"It's Wrong because It Could Be My Sister, Wife, or Mother": Workplace Sexual Harassment among Men and Women Farmworkers in USA and Mexico.

These findings from focus groups explore attitudes, beliefs, perspectives, and experiences relevant to workplace sexual harassment (WSH) among men and women farmworkers in California, USA, and Michoacán, Mexico. Focus groups are stratified by country and gender, with two in California (10 men and 10 women) and two in Michoacán (8 men and 5 women). This community-based participatory research includes Community Advisory Boards (CABs) consisting of farmworkers, academicians, non-profit organizations, attorneys, industry personnel, and community leaders who took part in strategy and the development of materials. Themes are related to the experience of, responses to, and farmworkers' recommendations for prevention of WSH. Although men and women faced WSH, women's experiences were more severe and frequent. Participants condemned WSH as contrary to principles of caballerosidad, cortesía, respeto - cultural values promoting respect for others and protection for vulnerable persons. Participants endorsed the notion that women are responsible for WSH. Although farmworkers try to resolve WSH on their own with help from co-workers, family, and leadership, they face significant barriers that silence victims and allow WSH to persist. All farmworkers recommended that management set a good example and enforce consequences for offenders. Implications include directly appealing to cultural values (emphasizing respect), incorporating bystander education, and countering the myth that women are responsible for WSH in workplace training. WSH is a recognized occupational hazard that affects all directly or indirectly exposed workers. We emphasize that employers are ultimately responsible for their workers' safety, supported by a governmental regulatory role. Enforcement of existing policy is needed in California , whereas awareness and policy development is needed in Michoacán. These findings will support the researchers, agricultural community, educators, and organizations working to prevent WSH.

Smoking prevalence and tobacco control measures in Kenya, Uganda, the Gambia and Liberia: a review.

BACKGROUND: Smoking prevalence is increasing in developing countries. These resource-poor countries will have to battle tobacco-related diseases before they have eliminated common communicable diseases. METHODS: We conducted a computerised search of PubMed to identify published estimates of smoking prevalence in Kenya, the Gambia, Uganda and Liberia. We also reviewed tobacco control measures in each country using information provided by the respective health departments. RESULTS: We noted a high prevalence of smoking in Kenya, Uganda and the Gambia. There were no published data on tobacco use prevalence for Liberia. Tobacco control measures were inadequate. CONCLUSION: Standardised prevalence studies involving general populations should be conducted. Tobacco control efforts need to be reinforced.

Effectiveness of a training program to increase the capacity of health care providers to provide HIV/AIDS care and treatment in Swaziland.

Implementation of HIV care and treatment programs in sub-Saharan Africa is a complex undertaking that requires training of health care providers (HCPs). Many sub-Saharan African countries have introduced training programs to build human resources for health. Evaluation of the ongoing trainings is warranted so that programs can be improved. The purpose of this study was to evaluate Baylor International Pediatric AIDS Initiative's (BIPAI) HCP training program in Swaziland. The specific aims were: (1) to assess coverage and delivery of the training program; and (2) to determine the impact of the training program on HCPs' knowledge about HIV and pediatric practices, attitudes toward HIV/AIDS patients, and self-efficacy to provide antiretroviral therapy (ART). The evaluation was a multimethod design with two types of data collection and analysis: (1) one-group pretest-posttest survey with 101 HCPs; and (2) semi-structured in-depth interviews with seven trainers from Baylor College of Medicine and 16 local HCPs in Swaziland. Quantitative data were analyzed using Stata Statistical Software version 8.2 for descriptive and multivariate analysis while factor analysis was done using Statistical Program for Social Sciences version 14. The transcribed interviews were analyzed using a didactic approach. Process evaluation showed that the training had good coverage, was delivered as intended, and improved as the work progressed. The training program led to a significant increase (p=0.0000) in HCPs' knowledge about HIV/AIDS, ART, and relevant clinical pediatrics practices between pretest (mean 68.7% SD 13.7) and post training (mean 84.0% SD 12.0). The training program also increased trainees' self-efficacy to provide ART and their attitudes toward AIDS patients (p=0.0000 and 0.02, respectively). In conclusion, BIPAI training program in Swaziland had good coverage of all health care facilities and HCPs in Swaziland. The training was effective in imparting knowledge and skills to HCPs and in their attitudes toward HIV/AIDS patients.

