Obstructive Sleep Apnea Indicators and Injury in Older Farmers

ABSTRACT

The purpose of this study was to explore the relationship between sleep apnea indicators and injury in older farmers from Kentucky and South Carolina. Participants reported at least 1 day of farm work during the preceding year (n = 756) and received income from farming. The primary outcome variable was occurrence of injuries because of farm work in the past year. Main explanatory variables of interest included snoring, gasping, snorting, or cessation of breathing while asleep; trouble sleeping; consumption of sleep medications; trouble staying awake during daytime; and sleep quality. Simple logistic regressions established bivariate associations between explanatory and outcome variables. Explanatory variables significantly associated with the outcome in the bivariate analyses were used to fit a multivariable logistic regression model. The results show that just over 10% of participants experienced a farm injury in the past year. Significant bivariate associations were detected between the occurrence of injuries and number of days of farm work (odds ratio [OR] = 1.003, p = .0002); number of hours of farm work during the last week (OR = 1.017, p = .0047); male gender (OR = 2.48, p = .0007); arthritis or rheumatism conditions (OR = 1.981, p = .004); stopped breathing while sleeping (OR = 2.338, p = .0027); and problems staying awake during the past month (OR = 2.561, p = .001). In the final multivariable model, “stopping breathing while asleep” (p ≤ .05) and “problems staying awake last month” (p ≤ .01) were retained. These results show that sleep problems were associated with injury in this sample of older farmers. Future studies are necessary to screen and diagnose older farmers with obstructive sleep apnea (OSA) to empirically determine the effect of this sleep disorder on injury.     

Agricultural injuries among farm and non‐farm children and adolescents in Alberta,Canada

Background

Understanding of the specific risk of agricultural injury sustained by different populations of children and adolescents is needed for effective safety intervention.

Objective

To compare the rates and patterns of agricultural injury incidence (fatal and non‐fatal injury) between farm and non‐farm children less than 18 years of age in Alberta, Canada.

Methods

A total of 115 378 children (five subgroups: two groups of farm children and three groups of non‐farm children) in Alberta were followed from 1999 to 2010 to examine injury incidence using the linkage of three administrative health databases. A recurrent event survival analysis using Cox proportional hazards regression was carried out.

Results

A total of 1 849 agricultural injury episodes (1 616 emergency department visits, 225 hospitalizations, and 8 deaths) were identified from 1999 to 2010. The age‐ and gender‐adjusted rate (per 100 000 person years) of agricultural injury was 672.3 for rural‐living farm children, 369.4 for urban‐living farm children, 180.2 for rural non‐First Nations (FN) children, 64.4 for rural FN children, and 23.7 for urban children in descending order.

Conclusion

Specific strategies for different children's populations to prevent agricultural injuries and to extend agricultural injury controls to non‐farming populations are needed.

     

Severe farm injuries among New York farmers.

BACKGROUND: Data from the telephone interview portion of the New York State Farm Family Health and Hazard Surveillance were used to study the incidence and predictors of severe farm injury. METHODS: One thousand seven hundred and six participants completed two telephone interviews in which they reported all injuries over a 12-month period. RESULTS: Nine percent of participants reported at least one severe farm injury. Using logistic regression the significant risk factors for sustaining at least one severe farm injury are younger age, the presence of hearing loss or joint trouble, working more hours per day, being the owner/operator of the farm, and being from a farm with higher gross sales. CONCLUSIONS: There needs to be continuing education of all farmers as to the risks of injury. However, when resources are limited, we recommend that injury education and interventions in this farming population should target younger farmers, those who work longer hours, owner/operators, farmers from higher grossing farms, with special attention to farmers who have physical impairments.     

Risk Factors for Agricultural Injury: A Systematic Review and Meta-analysis

ABSTRACT

The objective of this study was to identify significant risk factors for agricultural injury based on the literature. The authors conducted a systematic review of commonly reported risk factors. Studies that reported adjusted odds ratio (OR) or relative risk (RR) estimates for the selected risk factors were identified from PubMed and Google Scholar. Pooled risk factor estimates were calculated using meta-analysis. A total of 441 (PubMed) and 285 (Google Scholar) studies were found in the initial searches; of these, 132 and 78 studies, respectively, met the selection criteria for injury outcomes, and 32 of these reported adjusted OR or RR estimates. One study was excluded because it did not meet the set Newcastle-Ottawa Scale quality criteria. Finally, 31 studies were used for meta-analysis. The pooled ORs for the risk factors were as follows: male gender (vs. female) 1.68, full-time farmer (vs. part-time) 2.17, owner/operator (vs. family member or hired worker) 1.64, regular medication use (vs. no regular medication use) 1.57, prior injury (vs. no prior injury) 1.75, health problems (vs. no health problems) 1.21, stress or depression (vs. no stress or depression) 1.86, and hearing loss (vs. no hearing loss) 2.01. All selected factors except health problems significantly increased the risk of injury, and they should be (a) considered when selecting high-risk populations for interventions, and (b) considered as potential confounders in intervention studies.     

