Significados y usos que los habitantes de una vereda en Chigorodó, Antioquia, Colombia, dan a los alimentos que producen / Significance and Uses of Foods Cultivated by Rural Inhabitants of Chigorodó, Antioquia, Colombia

Antecedentes: la agricultura familiar se reconoce como una práctica importante para que las poblaciones mejoren el acceso a alimentos propios y los ingresos, y contribuyan a la seguridad alimentaria en su región. Objetivo: conocer los significados y usos dados por los habitantes de una vereda del municipio de Chigorodó, Antioquia, a los alimentos que producen. Materiales y métodos: investigación cualitativa basada en etnografía enfocada. Los datos se recolectaron mediante entrevistas semiestructuradas a 14 participantes, observación participante y elaboración de mapas de los predios. La información obtenida se transcribió, leyó y codificó, identificando aspectos significativos, relaciones entre los datos, hasta conformar categorías preliminares y emergentes, que fueron validadas con los participantes. Resultados: las razones para cultivar incluyen vocación, tradición familiar y necesidad del sustento. Vivir en el campo se relaciona con felicidad, tranquilidad y salud. Los alimentos más cultivados son plátano, mango, limón, coco, guayaba; además se crían animales. Los participantes dan a lo producido usos alimentarios, cosméticos, medicinales y de aseo; algunos productos también se venden o intercambian. Conclusión: los alimentos producidos aportan a la soberanía alimentaria y a la economía familiar, tienen usos que reflejan diversos saberes; se resalta el papel protagónico de la mujer en la agricultura familiar.

Background: Family farming is a practice that makes it possible for the population to obtain food and income while contributing to the food security of their region. Objective: To understand the significance and uses that the inhabit¬ants of a rural settlement, located in the Chigorodó municipality in the Department of Antioquia, place on the food they grow. Materials and Methods: A qualitative study, based on focused ethnography, in which data were collected via active observation, semi-structured interviews administered to 14 participants, and property mapping. The data were transcribed, read and coded. Significant aspects and data relationships were identified. Preliminary and emergent categories were consolidated and the results were validated with the participants. Results: Among the reasons for growing food, the following stand out: vocation, tradition, and need to support one's family. Additionally, living in the countryside is associated with happiness, tranquility and health. The most common types of food produced are: plantain, mango, lime, coconut and guava. In addition, they also raise animals. Household use the foods and products they cultivate for food, cosmetics, medicine, and cleaning. Outside the household these products are sold and traded. Furthermore, people express diverse knowledge on the medicinal and cosmetic uses of plants as well as on how to grow them. Conclusions: Growing food contributes to the food security of these households and their family economy. Likewise, the leading role of women is highlighted in this activity. Finally, a diverse body of everyday knowledge was observed in this study.

Extent of Health Care Fragmentation in Different Payer Populations: Evidence from the Hudson Valley of New York.

Health care fragmentation occurs when patients see multiple ambulatory providers, but no single provider accounts for a substantial proportion of visits. Most previous studies have measured fragmentation in Medicare, which may not be generalizable. The study objective was to compare the extent of fragmented ambulatory care across commercially insured, Medicare, and Medicaid populations. The authors conducted a cross-sectional study of adults (N = 256,047) in the Hudson Valley region of New York, who were continuously insured (through 5 commercial payers, Medicare, or Medicaid), were attributed to a primary care physician, and had ≥4 ambulatory visits in the study year. Fragmentation was calculated using a reversed Bice-Boxerman Index, which captures both dispersion of care across providers and the relative share of visits by each provider. Chi-square tests, t tests, and correlation were used to compare patient characteristics and patterns of care across payers. Patients with Medicare had more chronic conditions (45% had ≥5 chronic conditions) than patients with commercial insurance (20%) or Medicaid (23%) (P < 0.01). However, mean fragmentation scores were comparable across all 3 payer populations: 0.73 (commercial insurance), 0.74 (Medicare), 0.72 (Medicaid). The correlation between number of chronic conditions and fragmentation was weak across payers, ranging from r = 0.004 to r = 0.12. If the extent of fragmentation does not vary with payer type or with the number of chronic conditions, it suggests that the causes of fragmentation may be more numerous and more complex than medical need alone.

Academic physicians' views on low-value services and the choosing wisely campaign: A qualitative study.

BACKGROUND: In 2012, the American Board of Internal Medicine (ABIM) Foundation launched a campaign called Choosing Wisely which was intended to start a national dialogue on services that are not medically necessary. More research is needed on the in-depth reasons why doctors overuse low-value services, their views on Choosing Wisely specifically, and ways to help them change their practice patterns. METHODS: We performed a qualitative study of focus groups with physicians to explore their views on the problem of overuse of low-value services, the reasons why they overuse, and ways that they think could be effective at curbing overuse. Participants were attendings in the fields of emergency medicine, internal medicine, hospital medicine, and cardiology. RESULTS: All physicians felt that overuse of low-value services was a significant problem. Physicians frequently cited that patient expectations drove the use of low-value services and lack of time was the most cited reason why behavior change was difficult. Facilitators that could promote behavior change included decision support through the electronic medical record, motivation to maintain their reputation among their colleagues, internal motivation to be a good doctor, objective data showing their rates of overuse, alignment of institutional goals, and forums to discuss evidence and new research. CONCLUSIONS AND IMPLICATIONS: In focus groups with physicians, we found that physicians perceived that overuse of low-value services was a problem. Participants cited many barriers to behavior change. Methods that help address patient expectations, physician time, and social norms may help physicians reduce their use of low-value services.

US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures.

Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures. While much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report.

Large Independent Primary Care Medical Groups.

PURPOSE: In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODS: We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers-leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTS: The groups' physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale. CONCLUSIONS: Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting.