The National Institutes of Health has issued a new policy for open access to all NIH-funded research, whereby NIH grantees are strongly encouraged to deposit their complete manuscripts and supplementary material to an Internet repository, thereby enabling the rapid dissemination of research results and the long-term archiving of scientific literature ,2. EntitPublications are perhaps the sole currency of scientific research--for it is publications which beget funding, and in turn, funding which begets more publications--and as such they are vitally important to the career of any research scientist. How, when, and where the research is published can be as significant as the research results themselves since the influence of a research article may only be as potent as its ability to attract an audience of readers and thereby disseminate through the field.public readership generally, and in this way the progress of science is archived in the historical record. True to this spirit, the NIH has initiated the Public Access Policy [Indeed, the root of the word publication implies its dissemination to a s Policy ,2 and has Policy .The NIH proposal mandates Open Access, but only to those research articles deriving in part or whole from direct costs provided by NIH grants. Nonetheless, this policy will likely apply to a major fraction of all research publications. By its own estimation, the NIH currently funds at least ten percent  of all biomedical literature annually [The Proceedings of the National Academy of Sciences USA (PNAS) has fully embraced the new NIH open-access policy. PNAS has in the past and will continue in the future to deposit all of its final, publisher-formatted articles into the PMC repository after a six-month embargo, regardless of the funding source. Furthermore, PNAS has adopted a democratic compromise by allowing authors to choose an "Open Access option" whereby the publisher-formatted final edition of their paper can be made freely available at PMC and PNAS immediately upon its online publication [PNAS imposes a modest surcharge ($750) that is in line with the "author pays" model used presently by most of the approximately 1500 Open Access journals [The journal lication . For thijournals .PNAS, and at least explore the possibility of making the transition to an Open Access model of publishing. Indeed it seems that an increasing number of subscription-based journals are exploring hybrid approaches, such as that used by PNAS, that enable authors to offer their content online by paying publication costs for open access. But the publishing world is uniquely devoid of market forces that might expedite this transition. One need only look to the skyrocketing subscription costs (print or online) for scientific and medical journals, and the inability of institutional libraries to afford them. A study by the NIH concluded that journal prices increased during the last decade at a rate that was over 6 times inflation [New England Journal of Medicine acknowledges that some journal editors and publishers will perceive some aspects of the Public Access Policy as "potential threats" to their "revenue sources" [Open Access already exists  and othenflation . A recensources" . In addisources" ,2,12,13.BMC Bioinformatics [de facto due to the immediacy and ease with which their research articles may be retrieved, disseminated, and cited by scientific colleagues. It is this immediacy that, in part, fuels the movement towards Open Access, for such immediacy is required now more than ever given the breakneck speed of scientific progress. This is reflected in the changing landscape of scientific publishing as it transitions from print-based to electronic journals for the communication of biomedical research.A study by Thomson ISI–the company that assigns impact factors to journals–indicates that, among the 200 Open Access journals it monitors, these journals are competitive with their traditional counterparts: Open Access journals "adhere to high publishing standards, are peer reviewed comparably to other journals in their respective fields, and are cited at a level that indicates they compete favorably with similar journals in their field" . One telormatics . Since OBioMed Central (BMC) and the Public Library of Science (PLoS) are two current, and successful, Open Access publishing models that provide immediate access to biomedical research articles. With high visibility and high quality articles monitored by strict peer-review standards, these publishing "houses" provide an alternative to traditional print journals and embody the ideals recently articulated in the NIH Public Access Policy. Thus, we encourage compliance with the new NIH policy and, furthermore, would suggest that authors submit their research articles to an Open Access journal, all of which archive their content in PubMed Central.Alternatives to traditional subscription-based journals continue to gain momentum as policies in support of Open Access are made by some of the world's largest science funding agencies, namely, the NIH, the Howard Hughes Medical Institute, and the Wellcome Trust. All these agencies now provide generous budget supplements to cover the costs of publication in Open Access journals . It is iPublication models evolve over time. We have entered a very exciting period in which the scientific community can choose between two models, the traditional, subscription-based model or the Open Access model. As the number of Open Access journals and publishing houses grows, the scientific community is now in the position to `vote' for one or the other model. We firmly believe that immediate and unrestricted access to scientific information will be the gold standard for scientific publication and urge every researcher to submit their manuscripts to Open Access journals. The growing number of freely available articles, which are archived in PubMed Central, marks the trend towards Open Access.Molecular Cancer and receives no remuneration for his efforts. CS is exempted from Molecular Cancer's Article Processing Fee.GCI, CD and PWT declare that there are no competing interests. CS is Deputy Editor of GCI wrote and finalized this manuscript. CS, CD and PWT provided critique and suggestions. All authors read and approved the final manuscript.


This paper describes the outcomes of episodes of care for adults in public sector mental health services across Australia, with a view to informing the debate on service quality. Health of the Nation Outcome Scales (HoNOS) change scores and effect sizes were calculated for 14,659 acute inpatient episodes and 23,692 community episodes. The results showed that people in contact with public sector mental health services generally do get better, although the magnitude of improvement depends on the setting and episode type. This confirmatory finding is particularly positive, given current community concerns about the quality and effectiveness of mental health services. In Australia, as in other countries, there has been increasing concern about how well mental health services serve the community. Australia's National Mental Health Strategy has provided a strong policy platform for mental health service reform over the last decade or more , emphasiVarious sources of evidence have been cited in the debate over the nature and quality of Australia's mental health services, and their capacity to meet consumers' needs. Key among these are several reports on the direct experiences of consumers and carers, which draw on the findings of large-scale consultations -6. Also What has been missing to date is any systematic evidence regarding whether people in receipt of mental health care improve. Consumer-level outcome data that can inform this question are necessary, and are now being collected by public sector inpatient and community mental health services in all Australian states/territories, and being routinely submitted by each state/territory to the Australian Government. Australia is an international leader in this regard – the United States, the United Kingdom and several continental European countries have also begun to routinely collect outcome data, but have not done so on such a comprehensive scale -12.Collectively, the Australian outcomes data are known as the Mental Health National Outcomes and Casemix Collection (MH-NOCC). For adults, two clinician-rated outcome measures are used in each state/territory, along with one of three consumer-rated measures  during given 'episodes of care', at particular 'collection occasions'. An episode is defined as '... a more or less continuous period of contact between a consumer and a mental health service organisation that occurs within the one mental health service setting ' . CollectMH-NOCC data were available for the period July 2000 to April 2005. Data were provided at the collection occasion level, and then 'cleaned' and aggregated to 'episodes' by the AMHOCN study team. All episodes comprised more than one collection occasion, but it should be noted that not all episodes were bounded by admission and discharge collection occasions. The first collection occasion for those in ongoing treatment at the point of implementation of the national collection was a review, rather than an admission; and the last collection occasion for those in ongoing treatment when the MH-NOCC data were submitted was a review, rather than a discharge. In other words, certain valid sequences bounded episodes, creating the following episode sub-types: admission to review; admission to discharge; review to review; review to discharge.The current paper focuses on one outcome measure only, the clinician-rated Health of the Nation Outcome Scales (HoNOS), developed by Wing and colleagues in the United Kingdom . The HoNEach HoNOS item is rated from 0 (no problem) to 4 (very severe problem), resulting in individual item scores, subscale scores and a total score. HoNOS measures were included in the current analysis if at least 10 of the 12 items had valid clinical ratings. Missing items were treated as contributing 0 to the relevant subscale score, and to the total score.HoNOS change scores and effect sizes were calculated for valid episode of care. The change score was defined as the mean difference between the 'start' and 'end' scores: a positive change score indicated a reduction in clinical severity  and a negative change score indicated an increase in clinical severity . The effect size quantified the difference in change scores within episodes  , with anIn total, data were available from 101,820 collection occasions from acute inpatient settings, and 183,071 from community settings. In the former setting, these collection occasions aggregated to 21,911 valid episodes, 14,659 (66.9%) of which had sufficiently complete HoNOS ratings at the first and last collection occasions. In the latter, they aggregated to 36,803 valid episodes, 23,692 (64.4%) with eligible HoNOS ratings.Table Table Tables Also of note in Tables The findings suggest that, on the whole, people in contact with Australia's public sector mental health services do get better. The magnitude of improvement is greater in acute inpatient episodes than in community episodes. This makes sense, given that people who are admitted to the former setting would typically experience greater problem severity than those admitted to the latter, and would therefore have greater room for improvement. In both acute inpatient and community settings, the extent of improvement is greater in episodes that begin with admission and end with discharge, than it is in episodes that are