Stress as a Risk Factor for Agricultural Injuries

SUMMARY

This paper presents a comparative analysis from two data sets, the NIOSH Iowa Farm Family Health and Hazard Survey and the Iowa Farm and Rural Life Poll. The objective was to investigate the role of stress as a possible risk factor for agricultural injuries. The Iowa Farm Family Health and Hazard Survey is based on a sample of 989 farm families in Iowa resulting in 390 useable responses from 1994. The Iowa Farm and Rural Life Poll is a statewide random sample of 3270 farmers in 1989 to which 2016 Iowa farmers responded. Complementary dimensions of stress from each survey are analyzed and shown to be strongly associated with agricultural injuries.     

Increasing the Number of Trained Health and Safety Professionals in Agricultural Medicine: Evaluation of the “Building Capacity” Program, 2007–2013

ABSTRACT

The University of Iowa began training health care professionals to care for farmers’ occupational health needs since 1974. In order to geographically expand this training to practicing health and safety professionals, the “Building Capacity: A National Resource of Agricultural Medicine Professionals” program was developed and launched in 2006. The model began in 1987 as a program of Iowa’s Center for Agricultural Safety and Health. In 2006, with funding from the National Institute for Occupational Safety and Health (NIOSH), Great Plains Center for Agricultural Health (GPCAH), the program was expanded beyond the Iowa borders. The principal component of the program, the 40-hour course, Agricultural Medicine: Occupational and Environmental Health for Rural Health Professionals—the Core Course (AMCC) is now being offered to health and safety professionals in nine states in the United States, in Australia, and a modified version presented in Turkey. An initial paper evaluated the first phase of the program, years 2007–2010. This paper compares the first phase (2007–2010) with the second phase (2011–2013), which has involved over 500 health and safety professionals. This paper also describes evaluation of the course and changes resulting from the evaluation. Finally, this paper describes best practices for operating this program and makes recommendations for future courses, as well as other trainings within the field.     

HealthInfoIowa

Abstract

No shortage of health information exists on the Internet, but how does the consumer know what is accurate and reliable? What criteria should one use when judging the credibility of a Web site? When the searcher does not find the information he is seeking, where can he go for assistance? In Iowa, he can begin with HealthInfoIowa http://www.HealthInfoIowa.org, a consumer health information Web site sponsored by the State Library of Iowa, the Iowa Department of Public Health, the University of Iowa Hardin Health Sciences Library, Iowa Methodist/Lutheran/Blank Hospitals in Des Moines, Ames Public Library, and the Iowa Substance Abuse Information Center in Cedar Rapids. This article explains why and how HealthInfoIowa was developed and the Web site links that guide the user in locating appropriate health information resources.     

Report on the University of Iowa International Workshop on Agricultural Health and Safety

ABSTRACT

The University of Iowa organized an international workshop on agricultural health and safety which was held in Iowa City in conjunction with the Third NIOSH Agricultural Health and Safety Conference during the week of March 24, 1996. Workshop participants from eleven countries, six NIOSH Centers and The Fog erty International Center spent three days exchanging information regarding programs of research, intervention, training and education; and developing international cooperation and collaboration in these areas. Results of this workshop are discussed.     

An Overview of Livestock-Associated MRSA in Agriculture

ABSTRACT

Researchers, veterinary and health care practitioners, and agricultural producers gathered in Johnston, Iowa, to attend the eighth annual Midwest Rural Agricultural Safety and Health Forum (MRASH), November 2009. Among several focus areas, four plenary talks were given on the current research being conducted examining methicillin-resistant Staphylococcus aureus (MRSA) on swine farms in the United States. These focused on prevalence of MRSA on farms, both in swine and in human workers; the presence of MRSA in air samples and in swine barn shower facilities; and the presence of methicillin-resistant and methicillin-sensitive S. aureus in retail meats. These findings begin to elucidate the overall picture of livestock-associated MRSA in the Midwestern United States.     