What Happens to the Farm? Australian Farmers’ Experiences after a Serious Farm Injury

Objectives: To investigate the experiences of farmers on returning to farming following a serious farm-related injury.

Methods: Patients who had sustained major trauma on a farm in Victoria, Australia, were identified using the Victorian State Trauma Registry (VSTR). In depth, semistructured phone interviews were conducted with 31 participants. Interview data were subjected to thematic analysis to identify important recurring themes. Interviews continued until data saturation was achieved.

Results: Interviewees included self-employed full-time farmers, part-time farmers with a supplementary income, and agricultural employees. Analysis of participant responses connected to returning to farming after a serious farm-related injury identified five major interconnected themes: (i) effect on farm work, (ii) farming future, (iii) safety advocacy, (iv) changes to farming practices, and (v) financial ramifications.

Conclusion: Farmers who have sustained a serious farm-related injury are an important resource; their experiences and perspectives could assist in the development of educational and transitional support services from recovery back to working at a preinjury level, while ensuring farming production is sustainable during this period. Furthermore, farm safety programs can be enhanced by the engagement of farmers, such as participants in this study as advocates for improved farm safety practices.     

Relationship Between Sleep Loss and Economic Worry Among Farmers: A Survey of 94 Active Saskatchewan Noncorporate Farms

ABSTRACT

Farm work involves seasonal peak busy periods with long hours of work and potential sleep loss. Social, technological, and economic changes, and depressed commodity prices, have resulted in financial stress. There may be a relationship between sleep loss and worry about economic conditions. The objective of this study was to examine the association between hours of sleep and worry associated with cash flow shortages and worry associated with debt among a population of farmers and their family members. One hundred and ninety-five persons from 94 active farms in two rural municipalities in west central Saskatchewan were interviewed by questionnaire. Logistic regression analyses were used to quantify associations between sleep patterns and economic concerns during peak seasons and nonpeak seasons. During peak agricultural seasons, 31.6% of owner/operators reported less than 6 hours of sleep per night compared to 6.3% during the nonpeak season (p < .01). A significant relationship (odds ratio [OR] 3.59, confidence interval [CI] 1.58–8.13) was observed between daily cash flow worry and impaired sleep during peak busy seasons. A large proportion of farmers surveyed suffered severe sleep deprivation during peak seasons, and this sleep loss appeared related to worries about cash flow that were not observed during nonpeak seasons. It is possible that sleep loss during peak busy seasons may be related to impaired judgment, as shown by differential worry habits, and might also be related to the high injury rates observed in farmers during peak busy seasons.     

Farm injury hospitalisations in New South Wales (2010 to 2014)

Objective: To examine gender differences in the characteristics, treatment costs and health outcomes of farm injuries resulting in hospitalisation of New South Wales (NSW) residents. Method: A population‐based study of individuals injured on a farm and admitted to hospital using linked hospital admission and mortality records from 1 January 2010 to 30 June 2014 in NSW. Health outcomes, including injury severity, hospital length of stay (LOS), 28‐day readmission and 30‐day mortality were examined by gender. Results: A total of 6,270 hospitalisations were identified, with males having a higher proportion of work‐related injuries and injuries involving motorbikes compared to females. Females had a higher proportion of equestrian‐related injuries. There were no differences in injury severity, with around 20% serious injuries, in mean LOS or 28‐day hospital re‐admission. Treatment costs totalled $42.7 million, with males accounting for just under 80% of the total. Conclusions: There are some gender differences in the characteristics of farm injury‐related hospitalisations. Farm injury imposes modest, but nonetheless relatively considerable, financial costs on hospital services in NSW. Implications for public health: Continued efforts to ameliorate these injuries in a farm environment, which are mainly preventable, will have personal and societal benefits.     

