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1.

Health risk assessment of pesticides residue in maize and cowpea from Ejura, Ghana.

Akoto O; Andoh H; Darko G; Eshun K; Osei-Fosu P
| Idioma(s): Inglés
Low productivity in agriculture due to damage cause by pests has led to the application of pesticides to control pest infestation. Residues of pesticides applied on crops are often found in the food which can cause chronic effect on the health of humans who consume such products. The aim of this study is to measure pesticides residues in maize and cowpea and compare the values with stablished safety limits. A total of 37 pesticides comprising 15 organochlorines, 13 organophosphorus and 9 pyrethroids pesticides were identified in maize and cowpea samples obtained from farms in Ejura. Analytical methods included solvent extraction of the pesticide residues and their subsequent quantification using gas chromatograph equipped with Electron Capture Detector and Pulse Flame Photometric Detector after clean-up on alumina/activated charcoal column. The results showed that the mean concentration of pesticides in maize ranged from 0.001 to 0.103mgkg(-1) for organochlorine pesticides, 0.002-0.019mgkg(-1) for organophosphorus pesticides and 0.002-0.028mgkg(-1) for pyrethroids pesticides. In cowpea the mean concentration ranged from 0.001 to 0.108mgkg(-1) for organochlorine pesticides, 0.002-0.015mgkg(-1) for organophosphorus pesticides and 0.001-0.039mgkg(-1) for pyrethroids pesticides. Maximum Residue Limits for ß-HCH, ß-endosulfan, p,p'-DDE and p,p'-DDD were exceeded in both maize and cowpea samples. Health risk estimation revealed that residues of heptachlor, dieldrin, endrin, ß-endosulfna, γ-chlordane and chlorfenvinphos found in maize exceeded the Acceptable Daily Intake. Similarly the levels of heptachlor and p,p'-DDD found in cowpea also exceeded the Acceptable Daily Intake. This suggests a great potential for chronic toxicity to consumers of these food items.
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2.

"Never mind the logic, give me the numbers": Former Australian health ministers' perspectives on the social determinants of health.

Baum FE; Laris P; Fisher M; Newman L; Macdougall C
| Idioma(s): Inglés
The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure. Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long.
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3.

Source attribution of health benefits from air pollution abatement in Canada and the United States: an adjoint sensitivity analysis.

Pappin AJ; Hakami A
| Idioma(s): Inglés
Background: Decision making regarding air pollution can be better informed if air quality impacts are traced back to individual emission sources. Adjoint or backward sensitivity analysis is a modeling tool that can achieve this goal by allowing for quantification of how emissions from sources in different locations influence human health metrics.Objectives: We attributed short-term mortality (valuated as an overall "health benefit") in Canada and the United States to anthropogenic nitrogen oxides (NOx) and volatile organic compound (VOC) emissions across North America.Methods: We integrated epidemiological data derived from Canadian and U.S. time-series studies with the adjoint of an air quality model and also estimated influences of anthropogenic emissions at each location on nationwide health benefits.Results: We found significant spatiotemporal variability in estimated health benefit influences of NOx and VOC emission reductions on Canada and U.S. mortality. The largest estimated influences on Canada (up to $250,000/day) were from emissions originating in the Quebec City-Windsor Corridor, where population centers are concentrated. Estimated influences on the United States tend to be widespread and more substantial owing to both larger emissions and larger populations. The health benefit influences calculated using 24-hr average ozone (O3) concentrations are lower in magnitude than estimates calculated using daily 1-hr maximum O3 concentrations.Conclusions: Source specificity of the adjoint approach provides valuable information for guiding air quality decision making. Adjoint results suggest that the health benefits of reducing NOx and VOC emissions are substantial and highly variable across North America.
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4.

Land application of treated sewage sludge: community health and environmental justice.

Lowman A; McDonald MA; Wing S; Muhammad N
| Idioma(s): Inglés
Background: In the United States, most of the treated sewage sludge (biosolids) is applied to farmland as a soil amendment. Critics suggest that rules regulating sewage sludge treatment and land application may be insufficient to protect public health and the environment. Neighbors of land application sites report illness following land application events.Objectives: We used qualitative research methods to evaluate health and quality of life near land application sites.Methods: We conducted in-depth interviews with neighbors of land application sites and used qualitative analytic software and team-based methods to analyze interview transcripts and identify themes.Results: Thirty-four people in North Carolina, South Carolina, and Virginia responded to interviews. Key themes were health impacts, environmental impacts, and environmental justice. Over half of the respondents attributed physical symptoms to application events. Most noted offensive sludge odors that interfere with daily activities and opportunities to socialize with family and friends. Several questioned the fairness of disposing of urban waste in rural neighborhoods. Although a few respondents were satisfied with the responsiveness of public officials regarding sludge, many reported a lack of public notification about land application in their neighborhoods, as well as difficulty reporting concerns to public officials and influencing decisions about how the practice is conducted where they live.Conclusions: Community members are key witnesses of land application events and their potential impacts on health, quality of life, and the environment. Meaningful involvement of community members in decision making about land application of sewage sludge will strengthen environmental health protections.
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6.

Evaluating the effectiveness of a lay health promoter-led, community-based participatory pesticide safety intervention with farmworker families.

Quandt SA; Grzywacz JG; Talton JW; Trejo G; Tapia J; D'Agostino RB; Mirabelli MC; Arcury TA
| Idioma(s): Inglés
Pesticide safety training is mandated for migrant and seasonal farmworkers. However, none is required for family members, who implement home sanitation to protect against pesticide exposure and need to control pests in substandard housing. Controlled studies have demonstrated the efficacy of pesticide education programs for farmworker families, but no carefully evaluated demonstration projects have shown effectiveness in public health settings. This project evaluates a lay health promoter program to improve pesticide-related knowledge and practices. Promotoras from six agencies recruited families with children to deliver a six-lesson, in-home, culturally and educationally appropriate curriculum. Independently conducted pre- and posttests evaluated changes in knowledge and practices. Adults in 610 families completed the study. Most were from Mexico, with low levels of formal education. Significant improvements in knowledge were observed for all six lessons. Significant improvements were observed in practices related to para-occupational exposure and residential pest control. Lay health promoters with limited training and supervision can have significant impacts on families' knowledge and practices. They represent a workforce increasingly recognized as a force for reducing health disparities by providing culturally appropriate health education and other services. This study adds to the literature by demonstrating their effectiveness in a public health setting with rigorous evaluation.
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9.

Psychosocial work environment and prediction of quality of care indicators in one canadian health center.

Paquet M; Courcy F; Lavoie-Tremblay M; Gagnon S; Maillet S
| Idioma(s): Inglés
BACKGROUND: Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. QUESTION: What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. METHODS: The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. RESULTS: The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. CONCLUSIONS: This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay.
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10.

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme.

Iloh G; Ofoedu J; Njoku P; Okafor G; Amadi A; Godswill-Uko E
| Idioma(s): Inglés
BACKGROUND: The increasing importance of the concept of patients' satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. AIM: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. SUBJECT AND METHODS: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient-staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. RESULTS: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient-staff relationship (3.9), patient-staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). CONCLUSION: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status.
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