Maintaining Internal Validity in Community Partnered Participatory Research: Experience from the Community Partners in Care Study

Objective

With internal validity being a central goal of designed experiments, we seek to elucidate how community partnered participatory research (CPPR) impacts the internal validity of public health comparative-effectiveness research.

Methods

Community Partners in Care (CPIC), a study comparing a community-coalition intervention to direct technical assistance for disseminating depression care to vulnerable populations, is used to illustrate design choices developed with attention to core CPPR principles. The study-design process is reviewed retrospectively and evaluated based on the resulting covariate balance across intervention arms and on broader peer-review assessments. Contributions of the CPIC Council and the study's design committee are highlighted.

Results

CPPR principles contributed to building consensus around the use of randomization, creating a sampling frame, specifying geographic boundaries delimiting the scope of the investigation, grouping similar programs into pairs or other small blocks of units, collaboratively choosing random-number-generator seeds to determine randomized intervention assignments, and addressing logistical constraints in field operations. Study protocols yielded samples that were well-balanced on background characteristics across intervention arms. CPIC has been recognized for scientific merit, has drawn attention from policymakers, and has fueled ongoing research collaborations.

Conclusions

Creative and collaborative fulfillment of CPPR principles reinforced the internal validity of CPIC, strengthening the study's scientific rigor by engaging complementary areas of knowledge and expertise among members of the investigative team.

Senecio scandens Buch.-Ham.: a review on its ethnopharmacology, phytochemistry, pharmacology, and toxicity

ETHNOPHARMACOLOGICAL RELEVANCE

The aerial parts of Senecio scandens Buch.-Ham. (family Asteraceae) have a long history in traditional Chinese medicine as a treatment for various ailments, such as bacterial diarrhea, enteritis, conjunctivitis, and respiratory tract infections.

MATERIALS AND METHODS

A bibliographic investigation of Senecio scandens was accomplished by analyzing secondary sources, including the Chinese Medicinal plantal Classics, the Internet (Google Scholar and Baidu Scholar), and scientific databases accepted worldwide (Pubmed, Scopus, Web of Science, SciFinder, and CNKI). These sources were scrutinized for available information about the uses of Senecio scandens in traditional Chinese medicine, phytochemistry, pharmacology, and toxicology.

RESULTS

Senecio scandens is a medicinal plant with a climbing woody stem. Phytochemical studies have shown the presence of numerous valuable compounds, such as flavonoids, alkaloids, phenolic acids, terpenes, volatile oils, carotenoids, and trace elements. Among them, PAs are the characteristic constituents, adonifoline is one of the index ingredients of Senecio scandens. Studies in modern pharmacology have demonstrated that extracts and compounds isolated from Senecio scandens show a wide spectrum of pharmacological activities, including anti-inflammatory, antimicrobial, anti-leptospirosis, hepatoprotective, anti-infusorial, antioxidant, antiviral, antitumoral, analgesic, mutagenic, and toxicological activities.

CONCLUSIONS

Phytochemical and pharmacological studies have demonstrated that the extracts of the plant possess various pharmacological activities that can be attributed to the presence of various flavonoids, phenolic acids, and alkaloids. Newer technologies for qualitative and quantitative methods of PAs need to be developed to obtain better accuracy and sensitivity. Due to the toxicity of PAs present in this medicinal plant, the regulations on PAs of Senecio scandens were varied among different countries and regions. In China, the PAs toxicity of Senecio scandens ranking criteria is not well defined in the Chinese Pharmacopoeia 2010, and there is no strict uniform requirement on the PAs in western countries. We propose that the use of Senecio scandens should be reevaluated based on a set of criteria, which includes risk-benefit analysis and severity of the toxic effects, clinical and preclinical data to ensure safe use while continuing to satisfy the need for access to the medicinal plant.