AGRICULTURAL HEALTH AND SAFETY IN AUSTRALIA

ABSTRACT: Farm injury is a major problem for agriculture in Australia. Agriculture is subject to rates of work-related deaths that are among the highest in Australia, while on-farm injuries result in between 20 and 60 presentations to rural hospital emergency departments per 100 farms per annum. Prevention of farm injury has been constrained by: (i) lack of relevant information regarding injury causation; (ii) lack of appropriate education and training in occupational health and safety; (iii) limited applicability of previous occupational health and safety legislation; and (iv)lack of the necessary management tools for farmers to manage risk Farmsafe Australia has developed a risk management approach to assist the farming community to reduce risk of injury and death and, to reduce the costs associated with the current high injury and death rate. The Farmsafe network is maintained to varying degrees at local, State and national levels. Farmsafe organisations are comprised of members from relevant agencies and other individuals with an interest and commitment to improved safety in agriculture; namely, farmers, women, government departments and unions. Moves have been made to develop joint farm injury prevention programs between health service providers and those whose role is primarily in prevention. The challenge remains, however, to develop more effective and sustainable partnerships between these groups to minimise the impact of farm injury for those who are injured and for rural communities.     

Fatal Incidents in Australia’s Older Farmers (2001–2015)

Objectives: This study assesses nonintentional injury deaths of older farmers and the causal agents associated with these fatalities in Australia (2001–2015). It also explores approaches based on the hierarchy of risk controls to reduce fatalities and injuries in this cohort. Methods: Data on farm-related incidents were sourced from the National Coroners Information System (NCIS) for the study period and coded. Rates were calculated and regression analyses completed to assess trends over time. Results: Those in the 50+ years category (n = 610) accounted for 49.8% of all on-farm nonintentional injury deaths, with males (n = 566) dominating the cases. The annual mean was 40.66 cases (SD = 8.08) and the average rate 36/100,000. Trend analysis revealed a nonstatistically significant (P < 0.05) increase in cases over the period. Farm vehicles and machinery were responsible for almost two thirds of the fatal cases. Conclusion: Nonintentional fatality rates for older farmers have remained relatively unchanged for a significant period in Australia. There is a need to examine additional approaches that not only maintain the benefits of work activity for older farmers but also balance this against a safety perspective.     

Trauma in Hispanic Farm Workers in Eastern North Carolina

Abstract

Context: In spite of the attention directed at the problem of occupational injuries within the farm environment and at the general health status of migrant farm workers in the United States, there have been no studies focusing on the risk for traumatic injury in general for this disadvantaged group.

Purpose: Trauma affecting Eastern North Carolina Hispanic farm workers was quantified and certain risk factors were found.

Methods: Through chart review and retrieval of trauma registry information, patient occupational history, injury patterns, treatment variables as well as outcome and hospital charges were determined and compared with data for Hispanic construction workers and other service area males.

Findings: Two hundred fifty-six Hispanic farm workers were admitted to the trauma center from July1992 to June 2002, which is comparable to the risk (0.1%) of being admitted to the trauma center for an age-matched service area male. Only 5% of injuries occurred during farm work, 21% were penetrating injuries, and in 66% ofcases (compared to 51% for other age-matched males) alcohol was involved.

Conclusion: Most trauma affecting Hispanic farm workers in Eastern North Carolina is not directly occupational and happens in conjunction with recreational activity, where alcohol is an important risk factor. The human and financial cost resulting from such injuries is of such magnitude that it deserves consideration by everybody who is involved in shaping policies in agriculture, immigration and rural public health.     

The Economic Impact for Farm Injury in Minnesota, 2004–2010

Only 2% of Minnesota’s employed population worked in agriculture between the years 2005 and 2012. However, this small portion of the state’s employed population accounted for 31% of total work-related deaths in the state during that same time period. During a similar time period, 2007–2013, the contribution of agriculture to Minnesota’s gross domestic product increased from approximately 1.5% to about 2.3%. This article describes the economic impact of injuries related to farm work between the years 2004 and 2010. Using hospital discharge data and the Census of Fatal Occupational Injuries (CFOI), estimates of the number of injuries and fatalities related to agricultural work were compiled. A cost of illness model was applied to these injury and fatality estimates to calculate the related indirect and direct costs in 2010 dollars. Estimated total costs, in 2010 dollars, ranged between $21 and $31 million annually over the 7-year study period. The majority of the costs were attributable to indirect costs, such as lost productivity at work and home. Fatal injuries accrued the largest proportion of the estimated costs followed by hospitalized and nonhospitalized injuries. A sensitivity analysis was performed to evaluate the impact each selected data source had upon the cost estimate. The magnitude of the costs associated with these injuries argues for better surveillance of injury related to agriculture to prioritize resources and evaluate intervention and prevention programs.     

