No abstract

el acceso a servicios de salud es un tema de creciente preocupación, en el caso colombiano haganado importancia frente al aseguramiento. Objetivo: construir un concepto de acceso e identificar barrerasy estrategias, desde la perspectiva de actores en Medellín. Material y métodos: investigación cualitativacon énfasis en tres zonas de Medellín. Resultados: se identificaron similitudes y diferencias en la visióndel acceso, las cuales permitieron construir el concepto. Las barreras y los facilitadores se atribuyen afactores de oferta y de demanda. La mayoría de las barreras se dan en el acceso real, durante la búsqueda ycontinuidad del tratamiento. Algunas características sociales de la población también son factores determinantes.Discusión y conclusiones: los actores recurren a estrategias para solventar las barreras de acceso. Elanálisis cualitativo del concepto de acceso, de las barreras y las facilidades permite identificar alternativasque pueden servir de insumo para políticas en salud.

The high exposure risks of workers to herbicides in low- and middle-income countries is an important public health concern because of the potential resulting negative impacts on workers' health. This study investigated workers' personal protective equipment (PPE) compliance as a risk mitigation measure; particularly workers who apply herbicides for Working for Water (WfW) - a South African invasive alien vegetation control programme. The study aim was to understand workers' low PPE compliance by analysing their risk perceptions of herbicide use, working conditions and socio-cultural context. Research methods included ethnographic observations, informal interviews, visual media, questionnaires and a focus group. Study results indicated that low PPE compliance persists despite workers' awareness of herbicide exposure risks and as a result of the influence from workers' socio-cultural context (i.e. gender dynamics and social status), herbicide risk perceptions and working conditions (i.e. environmental and logistical). Interestingly, teams comprised of mostly women had the highest compliance rate. These findings highlighted that given the complexity of PPE compliance, especially in countries with several economic and social constraints, exposure reduction interventions should not rely solely on PPE use promotion. Instead, other control strategies requiring less worker input for effectiveness should be implemented, such as elimination and substitution of highly hazardous pesticides, and altering application methods.

Background: Planetary health is an emerging holistic health field to foster interdisciplinary collaborations, integrate Indigenous knowledge, facilitate education, and drive public and policy engagement. To understand to what extent the field has successfully met these goals, we conducted a scoping review and bibliometric analysis. Methods: We searched 15 databases from 2005 to 2019 for peer-reviewed publications with the term "planetary health" in the title, abstract and/or keywords, with no language or geographical location limitations. We classified results into four categories (commentaries, comprehensive syntheses, educational material, and original research) and categorized original research according to expert-derived planetary health themes. Our bibliometric analysis highlighted publications over time, collaborations, and networks of keywords. Findings: Only 8.1% (n = 22) were research articles. Publications rose rapidly from 8 to 64 publications per year in 2015-2018. The top five author affiliation countries for most publications were the US, UK, Australia, Canada, and New Zealand, and the top five collaborations were a subset of pairwise combinations between the US, UK, Australia, and Canada. The most common author keywords were the following: planetary health, climate change, ecology, and non-communicable diseases. Keyword co-occurrences clustered around high-level concepts (e.g., Anthropocene) and food system-related topics; two clusters lacked a theme. Interpretation: We show that the term planetary health is used mainly in commentary-like publications, not original research. Additionally, more global collaborations are lacking. Interdisciplinary work, as represented by keyword co-occurrence networks, is developing but could potentially be extended. The planetary health community should promote more worldwide research and interdisciplinary collaborations.