punctuated at one end or the other by a review. Again, this finding has good face validity, in the sense that improvement would be expected to occur on a gradient. Within settings, the patterns of improvement are also intuitively sensible.Some caution should be exercised in interpreting the above findings, since they cannot be interpreted as causal. To demonstrate that mental health services were making people better would require a different study design, and would require evidence that those who were not in contact with mental health services did not show similar degrees of improvement.In addition, the study had several limitations related to data volume and quality. Firstly, although all Australian states/territories are now submitting MH-NOCC data, the progress with which individual jurisdictions have implemented routine outcome measurement has not been uniform, so the majority  of collection occasions were recorded in 2003–04 and 2004–05. Secondly, there was no way of knowing the level of compliance with administering the HoNOS, since no denominator data were available on the total number of consumers under care. Thirdly, some collection occasions were 'dropped' at the point of converting them to episodes  and some episodes were not included in the analysis , which may have introduced systematic biases into the results if particular types of consumers were more likely to be the focus of these collection occasions or episodes. Fourthly, the reliability and validity of the HoNOS ratings are arguably open to question, although it should be noted that clinicians across the country have been trained in the instrument's use, and there are no financial incentives for 'gaming' .These limitations aside, the findings address an evidence gap in a way that can inform the debate on how well Australia's public sector mental health services are serving the community. Until now, no comprehensive data have been available on consumer outcomes; the current study provides such data, and suggests that, in general, these outcomes are positive. This is particularly impressive, given that these services primarily provide treatment for people with psychotic and affective disorders , which cThe study demonstrates the value of routine outcome measurement, in terms of informing questions of service quality and effectiveness. Routine outcome measurement was introduced in Australia under the National Mental Health Strategy, in recognition of the fact that the quality and effectiveness of services can only be achieved through the development of sound information to support service planning and delivery. In mental health circles, Australia is considered a world leader in this regard . Other aThe current study provides a global picture of adult consumers' improvement in public sector acute inpatient and community mental health services, as measured by the HoNOS. The challenge for mental health services is now to use this information to inform service and program development to support high quality care. There is also a need for further research endeavours, and future work by the AMHOCN study team will pursue more detailed analysis of the above data , consider additional consumer groups  and additional settings , and explore outcomes assessed by different instruments, both clinician-rated and consumer-rated.To conclude, the current study suggests that adults in contact with public sector acute inpatient and community mental health services experience a reduction in problem severity during the course of a typical episode of care. While one would hope that this would be the case, it has not been demonstrated in any systematic way before. This confirmatory finding is particularly positive, given current community concerns about the quality and effectiveness of mental health services.The author(s) declare that they have no competing interests.PB, JP and TC conceptualised the idea for the paper, PB undertook the analyses, and PB, JP and TC all prepared the manuscript. All authors read and approved the final manuscript.


A relationship between early menarche in girls and later development of breast cancer has long been observed. Some environmental factors, such as diet and exposure to endocrine disruptors and other chemicals, could affect children’s timing and pace of puberty and development. This leads to the question of whether exposure to these agents may also lead to breast cancer later in life. That is the scientific premise for the establishment of the Breast Cancer and the Environment Research Centers (BCERCs), which presented results of ongoing studies at their third annual meeting on 2–3 November 2006.The centers are co-funded by the NIEHS and the National Cancer Institute (NCI) Epidemiology and Genetics Research Program. They work together to integrate community outreach and two lines of research: 1) basic biology of the mammary gland and its development using animal models, and 2) epidemiological studies of how environmental factors affect puberty in girls. Four centers were established across the nation: the Fox Chase Cancer Center in Philadelphia (collaborating with Mount Sinai School of Medicine in New York and the University of Alabama at Birmingham), the University of Cincinnati in Ohio , the University of California, San Francisco , and Michigan State University in East Lansing.“Using a transdisciplinary scientific approach, the centers are able to investigate possible windows of susceptibility during pubertal development more comprehensively and on a larger scale,” said Shannon Lynch, a program analyst at the NCI. The BCERCs’ ability to work closely together, share resources, compare findings, and establish common research protocols is especially important in epidemiological studies. With each center recruiting a number of girls from diverse racial/ ethnic, geographical, and socioeconomic backgrounds, the data that are ultimately generated should be more robust due to a greater number of samples that are more representative of different populations.EHP. Center researchers collaborated with the CDC to analyze urine samples collected from 6- to 8-year-old girls to assess the levels of bio-markers of exposure to a number of phytoestrogens, phthalates, and phenols. Many of these compounds are known or suspected to cause endocrine disruption.One example of the kind of multidisciplinary data that can be generated by this collaboration can be found in a paper presented at the meeting, which was later published in the January 2007 issue of The authors found that these potentially hormonally active compounds were widely detectable in the girls studied. For several of the compounds, concentrations varied by geographic location, body size, or race/ethnicity such that meaningful comparisons may become possible. It is still too early to tell whether exposure to these compounds will be associated with puberty, but so far the preliminary data show that exposures can be substantial and perhaps biologically relevant.Each center is also producing new research results within its own populations of study. The University of California center, for example, working together with the Kaiser Permanente Division of Research, has recruited 444 girls, along with their families, to study how environmental exposures may affect growth and development. The study participants are members of Kaiser Permanente of Northern California, an integrated prepaid health care system, so researchers have access to early medical information for the girls including birthweight.In preliminary analyses, Larry Kushi, associate director of the Kaiser Permanente Division of Research, and colleagues found that higher birthweight predicted risk of overweight in 6- to 7-year-old girls. It is important to assess peripubertal obesity in girls enrolled in the study because obesity is a strong predictor of breast development; how obesity may affect timing and degree of puberty development is one of the subjects of this investigation. A significant proportion (29%) of girls enrolled in this study were classified as overweight, defined as being at or above the 85th percentile for body mass index. Ongoing analyses are assessing the levels of pubertal development in the cohort. The preliminary findings suggest that the black and Latina girls are having a higher prevalence of early puberty onset.Investigators at the meeting also presented results of studies conducted in the basic science components of their centers. Deborah J. Clegg, an assistant professor in the Department of Psychiatry at the University of Cincinnati College of Medicine, conducted a yet-unpublished study to assess how caloric content and type of dietary fat eaten may affect obesity and carcinogenesis susceptibility in laboratory rats. Her team tested high- and low-fat diets rich in olive oil, fish oil, safflower oil, or butter (a “1950s diet”). They found that the high-fat olive oil diet accelerated puberty and increased propensity to carcinogenesis in the exposed rats. Additionally, they found that the high-fat diets enriched with safflower oil and fish oil increased body weight and susceptibility to carcinogenesis. Interestingly, however, the high-fat butter diet did not increase body weight or carcinogenicity.In addition to the basic and epidemiological research being conducted, each center also has a Community Outreach and Translation Core (COTC). The COTCs have different functions within each center, including sharing information with the community, conducting research on translating science findings, and studying recruitment and retention strategies.The COTC at Michigan State University presented data on the types of meaningful messages about breast cancer that women remember for long periods of time and the sources of such messages. Based on responses from 137 women who completed an online questionnaire, researchers concluded that most messages were recalled from the mass media. Most messages were about the detection of breast cancer rather than its prevention. These findings demonstrate that the media has a strong influence on the messages received by women, perhaps more influence than the medical community.The issue of what health messages can impact the community at large resonated with many participants present at the meeting, which included leaders of the breast cancer control advocacy community, who are active participants in the centers. Beth Hartung, a member of the Young Survival Coalition (a network of breast cancer survivors who are 40 or younger), expressed this succinctly as she asked a panel of center scientists, “What do we tell our daughters [about their risk of breast cancer]?” Program administrator Les Reinlib of the NIEHS Division of Extramural Research and Training, himself the father of two daughters and husband to a breast cancer survivor, answered, “We tell them to make lifestyle choices that improve general health.”For now, until more definitive research on specific environmental exposures has been completed, exercise and good nutrition are the two main lifestyle choices that can help in the prevention of disease. And despite the uncertainty that remains, there have been many scientific advances that have extended the lives of women diagnosed with breast cancer.Andrea Ice, cofounder of the Sisters Network , has seen this first-hand. “Since my initial diagnosis in 1989, the biggest change has been that women see other women who have survived the disease for many years,” she says. “It is no longer a death sentence.” The hope is that the BCERCs will be able to add prevention to the progress made in breast cancer research.


Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators". "Waterpipe" smoking is now considered a global public health threat and the corresponding artefact is actually known in the world under three main terms: hookah, narghile and shisha. This important report, the first ever prepared by WHO on the subject, poses two major problems. On one hand, its bibliographical references dismiss world chief relevant studies. On the other, it contains a certain number of errors of many orders: biomedical, sociological, anthropological and historical. The purpose of the present study is to highlight, one by one, where these weaknesses and errors lie and show how this official report can be considerably improved.The World Health Organisation Study Group on Tobacco Product Regulation (TobReg) has issued in 2005 an "Advisory Note" entitled: "We realise that widely advertised early anthropological studies were not taken into consideration whereas they shed a substantial light on this peculiar form of smoking and help understanding its high complexity. As for concrete errors to be found in this report, they deal with the chemistry of smoke, health-related effects, smoking patterns, description and history of the artefact and its use, gender and underage use aspects, prevention and research needs in this field.The scientific credibility of an international expert report may be at stake if its recommendations do not rely on sound objective research findings and a comprehensive review of the existing literature. The critical comments in this study will certainly help improve the present WHO report. Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators"  filters to be inserted to the mouthpiece. In addition, pH, resins or other modifications can be made to the HB water to improve its filter properties." [In this field  that "sharing a waterpipe mouthpiece poses a serious risk of transmission of communicable diseases, including tuberculosis and hepatitis". This statement is wrongly attributed to researchers [The report states  that "in Syria . Accordiin Syria . The maiy hours" . Unfortuy hours" .We deem it not necessary to insist too much on the biochemical and health dimensions provided that the methodological conditions are respected in order to avoid the too frequent bias. Two critical reviews in French and Italian, among others, were published on these very aspects ,6,13,21.We also hope that in the coming future the nicotine addiction dogma will be sidestepped when tackling the dependence aspects. On one hand, it is not appropriate in the field of hookah smoking and the results of a study carried on by one of the very teams mentioned in this report, are quite clear: about 3/4 of the interviewees declared narghile use was easy to quit . On the Globally, we may wonder why controversial studies ,8,35,36 Prevention is the most important and pressing issue and no suggested action (page 7) is given in this report whereas a public health catastrophe is looming and so many ideas could immediately be put forward to avoid it and reduce the harm caused by this new widespread form of smoking ,13,21,37there is surprisingly little research addressing tobacco smoking using a waterpipe, especially given that there are many millions of current waterpipe smokers and that waterpipe use is spreading across the globe". It is true that very little research has been devoted to the subject. Therefore to perform an exhaustive bibliography was not a superhuman task, and the WHO report should have done it. We personally regret that the authors did not even mention the deep and early health oriented anthropological research that we carried on in this field, which contains many ideas for the desired development of prevention and cessation strategies" [The report states page 6) that "ategies" ,6,13,21. that "atthe relationship between waterpipe smoking and the use of other drugs, including marijuana" (page 6). We will point out that a 262 page scientific book, entirely dedicated to this topic, was published as early as 1997 [One can also read that there would be research needs for " as 1997 .The International Organization for Standardization (ISO) machine-based cigarette test for determining the tar, nicotine, and carbon monoxide content of cigarettes should be banned and replaced" [th core principle set out in another TobReg important report is: "Regardless of the funding mechanism adopted, it should ensure that the independence and integrity of research and testing operations are not compromised or inappropriately influenced » [ibid.).We hope these comments will be useful for the future reports which, we insist, should be clear and objective, if we want them to be accepted, as far as their recommendations are concerned, by health practitioners, prevention activists, researchers and the one-day or regular smokers themselves all over the world. Methodology needs substantial improvement. The World Health Organisation Study Group on Tobacco Product Regulation itself, responsible for the publication of this very report actually concluded in a meeting: "eplaced" . What iseplaced" ,8 shouldeplaced" . The 12tuenced » . The samWe invite our colleagues, particularly those working in the epidemiological field, to amend the design of their questionnaires and include one or several items related to the past and present career  of the volunteers analysed in their studies ,21,37. TThe present work is based on a critical and thorough review of the WHO report. The findings of the studies cited by the authors are compared with the results of those not cited in that document, both in the biomedical and social sciences fields. We realised that the errors concretely deal with the following themes: the chemistry of smoke, health-related effects, smoking patterns, description and history of the artefact and its use, gender and underage use aspects, prevention and research needs in this field. Their corresponding analysis and comments are combined as far as possible and reported as subsections in the Results and Discussion section, namely: Origins; Tar yields; Heating and burning; Children; Women; New charcoal; Harm reduction; Infections; Scenario for the Epidemic; "Nicotine addiction"; Chief studies; Prevention; State of research; Drugs.The author(s) declare that they have no competing interests.


The data obtained here showed that a huge body of knowledge the farmers have on many forms or strategies of management are generally compatible with scientific knowledge.Ethnoecological knowledge may be understood as spontaneous knowledge, culturally referenced of any society's members, learned and transmitted through social interactions and that are targeted at resolution of daily routine situations. The traditional knowledge in small scale economy societies as well as the non-academic knowledge in urban-industrial societies might be included in this concept. An ethnoecological approach study was performed here on people living at the communities of Alvinho, Almeida, Chã do Marinho, Floriano, and Chã de Oiti, all located in the municipality of Lagoa Seca, Paraíba state, Northeast Brazil. The general objective pursued here was to study the knowledge that peasant farmers have on management of plant species utilized for pest control. For this, the methodological instruments employed here to investigate the ethnoecological knowledge were: direct observation, structured and semi-structured interviews, and tours conducted by local peasant farmers. We analyzed the data obtained under an emic/etic view and also by comparing the local knowledge with those obtained from the literature. The results showed that people in those communities utilize management alternatives for controlling pests, which are mainly: (i) fallowing; (ii) crop rotation; (iii) destruction of crop remains and fruits attacked by pests; (iv) alternations of crops with repellent plants; and/or (v) mixed cropping; (vi) insect's larvae covered with soil; (vii) crops irrigated abundantly; and (viii) soil preparation. The recovery and comprehension we get about this knowledge as well as the farmers'  The systematic knowledge of crops management for pest control is not an invention of modern western science. Many communities of peasant farmers and indigenous peoples developed their own strategies by using natural chemicals against crop pests. Such system results from people's experience throughout generations in interaction with their environments, since externally financial resources and scientific knowledge have not been accessible to them . Studiessavoir faire, which makes up the human cultural universal heritage. The interdisciplinary nature of ethnoecology is another relevant aspect that promotes articulation and integration between formal knowledge (researchers' experience on pest control shared among them) and local people's knowledge .All different forms of view, representation and practices of pest control have been discussed in the present study through a theoretical methodological focus provided by ethnoecology, as reported elsewhere -5 and 66]. Ethno6. Ethno6In this way, it was aimed in the present study to describe the knowledge and practices utilized by traditional peasant farmers of the municipality of Lagoa Seca, Paraíba state, for managing crops pest control.The study area2 [The municipality of Lagoa Seca is located 129 km of João Pessoa. It makes part of the 'agreste' and 'brejo' , at the eastern side of the Planalto da Borborema (the Borborema Upland). It is located at an altitude of 634 m, covering an area of 133 km2 . The geo2 .The target populations of the present research make part of the communities of Alvinho, Almeida, Chã do Marinho, Floriano, and Chã do Oiti, where peasant farmers carry out agricultural activities, cultivating mainly maize, bean, and green vegetables. They are categorized as farming family's activity involved in traditional subsistence agriculture. Some authors ,9 considca. 50 farmers from the communities. On the basis of identified themes, the methodological techniques employed here were free interviews, direct observation, and application of structured and semi-structured questionnaires to farmers with considerable expertise. These farmers were suggested by other communities' members, and their number varied according to the subject-matter. Such technique has been denominated as 'snow ball', where the own members of the communities suggest their fellows to be interviewed [Our field work was carried out in the studied communities by selecting the peasant farmers according to criteria  which taerviewed .The data obtained were transcribed and codified on the basis of themes and identified emic categories and they were organized in a data bank. We chose the option of an essentially qualitative approach and speech analysis, with quantitative approach only in specific situations. The results were analyzed through the union model of several individual competences . Direct The results obtained here show interaction of factors in farmers' management of plants as they prepare and fertilize the soil that is hoed into ridges, being crops planted on them, irrigated and later their produces are harvested. This process is subsequently adopted by each family and so the soil is maintained potentially productive. This cropping system, up to the harvest, may suffer interferences interrupting the production cycle, like crop pests to which the farmers put a high valuation owing to their hazardous effect on production.This way, the peasant farmers were stimulated to find out several forms or strategies of management, through practical knowledge, so preventing the development of some pests in that region.The interactions of soil, air, water and plants, are clearly and permanently necessary to the communities' life, being then quite important to keep these factors in equilibrium by means of a simple and healthy management. According to the farmers studied here, management means the ability of the use and re-use of a certain area, by preventing its exhaustion. The concept of natural resources emerged