Digital Information for Latin American Social Medicine: A Case Study

Holly Shipp Buchanan, MLn, MBA, EdD

Howard Waitzkin, MD, PhD

Jonathan Eldredge, MLS, PhD

Russ Davidson, MSLS, PhD

Celia Iriart, PhD


A multi-institutional collaborative project is described. The aim of the project is to improve access to information on Latin American Social Medicine. The use of the Internet to improve access rather than continue to create barriers to access will be explored. The utility of a digital library of structured abstracts in such initiatives will be demonstrated.

According to José-Marie Griffiths (1998), the Web has become a "bewitching attraction" because it "makes rare resources available anywhere." However, she laments that these very benefits are compromised since the information is not comprehensive, there is an absence of standards and validation, little cataloging and thus minimal structure or organization is apparent, and effective retrieval is limited. This chapter will describe a recently initiated multi-institutional collaborative project to improve access to information on Latin American Social Medicine and will discuss how the use of the Internet will improve access rather than continue to create barriers to access as identified by Griffiths.

The University of New Mexico Health Sciences Center (UNM HSC) was awarded a three-year grant in 2000 by the U.S. National Library of Medicine to develop and implement an Internet-based information system to maximize access to Latin American social medicine literature. A further aim was to facilitate continuing publication and distribution efforts in this field. Social medicine in Latin America is based on belief systems of indigenous cultures as well as on scientific investigations by such early European researchers as Virchow that link social conditions and public policy to patterns of illness and death (Waitzkin, 2000).

The project was undertaken for several important reasons. While social medicine in Latin America has become a widely respected and influential field of research, teaching, and clinical practice, its accomplishments remain little known in the English-speaking and -reading world. (Waitzkin, Iriart, Estrada, and Lamadrid, in press). Contributing factors for this situation are that important publications have not been translated into English and the field's development has been hampered by technical difficulties of publishing and distributing health sciences scholarly communication within Latin America. The investigators recognize that overcoming these barriers provides an opportunity to convert to digital information and offer a platform upon which Latin American medical societies eventually could transition to electronic publishing.

The project will address both of these barriers of language and distribution. In addition, the work will build upon an earlier project based in Chile, funded by the Fulbright Program for the International Exchange of Scholars and by the Fogarty International Center of the National Institutes of Health. That effort used qualitative research methodology to examine the major theoretical approaches and methodological techniques of Latin American social medicine and its impact on research, medical practice, and public health. This new project has been undertaken by the UNM investigators for several key reasons. First, Howard Waitzkin, the principal investigator for the project and the director of the UNM School of Medicine's Division of Community Medicine, holds a long-term interest in research and service concerning U.S. and Latin American public health policy (Iriart, Merhy, and Waitzkin, in press; Waitzkin, in press; Waitzkin and Iriart, 2000; Waitzkin, 2000; Stocker, Waitzkin, and Iriart, 1999).

In addition, UNM has an institutional priority to serve as a "University for the Americas" that encourages collaborative projects with universities and government research centers in Latin America. UNM demonstrates this commitment primarily through its Latin American & Iberian Institute (LAII). The LAII, a federally-funded National Resource Center for Foreign Language and Area Studies, administers UNM's interdisciplinary programs in Latin American studies and provides university-wide support for a wide spectrum of Latin American and Iberian initiatives in all of UNM's eleven schools and colleges. Other UNM programs, not under the umbrella of the LAII involve collaboration with Latin American partners. Finally, the UNM HSC Library (HSCL) is one of only two libraries in the U.S. (the other being the Benson Latin American Library at the University of Texas) which attempt to collect materials in the field of social medicine. The HSCL has undertaken similar technology projects to serve the health information needs of special populations (Buchanan, Morris, and Kauley, 1999).

Project partners include faculty in the:

UNM School of Medicine; UNM Health Sciences Center Library; UNM General Library; the University of Buenos Aires (Argentina); the University of Campinas School of Medicine (Brazil); the Group for Research and Training in Social Medicine (Chile); and the Center for Research and Consulting in Health (Ecuador).

The project has three objectives. One, the authors plan to develop and implement an Internet mechanism of structured abstracts to access previously published seminal journal articles and books in Latin American social medicine and make the abstracts available in English, Spanish, and Portuguese. Two, we hope 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. Three, the authors will develop and implement a repository for key journals and books for physical or electronic access by researchers working in the same three languages.