Toward a National Core Course in Agricultural Medicine and Curriculum in Agricultural Safety and Health: The “Building Capacity” Consensus Process

ABSTRACT

The agricultural industry poses specific hazards and risks to its workers. Since the 1970s, the University of Iowa has been establishing programs to educate rural health care and safety professionals who in turn provide education and occupational health and safety services to farm families and farm workers. This program has been well established in the state of Iowa as a program of Iowa’s Center for Agricultural Safety and Health (I-CASH). However, the National 1989 Agriculture at Risk Report indicated there was a great need for agricultural medicine training beyond Iowa’s borders. In order to help meet this need, Building Capacity: A National Resource of Agricultural Medicine Professionals was initiated as a project of the National Institute for Occupational Safety and Health (NIOSH)-funded Great Plains Center for Agricultural Health in 2006. Before the first phase of this project, a consensus process was conducted with a group of safety and health professionals to determine topics and learning objectives for the course. Over 300 students attended and matriculated the agricultural medicine course during first phase of the project (2007–2010). Beginning the second phase of the project (2012–2016), an expanded advisory committee (38 internationally recognized health and safety professionals) was convened to review the progress of the first phase, make recommendations for revisions to the required topics and competencies, and discuss updates to the second edition of the course textbook (Agricultural Medicine: Occupational and Environmental Health for the Health Professions). A formal consensus process was held and included an online survey and also a face-to-face meeting. The group was charged with the responsibility of developing the next version of this course by establishing best practices and setting an agenda with the long-term goal of developing a national course in agricultural medicine.     

Planting the Seed: The 2009 Midwest Rural Agricultural Safety and Health Forum (MRASH)

ABSTRACT

The annual Midwest Rural Agricultural Safety and Health Forum (MRASH) is produced by the combined efforts and resources of Iowa's Center for Agricultural Safety and Health (I-CASH), the Great Plains Center for Agricultural Health, and The Heartland Center for Occupational Health. There is a regional focus for the conference on agricultural health issues for the 11 states of the upper Midwest, thus the new name for conference (MRASH). The purpose of this conference is to “plant the seeds” for stimulating and strengthening collaborative efforts among researchers, practitioner, agricultural producers, and medical professionals. This is accomplished by sharing cutting edge research, reviewing intervention theory and methodologies, reviewing activities of regional academic, public health, and nonprofit farm health and safety organization. The 2009 conference included plenary and topical breakout sessions. The plenary sessions included topics that have a relevance to the theory and practice of health interventions in populations. The breakout sessions were quite varied, with topics of community prevention programs (including Certified Safe Farm for large farms), AgrAbility programs, exposures from noise, pesticides, needle sticks, and all-terrain vehicle operation. The largest breakout session was on methicillin-resistant Staphylococcus aureus (MRSA). Should there be further questions of authors or the organizing committee, contact information is available at the following Web site address: http://www.public-health.uiowa.edu/ICASH/programs/MRASH/2009/index.htm.     

Agricultural Medicine Core Course: Building Capacity for Health and Safety Professionals

ABSTRACT

In 1987 the University of Iowa began training health care professionals to care for farmers' occupational health needs. The training enables health professionals from various disciplines to function in the anticipation, diagnosis, treatment, and prevention of occupational illnesses and injuries in the farm community. A grant from National Institute for Occupational Safety and Health (NIOSH) entitled “Building Capacity for Health and Safety Professionals” allowed for the expansion of this training to other states. This paper describes the challenges, successes, and lessons learned from dissemination of Agricultural Medicine Core Course.     

Collaborative Research in Maquiladoras

Abstract

In 1995, with support from the Fogarty International Center of the National Institutes of Health, The Center for International Rural and Environmental Health (CIREH) at The University of Iowa began developing the multi-level International Training and Research Program in Occupational and Environmental Health, focusing on countries in Central and Eastern Europe that were formerly under socialist control and have particular occupational and environmental health needs after decades of neglect and mismanagement. The purpose of the program is to prepare health science professionals to return to their home countries with new skills, added confidence, and leadership capabilities in public health to lead their colleagues and institutions in meeting the needs in their respective countries and establish active national and international networks and collaborations. By December 1998, 19 trainees had completed the five-month program and returned home to conduct workshops for others in their countries. Details of the program are presented.     