intensively from the 1980s when natural and social sciences researchers insisted on demonstrating the relationship of environmental degradation and questions of social justice, impoverished rural population, and Indians rights . These le.g. fertilization, use of water, soil maintenance, application of biocides, crop rotation, and interplanting with repellent plants. Those authors pointed out that some of these stages are beneficial to increase nitrogen content, reduction of soil erosion, nutrients turnover, and increase of productivity.The data obtained in this work showed that the farmers use eight techniques for managing their cropped plants, namely: (i) fallowing; (ii) crop rotation; (iii) destruction of crop remains and fruits attacked by pests; (iv) alternations of crops with repellent plants; and/or (v) mixed cropping; (vi) insect's larvae covered with soil; (vii) crops irrigated abundantly; and (viii) soil preparation. The technique they apply to control the most common crop pests, constitutes also an important aspect of their knowledge. Similar management techniques were also studied by other authors ,16, wherInformation on types of management and forms of control of the main pests in the study area are shown in Table One technique the farmers generally use is fallowing, where according to them the land needs time to recover for the next planting. This is an entirely valid reason for a profitable and healthy harvest, because well-regenerated and fertile soil is quite important for the prevention of pest attacks, as they say:A soil must be put at rest for producing good fruits'.'In studies performed on fishermen at the lower course of the River São Francisco, in the state of Alagoas , the autStudies performed on fallowing among Kayapó Indians for longer than three months  revealedCrop rotation is reported here as a very common strategy applied by the peasant farmers in our study area, for attenuating pest attacks in their crops. They reason they avoid monocultures because of their greater susceptibility to pests, which would put the crops at risk.A crop rotation practised by the farmer may inhibit development of a pest throughout the year by reducing its population and consequently will cause lesser damage in the subsequent plantings. Kayapó Indians in their agricultural activities showed a revival of old practices and management when using appropriately the environment for controlling pests ; they usCrop rotation is an annual alternation of different plant species in the same plantation area. The species the farmers select for cropping are intended to generate commercial profit and recovery of soil productive properties. At the time the farmers obtain a diversified production of food and other produces, if the crop is appropriately managed for a quite reasonably long period, some benefits will certainly be achieved, as follows: (i) improvement of physicochemical and biological properties of the soil; (ii) it helps to control weeds, diseases, and pests; and (iii) it renews the soil organic matter, which will protect the soil against the action of climate agents. Additionally, direct drilling would be a viable alternative to be applied and would certainly benefit farming and environment as a whole .In a study on horticulturists of northern littoral of Natal, state of Rio Grande do Norte , it was The other technique here investigated was the destruction of fruits attacked by pests or diseases. Such fruits are collected and burned to eliminate the pest and avoid its dissemination and high populations in subsequent crops. The farmers state that when there is a low level of attack, the fruits are their main target of destruction otherwise the entire crop will be destroyed. Crop remains are also destroyed as a complement to this technique. This sort of management avoids new incidence of the pest in the subsequent crop, as observed by a local farmer:We have to burn, or the pest will spread out'.'Tagetes minuta), will make the pest to recede owing to the flower's smell.In the community studied here, the farmers themselves observed that mixing a crop with repellent plants, like a species of marigold . Mixed crop, made up of pumpkin plus maize plus plants (tomato and marigold) that act as repellent of pests, have been proposed for use to avoid pests [It was reported from laboratory experiments  that exte. Later , also inid pests .A woman-farmer commented about such technique:One day I thoughtfully said: I'm going to find out a way to kill those little animals because the flowers's smell is quite strong; then I started by rubbing the marigold's flower on plant's parts that had those little animals and they were all killed'.'The use of jets of water applied on plants infected by pests is another management technique that kills the pests or carries them away, and their incidence is consequently reduced. Actually, it has been observed  that abuSpodoptera frugiperda, at initial phase of infestation, are combated by covering the larvae with ca. 100 g of soil, mainly on the ones situated between the leaves of maize which will die after some minutes. This procedure is utilized by the farmers at the beginning of the insect attack, preferably during summer, as the high temperature will kill them more quickly.Some crops attacked by the caterpillar of Daniel Duarte -UFPB  suggests that a soil fungus may act as an entomopathogen of the insect, killing it rapidly. But one of the peasant farmers gives this explanation:Just a little bit of soil we put on the caterpillars make them die of suffocation; but only if they are not many'.'Soil preparation technique involves the use of manure from cattle, goats, and chickens, which the farmers let to lie fallow for three days. Then they are applied in small amount because of their high combustion potential.What makes us to believe that the peasant farmers know the importance of preparing the soil for sowing the seeds, their sprouting, and unlimited crop yield, is confirmed from the following statement of one of them:The plant is like us; if we're weak, it'll be easier to get ill'.'The practical results of the techniques above-described are the produces harvested in the right time, and after land fallow, new seeds can be planted. Harvest is carried out from alternate ridges that the farmers construct on steep slopes, forming terraces. The ridging pattern acts as a set of barriers to the down slope movement of water and promotes infiltration, a fact the peasant farmers know for obtaining a dynamical crop yield. This procedure when associated to the other techniques described here, have been used by them because they know these are essential measures to guarantee pest control and high crop yield.savoir faire' they experience in their daily life in the field. The most practised management strategies of the farmers are crop rotation and land fallow, which are practical and effective. The other techniques are less used. Their knowledge on crop management varieties without application of toxic chemicals showed to us the 'corpus' and 'praxis' importance for controlling pests, when compared to scientific knowledge. For this reason, we understand that their knowledge must be at issue when pro-conservation attitudes are under discussion.Most of the crop management techniques used by the peasant farmers studied here stem from their '


Dental graduates are joining a profession experiencing changes in systems of care, funding and skill mix. Research into the motivation and expectations of the emerging workforce is vital to inform professional and policy decisions. The objective of this research was to investigate final year dental students' perceived motivation for their choice of career in relation to sex, ethnicity and mode of entry.Self-administered questionnaire survey of all final year dental students at King's College London. Data were entered into SPSS; statistical analysis included Chi Squared tests for linear association, multiple regression, factor analysis and logistic regression.A response of 90% (n = 126) was achieved. The majority were aged 23 years (59%), female (58%) and Asian (70%). One in 10 were mature students. Eighty per cent identified 11 or more 'important' or 'very important' influences, the most common of which were related to features of the job: 'regular working hours' (91%), 'degree leading to recognised job' (90%) and 'job security' (90%). There were significant differences in important influences by sex , ethnic group  and mode of entry (mature > early entry: 'a desire to work with people'). Multivariate analysis suggested 61% of the variation in influences is explained by five factors: the 'professional job' (31%), 'healthcare-people' (11%), 'academic-scientific' (8%), 'careers-advising' (6%), and 'family/friends' (6%). The single major influence on choice of career was a 'desire to work with people'; Indian students were twice as likely to report this as white or other ethnic groups.Final year dental students report a wide range of important influences on their choice of dentistry, with variation by sex, ethnicity and mode of entry in relation to individual influences. Features of the 'professional job', followed by 'healthcare and people' were the most important underlying factors influencing choice of career. Societal, political and economic change impacts on the healthcare workforce, which is recognised as 'critical' for health systems. ,2 Furthest century. [New graduates from UK dental schools are emerging into a profession facing a time of unprecedented change, both general as outlined above, and specific to the profession.  Fundamencentury. As with entrants to university in general and other professions, such as medicine, admissions to dentistry include an increasing proportion of females and ethnic diversity. -25 DentiChanges in education policy have resulted in students emerging with significant levels of student debt.  New entrThe motivation for studying dentistry has come under scrutiny amongst applicants to, and students of various schools across the UK, ,39-41 anKCLDI is the largest dental school in the UK and amongst the largest in Europe. The Institute contributes up to 25% of the home trained dentists to the profession in England, thus the views of its students, although not necessarily representative of the national picture, have a significant impact on the profession. UCAS data for 2003 and 2004 suggest that the dental school has a high proportion of students from ethnic groups relative to other schools, including medicine, within King's College London, ,52 and tThe findings presented in this paper represent part of a larger programme of research the aim of which is to investigate the views of final year dental students', and recent graduates, on their future professional careers and explore how they consider their working lives may be enhanced. Both qualitative and quantitative methodological approaches have been utilised, with the qualitative data informing the development of a questionnaire instrument for the quantitative research as well as providing the theory underpinning student views derived from qualitative analysis.This paper reports the reasons that final year students at the end of their course perceive have influenced their choice of dentistry as a professional career and relates them to the current educational and health policy. Subsequent papers will report on students short- and long-term future plans in more detail and the theory emerging from the qualitative data.The objective of the research presented in this paper was to investigate final year dental students' perceived motivation for their choice of dentistry as a professional career in relation to sex, ethnicity and type of entry to dental school.The questionnaire instrument was constructed using qualitative data from the focus groups of final year dental students at KCLDI and vocational dental practitioners nationally during 2004/05 and drawing on the published literature. The study was undertaken using the approach outlined by Dillman.  