A multifaceted intervention to improve blood pressure control: The Guideline Adherence for Heart Health (GLAD) study.

BACKGROUND: Although high blood pressure is associated with significant morbidity and mortality, the proportion reaching the goal blood pressures as outlined in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, Treatment of High Blood Pressure (JNC 7) is low. We conducted a randomized trial in primary care practices of a multifactorial intervention targeted to improve providers' adherence to hypertension guidelines. METHOD: A total of 61 primary care practices in North Carolina were randomized to receive either a multifactorial intervention (guideline dissemination via a continuing medical education session, academic detailing sessions, audit and feedback on preintervention rates of adherence, and automated blood pressure machines) or an attention control of similar magnitude but targeted at a different guideline. Outcomes were determined through review of patient charts conducted by an independent masked quality assurance organization. RESULTS: We found no difference between the 2 groups in any of the adherence measures including no difference in the percentage of patients at goal (intervention 49.2%, control 50.6%), with undiagnosed hypertension (18.1% vs 13.6%), average systolic (126 vs 125.1 mm Hg), or diastolic blood pressure (73.1 vs 73.4 mm Hg). Similarly, there was no difference in provider adherence to treatment recommendations (use of thiazide-type diuretic as first-line therapy: 32% vs 29.5%; use of 2-drug therapy in stage 2 hypertension: 11.3% vs 10.4%). CONCLUSION: An intensive, multifactorial intervention did not improve adherence to national hypertension guidelines among community-based primary care. Efforts should be focused on other types of interventions to improve rates of control of hypertension.

Migrant farmworker stress: mental health implications.

CONTEXT: The number of Latinos in rural regions of the United States is increasing. Little is known about factors that undermine the mental health of this segment of the rural population. PURPOSE: The goal of this study is to determine which stressors inherent in farmwork and the farmworker lifestyle contribute to poor mental health. METHODS: An interview containing the Migrant Farmworker Stress Inventory (MFWSI) and 3 mental health scales (the PAI [anxiety], CES-D [depression], and CAGE/4M [alcohol abuse]) was administered to a sample of 125 male migrant farmworkers. Factor analysis differentiated discrete domains of stressors in the MFWSI. Regression models identified associations of the MFWSI stressor domains with mental health outcomes. FINDINGS: Thirty-eight percent of participants had significant levels of stress as determined by the MFWSI. The MFWSI reduced to 5 stressor domains: legality and logistics, social isolation, work conditions, family, and substance abuse by others. Some 18.4% of participants had impairing levels of anxiety, 41.6% met caseness for depression, and 37.6% answered yes to 2 or more questions on the CAGE. Social isolation and working conditions were associated with both anxiety and depressive symptoms. However, social isolation was more strongly associated with anxiety, and working conditions were more strongly linked to depression. CONCLUSIONS: Specific categories of stressors (social isolation, working conditions) inherent in farmwork and the farmworker lifestyle are associated with mental health among immigrant farmworkers. Isolating specific categories of stressors helps in designing programs and practice for the prevention and management of mental health disorders in the immigrant, farmworker population.

Child healthcare in two farmworker populations.

Children in farmworker families are medically underserved. Little research has documented the healthcare of these children. This analysis uses data collected from two populations of Latino farmworker families, one located in western North Carolina and western Virginia, and the other located in eastern North Carolina, to describe and compare child healthcare utilization and mothers' satisfaction with their children's healthcare. Child, mother, household and health services characteristics are examined as causes of variation in child healthcare utilization and mothers' satisfaction for each farmworker population. Results highlight strengths in the provision of healthcare to farmworker children, including most receiving care at a consistent healthcare facility, age appropriate time since last visit, and satisfaction with the care received. Shortcomings in farmworker child healthcare include few having a consistent healthcare provider, and many not receiving visits with recommended frequency. Differences observed in child health services between the two populations include dissatisfaction with care received, perceptions that healthcare staff members are disrespectful, and difficulties with transportation. Further research is needed to determine the best means of providing care to this underserved population.

Review of pesticide education materials for health care providers providing care to agricultural workers.

CONTEXT: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health care providers receive little training in it. OBJECTIVE: To evaluate the medical resources available to providers caring for patients, particularly farmworkers, exposed to pesticides and to recommend a selective bibliography for use in educating clinicians about pesticides and health care. These resources are divided into 3 domains: (1) the working knowledge, (2) the skill set, and (3) the references needed to care for these patients. METHODS: We searched library databases dating back to 1995, as well as conference materials and Internet resources. Materials were included only if they were readily available through customary sources. Materials were randomly divided into 2 groups. Two authors wrote detailed reviews for each group. The remaining authors read each document and review, making changes that were agreed upon by the team. Review procedures were standardized to examine the contemporary relevance, quality, and overall strengths and weaknesses of the material relative to guidelines developed for each domain. These guidelines were developed from the authors' experience, national focus groups, and literature review. RESULTS: While no 1 resource adequately addresses all needs, a number of resources were identified addressing the categories of working knowledge, skill set, and reference materials. Few of the reviewed materials address the cultural competence of providers treating farmworkers. Additional education resources are needed.