The authors believe the project will have several significant outcomes. It will create access to a mostly unknown medical literature that addresses problems relevant to current U.S. medicine, public health, and health care delivery; expand the knowledge base on the mechanics and efficacy of structured abstracts as a means for accessing pertinent medical literature; provide models for librarian and health care provider collaboration; and explore expanded roles for health sciences librarians. In addition, the investigators will communicate lessons learned from these experiences, which will provide useful information to others considering similar collaborative projects involving these forms of technology.

To date, the authors have established a Peer Selection Committee (PSC) comprised of experts in social medicine from a number of Latin American countries. The PSC has reviewed the books and journals selected by project staff to serve as the most appropriate sources of publications to be summarized by the project. Monographs and journals reviewed favorably by the PSC already have been ordered for the HSCL collection.

A format appropriate for both the medical and social sciences literature has been developed to summarize articles, book chapters, and monographs selected for inclusion in the database. The project uses an innovative technique for establishing a quick assessment of the relevance and validity of the summarized publications, the so-called "structured abstract" (see Appendix 1 for an example). Structured abstracts were first proposed in 1987 by the Ad Hoc Working Group for Critical appraisal of the Medical Literature as a means to "assist clinical readers to select appropriate articles more quickly, allow more precise computerized literature searches, and facilitate peer review before publication." Over the past decade, leading U.S. health sciences journals such as JAMA; Journal of the American Medical Association and The New England Journal of Medicine have adopted the structured abstract format for original research articles. Various researchers have documented the value of structured abstracts to readers as well as to indexing/retrieval processes. (Harbourt, Knecht, and Humphreys, 1995; Haynes, Mulrow, Huth, Altman, and Gardner, 1990; McIntosh, 1994; Pitkin, Branagan, and Burmeister, 1999).

The literature of Latin American social medicine crosses disciplinary boundaries into the behavioral and social sciences, where examples of the structured abstract format are less commonly found. Experiments conducted in the United Kingdom, however, have demonstrated the superior readability and desirability of structured abstracts for summarizing articles in the social and behavior sciences. (Hartley, 1997, 1998) One article in Social Science Quarterly by Rudel and Gerson (1999) provided a model for this project. Based on a report from Booth and O'Rouke (1997) that structured abstracts improve the precision in retrieving relevant articles from databases, the authors believe that the inclusion of this type of abstract will enhance search retrieval from the Latin American social medicine database. The information technology components will be discussed in more depth below.

Project evaluation is an important component of the project. It will take place at several stages and will incorporate various forms of evaluation. In addition, the authors recognize that sustainability of the project after the initial granted funding period is vital. Griffin (2000, p.5) has stated that it is the "demand for high quality content and ease of access and use that will drive the funding and development of digital libraries." Therefore, the evaluation will include use statistics, an online (or web) user form to solicit user feedback, and pre-and post- surveys of potential and actual audiences for the project's products to analyze and measure aspects of services that users find most valuable (known as "key service attributes"). Results of analysis of frequently used journal titles or subjects will be provided to the National Library of Medicine's Literature Selection Technical Review Committee for their use in collection development and changes in controlled vocabulary for Medline.

Information technology is an important component of the project and will be used in various ways. The project will be based on Internet technologies. In 1994 the Internet Society showed that Latin America was the fastest growing world region in terms of Internet connectivity, and the region is expected to maintain this position into the 21st century. Not only do all Latin American countries now have Internet connections, four of them (Argentina , Brazil, Columbia, Mexico) rank in the top 50 domains worldwide for the number of hosts or nodes. (Molloy, 1998)

At the heart of the project is the database that will be created to establish a web-accessible repository of the multi-lingual structured abstracts and citations of the literature. ColdFusion® (Allaire Corporation) will be used to develop a front-end interface that will query an Oracle® database. ColdFusion is an integrated set of visual tools for programming web-based applications using a tag-based scripting language that integrates with HTML for user interfaces and XML for data exchange (

In addition to enabling the project, information technology will be used to support project management. As an example, to facilitate communication with members of the PSC and other project partners, the investigators have experimented with Internet-based collaborative, text-based conferencing using concurrent email sessions as well as NetMeeting (free Microsoft® Windows software), which was easily downloaded by project participants. During the course of the project, the authors anticipate that technology enhancements and network upgrades made by institutional partners will facilitate the integration of video conferencing. Readers interested in monitoring the work of this project and accessing the database are encouraged to use the web site created for the project:


This project demonstrates the immense information potential that resides in Latin American academic institutions and the strong basis this provides for joint ventures in developing digital library content.


Appendix 1.

Latin American Social Medicine

Example of Structured Abstract

Franco S, Nunes E, Breilh J, Laurell A. Debates en Medicina Social [Debates in Social Medicine]. Quito (Ecuador): Pan-American Health Organization / Latin American Association of Social Medicine, 1991.