King's CThe final version of the questionnaire had a total of 27 questions, 11 of which contained subdivisions. The instrument comprised five sections examining their vision of dentistry (i.e. why they had chosen it as a career), short-term career aspirations, long-term career aspirations, influences on their career and their personal details.The class list of all final year dental students in 2004/05 was requested from the School Registry and all students (n = 140) were included as the study population, 57% of whom were female and 70% Asian.To obtain maximum response and minimise disruption to academic studies, the questionnaires were distributed following the Fifth Year  examinations in mid-June. All students were offered the opportunity to complete a questionnaire. This survey was conducted anonymously. The tailored approach to the conduct of a questionnaire survey recommended by Dillman,  was usedDescriptive analysis was undertaken to present an overview of the findings from this population study, together with an analysis by sex, ethnicity, and mode of entry (direct or mature entry) to study. Differences between groups were examined using Chi-squared test for linear trends across the rated questions.In examining their 'vision' of dentistry, students were asked to identify how much they considered each of the 23 factors had influenced their choice of dentistry. The 'vision' section of the questionnaire explored why students perceived they had chosen dentistry as their professional career. Closed questions were utilised permitting students to scale responses such as why they chose dentistry, from "very important" (Score – 1) to "not important" (Score – 5) on a five-point Likert scale across 23 items. This section also covered questions to explore students' perception on alternative careers, in particular medicine and reasons for not pursuing alternative career pathways. Demographic details obtained included age, sex, and ethnicity, year of entry, mode of entry, qualifications and the level of existing debts.Proportions of respondents favouring each of the factors are provided with the corresponding 95% confidence intervals. Similarly, the distribution of the major influencing factors quoted is provided. A factor analysis of this question was used to determine the principal latent determinants of the choice of dentistry as a career, and aggregate scores were derived for each principal determinant in order to rank their impact and find the most important independent driving force on this choice.Linear regression models were then used to assess the relationship of demographic variables and their proposed plans for the future with the principal determinants and factors perceived as influencing their future careers. Finally, the corresponding relationships with the modal category of the single most important influence on their choice of dentistry were investigated using a logistic regression model.The results are in four sections: first, the response to the study; second univariate analysis; and third, multivariate analysis of the factors which students' perceive influenced their choice of dentistry as a career; fourth and finally, other career related issues are explored.Of the 140 questionnaires distributed to the Year 5 dental students, 126 were completed and returned giving an overall response rate of 90%. The age of respondents ranged from 22–33 years, with a mode of 23 years (59%). Thirteen respondents (10.5%) were mature students, aged 26 years and over.Females (58%) exceeded males (42%). The majority of the respondents identified their ethnicity as Asian (70%) followed by White (22%) Table . The majThe majority of students (76%) identified that they had debts, 45% of whom had debts of £21,000 or more. Students reporting debt did not differ markedly from the overall profile of respondents in terms of age, sex or ethnicity.Students were asked to score their level of support for a wide range of influences according to the level of importance they perceived the factor had in their choice of a professional career in dentistry Figure . Eighty There was variation by age, sex and maturity on entry, in relation to the influences ranked as important, with three of the top five influences in common Figures , 3.'Job security' was the top influence of importance for males (91%), followed by 'regular working hours' (90%), whereas for females 'degree leading to recognised job' (95%) and a 'desire to work with people' (93%) were most important Figure . SignifiAsian students identified ' academic knowledge' 93%), 'work experience' (91%) and 'regular working hours' (91%) most frequently as influences of importance, whereas white students identified 'degree leading to recognised job' (93%) and 'regular working hours' (93%)  as important in choosing dentistry, than mature students (88% cf 77%).The top five 'very important' influences for all respondents displayed in Table major influence on their career of choice. Only 17 of the same 23 listed options were utilised by respondents  Figure . 'SignifThe major influence reported by Asian students was also 'desire to work with people' (18%). Asian students were significantly more likely than white students to consider 'desire to work with people' (p = 0.03) as their major influence in choosing their professional career. In contrast, white respondents considered 'practical/artistic skills' (18%) as their major influence.The major influence for mature students was 'practical/artistic skills' ; however, significantly more direct entrants than mature students considered a 'desire to work with people' (p = 0.03) as the major influence on career choice.ethnicity was the only significant factor influencing the modal choice for the single most important influence on choice of dentistry as a career, i.e. a 'desire to work with people'. The odds of the 'desire to help people' being the driving force in choosing dentistry as a career were more than double for the Indian group, in relation to white, Pakistani, Bangladeshi and Other-Asian groups .A logistic regression model showed that professional job factor. The second factor, which we will refer to as the healthcare-people factor, explained 11% of the variability and was comprised of items related to the desire to work with people, in healthcare or public service. The third factor was the academic-scientific factor and explained 8% of the total variability. The fourth and fifth factors, each of which explained 6% of the variability, referred to influences from careers advisers and family and friends.The results of the maximum likelihood factor analysis using varimax rotation are set out in Table Living standards in future career choices were considered the main influential determinant for the professional job factor, followed to a lesser extent by sex. The students that scored high on this factor tended to be those who attach high importance to the standard of living in making future professional choices  and male . The model was adjusted for age (p = 0.22) and ethnicity (p = 0.53), although neither of these variables was shown to have an influential effect on the job factor.Table healthcare-people factor tended to be those who gave more importance to family commitments in their future professional choices . Neither age, nor sex, nor ethnicity showed an association with the healthcare-people factor.The students that scored high on the academic-scientific factor tended to be those who attached more importance to team work when making decisions about their professional career in the short-term decisions . Neither age, nor sex, nor ethnicity showed any significant association with this factor.The students that score high on the careers-advising factor tended to be those who gave importance to career opportunities when considering short term plans . Although not statistically significant, to some extent they tended to be older . Neither sex nor ethnicity demonstrated any association with this factor.The students that scored high on the family-friends-influencing factor.No variable showed a significant association with the factor As preliminary qualitative research identified that medicine had been an alternative career choice considered by many of the students, all students were asked whether they had considered choosing medicine as opposed to dentistry as their career of choice, together with reasons for not pursuing a career in medicine. Almost half of the respondents  and 55% of males had considered medicine as an alternative career. There was no difference between the two main ethnic groups.Medicine was actively rejected as a career option by dental students, for a range of reasons reported in open response Figure . These iThis section considers the contribution of the findings to the existing literature, examines the influences that have motivated students to choose dentistry as their professional career and the implications for health and education policy, professional action and future research.This study contributes to the literature on dental workforce in three main areas. First, it examines the motives of final year students as they prepare to leave dental school, in contrast to the majority of published studies, which have focused on admissions or new entrants to dental school. ,44-46,54The response rate amongst students was high (90%), thus providing support to generalise the findings to the final year population under study, particularly as non-respondents did not differ in terms of their demographic profile. Although the findings cannot be considered to be representative of dental students in general in the UK, the views of this group of students, given their demographic profile and the trends in admission to dental school, are nonetheless important to inform workforce planning and policy.KCLDI has a profile that is skewed towards Asian students. ,52 The mprofessional job factor was dominant followed by healthcare-people. Although the individual influence of 'high income' was an important influence for 78% of KCLDI students, it was not prominent in the factor analysis, when compared with US students, [Building on the qualitative components of this research programme, this quantitative study has confirmed the wide range of influences on students' choice of career, lending support to the range of influences raised in similar studies of applicants to or students of dentistry. ,40,44,50tudents,  However,tudents,  Each of professional job related factor. It is important to note that other aspects, close to being included were also job related: 'high income', and 'flexible working hours'. Aspects of the professional job have scored highly in other studies amongst admitted and final year students at the same school, [professional job.Professional job factors explained 31% of the variation with 'independence', 'being able to run a business', 'regular working hours' and job security' associated with the  school,  and beyo school, ,44,48,49 school,  which toprofessional job may be important to sub-groups with males showing significantly more interested in 'professional status' and 'business', whereas females were more interested in 'independence' and 'flexibility of working hours', as demonstrated in past research. [Multivariate analysis suggested that students attaching high importance to this factor also attached importance to future living standards and were more likely to be male. This supports sociologists perspectives on professions that their members are motivated by status in the social and economic orders, ,5 and paesearch. ,40,48,49esearch. Work experience, which provides insight into features of the professional job, was reported as an important influence for 87% of students. Looking to the future, it is clear that the features of the professional role of dentists and their day-to-day job are likely to change significantly to the extent that it will be rather different to that encountered by current cohorts on work experience. There is anticipated to be much greater emphasis on 'team-working' rather than 'independence',  and incrIf the influences that attracted dental students to their chosen professional career are being, or will be, challenged over the forthcoming decades, it is important that as a dental profession we provide a realistic view to those who seek work experience and apply to dental school. Skelly and Flemming have already stressed the importance that those advising and recruiting people into the profession should ascertain whether applicants have a realistic idea of what lies ahead.  