Perceptions of Access to Medical Care Among Iowa Farmers

ABSTRACT

Perceptions of medical care access were evaluated for participants in the Iowa Farm Family Health and Hazard Survey (IFFHHS) based on a representative sample of 373 Iowa principal farm operators. Although few Iowa farmers (3.4%) reported access difficulty, 32.2% of Iowa farmers ranked medical care access and health insurance as the most important area on which they wanted help. Based on a weighted multiple logistic regression model, perceived medical access difficulty was greater (P < 0.05) for farmers without medical insurance, with no usual medical care provider, who currently smoke and with fair or poor general health by 20.68, 20.04, 10.43 and 7.27 times, respectively.     

Comparison of Farmers in the Agricultural Health Study to the 1992 and 1997 Censuses of Agriculture

Abstract

Context: The Agricultural Health Study (AHS) is a large, prospective cohort study in the states of Iowa and North Carolina that has been developed to better understand how pesticides and other agricultural exposures relate to the occurrence of cancer and other diseases.

Purpose: This report compares the characteristics of AHS farmers to the Census of Agriculture to evaluate the generalizability of AHS findings.

Methods: We restricted the AHS to private pesticide applicators who enrolled in Iowa (n = 31,065) and in North Carolina (n = 17,239) between 1993 and 1997, and who identified themselves as living or working on a farm. We compared their self-reported data with data from the 1992 and 1997 Censuses of Agriculture.

Findings: AHS farmers in Iowa are younger; live or work on larger farms; more frequently apply herbicides, insecticides, and fungicides; and are more likely to raise beef cattle and swine, and grow corn, soybeans, hay, and oats. AHS farmers in North Carolina are also younger, live or work on larger farms, more frequently reported growing crops commonly seen in the state, and are more frequent pesticide users. However, animals raised are similar to those in the North Carolina Census of Agriculture.

Conclusions: AHS farmers likely represent the higher end of pesticide usage in both states in part because AHS farmers have larger farms. Since the health effects of pesticides are best ascertained among pesticide users with the greatest exposure, the AHS cohort should prove to be a valuable resource for health effects research.     

Depression and Risk Factors Among Iowa Farmers

SUMMARY

Previous studies have reported high rates of depression and suicide for farmers compared to other occupations. From a representative sample of 390 Iowa farmers in the Iowa Farm Family Health and Hazard Survey, we found that 12.1? of Iowa principal farm operators had depressive symptoms based on a cut-off point of 16 on a standardized questionnaire for depressive symptoms (the CES-D Scale). A weighted multiple logistic regression model yielded the following risk factors for depressive symptoms: had legal problems (adjusted odds ratio = 7.35, 95? confidence interval = 3.09-17.48); not married (3.89, 1.10-13.73); sentimental value loss (2.96, 1.03-8.54);substantial income decline (2.91, 1.67-5.06); and decline in general health assessment compared with the excellent health group [very good and good group (3.39, 0.82-14.06) and fair and poor group (5.41, 1.89-15.43)].     

Causes of Mortality and Risk Factors for Injury Mortality Among Children in the Agricultural Health Study

Abstract

Farm children face unique health risks due to sharing their residential environment with hazardous machinery and materials. Causes of mortality among farm children have not been comprehensively described.

Objective: In the Agricultural Health Study (AHS) cohort, we examined causes of mortality among 21,360 children in Iowa and North Carolina between 1975 and 1998.

Methods: We matched identifying information for children provided by mothers on self-administered questionnaires to state death registries (1975–1998). Data on farm and family characteristics were provided by parents via enrollment questionnaires (1993–1997). Standardized mortality ratios (SMRs) were calculated, using state mortality data to generate expected deaths. We used logistic regression to examine parent, child and farm characteristics associated with injury mortality.

Results: There were 162 deaths in Iowa (SMR = 0.69; 95% confidence interval (CI) = 0.60, 0.81) and 26 deaths in North Carolina (SMR = 0.42; 95%CI = 0.28, 0.61) in children aged 0–19 years. This deficit was largely due to deaths in the first year of life. Although deaths from overall unintentional injury were not increased, excess agricultural machinery mortality was observed in Iowa (SMR = 9.25; 95% CI = 5.12, 16.70). In case-control comparisons, maternal age less than 25 years at child's birth (OR = 2.17; 95%CI = 1.05, 4.49) and having more than 2 children in the family (OR = 2.79; 95%CI = 1.47, 5.30) were associated with increased child injury mortality. For children under 14 years, participation in farm work was associated with increased risk of agricultural machine-related mortality (OR = 3.92; 95% CI = 1.04, 14.78).

