Safety and Injury of US-Certified Organic Crop Producers in the Southwest Region.

OBJECTIVES: Literature on occupational risks among organic farmers is scarce. This study explored safety practices and non-fatal injuries among organic producers, and the role of sociodemographic, work, and farm characteristics on safety and injury. METHODS: Cross sectional survey of certified organic crop producers in the Southwest (SW) region of the United States (US). The Organic Integrity Database was used for recruitment. Data were collected through an electronic and paper survey. RESULTS: Analyses were conducted on 115 cases; response rate was estimated at 25%. A high majority of respondents owned their operation and were younger than 65 years, male, educated beyond high-school, and non-Hispanic whites. Less than half had more than 10 years of experience in organic farming; one-third worked off the farm year-round. Safety practices were very basic despite the widespread use of equipment and machinery, and limited to wearing normal clothing and apparel such hats and glasses. About half of respondents (52.6%) reported non-fatal injuries in the past year; and one-third (32.7%) time lost due to injuries. The overall cumulative incidence rate was estimated at 5.3 injuries per 10 workers within the last year. The injury rate decreased with hours worked. Significant differences were found on gender and education level and safety practices, with female respondents and the more educated being more proactive in practicing safety. Those working less than 40 h/week, in farms smaller than 50 acres, using light machinery or compact utility tractors, and tractors without roll-over protection reported significantly higher injury frequency compared to their counterparts. CONCLUSION: This study contributes unique data on an essential workforce not captured by current occupational injury and illness surveillance systems. It identifies important personal and contextual factors that may contribute to safety and injury in this population. The findings indicate the need to promote safety and prevent injuries that result in work time lost. This study may also inform future occupational safety and health research and practice, including surveillance, injury prevention programs that target certain workers and production practices, and policies that support and protect the organic farmer.

We Need You Here! Predictors of Job Placement and Practice among New Mexico Family Medicine Residents.

OBJECTIVES: Primary health care (PHC) is essential for a well-functioning health system. Although PHC has been shown to have adverse effects on health outcomes, many barriers prevent adequate access, including a shortage of primary care physicians. In New Mexico, 32 of 33 counties are designed as primary care health professional shortage areas, and the state has a lower-than-average primary care provider density compared with other states. This study explored the predictors of job placement among New Mexican Family Medicine residents. METHODS: A retrospective cohort study design was used, which included a subset of data from The University of New Mexico (UNM) Family Medicine Residency Alumni Database and hard copy personnel files. The study's population consisted of the 260 graduates from the UNM Family Medicine Residency Program between 1998 and 2019. Analysis included simple and multiple logistic regression. RESULTS: Results indicated that, consistently, approximately two-thirds of first practices are in New Mexico, whereas the percentage with a current practice in New Mexico decreases over time. Those born in New Mexico or who attended the UNM School of Medicine were more likely to have their first and current practice in New Mexico. CONCLUSIONS: The results of this study provide further evidence that the relationship between place of birth and place of medical training are determining factors for both place of first and current practice. These results can inform practice, policy, and future research to address the pressing need for PHC in underserved and rural communities.

COVID-19 Prevalence and Prevention Behaviors Among US Certified Organic Producers.

OBJECTIVE: There is a scarcity of data on the impact of the pandemic in farmers. METHODS: Cross-sectional survey of certified organic producers through a 28-item self-reported paper or electronic survey. Analysis included descriptive statistics, Cronbach α to measure the internal consistency of a six-item prevention scale, and correlation and regression analyses. RESULTS: A total of 344 records were computed. Infection rate among producers was 6.4%. Sex and farm size were the most statistically significant predictors of prevention behaviors. Women reported more use of prevention methods (ß = 0.333, P < 0.001) and those with 50 or more certified organic acres reporting less use of prevention methods (ß = -0.228, P < 0.001). Mask wearing was significantly related to lower COVID-19 prevalence. CONCLUSIONS: Determining prevalence and understanding how farmers follow prevention behaviors is essential for health care and public health interventions and policies.

Achieving equity in cervical cancer screening in low- and middle-income countries (LMICs): Strengthening health systems using a systems thinking approach.

The World Health Organization (WHO) is leading a call to action to eliminate cervical cancer by the end of the century through global implementation of two effective evidence-based preventive interventions: HPV vaccination and cervical screening and management (CSM). Models estimate that without intervention, over the next 50 years 12.2 million new cases of cervical cancer will occur, nearly 60% of which are preventable only through CSM. Given that more than 80% of the cervical cancer occurs in low- and middle-income countries (LMICs), scaling up sustainable CSM programs in these countries is a top priority for achieving the global elimination goals. Multiple technologies have been developed and validated to meet this need. Now it is critical to identify strategies to implement these technologies into complex, adaptive health care delivery systems. As part of the coordinated cervical cancer elimination effort, we applied a systems thinking lens to reflect on our experiences with implementation of HPV-based CSM programs using the WHO health systems framework. While many common health system barriers were identified, the effectiveness of implementation strategies to address them was context dependent; often reflecting differences in stakeholder's belief in the quality of the evidence supporting a CSM algorithm, the appropriateness of the evidence and algorithm to context, and the 'implementability' of the algorithm under realistic assessments of resource availability and constraints. A structured planning process, with early and broad stakeholder engagement, will ensure that shared-decisions in CSM implementation are appropriately aligned with the culture, values, and resource realities of the setting.

