orSpecimens

• Define broad, target set of interest and decide on experimental units

• Goal: To be able to extend findings in specific study specimens to associations in a population; to find a representative test group

Choosing Study Subjects: BasicConcepts

• Population: Complete set of subjects or measurements with specified set of characteristics

• Sample: Subset of population

• Subject or experimental unit: Object upon which measurements are made

Identifying Variables andPlanning Measurements

• Define phenomena of interest, identify actual variables, and plan measurements of those variables

• Goals: To pick variables that represent phenomena of interest and to measure those variables with accuracy and precision

Formulating Hypothesis

• Hypothesis: Tentative statement that can be tested or investigated. Often involves explanation of phenomenon and states idea about cause and effect explicitly

• Goals: Immediate: To establish strategy for analysis Long-term: To be able to draw conclusions at

end of study that actually answer research question

Research Hypothesis

• Formulate practical version of research question - research hypothesis

• Base it on research question, intended experimental units, and variables of study

Broad ResearchQuestion

Independent

Variables

Experimental units

Dependent

Variables

Established Established Study designStudy design Descriptive Descriptive studystudy Cross-Sectional Cross-Sectional studystudy Case-Control Case-Control studystudy Cohort studyCohort study Experimental Experimental studystudy Clinical studyClinical study Etc.Etc.

Clinical Study Types• Experimental Studies

– Randomized Control Trials (RCT)

– Randomized Cross-Over Trial

• Observational Studies– Cohort (Incidence, Longitudinal)

– Case-Control

– Cross-Sectional (Prevalence)

– Case Series

– Case Report

Establish backgroun

dSelect topic

Formulate problemReview

literatureFormulate hypothesis

Design studyWrite

proposalCollect data

Ready for problem?

Ready for hypothesis?

Is design feasible?

Problems found?

No

yes

No

yesNo

yes

No

yes

First Flagships of DDC

1. Public Health Emergency Management

• Public Health Emergency Management

would concerned about public safety and public health

• Our people are threatened or injured and damaged communities

Second Flagships of DDC

2. Behavioral Change Intervention Development

YOUNG CHILDREN AND OLDER PEOPLE PROJECTED INCREASE IN GLOBAL POPULATION

AS A PERCENTAGE OF GLOBAL POPULATION BETWEEN 2005 and 2030, BY AGE

United Nation Department of Economic and Social Affairs, Population Division.World Population Prospects. The 2004Revision. New York: United Nations, 2005 in Why Population Aging Matters: A Global Perspective at www.nia.nih.gov/ResearchInformation/ExtramuralPrograms/BehavioralAndSocialResearch/GlobalAging.htm

Shift from Acute to Chronic Conditions

Health Disparities

Emerging and Re-emerging Infectious Diseases

Aging Population

Emerging Non-communicable Diseases - Obesity

Evolving Public Health Challenges

Measured Obesity among People age 65+

0

5

10

15

20

25

30

35

1988-1994 1999-2002

Male Female

Source: National Health and Nutrition Examination Survey, selected years

Perc

ent

Science of Behavior Change:A Roadmap Pilot Proposal

National Institute on AgingNational Institute on Alcohol Abuse and Alcoholism

National Institute on Drug AbuseNational Institute of Mental Health

National Institute of Nursing Research

Behavior Change is Powerful

A 7% weight reduction and 2.5 hour per week activity increase led to a 58% reduction in the cumulative incidence of Type 2 diabetes in older insulin-resistant individuals (Diabetes Prevention Program Research Group, 2002).

Age Effects on Behavior Change Intervention

0

3

6

9

12

15

25-44(n=1000)

45-59(n=1586)

> 60 (n=648)

Case

s/10

0 pe

rson

-yr

Lifestyle Metformin Placebo

Source: Diabetes Prevention Program, 2001

Examples of Social and Behavioral

Research Translation

• Exercise Guide for Older People

• Resources for Enhancing Alzheimer’s Caregiver Health (REACH II)

• Visual Field Assessment and Training for Older Drivers

• Falls Prevention in Older People

NIA Research-based Exercise Guide

NIA-Funded Research on Identification of High-Risk Older Drivers

“Useful Field of View” is a good predictor of accident risk

Ball K.K., Roenker D, Wadley V.G., Edwards J.D., et al. (2006). Can high-risk older drivers be identified through performance-based measures in a department of motor vehicle setting? Journal of the American Geriatrics Society. 54:77-84.

Administration on AgingEvidence –Based Disease Prevention

Tinetti et al. (1994) was used to design falls prevention protocols for testing through AoA community demonstration grants (2003-2006)

• Risk factors were identified and modified through interventions that included:

• Adjusting medication• Exercise• Changing behaviors

Yale Frailty and Injuries: Cooperative Studies of

Intervention Trials Results

0

10

20

30

40

50

0 3 6 9 12

Months

% Falling

Control

InterventMoi

P = .04

Tinetti et al 1994 NEJM

Step by Step Program: Introducing Evidence-Based Fall Prevention Programming in Senior

Centers

• Incorporate a sustainable, evidence-based fall prevention program within the daily operation of Hartford area Senior Centers.

• Evidence Base:– Yale Frailty and Injuries: Cooperative Studies of

Intervention Trials (FICSIT) randomized trial

– Yale FICSIT demonstrated that a multifactorial intervention reduced the risk of falling among older adults living at home

• Tinetti, et al. NEJM 1994;331:821-827Courtesy of Dr. Richard Fortinsk

Center on Aging University of Connecticut Health Center

Behavioral and Social Research Program

• Demography of Health & Aging • Cognitive Science and Interventions• Health and Retirement Economics• Alzheimer’s Disease Services/Caregiving • Health Behaviors• Minority Aging

Geriatrics and Clinical Gerontology Program

• Older Americans Independence Centers (Pepper Centers) – Frailty Prevention

• Menopause• Osteoporosis• Musculoskeletal Disorders• Cardiovascular Disorders• Cancer and Aging

Emergence of Transdisciplinary Science

Neuroscience

BehavioralScience

Economics

Policy

Behavior Change

Genetics

Relevant science is rapidly emerging but is not optimally focused on Behavior Change.

Behavior

GeneticsBehavioralEconomics

NeuroeconomicsCognitiv

e/Affective

Neuroscience

General Pilot Research Program 2003-2009

Supplements supported from the “Translational Research for New Intervention in Aging

Conditions” initiative in FY 2008

Grant Number Principal Investigator Project Title3R01AG028082-01A2S1 GOLDSTEIN, DANIEL Mechanisms to augment primary immunity in aging

3P01AG010836-14S1 LANDFIELD, PHILIPCalcium Regulation in Brain Aging & Alzheimer's Disease

3R01AG024526-03S1 CARTER, CHRISTYACE Inhibition and Physical Performance in Aged Rats

3R37AG012712-12S1 MCCAFFREY, TIMOTHY TGF-BETA 1 Receptors in Restenosis and Aging

3R01AG026006-03S1 ZAUTRA, ALEXResilience and Health in Communities and Individuals.

3R01AG023410-05S1 MARTINSON, BRIANMaintaining Physical Activity in Older Adult MCO Members

3R01AG025016-04S1 GURTNER, GEOFFREYImpaired Stem Cell Trafficking in Complications of Aging

3R37AG007137-18S2 MCARDLE, JOHNAssessing and Improving Cognitive Measures in the HRS

3P01AG025204-03S1 DEKOSKY, STEVENIn VivoPIB PET Amyloid Imaging: Normals, MCI & Dementia

Thank you for your attention