Participatory action research in health systems : a methods reader

This “reader” in participatory action research (PAR) serves to inform, motivate and strengthen PAR as a research methodology useful for both health policy and systems research. It includes examples of PAR across all income areas and global regions, and provides a selection of readings on the subject. The texts are backed by references and resources, as well as ethics concerns and innovations in the field. Methods and tools for gathering evidence along with context are demonstrated, as well as guidance in the communication of findings. Social determinants of health may be more easily factored in to qualitative and participatory action research endeavours

Long-term stability in obsessive thoughts and compulsive behavior in the general population: a longitudinal study in Sweden

OBJECTIVE: Obsessive thoughts and compulsive behavior and their related disorder Obsessive-Compulsive Disorder (OCD) commonly occur in the general population. Clinical populations indicate a high level of stability, although there are few longitudinal studies in the general population. The recommended drug treatments are SSRIs/TCAs. However, there are few long-term follow up studies. The goal of this study was to 1) examine the occurrence and stability of obsessions, compulsions, and OCD in a longitudinal population-based survey, 2) investigate the use of SSRI and TCA and the potential effect on symptoms. METHODS: A ten-year longitudinal general population in Stockholm was used (2000 and 2010, n = 5650) Obsessional washing, checking, intrusive unpleasant thoughts and the level of suffering due to these symptoms were measured by self-report. Information on use of SSRIs and TCAs by these individuals was obtained from registers. Stability was examined using contingency tables and multinomial logistic regression. RESULTS: At baseline, 2.1, 11.7 and 11.9% reported obsessional washing, checking and intrusive thoughts. A total of 5% reported considerable suffering from these (i.e. OCD). Based on psychiatric interview only 0.4% had OCD. Ten years later a quarter of OCD cases were still classified as having OCD, one quarter reported any obsessive or compulsive symptom and half were classified as symptom-free. Treatment receipt was low and controlling for medication did not change the stability. CONCLUSION: Obsessive thoughts and compulsive behavior are common and stable. While this group is potentially undertreated, there is no indication that those treated display a different pattern of recovery

Mesoamerican nephropathy: geographical distribution and time trends of chronic kidney disease mortality between 1970 and 2012 in Costa Rica.

Mesoamerican nephropathy is an epidemic of chronic kidney disease (CKD) unrelated to traditional causes, mostly observed in sugarcane workers. We analysed CKD mortality in Costa Rica to explore when and where the epidemic emerged, sex and age patterns, and relationship with altitude, climate and sugarcane production

Molecular dosimetry of DNA and hemoglobin adducts in mice and rats exposed to ethylene oxide.

Experiments involving ethylene oxide (ETO) have been used to support the concept of using adducts in hemoglobin as a surrogate for DNA adducts in target tissues. The relationship between repeated exposures to ETO and the formation of N-(2-hydroxyethyl)valine (HEtVal) in hemoglobin and 7-(2-hydroxyethyl)guanine (7-HEG) in DNA was investigated in male rats and mice exposed by inhalation to 0, 3, 10, 33, or 100 ppm ETO for 6 hr/day for 4 weeks, or exposed to 100 ppm (mice) or 300 ppm (rats) for 1, 3, 5, 10, or 20 days (5 days/week). HEtVal was determined by Edman degradation, and 7-HEG was quantitated by HPLC separation and fluorescence detection. HEtVal formation was linear between 3 and 33 ppm ETO and increased in slope above 33 ppm. The dose-response curves for 7-HEG in rat tissues were linear between 10 and 100 ppm ETO and increased in slope above 100 ppm. In contrast, only exposures to 100 ppm ETO resulted in significant accumulation of 7-HEG in mice. Hemoglobin adducts were lost at a greater rate than predicted by normal erythrocyte life span. The loss of 7-HEG from DNA was both species and tissue dependent, with the adduct half-lives ranging from 2.9 to 5.8 days in rat tissues (brain, kidney, liver, lung, spleen, testis) and 1.0 to 2.3 days in all mouse tissues except kidney (t1/2 = 6.9 days). The concentrations of HEtVal were similar in concurrently exposed rats and mice, whereas DNA from rats had at least 2-fold greater concentrations of 7-HEG than DNA from mice.(ABSTRACT TRUNCATED AT 250 WORDS

