Storylines of family medicine VI: ways of being-in the office with patients.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.

Optimal management of on-farm resources in small-scale dairy systems of Central Mexico: model development and evaluation.

This study evaluates the available on-farm resources of five case studies typified as small-scale dairy systems in central Mexico. A comprehensive mixed-integer linear programming model was developed and applied to two case studies. The optimal plan suggested the following: (1) instruction and utilization of maize silage, (2) alfalfa hay making that added US$140/ha/cut to the total net income, (3) allocation of land to cultivated pastures in a ratio of 27:41(cultivated pastures/maize crop) rather than at the current 14:69, and dairy cattle should graze 12 h/day, (4) to avoid grazing of communal pastures because this activity represented an opportunity cost of family labor that reduced the farm net income, and (5) that the highest farm net income was obtained when liquid milk and yogurt sales were included in the optimal plan. In the context of small-scale dairy systems of central Mexico, the optimal plan would need to be implemented gradually to enable farmers to develop required skills and to change management strategies from reliance on forage and purchased concentrate to pasture-based and conserved forage systems.

Farm and socio-economic characteristics of smallholder milk producers and their influence on technology adoption in Central Mexico.

In order to identify the factors influencing adoption of technologies promoted by government to small-scale dairy farmers in the highlands of central Mexico, a field survey was conducted. A total of 115 farmers were grouped through cluster analysis (CA) and divided into three wealth status categories (high, medium and low) using wealth ranking. Chi-square analysis was used to examine the association of wealth status with technology adoption. Four groups of farms were differentiated in terms of farms' dimensions, farmers' education, sources of incomes, wealth status, management of herd, monetary support by government and technological availability. Statistical differences (p < 0.05) were observed in the milk yield per herd per year among groups. Government organizations (GO) participated little in the promotion of the 17 technologies identified, six of which focused on crop or forage production and 11 of which were related to animal husbandry. Relatives and other farmers played an important role in knowledge diffusion and technology adoption. Although wealth status had a significant association (p < 0.05) with adoption, other factors including importance of the technology to farmers, usefulness and productive benefits of innovations together with farmers' knowledge of them, were important. It is concluded that the analysis of the information per group and wealth status was useful to identify suitable crop or forage related and animal husbandry technologies per group and wealth status of farmers. Therefore the characterizations of farmers could provide a useful starting point for the design and delivery of more appropriate and effective extension.