PotentiaPeople and healthcare issues were the second underlying factor, suggesting an element of altruism but not as strong as with Danish students in 1972 and 1994.  Whereas healthcare-people factor was significantly related to 'family commitments' and this has implications for policy makers, managers and business owners as it will be important to facilitate commitment to family for these people-orientated dentists who can make an important contribution to professional care in terms of valuing patient contact and form a significant proportion of the profession. In addition to the professional job changing, the systems of providing healthcare are changing with increasing privatisation of dental care, [The other aspect of this factor, 'a desire to work in healthcare' was the second very important influence for females (52%) and Asians (53%). Factor analysis suggested that the al care, ,63 and pDentistry provides a clear avenue for pupils from a scientific background wishing to pursue an academic career. Other studies have identified a recurring 'interest in sciences' and the 'scientific nature of dentistry'. ,48 Both Faced with an ever expanding range of programmes available for study at university, assistance with choice becomes ever more important. In this technological age, computer-based advice through decision aid programmes was important for just over one quarter of students, with personal advice still more important for almost half of the total. Evidence from the multivariate analysis that those who report careers advice influenced their choice of dentistry are more likely to be influenced by the range of career opportunities in dentistry is important to note. Whether this relates to the quality of careers advice or the personality of the student seeking career advice, to inform a rational approach to decision making, is unknown; however these students' tended to be older and therefore perhaps especially anxious to have clear career plans. There are now more graduate entry students who will be older on exit from dental school; therefore these findings suggest that there may be more demands for careers advice within dentistry from this group. Moreover, in this time of change in modernising dental careers,  changingThis factor involved only 6% of the variation and interestingly was not associated with age, sex or ethnicity. However, univariate analysis would suggest that 'family' were the important single major influence for a small group of individuals, who tended to be female and come from minority ethnic groups. These individuals only represent a minority of students and the data do not support generalisation to the study population.This study has highlighted the underlying factors, which determine students' choice of dentistry as a professional career. The balance between professional and people-healthcare factors appears to differ across published research; however, in this group of students, professional job related factors are dominant. In considering the wider context of health and health services, it appears that elements of three factors, which together describe 50% of the underlying motivation, are under particular challenge: features of the professional job, healthcare-people, and academic-scientific factors. The findings raise important issues about health professionals' motivation and highlighted the need for entrants to the healthcare workforce to understand the dynamic nature of professions and the pace of change, along with the need for mentoring support in relation to career development. Longitudinal research into the workforce expectations and subsequent career decisions and pathways could contribute to professional debate and inform policy planning, as with our medical counterparts. ,73 GivenFinal year dental students confirmed a wide range of influences as important or very important, in their choice of dentistry as a professional career. The underlying influencing factors relate to features of the 'professional job', followed by 'healthcare-people' factors and to a lesser extent 'academic-scientific', 'careers-advising' and family-friends'. There is evidence that students' sex, ethnicity and maturity on entry to dental school are associated with individual influences relating to these factors. As professional job factors are the dominant motivating influence amongst contemporary students, and most likely to change, this has implications for the motivation of this cohort of dentists.Three of the authors  are academic staff at King's College Dental Institute. NHFW is Dental Dean and Head of School.JEG and NHFW conceived and designed the overall research programme. JG led the development of the protocol, gained ethics committee approval, oversaw the fieldwork including development of the questionnaire, contributed to the data analysis, interpretation of results and led on writing of the paper. RP conducted the fieldwork, entered the data to SPSS and contributed to the descriptive analysis. ND undertook the multivariate analysis. JG, ND and NHFW contributed to the paper. All authors reviewed the final manuscript.The pre-publication history for this paper can be accessed here:


Edible insects are a natural renewable resource that provides food to many ethnic groups in Mexico. Some of these species are overexploited because of increased consumption, caused by the huge human population growth in the area and because of the large demand of these insects from many restaurants in Mexico and in other countries.In Tulancalco, a small arid village in the State of Hidalgo, I carried out studies on edible insects over 25 years. The inhabitants of this village have a natural economy and use some 30 species of insects as food. At present, we have noticed a decrease in the population of several species due to overexploitation, which is carried by non-qualified independent workers who are not natives of the town. These gatherers sell their catch to make a living, thus contributing to the socioeconomic factors associated with this issue. These actions have degraded the ecosystems of this area, and consequently the prevention of these measures is critical.The study species in this paper include 14 threatened species and we discuss some pragmatic measures that could implemented to avoid their extinction. In addition, some actions for the preservation of the ethnoentomobiodiversity in the area are proposed. A great part of the Mexican territory is covered by mountains which are home to a variety of habitats, ecological niches and communities  Fig. 1)1), many Posey  stated tMigration to the country's capital or abroad is a common phenomenon which must be considered in the present study . Mainly As rural workers grow older and try to satisfy their new psychological needs they abandon the fields in search of jobs in the city and forget their origins, their autochthonous food, and, consequently, their means of acquiring resources.This lack of interest and jobs in rural areas allowed unqualified people to capitalize on the demand and lack of supply for edible insects for the market. Consequently, they exploit the resources in an irrational way, deteriorating the environment and depleting the resources. The situation is exacerbated by the desire for certain insect species from the middlemen or from monopolies of this industry.Originally, indigenous people gathered edible insects for consumption, sharing it among their families, and only selling the surplus on certain occasions. Due to pressure and the hope of satisfying other needs  they began overexploiting this resource  to fill Generally, indigenous people who migrate to Mexico City return on the weekends to spend time with their families. Since they know about the demand and the price paid for edible insects from being in the city, they quickly harvest large quantities of these resources without respecting the conditions required by these species to thrive. This, together with the demographic explosion of the country and the economic crisis in which it is submerged, has increased this immoderate exploitation.Nowadays, insects are considered to be a non-domesticated resource since few species are cultivated. According to research, 40 species of edible insects in Mexico are presently in danger .Ethnobiology has a great social responsibility, not only through the study of humans and their relationship with nature, but also through the responsibility of denouncing the deterioration that humans inflict on resources in order to prevent such damage in the future. Ethnobiological studies are multidisciplinary and inter-institutional since these studies link many disciplines, including Entomology, Ecology, Biology, Anthropology, Sociology, Economy, History, Geography and Ethnobiology. The latter was the first science to join man and the environment in a pragmatic way, mostly focusing on the preservation of species, and is based on the interests of the local population.Here, we will discuss the case of a town in the State of Hidalgo Fig. , which hTulancalco, Hidalgo is a small town a few kilometers from Mexico City with 3,000 inhabitants of Nahuatl (2/3) and Otomi (1/3) origin. Located at the base of the Sierra Madre Oriental (20°20' north latitude and 99°20' east longitude) . It is aProsopis juliflora (Sw.) DC), "pirul" (Schinus molle L.), nopal (Opuntia spp.), maguey (Agave spp.), wild lettuce (Agave lechuguilla T.), "palo loco" (Senecio praecox (Cav.) D.C.), "jarilla"  and "garambullo" (Myrtillocactus geometrizans (M.). Besides shrubs like the "barredero" (Baccharis conferta HBK), there are many herbaceous plants of Eupatorium, Vigueira and Zaluzania genus and various gramineous during the rainy season.The ecosystem is classified as Xerophytic bush  and is mWe have frequently visited this town during many years. Its inhabitants were workers of an old Hacienda producing "pulque" (fermented drink of water-honey agave), which after the Mexican Revolution became their property. Initially, the land was divided among the families that worked there, but the land was continually divided further when children reached adulthood, and now each property is so small that it cannot provide enough to live on. This situation, together with the decreased popularity of Mexican "pulque", caused the replacement of agave plants with corn or other crops, and modifying their environment further.Liometopum apiculatum M. and Myrmecosistus melliger W. or hives of Polybia occidentalis nigratella B. to evaluate their condition. We also measured the number of organisms of white and red agave or "botija" worms  and xamues (Thasus gigas B.) in an area of about 300 Km2, and observed the status of the aquatic bugs of the Corixidae family which produce the "Ahuauhtle" in water ponds or lagoons.This study is based on 25 years of field work carried out in different states of the Mexican Republic. We went to Tulancalco every month for three years, to determine which insect species the inhabitants ate, and how they preserved these species. Later, we went back twice a year to evaluate the status of some species of edible insects. These stays consisted of visits to the nests of the recorded In Tulancalco, five main orders of insects are consumed. Most of these species are terrestrial (79%) and only a few aquatic 21%; Table . QualifiThere is a huge gap between the knowledge of the gatherers and that of the scientists, because many of gatherers do not know how to maintain these resources at a sustainable level.Liometopum) were part of the tributes for the Aztec Emperor Moctezuma  denominates as intermediate technology, which requires only the resources on site.


Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10%–18%. In developed countries, mental health problems are one of the main grounds for receiving disability benefits. In up to 90% of cases the cause is stress-related, and health-care utilisation is mainly restricted to primary care. The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave (MISS) in primary care, which is intended to reduce sick leave and prevent chronicity of symptoms.Cluster-randomised controlled educational trial.Primary health-care practices in the Amsterdam area, The Netherlands.n = 227, usual care [UC] n = 206) with sick leave and self-reported elevated level of distress.A total of 433 patients  nor on severity of self-reported symptoms.We found no evidence that the MISS is more effective than UC in our study sample of distressed patients. Continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective. Background: People who take sick leave from work as a result of mental health problems very often report that the cause is stress-related. Although stress-related sick leave imposes a significant burden on individuals and economies, few evidence-based therapies exist to prevent sick leave in people who are experiencing stress-related mental health problems. The researchers carrying out this study wanted to evaluate the effectiveness of an intervention for stress-related mental health disorders amongst people who had been on sick leave for less than three months. The intervention involved short training sessions for primary health-care practitioners, during which the practitioners were taught how to diagnose stress-related problems; how to provide information to patients and encourage their recovery and active return to work; and how to give advice and monitor patients' recovery. The researchers carried out a cluster-randomized trial evaluating this training program, in which 46 primary care practitioners were assigned by chance to receive either the training program or to practice usual care. Over the course of the trial, 433 patients with elevated levels of distress and sick leave were included in the study, 227 of whom were treated by practitioners receiving the training program and 206 of whom received usual care. These patients were followed up for 12 months and the primary outcome studied in the trial was the length of sick leave taken until full return to work. Secondary outcome measures included patients' reports of distress, depression, and other symptoms as recorded using specific questionnaires.What the trial shows: In the trial, data on the primary outcome measure was available for 87% of the patients treated by practitioners receiving the training intervention and 84% of the patients receiving usual care. When these outcomes were analyzed, there was no evidence of a benefit of the training program on amount of sick leave taken. Over the course of the study, the severity of patients' self-reported symptoms fell in both groups, but there was no significant difference in symptom severity between the two groups of patients. A subgroup analysis suggested that more practitioners in the intervention group recognized patients as having stress-related mental health problems. Among the group of patients who were diagnosed as having stress-related mental health problems, those who were treated by practitioners in the intervention group seemed to return to work slightly more quickly than those in the usual care group. However, it is not easy to interpret the findings of this secondary analysis.Strengths and limitations: Strengths of this study include the procedures for cluster randomization, in which primary care practitioners were randomized, rather than patients. This process ensures that only patients assigned to the intervention arm receive the benefits of the intervention, and avoids “contamination” between intervention and control groups. A further strength includes the blinding of researchers who were collecting data to the intervention that each practitioner had received. The findings of the study, however, are difficult to interpret. No effect of the training intervention was found on the study's primary outcome measure; it is possible that the training intervention does indeed have some benefit, but the benefit may not have been found in this particular trial because of the inclusion of patients with a very wide range of problems; in addition the practitioners may have not had the time or ability to apply what they learnt in the training program.Contribution to the evidence: Very little evidence exists regarding the effects of training interventions for improving care of patients with stress-related mental health problems. The findings of this trial support those of another study carried out in a primary care setting, which found that training interventions do not seem to reduce length of sick leave. However, another study carried out in an occupational health-care setting, in which patients included in the trial had been recognised as having stress-related mental disorders, did find some benefit of an intervention program. Mental health problems often affect functioning to such an extent that they result in sick leave . The worCommon psychopathology, as seen in primary care, often starts with failure to cope with personal, social, or occupational demands. The ability to cope or readjust is overtaxed, and this increases the probability that psychological distress will follow –13. SickAs yet, there are no evidence-based primary care interventions to improve functioning and to prevent long-term sick leave in patients with SMDs. Primary care physicians (PCPs) are not always aware of the potentially harmful consequences of sick leave and stress, because the symptoms seem to be self-limiting. Or, PCPs may be overly cautious and not question the continuation of sick leave nor ask the patient to make more effort to cope with the situation, feeling that this type of response undermines the mutual trust between patient and doctor ,19.The present study is a cluster-randomised controlled effectiveness trial in which PCPs were randomised to an intervention group that was trained to deliver a minimal intervention for stress-related mental disorders, or to a control group that delivered care as usual. Distressed patients on sick leave visiting the practices of both PCP groups were screened, included, and followed up for one year . The MedWe approached 139 PCPs in two districts where the Department of General Practice of the VU University Medical Center has some type of network positioned. A total of 46 PCPs signed informed consent, both for participating in our trial and for being randomised to either the intervention training or to the usual care (UC) group.n = 22,740, see In order to recruit enough eligible patients, we made use of the computerised patient record system and approached the source population of patients  situation into a problem that could be solved. Lastly, the PCPs were instructed to consider referral to more specialised care in case no progress had been made, since the patient was not likely to benefit from more time off work. The PCPs in the UC group received no information or advice about the content of the intervention beforehand, but were offered the training at the end of the trial. Guidelines for PCPs are available for the treatment of depression [Over a period of 6–10 wk, the PCPs randomised into the intervention group received training in the Minimal Intervention for Stress-related mental disorders with Sick leave (MISS). The training comprised two sessions of 3.5 h and two regular follow-up sessions of 2 h . The tutors during the training were the PCP who developed the intervention (BT) and an occupational physician. During the training, the PCPs were instructed to use specific methods of communication to help the patient, within three consultations on a time-contingent course, to achieve functional recovery. The MISS takes into account the time constraints under which a PCP works, as well as the position of a PCP as a generalist who does not have the capacity to apply highly specialised interventions. The necessary set of skills was clearly defined and taught to the PCPs. First, the PCPs were taught to pression  and anxipression , but notActual treatment of the participating patients was left to the discretion of the PCPs, who were informed of a patient's participation only after a month. At baseline, patients were asked whether or not they had planned another visit to their PCP. If not, they were asked if they were considering another visit. The PCP was not obliged to apply the MISS or any other intervention, nor were the patients obliged to visit their PCP.The aim of this study was to assess the effectiveness of our MISS in primary care, which is intended to reduce sick leave and prevent chronicity of SMD symptoms in patients. We hypothesised that the MISS would be more effective than UC, particularly in patients who had been diagnosed with SMD by the PCP.The primary outcome was duration of sick leave in calendar days from the first day of sick leave until full (not part-time) return to work, lasting for a period of at least 4 wk without partial or full relapse into sick leave. Patients were asked to record their days of sick leave, and this information was collected at baseline and after 2, 6, and 12 mo during telephone interviews. The secondary outcome measures were self-reported symptoms of distress, depression, anxiety, and somatisation. These were measured with the Four-Dimensional Symptom Questionnaire (4DSQ ) at basehttp://www.statsol.ie/html/nquery/nquery_home.html). A related study completed in occupational health care showed a difference of 15% in full return to work after a period of three months [To estimate the required sample size, we used a method that takes into account potential clustering of effects within practices, the expected difference in outcome between intervention groups and the required power of the study. Sample size calculation was done with nQuery Advisor  were put on a list in random order. Independently, a randomly ordered list of codes  was generated. These lists were brought together and the first PCP on the list was allocated to the group indicated by