Accuracy and precision of a portable anticoagulation monitor in a clinical setting.

BACKGROUND: Office-based anticoagulation monitors offer significant advantages in convenience, yet their performance has been inadequately characterized. METHODS: We characterized the performance of a portable anticoagulation monitoring system with respect to precision and agreement with a reference laboratory. Eighty-five patients from a university outpatient anticoagulation clinic provided 143 whole blood sample pairs for evaluating agreement between the monitor and the laboratory. Fifty-four patients each provided a second pair of samples for assessing the monitor's precision, and 23 pairs of measurements from the reference laboratory were used for assessing the laboratory's precision. Anticoagulation was measured using International Normalized Ratio (INR) values. Agreement between monitor and laboratory was evaluated as the difference between paired measurements. Precision was calculated as the within-patient standard deviation based on paired values. RESULTS: Within the range of 2.0 to 3.0 INR units, the monitor yielded values that were up to 0.3 units higher on average than the laboratory values. Within the range of greater than 3.0 to 4.5 INR units, the monitor yielded values that were up to 0.5 units lower on average than the laboratory values. Seventy-five percent of paired monitor and laboratory values were within 0.7 INR units; 90% were within 0.9 units. Within-patient standard deviation was 0.23 units for the monitor and 0.19 units for the laboratory. CONCLUSIONS: The monitor differed systematically from the laboratory and was moderately less precise. The magnitude of these effects was not great, however, and accuracy was best at around INR = 3.0, the border between low and high therapeutic ranges. The clinic-based monitor is useful for patients requiring frequent surveillance of anticoagulation status.

Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin.

In a randomized, nonblinded clinical trial, 36 consecutive patients with generalized convulsive status epilepticus were treated with either combination diazepam and phenytoin (DZ/DPH) or phenobarbital (PB). Phenytoin was added to the PB regimen if seizures persisted for 10 minutes after beginning therapy. The cumulative convulsion time (total time spent in active convulsive movements) was shorter for the PB group than for the DZ/DPH group (median, 5 versus 9 minutes, p less than 0.06); the response latency (elapsed time from initiation of therapy to the end of the last convulsion) was also shorter for the PB group (median, 5.5 versus 15 minutes, p less than 0.10). The median cumulative convulsion time is between 0 and 14 minutes shorter for the PB regimen than for the DZ/DPH regimen (95% confidence interval). Similarly, the median response latency for the PB regimen is between 1 minute longer and 20 minutes shorter than that for the DZ/DPH regimen (95% confidence interval). The frequencies of intubation, hypotension, and arrhythmias were similar in the two groups. Eleven of 18 patients in the PB group responded to phenobarbital monotherapy. We conclude that the PB regimen is rapidly effective, comparable in safety, and enjoys certain practical advantages in comparison with the DZ/DPH regimen.

Smoking, respiratory symptoms, and pulmonary function among a population of Hispanic farmworkers.

We conducted a cross-sectional study in the agricultural Central Valley to evaluate the prevalence of respiratory symptoms, smoking status, and pulmonary function in Hispanic California farmworkers. Of 759 farmworkers completing questionnaires and spirometry, 747 were Hispanic. The prevalences of current, former, and never smokers (29, 17, and 54 percent, respectively) were comparable to rates in other studies of Hispanics, but daily cigarette consumption (median-five for men and three for women) was lower than in comparison populations. Prevalences of chronic cough, chronic phlegm, and persistent wheeze were low (1.6, 5.1, and 2.8 percent, respectively). Current smoking, increased age, female sex, and working greater than or equal to 8 months per year in agriculture were associated with increased prevalence of respiratory symptoms. Adjusted lung function was higher than for reference populations. Hispanic California farmworkers have a similar smoking prevalence to other Hispanic populations, but lower respiratory symptom prevalences and higher pulmonary function are consistent with lower daily cigarette consumption and the "healthy worker effect."

Measuring personal exposure to airborne mutagens and nicotine in environmental tobacco smoke.