Objectives: To present the state of the art of social medicine by means of analyzing its European antecedents, its emergence in Latin America, its introduction in degree and post-degree studies, the revision of scientific achievements and of social practices by Latin American groups during three decades (1960, '70, and '80). To define the specificity of this field in relation to public health and preventive medicine. To examine the development of Latin American critical epidemiology and investigation into work and health.

Methodology: An analytical and historical methodology was used to study the antecedents, and the theoretical, methodological and thematic production of the most outstanding Latin American authors, and of journals published in Latin America previous to this study.

Statistical methods were used to carry out a quantitative analysis of social medicine's production according to thematic areas and conceptual categories. Degree and post-degree programs, starting from the 1950's, are described through content analysis in relationship to the incorporation of social sciences.

Results and Conclusions: Through the analysis of more than 300 works, this exhaustive study of the most important achievements of social medicine allows the authors to show the social and political context where this field emerges; the antecedents in works of the European social medicine in the 19th century; and the differences between hygienism, public health and preventive medicine. The authors present very deep and broad analyses of social medicine's theoretical conception, and of the main categories, methods, topics, and most important authors and academic and researcher groups in this field. They have produced a work of greater depth on the emergence of critical epidemiology, the differences between critical and traditional epidemiology, and the Latin American production. In the last chapter the authors present the same type of analysis applied to the relationship between work and health; a revision of the works of the principal authors concerned with theoretical and methodological questions; analytic and descriptive studies about the work-health relationship; and investigations about how the impact of capitalism transforms the work and health.


Ad Hoc Working Group for Critical Appraisal of the Medical Literature. (1987). A proposal for more informative abstracts of clinical articles. Annals of Internal Medicine, 106, 598-604.

Booth, A., & O'Rourke, A. J. (1997). The value of structured abstracts in information retrieval from MEDLINE. Health Libraries Review, 14, 157-166.

Buchanan, H. S., Morris, R. C. T., & Kauley, T. D. (1999). Serving native health needs: Merging high-end technology and traditional information services. Western Journal of Medicine, 171, 373-5.

Griffin, S. M. (2000). NSF/DARPA/NASA digital libraries initiative: a program manager's perspective. In S. Harum & Twidale, M. (Eds.) Successes & Failures of Digital Libraries (pp. 4-11). Champaign, IL: University of Illinois at Urbana-Champaign.

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Hartley, J. (1997). Is it appropriate to use structured abstracts in social science journals? Learned Publishing, 10, 313-17.

Hartley, J. (1998). Structured abstracts in the British Journal of Clinical Psychology. British Journal of Clinical Psychology, 37, 1-2.

Haynes, R. B., Mulrow, C. D., Huth, E. J., Altman, D. G., & Gardner, M. J. (1990). More informative abstracts revisited. Annals of Internal Medicine, 113, 69-76.

Harbourt A. M., Knecht L. S., & Humphreys B. L. (1995). Structured abstracts in MEDLINE. 1989-1991. Bulletin of the Medical Library Association, 83, 190-195.

Iriart, C., Merhy, E., & Waitzkin, H. (In press). Managed care in Latin America: The new common sense in health policy reform. Social Science in Medicine.

McIntosh, N. (1994). Structured abstracts and information transfer. London: British Library Research and Development Department.

Molloy, M. (1998, January). Internet resources for Latin America, Version 4.0. [Online at]:

Pitkin, R. M., Branagan, M. A., & Burmeister L.F. (1999). Accuracy of data abstracts of published research articles. JAMA, 281, 1110-1111.

Rudel, T. K., & Gerson, J. (1999). Postmodernism, institutional change, and academic workers: a sociology of knowledge. Social Science Quarterly, 80, 213-8.

Stocker, K., Waitzkin, H., & Iriart, C. (1999). The exportation of managed care to Latin America. New England Journal of Medicine, 340, 1131-6.

Waitzkin, H. (in press). At the front lines: Primary care and the future of American medicine. Lanham, MD: Rowman and Littlefield.

Waitzkin, H. (2000). The second sickness: Contradictions of capitalist health care. Second Edition. Lantham, MD: Rowman and Littlefield.

Waitzkin, H., & Iriart, C. (2000). How the United States exports managed care to third world countries. Monthly Review, 52, 21-35.

Waitzkin, H., Iriart, C., Estrada, A., & Lamadrid, S. Social medicine in Latin America (4-part series). Manuscript submitted for publication.