the first code, and so on. As a result, 24 PCPs were allocated to the MISS group and 22 to the UC group. After the PCPs were assigned and the MISS group had received 7 h of training, the patients were enrolled by screening the source population. Patient selection was performed by the research team, in order to prevent selection bias due to the MISS training. The PCPs entered the names and addresses of the source population, and the source population was given the inclusion criteria through a screening questionnaire. The research assistance team contacted the patients who returned the questionnaire by phone, gave information about the study, and was responsible for the final recruitment. The internal research team, responsible for the process of data collection, knew the study involved was a randomised controlled trial, but they had no information on which PCP was allocated to what condition. Patients and external interviewers were blinded. They were kept unaware that two different groups were formed, and were told that the study was about stress and sick leave.The PCPs were randomly allocated at four different recruitment moments, with block sizes of http://www.stata.com/stata8/) with robust standard errors [http://www.spss.com).To evaluate the effectiveness of the MISS compared to UC, we used Cox regression analysis in STATA 8.0 .All analyses were conducted according to the intention-to-treat principle and corrected for the clustered design. The analyses were performed in several stages. First, baseline similarity of the two groups was examined for all potential confounders  and baseline values of symptom scores . Secondly, the unadjusted association between the groups (MISS versus UC) and both outcome measures were calculated. This association was then adjusted for each of the potential confounders separately. A forward selection procedure was followed to include the potential confounders. For our primary outcome measure this was done in order of highest change in the regression coefficient. Only those factors that changed the regression coefficient by more than 10% were considered to be confounders, and retained in the model. For our secondary outcome measure this was done by checking the significance of the p < 0.10). If significant, we proceeded with subgroup analyses. Since the diagnostic behaviour of the PCPs in the MISS group might have been changed as a result of the training, we were aware of confounding by selection bias. If the MISS PCPs detected more patients with an SMD than their UC counterparts, they would possibly detect a significantly higher proportion of patients with relatively mild disorders, which in itself could explain any differences in the patient outcomes of the groups. Therefore, we tested again for confounding of the association between the intervention and the outcome by baseline values of symptom scores .Furthermore, we were interested in potential modification of the treatment effects by the PCPs' diagnosis of SMD, and therefore preplanned subgroup analyses on diagnosis in the Cox regression analysis and linear mixed models effect evaluation. Baseline measures of self-reported symptoms, as well as diagnoses from the electronic medical records were examined, so we were able to check for classification of patients and severity of complaints (inclusion is only by self-reported level of distress with sick leave). We added product terms for the possible effect-modifier “diagnosis”  and condition (MISS or UC) to the model and checked for significance of the interaction term  were included in the study, 66.3% of whom were women. The participant flow from baseline up to 12 mo follow-up is represented in a diagram . For ourp < 0.001), and on our secondary outcome measure no significant differences were found between the MISS group and the UC group. A considerable number of patients still scored above threshold on self-reported symptoms after 12 mo follow-up. As can be seen in All analyses were adjusted for the clustering effect of PCPs. p = 0.068). These diagnosis categories showed interaction with the intervention in the Cox regression analysis on differences in duration of sick leave (p = 0.033). The PCPs' diagnosis of both SMDs and other mental health problems was associated with a longer median duration of sick leave, compared to the diagnosis of somatic health problems. The baseline diagnoses from the medical records are shown in We were unable to prove our hypothesis that the MISS would be more effective than UC, either on our primary outcome measure nor on the secondary. The median number of days on sick leave before return to work was substantial in both groups and a considerable number of patients still scored above threshold on the self-reported symptoms. However, the severity of symptoms was reduced significantly during the 1 y follow-up.The MISS did not show an overall effect in our study sample of patients with symptoms of distress on sick leave. Possible explanations for the failure to find an effect can be sought within the patients, the PCPs, and the intervention used. First of all, we shall discuss the patients. There might have been a problem with the inclusion criteria used. It is possible that we misclassified a substantial part of the patients because our criteria might have been much too broad at both sides of the severity continuum. As can be seen with the self-reported symptoms of depression, 24.0% in the MISS group and 28.8% in the UC group still scored above threshold level after one year. This substantial group of patients may have had conditions that were of a more chronic nature  and needed more extensive care. The difficulty here is that relevant dimensions of psychopathology that are subacute, but not yet chronic, and clearly related to stress , could not be distinguished in a straightforward way from more severe psychopathology or from an admixture of somatic and psychological symptoms. Nevertheless, we used only three questions on distress symptoms and one question on sick leave to recruit patients who had visited their PCP. We were convinced of the importance of undertaking this study, and for that reason might have underestimated the challenge of diagnosing SMDs. Thus, it is clear that the evidence base on criteria for the diagnosis of SMD in patients has to grow substantially.Furthermore, the lack of effect might be due to the PCPs. They are the gatekeepers of health care and have extensive workloads. The MISS takes into account the time constraints under which a PCP works, as well as the position of a PCP as a generalist who does not have the capacity to apply highly specialised interventions. Nevertheless, the PCPs may have been too busy to carry out any intervention at all. Alternatively, the intervention might have been too minimal, or the training hours too short for the PCPs to actually learn the necessary skills. Unfortunately, except for detection and labelling of symptoms, the extent to which the PCPs actually applied their skills was not addressed in this study.Ancillary analyses showed there was an interaction between the intervention and detection of SMDs, other mental health problems, or somatic problems. Both SMDs and other mental health problems were more frequently diagnosed by the PCPs in the MISS group than by the PCPs in the UC group. Since, as a result of the training, the MISS PCPs were more sensitive to mental disorders and more keen to diagnose SMDs in particular, it seems logical to expect that this result would be biased. It seems likely that the SMD patients in the MISS group were significantly less severely affected than the SMD patients in the UC group. This in turn could have caused differences in outcome of the SMD patients in the study group, giving a false (confounded) impression of the effect of the MISS. However, the SMD patients in the MISS group actually turned out to have higher baseline levels of symptoms than the SMD patients in the UC group see . We testWe carried out a randomised controlled trial with only a few exclusion criteria and thereby allowed considerable variation due to context, diagnosis, and treatment, so flattering performances or overestimation of application are unlikely to be issues. Instead, this considerable variation increases the relevance of our results because it reflects routine clinical practice instead of ideal circumstances.p = 0.02). In our study, these rates were lower . In the meantime, the results of one other randomised controlled trial performed in primary care have been published [As far as we know, this is the first randomised controlled trial to evaluate the effects of an intervention in primary care for SMDs with sick leave as a primary outcome. At the start of our study, the only comparable study had been performed in occupational health care by Jac van der Klink et al. , who repThis project represents a further step in the development of an evidence-based intervention for the treatment of distressed patients on sick leave. We were unable to show an effect of the MISS on duration of sick leave. In subgroup analyses a possible direction for further research was identified: namely, whether patients diagnosed with SMDs may benefit from an effect of the MISS on duration of sick leave. We feel that emphasis on functional rehabilitation of the patient is important, because continuation of sick leave may lead to chronicity and deterioration of symptoms. Unfortunately, diagnosis of SMD in primary health care turns out to be less straightforward than we expected, and the evidence base on criteria for this diagnosis will need to grow substantially before definite conclusions can be drawn. Researchers should take into account the importance of a diagnostic work-up to differentiate between common mental health problems, because there is still a lack of generally accepted criteria to diagnose “uncomplicated SMD” as a level of psychopathology.Furthermore, continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective.CONSORT ChecklistClick here for additional data file.(51 KB DOC)Trial Protocol (English)(165 KB PDF)Click here for additional data file.Trial Protocol (Dutch)Click here for additional data file.(137 KB PDF)Table S1(41 KB DOC)Click here for additional data file.