Integrative Systems Praxis for Implementation Research (INSPIRE): An Implementation Methodology to Facilitate the Global Elimination of Cervical Cancer.

BACKGROUND: The World Health Organization (WHO) has called for a systems thinking approach to health systems strengthening to increase adoption of evidence-based interventions (EBI). The Integrative Systems Praxis for Implementation Research (INSPIRE) methodology operationalizes the WHO systems thinking framework to meet cervical cancer elimination-early detection and treatment (CC-EDT) goals. METHODS: Using a systems thinking approach and grounded in the consolidated framework for implementation research, INSPIRE integrates multiple research methodologies and evaluation frameworks into a multilevel implementation strategy. RESULTS: In phase I (creating a shared understanding), soft systems methodology and pathway analysis are used to create a shared visual understanding of the CC-EDT system, incorporating diverse stakeholder perspectives of the "what, how, and why" of system behavior. Phase II (finding leverage) facilitates active stakeholder engagement in knowledge transfer and decision-making using deliberative dialogues and multiple scenario analyses. Phase III (acting strategically) represents stakeholder-engaged implementation planning, using well-defined implementation strategies of education, training, and infrastructure development. In phase IV (learning and adapting), evaluation of key performance indicators via a reach, effectiveness, adoption, implementation, and maintenance framework is reviewed by stakeholder teams, who continuously adapt implementation plans to improve system effectiveness. CONCLUSIONS: The INSPIRE methodology is a generalizable approach to context-adapted implementation of EBIs. IMPACT: Replacing static dissemination of implementation "roadmaps" with learning health systems through the integration of systems thinking and participatory action research, INSPIRE facilitates the development of scalable and sustainable implementation strategies adapted to local contexts.

What matters in health (care) universes: delusions, dilutions, and ways towards universal health justice.

The presumed global consensus on achieving Universal Health Coverage (UHC) masks crucial issues regarding the principles and politics of what constitutes "universality" and what matters, past and present, in the struggle for health (care) justice. This article focuses on three dimensions of the problematic: 1) we unpack the rhetoric of UHC in terms of each of its three components: universal, health, and coverage; 2) paying special attention to Latin America, we revisit the neoliberal coup d'état against past and contemporary struggles for health justice, and we consider how the current neoliberal phase of capitalism has sought to arrest these struggles, co-opt their language, and narrow their vision; and 3) we re-imagine the contemporary challenges/dilemmas concerning health justice, transcending the false technocratic consensus around UHC and re-infusing the profoundly political nature of this struggle. In sum, as with the universe writ large, a range of matters matter: socio-political contexts at national and international levels, agenda-setting power, the battle over language, real policy effects, conceptual narratives, and people's struggles for justice.

Capacitación del personal de los servicios de salud: proyectos relacionados con los procesos de reforma sectorial / Training of health services: projects related to sector reform processes

Esta publicación ha sido posible gracias a la contribución de un numeroso grupo de profesionales de salud, educadores y responsables de los componentes de capacitación de los proyectos que participaron en el estudio mencionado. Ellos aportaron su trabajo, información, saber y experiencia a lo largo de todo el proceso del estudio y más allá, en el proceso reflexivo de balance. Los primeros capítulos de esta publicación constituyen la "base empírica" de una reflexión teórica y metodológica que se desarrolla posteriormente: balance y perspectiva teórica, metodológica y vivencial de la construcción de una visión y práctica educativa en los servicios de salud. La necesidad de identificar cuáles son las posibilidades de la educación del personal de salud para el logro de los objetivos estratégicos de los sistemas y servicios en trance de cambio resultó al final en un balance de lo pensado, de lo aprendido y de lo experimentado, y en una proposición de estrategia integral para la acción educativa en los servicios de salud. Así, de cierta manera, se vuelve a empezar, como debe ser, como suele ser en este apasionante campo técnico y político de los recursos humanos de salud

Tecnoburocracia sanitaria: ciencia, ideología y profesionalización en la salud pública

Introducción. Reflexiones preliminares. Surgimiento de la politica de formación de recursos humanos en salud pública en Argentina. La profesionalización en salud pública. Los ejes temáticos de la concepción sanitarista. Matriz teórico metodológica de la salud pública argentina. La escuela de salud pública de la Universidad de Buenos Aires. A manera de reapertura

Impact of the Research Grants Program of the Pan American Health Organization

Meeting of the Advisory Committee on Health Research, 29. Pan American Health Organization; 2-6 Aug. 1993

Impacto del Programa de Subvenciones de la Organización Panamericana de la Salud / Impact of the Research Grants Program of the Pan American Health Organization

Reunión del Comité Asesor de Investigaciones en Salud, 29. Organización Panamericana de la Salud; 2-5 ago. 1993