TICAREX: Exposiciones laborales a agentes cancerígenos y plaguicidas en Costa Rica

The European data system CAREX takes the workforce of a country grouped into 55 economic sectors according to the International Economic Activity Classification (IEAC) of the United Nations, the second 1968 revision and through the application of proportions of workers exposed to 139 carcinogenic agents based on data from industrial hygiene studies, converting it into the total workforce exposed to carcinogens by sector. . In this article we describe a modification and extension of of the CAREX system in order to calculate the number of workers exposed to carcinogens in Costa Rica. It is the first use of CAREX outside Europe (TICAREX) in Costa Rica, Central America, for 27carcinogens and 7 groups of pesticides thought to be of interest for the country, with separate estimations for men and women. The most frequent agents of exposure for the 1.3 million workers of Costa Rica were solar radiation (333,000 workers); diesel exhaust (278,000); paraquat and diquat (175,000); environmental tobacco smoke (71,000); hexavalent chromium compounds (55,000); benzene (52,000); mancozeb, maneb and zineb (49,000); chlorothalonil (38,000); wood dust (32,000); quartz (27,000); benomyl (19,000); lead and its inorganic compounds (19,000); tetrachloroethylene (18,000); and polycyclic aromatic hydrocarbons (17,000). Owing to the different occupational distribution between the genders, exposures to formaldehyde, radon and methylene chloride were more frequent than pesticides, hexavalent chromium, wood dust, and quartz in women. Agriculture, construction, personal and domestic services, manufacture of wood products, mining, forestry, fishing, manufacture of electrical products, and bars and restaurants were sectors with frequent exposures. Substantial reduction of occupational and environmental exposures to these agents would significantly improve public and occupational health. Reduction of occupational exposures is usually also followed by improvement of environmental quality. Monitoring of exposures and health of workers and the general public is an essential element in the control of environmental contamination and human exposures.El sistema europeo de datos CAREX ( CARcinogen Exposure ) considera la fuerza laboral de un país agrupada en 55 sectores económicos según la Clasificación Internacional de Actividades Económicas ( CIAE ) de las Naciones Unidas, segunda revisión de 1968 y mediante la aplicación de proporciones de trabajadores expuestos a partir de datos generados en estudios de higiene industrial para 139 agentes carcinógenos , los convierte a total de fuerza laboral expuesta y número de trabajadores expuestos a agentes carcinogénicos según rama de actividad. . En este artículo se describe una modificación y extensión del sistema CAREX (de CARcinogen Exposure) para calcular los números de trabajadores expuestos a agentes cancerígenos y plaguicidas en Costa Rica. Esta es la primera aplicación de CAREX fuera de Europa (TICAREX) fue realizada en Costa Rica, Centroamérica para 27 agentes cancerígenos y 7 grupos de plaguicidas, considerados de interés para el país, realizando estimaciones por separado para mujeres y hombres . Los agentes cancerígenos más frecuentes a los que se expone la fuerza laboral de Costa Rica de 1.3 millones fueron la radiación solar (333,000 trabajadores); las emisiones de diesel (278,000); paraquat y diquat (175,000); el humo de tabaco ambiental (71,000); los compuestos de cromo hexavalente (55,000); el benceno (52,000); mancozeb, maneb y zineb (49,000); clorotalonil (38,000); el polvo de madera (32,000); el cuarzo (27,000); benomil (19,000); el plomo y sus compuestos inorgánicos (19,000); tetracloroetileno (18,000); y los compuestos aromáticos policíclicos (17,000). En los hombres , la distribución se mantuvo muy ajustada a los anteriores rangos, sin embargo en las mujeres, debido a su diferente distribución en los sectores, el formaldehído, el radón y el cloruro de metileno superaron a los plaguicidas, el cromo (VI), el polvo de madera y el cuarzo. La agricultura, la construcción, los servicios personales y domésticos, el transporte terrestre y acuático y los servicios asociados al transporte , la fabricación de productos cerámicos y semejantes, la manufactura de productos de madera, la minería, la silvicultura, la pesca, la fabricación de maquinaria y aparatos eléctricos, bares y restaurantes fueron sectores de donde las exposiciones son frecuentes. Una reducción drástica de exposiciones laborales y ambientales a estos agentes daría por resultado mejoras sustanciales en los niveles de salud pública y ocupacional. . La vigilancia de las exposiciones laborales y de la salud en el trabajo son esenciales para el control de la contaminación y de las exposiciones a los agentes cancerígenos. La adopción de políticas efectivas para la reducción de los peligros por estos agentes , debe considerar todas las fuentes de exposición y la coordinación intersectorial para la creación, administración e implementación de las regulaciones en esta materia. La reducción de los peligros químicos en el trabajo frecuentemente es seguida por una reducción en las emisiones industriales al ambiente cercano a la planta o proceso productivo