The exposure of individuals to environmental tobacco smoke (ETS) is of increasing public health concern because epidemiological studies have associated passive smoking with increased risk of a variety of adverse health effects among non-smokers including lung cancer. As a way to measure individual exposure to the mutagenic compounds in the complex mixture of ETS, we used a sensitive Salmonella/microsome micro pre-incubation (microsuspension) assay to detect mutagenicity of particulate matter collected on filters from low volume (1.7 1/min flow rate) personal sampling pumps. Airborne nicotine was collected concurrently as a marker for ETS exposure. In pilot-field studies, individual exposure to ETS was measured in two separate indoor environments in which smokers were present: a gambling casino and a bingo parlor. Total suspended particulate matter (TSP) was collected on filters worn near the breathing zone of non-smoking individuals. Sampling times ranged from 40 min to 6 h. All extracts of filters had detectable levels of mutagenic activity (TA98, +S9) resulting in airborne mutagenic activity concentrations of 500-5000 rev/m3. The mutagenic activity of the filters from the casino and bingo parlors was significantly correlated with total particulate matter per filters (n = 12; Rho = 0.85, p less than 0.01) and with airborne nicotine per filter (n = 12; Rho = 0.95, p less than 0.01). The microsuspension assay was sufficiently sensitive to detect the mutagens associated with extracts of particulate matter from low volume samples (0.2-0.6 m3) in these indoor environments over a relatively short sampling time, and could be useful in studies of personal exposure to the mutagens in environmental tobacco smoke. Further, airborne nicotine concentrations were highly correlated with airborne mutagenicity and the mutagenic activity associated with ETS could therefore be estimated by the concentrations of nicotine.

Occupational history collection by third-year medical students during internal medicine and surgery inpatient clerkships.

Occupational history is fundamental for the evaluation of possible workplace influences on health. We reviewed 2,922 initial history-and-physical reports from 137 third-year medical students to examine occupational history collection. Overall reporting frequencies were recorded as the following: industry, 55.8%; occupation, 70.0%; specific occupational exposure, 8.4%; smoking status, 91.4%. Patients younger than 40 years of age and women were significantly less likely than other older patients and men to have notations of occupation and industry. Surgery students were less likely than internal medicine students to collect data for industry (41.6% vs 66.6%, P < 0.001), occupation (57.4% vs 79.7%, P < 0.001), and smoking (88.1% vs 94.0%, P < 0.001). The highest frequencies of notation were those for circulatory and respiratory conditions. No significant differences were noted for student gender, academic quarter, or week of clerkship. Clinical occupational medicine teaching should emphasize the need to collect occupational information from all patients, including women and young persons.

Hemostatic abnormalities associated with monoclonal gammopathies.

To confirm and expand previous observations about the association of monoclonal gammopathies with hemostatic defects, a prospective evaluation was made in 42 patients with lymphoplasmacytic disorders. The incidence of bleeding complications was low, despite the diversity of abnormal hemostatic tests observed in these patients. Patients with myeloma frequently had abnormal coagulation tests, including thrombin time (64%), fibrin degradation products (32%), platelet aggregation tests with different agonist (30% to 55%), and bleeding time (22%). The lack of platelet response to ristocetin and normal ristocetin cofactor activity in four patients with myeloma may suggest a Bernard-Soulier-type defect. Serum viscosity was negatively correlated with platelet aggregation with collagen, ristocetin, and adenosine diphosphate. In patients with immunoglobulin myeloma, there was a positive correlation between an increased viscosity and a prolonged thrombin time. This study demonstrates the wide variety of coagulation abnormalities in lymphoplasmacytic disorders, usually without significant clinical implications.

Costs of occupational injuries in agriculture.

OBJECTIVE: This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. METHODS: The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. RESULTS: Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion. CONCLUSIONS: The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.

Assessment of azinphosmethyl exposure in California peach harvest workers.

We compared measurements of urinary alkylphosphate metabolites and oxime-induced reactivation of plasma cholinesterase (P-ChE) and erythrocyte acetylcholinesterase (RBC-AChE) with measurements of foliar residues, skin and clothing contamination, and P-ChE and RBC-AChE activities among 20 Northern California peach orchard workers exposed to the organophosphate agent azinphosmethyl (Guthion). Subjects entered orchards treated 30 d previously with azinphosmethyl and worked 21 d in treated fields during the ensuing 6 wk. Dislodgeable foliar residues ranged from 0.32-0.96 micrograms/cm2. Median reduction in RBC-AChE activity was 7% (p < .001) over the initial 3-d period of exposure and 19% (p < .01) over the 6-wk season. Urinary metabolites were the most sensitive indicator of recent exposure and correlated moderately with dermal and clothing levels (rs = +0.31-(+)0.55); urinary metabolites correlated well with RBC-AChE drawn 3 d after exposure began (rs = -0.77). No significant oxime-induced reactivation was found.

