Promoting the occupational health of indigenous farmworkers.

In the United States, approximately 78% of agricultural farmworkers are immigrants. In Oregon, a growing number of these farmworkers are indigenous and speak an indigenous language as their primary language. This group of farmworkers suffers from linguistic, cultural and geographic isolation and faces a unique set of challenges yet little has been done to identify their health needs. Using data from focus groups, partners from this community-based participatory research project examined indigenous farmworkers' concerns regarding occupational injury and illness, experiences of discrimination and disrespect, and language and cultural barriers. The data revealed examples of disrespect and discrimination based on the languages and cultures of indigenous farmworkers, and a lack of basic occupational health and safety information and equipment. For example, participants mentioned that occupational safety information was inaccessible because it was rarely provided in indigenous languages, and participants felt there were no legal means to protect farmworkers from occupational hazards. Community-based strategies designed to address the occupational health status of farmworkers must consider the unique circumstances of those farmworkers who do not speak Spanish or English.

Measuring adherence to depression treatment guidelines in a VA primary care clinic.

The primary objectives of this pilot study were to develop a measure of adherence for depression practice guidelines and to assess the degree to which providers and patients adhere to guidelines in a VA primary care setting. The Depression Guideline Measure (DGM) is based on three national guidelines. The DGM was used to review medical records of 111 patients with Patient Health Questionnaire (PHQ) scores >or=10. Interrater reliability for 15 of 19 DGM checklist items was excellent (kappa > 0.75). There was a broad range of adherence to guideline criteria: only 13.5% of patients were contacted for follow-up within 2 weeks, while 100% of providers documented follow-up plans. Forty percent of patients saw mental health providers, and 63% were prescribed antidepressants. A secondary objective of the study was to explore the relationship between guideline adherence and changes in PHQ scores. Among 51 patients who completed follow-up PHQs, no associations were detected. The results suggest that the DGM shows promise as a reliable measure of guideline adherence and that guideline criteria are frequently not met in busy primary care clinics. More research is needed to determine the validity of the DGM and the impact of guideline adherence on depression outcomes.