자연주의적 탐구조사(Naturalistic Inquiry)

Doing Qualitative Research

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Narrative Methods for the Human Sciences

This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

It made it possible to improve people's lives. Now it prevents all forms of discrimination in the world. It helps to improve our world.

Universal Declaration of Human Rights

BACKGROUND: Since 1972, oil companies have extracted more than 2 billion barrels of crude oil from the Ecuadorian Amazon, releasing billions of gallons of untreated wastes and oil directly into the ...

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Geographical differences in cancer incidence in the Amazon basin of Ecuador in relation to residence near oil fields

Desde la decada de 1970, el petroleo ha sido una de las principales fuentes de ingresos del Ecuador y ha servido como "motor impulsor" de la economia nacional. La mayor parte del petroleo ecuatoriano se extrae en la cuenca amazonica del nordeste del pais. Desde que comenzo la explotacion petrolera, companias extranjeras y la empresa petrolera estatal Petroecuador han extraido mas de dos mil millones de barriles de petroleo crudo de la Amazonia ecuatoriana. A lo largo de este proceso se han liberado al medio ambiente miles de millones de galones de desechos sin tratar, gas y petroleo crudo. Este articulo analiza el impacto ambiental y sanitario provocado por el desarrollo petrolero en la region amazonica del Ecuador. Por ejemplo, el analisis del agua de varias corrientes fluviales de la localidad ha demostrado la presencia de altas concentraciones de productos quimicos derivados del petroleo en las zonas petroliferas en explotacion. Los estudios epidemiologicos han encontrado un mayor riesgo de sufrir sintomas asociados con el petroleo y abortos espontaneos en las mujeres que viven en las proximidades de los campos petroleros. Tambien se ha encontrado una incidencia excesiva de cancer. Se necesitan intervenciones locales, nacionales e internacionales para evitar que se empeoren los efectos negativos que ejerce sobre el medio ambiente y la salud el desarrollo petrolero. Estas intervenciones deben abarcar un sistema de monitoreo y remediacion ambiental, consultas a la comunidad y participacion comunitaria, mecanismos para hacer cumplir las leyes que protegen el medio ambiente y la salud de la poblacion, y cambios en las politicas comerciales dirigidos a lograr la sostenibilidad en materia ambiental y la justicia social.

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Oil exploitation in the Amazon basin of Ecuador: a public health emergency

To determine whether there was any difference in childhood leukemia incidence rates between populations living in the proximity to oil fields and those living in areas free from oil exploitation in the Amazon basin of Ecuador, 91 cancer cases among children (0-14 years) from the provinces of Sucumbios, Orellana, Napo, and Pastaza during the period 1985-2000 were studied The relative risks for all leukemias indicated significantly elevated levels in the youngest age group (0-4 years), both genders combined (RR 348, 95% CI 125-967), and in all age groups (0-14 years) combined for females (RR 260, 95% CI 111-608) and both genders combined (RR 256, 95% CI 135-486) There was no significant difference between the two groups in all other cancer sites combined Study results are compatible with a relationship between childhood leukemia incidence and living in the proximity of oil fields in the Ecuadorian Amazon

Incidence of Childhood Leukemia and Oil Exploitation in the Amazon Basin of Ecuador

Pesticide use is one of the most significant occupational exposures for agricultural workers in the Amazon basin of Ecuador. A structured questionnaire was developed focusing on sociodemographic characteristics, knowledge and experience of adverse health effects related to pesticide use, details of work practices, and an inventory of pesticides used on the farm. Of the 112 farmers interviewed, 111 (99.1%) used pesticides. Paraquat was most commonly used (77.4%), followed by glyphosate (65.7%). Respondents had good knowledge about the acute health effects of pesticides and their exposure routes. Risk behaviors were identified as frequent pesticide use, washing pesticide equipment in water sources used by humans, inadequate disposal of empty pesticide containers, eating and drinking during pesticide application, and using inadequate protective clothing. Training and educational campaigns on pesticide use should be encouraged for this cohort, along with suggestions for alternative methods of pest control.

Pesticide Use among Farmers in the Amazon Basin of Ecuador

Background: Despite the development of national community-based health worker (CBHW) programmes in several low- and middle-income countries, their integration into health systems has not been optimal. Studies have been conducted to investigate the factors influencing the integration processes, but systematic reviews to provide a more comprehensive understanding are lacking. Methods: We conducted a systematic review of published research to understand factors that may influence the integration of national CBHW programmes into health systems in low- and middle-income countries. To be included in the study, CBHW programmes should have been developed by the government and have standardised training, supervision and incentive structures. A conceptual framework on the integration of health innovations into health systems guided the review. We identified 3410 records, of which 36 were finally selected, and on which an analysis was conducted concerning the themes and pathways associated with different factors that may influence the integration process. Results: Four programmes from Brazil, Ethiopia, India and Pakistan met the inclusion criteria. Different aspects of each of these programmes were integrated in different ways into their respective health systems. Factors that facilitated the integration process included the magnitude of countries’ human resources for health problems and the associated discourses about how to address these problems; the perceived relative advantage of national CBHWs with regard to delivering health services over training and retaining highly skilled health workers; and the participation of some politicians and community members in programme processes, with the result that they viewed the programmes as legitimate, credible and relevant. Finally, integration of programmes within the existing health systems enhanced programme compatibility with the health systems’ governance, financing and training functions. Factors that inhibited the integration process included a rapid scale-up process; resistance from other health workers; discrimination of CBHWs based on social, gender and economic status; ineffective incentive structures; inadequate infrastructure and supplies; and hierarchical and parallel communication structures. Conclusions: CBHW programmes should design their scale-up strategy differently based on current contextual factors. Further, adoption of a stepwise approach to the scale-up and integration process may positively shape the integration process of CBHW programmes into health systems.

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Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low-and middle-income countries

Anna-Karin Hurtig

Papers

Geographical differences in cancer incidence in the Amazon basin of Ecuador in relation to residence near oil fields

Oil exploitation in the Amazon basin of Ecuador: a public health emergency

Incidence of Childhood Leukemia and Oil Exploitation in the Amazon Basin of Ecuador

Pesticide Use among Farmers in the Amazon Basin of Ecuador

Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low-and middle-income countries