Region of birth, sex, and agricultural work of immigrant Latino farm workers: the MICASA study.

Agricultural work is hazardous, and immigrant workers perform the majority of production tasks, yet there are few data describing agricultural work and use of protective measures by demographic characteristics. We examined cross-sectionally the influence of region of birth (Mexico vs. Central America) and sex on agricultural work and use of protective measures in the MICASA cohort of immigrant Latino farm workers in Mendota, California. Of 445 participants, 293 (65.8%) were born in Mexico (163 men, 130 women) and 152 (34.2%) were born in Central America (80 men, 72 women). Men worked on average 74.4 more days than women (95% CI 62.0, 86.9) and were more likely to perform tasks requiring high levels of training or strength, such as machine operation, pruning, picking, planting, and irrigation; more likely to work in dusty conditions; and more likely to work directly with pesticides. Women predominated in packing. Respondents from Mexico were more likely to work with tomatoes and less likely to work with melon and lettuce. Central America-born respondents were less likely to engage in planting, irrigation, and pesticide use. Use of task-appropriate personal protective measures on at least a half-time basis was rare, with the exception of persons working with pesticides (a group limited to men) and for facial scarves among Central American women. Further work should focus on identifying barriers to use of preventive measures and programs to further their use. Educational models accounting for cultural factors and driving social norm change, employer engagement, and use of community health workers (promotores) may be helpful in promoting use of preventive measures.

Factors associated with agricultural work performed by adolescents from an immigrant farm worker population (MICASA study).

UNLABELLED: While studies have looked at the relationship of adolescent employment with health outcomes and risk behaviors, few have focused on children of hired farm workers. These children face unique challenges affecting their health and work environment. Exploring the frequency and nature of agricultural work characteristics among adolescent children of Hispanic hired farm workers is important for assessing the potential risks they face. METHODS: MICASA is a population-based study of settled immigrant Hispanic farm working families in Mendota, California. We selected a cross-sectional random sample of adolescents (ages 11 to 18). Interviews assessed work history, place of birth, and acculturation. RESULTS: 38% of participants were female and 62% were male; 55% were born in the U.S., 38% in Mexico, and 7% in El Salvador; and 49% worked for pay during the last year. Among those who worked, farm work was most frequently reported (73.5%). Among those who had done farm work, the mean age at initiation was 14 years, and they worked a mean of 4.3 weeks during the previous year. Hoeing, picking, and packing/sorting were the most common tasks. In models adjusted for age and sex, low-acculturated adolescents were more likely than moderately acculturated to have worked in the past 12 months, to start work younger than age 14 years, and to do farm work. SIGNIFICANCE: Farm work is common among adolescents in this Hispanic agricultural community and is strongly associated with foreign birth and low acculturation.

Investigators' perspectives on translating human microbiome research into clinical practice.

BACKGROUND: Human microbiome research has the potential to transform the practice of medicine, fundamentally shifting the ways in which we think not only about human health, illness and disease, but also about clinical practice and public health interventions. Drawing from a larger qualitative study on ethical, legal and social dimensions of human microbiome research, in this article, we document perspectives related to the translation of human microbiome research into clinical practice, focusing particularly on implications for health, illness and disease. METHODS: We conducted 60 in-depth, semi-structured interviews (2009-2010) with 63 researchers and National Institutes of Health project leaders ('investigators') involved with human microbiome research. The interviews explored a range of ethical, legal and social implications of human microbiome research, including investigators' perspectives on potential strategies for translating findings to clinical practice. Using thematic content analysis, we identified and analyzed emergent themes and patterns. RESULTS: We identified 3 themes: (1) investigators' general perspectives on the clinical utility of human microbiome research, (2) investigators' perspectives on antibiotic use, overuse and misuse, and (3) investigators' perspectives concerning future challenges of translating data to clinical practice. CONCLUSION: The issues discussed by investigators concerning the clinical significance of human microbiome research, including embracing a new paradigm of health and disease, the importance of microbial communities, and clinical utility, will be of critical importance as this research moves forward.