Study of the influence of Beta-radiation on the properties and mineralization of different starch-based biomaterials

In this work, the effects of beta-radiation are assessed, for the first time, on starch-based biodegradable polymers, with the aim of using it as an alternative sterilization process to the previously studied sterilization methods. Different doses of radiation were used in order to investigate the possibility of using this sterilization technique as a treatment to tailor the surface and bulk properties (namely mechanical) of these polymers. The as-treated substrates were characterized by water-uptake measurements and contact angle (theta) measurements. The mechanical properties of the materials were characterized by tensile tests by means of ultimate tensile strength (UTS) and strain at break (epsilon). The fracture of the surfaces was observed by scanning electron microscopy (SEM). Dynamic mechanical analysis (DMA) was also used to characterize the viscolelastic behavior of the irradiated materials. The main effect of sterilization with beta-radiation over the starch-based polymers seems to be a surface modification by an increase of the hydrophilicity. Nevertheless, because beta-radiation did not significantly affect the mechanical properties, it can be regarded as an effective way of modifying the surface for applications were more hydrophilic surfaces are desirable

Illness behavior in patients on long-term sick leave due to chronic musculoskeletal pain

Background and purpose Methods for identification of patients with illness behavior in orthopedic settings are still being debated. The purpose of this study was to test the association between illness behavior, depressed mood, pain intensity, self-rated disability, and clinical status in patients with chronic musculoskeletal pain (CMP)

Chimpanzees communicate to two different audiences during aggressive interactions

Conflict and aggressive interactions are common phenomena in group-living animals and vocal behaviour often plays an important role in determining their outcomes. In some species, vocal signals seem to provide bystanders with information about the nature of an ongoing aggressive interaction, which can be beneficial for the victims. For example, in chimpanzees and some other primates, victims adjust their screams depending on the composition of the by-standing audience, probably to solicit their support. Considerably less is known, however, about the role of other call types produced by victims of aggression. In this study, we focused on the fact that, immediately after screams, chimpanzee, Pan troglodytes schweinfurthii, victims often produce 'waa' barks, but little is known about their function. Our results showed that for screams, but not 'waa' barks, production was dependent on the audience composition with victims being more likely to scream when adult or late-adolescent males were in close proximity. We also found that after 'waa' barking, but not screaming, victims were more likely to retaliate against and less likely to reconcile with their aggressors, and that 'waa' barking was more common after victims had received support from other party members. These results suggest that, in chimpanzees, victims of aggression vocalize with a dual social strategy of attempting to recruit support from bystanders and to repel their attackers by signalling readiness to retaliate. We conclude that victim scream and 'waa' bark calls, although often produced during the same agonistic event, are directed at different audiences and fulfil different social functions, and that these calls can mediate both aggressive interactions and aggressor-victim relationships following aggression

Initiatives addressing precarious employment and its effects on workers’ health and well-being: a protocol for a systematic review

Precarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers’ exposure to precarious employment conditions and its effects on the health and well-being of workers and their families