Bridging the gap in population health for rural and Aboriginal communities: a needs assessment of public health training for rural primary care physicians.

INTRODUCTION: The literature identifies significant inequalities in the health status of rural and Aboriginal populations, compared with the general population. Providing rural primary care physicians with public health skills could help address this issue since the patterns of mortality and morbidity suggest that prevention and health promotion play an important role. However, we were unable to identify any community needs assessment for such professionals with dual skills that had been performed in Canada. METHODS: We conducted key informant interviews and focus groups in 3 rural and Aboriginal communities in British Columbia (chosen through purposive sampling). We analyzed transcripts following standard qualitative iterative methodologies to extract themes and for discussing content. RESULTS: There was broad support for a program to train primary care physicians in public health. The characteristics identified as necessary in such a physician included a long-term commitment to the community with partnership building, advocacy, communication and cultural sensitivity skills. The communities we studied identified some priority challenges, most notably that the current remuneration structure does not support physicians engaging in public health or research. CONCLUSION: There is great potential and support for the training of rural primary care practitioners in public health to improve population health and engage communities in this process.

Social and environmental determinants of Aedes aegypti infestation in Central Havana: results of a case-control study nested in an integrated dengue surveillance programme in Cuba.

OBJECTIVE: To characterize the social and environmental risk factors associated with the presence of Aedes aegypti in order to improve community dengue control. METHODS: A case-control study with 'cases' being households with entomologically confirmed A. aegypti infestation; personal interviews in Central Havana, a densely populated inner city area characterized by overcrowded housing and irregular water service. The participants were residents of 278 houses with infestation and 556 houses without infestation. RESULTS: Greater risk of infestation was associated with lack of preventive measures, such as no larvicide in the water tanks (OR = 2.21) and use of flower vases for religious practice (1.93), not being economically active (1.64), vulnerable populations with higher risks in households with older people (1.52) and households with children (1.94). CONCLUSIONS: Efforts to reduce infestations should continue to focus on water tank sanitation and improving housing conditions, but also engage community religious leaders to help promote safe practices. Vulnerable populations should be especially targeted by prevention activities. A surveillance programme can produce evidence to guide interventions.

Worker satisfaction with a workplace injury prevention and return-to-work program in a large Canadian hospital: the importance of an integrated approach.

BACKGROUND: Workplace injuries cause considerable morbidity, requiring intervention programs with strong stakeholder support and effective interdisciplinary practitioner involvement. Such a program, called Prevention and Early Active Return-to-Work Safely (PEARS), decreased time loss and costs in a large Canadian hospital. However, it only attracted 39% of workers who reported injuries. This triggered a study of utilization and satisfaction with PEARS to determine areas to further enhance the program. METHODS: The hospital's occupational health department records identified 758 workers who reported a musculoskeletal injury (MSI) during the first year of PEARS, along with demographic and injury details. All were telephoned regardless of participation in the PEARS program. RESULTS: Of the 335 survey respondents, 136 had used PEARS. The most common reason justifying non-participation was perception of the injury as minor (45%). PEARS participants accessed significantly more resources than non-participants--cluding accessing physiotherapy (82.8% of participants versus 33.3% of non-participants) and physicians (74.8% versus 64.3%), and workplace assessments (37.9% versus 11.4%). Workplace assessment was the only component of the program that was perceived to be significantly more successful by PEARS participants (64.9%) versus non-participants (35.3%) (p=0.002). CONCLUSION: The fact that the only significant difference in satisfaction of services between those who accessed PEARS versus those who did not related to the workplace assessments underscores the value of proving workplace assessments in the context of an integrated approach to primary and secondary prevention, in which there is a direct link to knowledgeable medical and rehabilitation professionals who provide clinical advice that dovetails with the reality of the workplace setting. A program that emphasizes workplace assessment as an important complement to medical advice and physiotherapy is, therefore, advisable to decrease work disability.

How can PhD research contribute to the global health research agenda?

We propose that PhD and post-doctoral researchers are a strong, untapped resource with the potential to make a real contribution to global health research (GHR). However, we raise some ethical, institutional and funding issues which either discourage new researchers from entering the field or diminish their capacity to contribute. We offer a number of recommendations to Canadian academic and non-academic institutions and funders, and aim to generate discussion among them about how to overcome these constraints. We need changes in the way graduate research is organized and funded, to create opportunities to work collaboratively within established low- and middle-income country (LMIC)/Canadian research partnerships. We urge changes in the way institutions fund, recognize, value and support GHR, so established researchers are encouraged to develop long-term LMIC relationships and mentor new Canadian/LMIC researchers. We ask funders to reconsider additional GHR activities for support, including strategic training initiatives and dissemination of research results. We also encourage the development of alternative institutions that can provide training and mentoring opportunities. GHR per se faces many challenges. If we address those that reduce our potential to contribute, we can become real partners in GHR, working towards equitable global health and solutions to priority health issues.