The California Agricultural Workers Health Survey.

The California Agricultural Workers Health Survey was a statewide cross-sectional household survey of 970 hired farm laborers. Randomly selected participants residing in randomly selected dwellings were recruited in seven communities representing all of the state's agricultural regions. Participants were interviewed in their preferred language by professional staff. The response rate was 83%. The comprehensive interview included self-reported health conditions, doctor-reported health conditions, work history, workplace health conditions, field sanitation, and work-related injuries. A farm workplace injury during the twelve-month period prior to the interview was reported by 6% of male workers (95% CI: 4% - 8%) and 2% of female workers (95% CI: 1% - 3%). Significant numbers of both male (41%) and female (40%) workers reported persistent pain (every day for more than one week) in the back, neck, knees, shoulders, hands, feet, or multiple body parts. The number of body parts in which female workers reported persistent pain correlated with increased years of U.S. hired farm work (Spearman r = 0.24, p < 0.01). Direct contact with pesticides from being sprayed or drifted upon among both male and female workers was associated with multiple workplace health conditions such as irritated, itchy, or water eyes (male: OR 2.9, 95% CI: 1.6 - 5.0; female: OR 13.8, 95% CI: 4.3 - 44.7). Persistent stomach aches among male and female participants was associated with being required to taste unwashed grapes for sweetness while picking (male: OR 4.6, 95% CI: 2.1 - 9.9; female: OR 5.8, 95% CI: 2.6 - 12.6).

Health-seeking behaviour for sexually transmitted infections and HIV testing among female sex workers in Vietnam.

This qualitative study was conducted to explore health-seeking behaviour for sexually transmitted infections (STIs) and HIV testing among female sex workers (FSWs) in the cities of Hanoi and Da Nang, Vietnam. Data were gathered from in-depth interviews, focus groups and participant observation. Results suggest that women's decision to seek STI treatment and HIV testing is influenced by the complex interplay of personal risk perceptions, social relationships and community discourse. The women exhibited adequate knowledge of HIV while their knowledge of STIs was limited. They demonstrated high-risk perceptions of HIV, but they showed little concern for STIs. Most women sought treatment at pharmacies when they noticed symptoms of the genital tract. Their decision to seek care in health facilities and HIV testing was hampered by the high costs of treatment, judgmental attitudes of service providers, and a lack of information on testing services. Future interventions need to focus on strengthening knowledge of STIs and the STI-HIV association, and increasing awareness of HIV counselling and testing services. Training for STI service providers including pharmacies and private practitioners on sex-worker friendly and non-judgmental services and counselling skills should be emphasized to provide timely diagnosis and treatment of STIs, and to refer women to HIV testing.

The prevalence of suicidal behaviours in a group of HIV-positive men.

We studied a convenience sample of 54 HIV-positive men, recruited from HIV/AIDS community based service organizations. Data were collected on HIV risk factors and suicidal behaviours. Fifty-nine percent of the sample reported ever thinking about suicide, and 50% of those individuals reported attempting suicide at some point in their lives. Suicide ideation and attempts were more common among white participants. Suicidal behaviours were prevalent in this sample suggesting a need for mental health and suicide interventions targeted for this population.

Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto and injecting practices.

HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighbourhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the 'geto' (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin 'ghettoes' are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.

The prevalence of partner violence in a group of HIV-infected men.

There is a paucity of literature regarding partner violence among males that identifies the sex and relationship of their partner(s). We studied a convenience sample of 54 HIV-infected men, recruited from HIV/AIDS service organizations. Using a standard questionnaire, we collected data on HIV risk behaviours and self-reports of acts of partner violence and forced sex. Physical violence perpetrated by a primary or a casual partner was reported by 39% and 17% of the sample, respectively. Life-time forced sex by a primary or casual partner was reported by 32% and 15% of the sample, respectively. Forced sex was more commonly reported by participants who were non-white and reported a higher number of primary partners in the previous 12 months. We recommend that health care providers be aware of the high rates of intimate partner violence among men infected or at risk of infection with HIV.