Fatal and non-fatal machine-related injuries suffered by children in Alberta, Canada, 1990-1997

BACKGROUND: Children raised on farms are exposed to many hazardous types of machinery. The objective of this study was to describe the magnitude of non-fatal and fatal farm machinery injuries in Alberta children and adolescents (0-17 years) for the years 1990-1997. To date, there have been no published studies of pediatric farm injuries in Western Canada. METHODS: Data were collected through the Canadian Agricultural Injury Surveillance Program (CAISP). Death certificates and hospital charts were audited to provide enhanced information about the circumstances of injuries related to farm machinery for farm persons aged 17 years and younger. RESULTS: A total of 302 farm machinery injuries were recorded for the years 1990-1997. Of these, 14 resulted in death. All-terrain vehicles (ATVs) were the most common cause of injury (n = 76), followed by tractors (n = 72), and power take-offs (n = 15). The predominant injury mechanism was entanglement (n = 69), followed by falls from machines (n = 57), and being pinned/struck by a machine (n = 49). The median length of hospital stay for injuries was 2.0 days. Males (median = 2.0 days) had significantly longer hospital stays than females (median = 1.0 days). There were significantly more injuries reported during the summer and autumn than during the winter and spring. Those injured in the autumn were significantly older (median = 13.0 years) than children injured in the spring (median = 9.0 years). Injury rates dropped significantly during the study period from 119.9/100,000 per year in 1990 to 50.7/100,000 in 1997. CONCLUSIONS: While injury rates have dropped, the number of injuries occurring to children on Alberta farms is of concern. The large number of ATV related injuries suggests that preventative strategies need to be focused in this area. Am. J. Ind. Med. 45:177-185, 2004.     

Incidence Rates and Trend of Serious Farm-Related Injury in Minnesota, 2000–2011

ABSTRACT

Only about 2% of Minnesota’s workers were employed in agriculture for the years 2005–2012, this small portion of the workforce accounted for 31% of the 563 work-related deaths that occurred in Minnesota during that same time period. Agricultural fatalities in Minnesota and elsewhere are well documented; however, nonfatal injuries are not. To explore the burden of injury, Minnesota hospital discharge data were used to examine rates and trends of farm injury for the years 2000–2011. Cases were identified through the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), injury codes and external cause of injury codes (E codes). Probable cases were defined as E code E849.1 (occurred on a farm) or E919.0 (involving agricultural machinery). Possible cases were based on five less specific E codes primarily involving animals or pesticides. Multiple data sources were used to estimate the agricultural population. An annual average of over 500 cases was identified as probable, whereas 2,000 cases were identified as possible. Trend analysis of all identified cases indicated a small but significant average annual increase of 1.5% for the time period 2000–2011. Probable cases were predominantly male (81.5%), whereas possible cases were predominantly female (63.9%). The average age of an injury case was 38.5 years, with the majority of injuries occurring in late summer and fall months. Despite the undercount of less serious injuries, hospital discharge data provide a meaningful data source for the identification and surveillance of nonfatal agricultural injuries. These methods could be utilized by other states for ongoing surveillance for nonfatal agricultural injuries.     

Trends of ATV use and associated injury on Saskatchewan farms

Purpose: All-terrain vehicles (ATV's) are a hazardous source of injury in many contexts and geographical regions, but to date have not been investigated in Saskatchewan.

Methods: Baseline surveys from the Saskatchewan Farm Injury Project were examined at two time points in terms of: (1) rates and correlated characteristics of reported ATV use; and (2) qualitative content analysis of injury events involving ATVs. The sample of eligible farmers was 2,972 in 2007 and 1,702 in 2013.

Findings: Self-reported ATV use increased on Saskatchewan farms over the five-year period, both in terms of the number of individuals using ATV's on the farm and the days per year of operation. ATV use is significantly more common on farms with livestock, among male farmers, and among younger farmers. Farmers with low back pain were also more likely to report ATV use. Qualitative content analysis of farmers' reported “most serious injury” on the farm revealed themes related to: (1) tasks undertaken with ATV's at the time of the incident (e.g., stock work and personal transport); (2) contributing factors (vehicle, environmental and driver); and (3) safety reflections.

Conclusion: The apparent trends of increasing ATV use on Saskatchewan farms and serious nature of the injury incidents reported indicate that this is an issue worthy of further investigation.