Conclusions: Parent and child characteristics associated with child injury mortality could be used to target farm safety interventions.     

Prevalence and correlates of depressive symptoms in secondary school children in Dhaka city,Bangladesh

ABSTRACT

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh.

Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms.

Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15–16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast.

Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.     

Validation of the Comprehensive ICF Core Set for Multiple Sclerosis from the perspective of occupational therapists

Abstract

Objective: The Comprehensive ICF Core Set for Multiple Sclerosis (MS) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of People with MS (PwMS). The objective of this study was to validate this ICF Core Set from the perspective of occupational therapists (OTs). Method: In a three-round Delphi study, OTs were asked about problems and resources of PwMS, as well as environmental aspects treated by OTs. Statements were linked to the ICF and compared with the categories included in the Comprehensive ICF Core Set for MS. Results: Sixty-one OTs from 21 countries agreed on 71 categories that are included in the Comprehensive ICF Core Set for MS (19 Body Functions, 40 categories of Activities and Participation, 12 Environmental Factors). Eleven ICF categories were identified as not-yet-included ICF categories in the Comprehensive ICF Core Set for MS (6 Body Functions, 2 categories of Activities and Participation, 3 Environmental Factors). Conclusion: This study contributes to the validity of the ICF categories included in the Comprehensive ICF Core Set. It outlines which areas of functioning and health are relevant for PwMS from the perspective of OTs and consequently should be assessed.     

The Keokuk County Rural Health Study

SUMMARY

The Keokuk County Rural Health Study is a population-based, prospective study of environmental exposures and health status of a large randomly-selected sample of residents from each of three strata in one rural Iowa county. The study focuses on injury rates and respiratory disease; in addition, it monitors health care de-livery; geriatric, reproductive, and mental health; and other health outcomes. Injury and disease prevalence are investigated in relation to occupational, agricultural, and other environmental exposures. This paper describes the sampling method, the protocol, and the demographic profile of adult subjects of the first 400 households en-rolled in the study. Farmers were slightly younger than rural non-farmers and townspeople and more farmers had lived in the county all of their lives. Females were more highly educated than were males, and less than half as many female farmers had lived in the county all their lives than had male farmers. Net household income figures were complex and are shown in a graph in Table 1.     

Intervening to Improve Health Indicators Among Australian Farm Families

ABSTRACT

The Sustainable Farm Families project (http://www.sustainablefarmfamilies.org.au/) was a 3-year demonstration and education project designed to influence farmer behavior with respect to family health and well-being among cropping and grazing farmers in Victoria, New South Wales, and South Australia, Australia. The project was conducted by the Western District Health Service, Hamilton, Australia, in partnership with farmers; Farm Management 500 (peer discussion group); the Victorian Farmers Federation; Royal Melbourne Institute of Technology; and Land Connect. During the 3 years of the project, 128 farmers—men (70) and women (58)—were enrolled. The project utilized a combination of small group workshops, individualized health action plans, and health education opportunities to encourage farm safety and health behavior changes and to elicit sustained improvements in the following health indicators: body mass index (BMI), total cholesterol, fasting blood glucose, and blood pressure. Mean changes in these health indicators were analyzed using repeated measures analysis of variance (ANOVA) and McNemar's test compared the proportion of individuals with elevated indicators. Among participants with elevated values at baseline, the following average reductions were observed: BMI 0.44 kg/m² (p = .0034), total cholesterol 48.7 mg/dl (p < .0001), blood glucose 10.1 mg/dl (p = .0016), systolic blood pressure 12.5 mm Hg (p < .0001), and diastolic blood pressure 5.0 mm Hg (p = .0007). The proportion of participants with elevated total cholesterol at baseline decreased after 24 months (p < .001). Such findings suggest that proactive intervention by farmer associations, rural health services, and government agencies may be an effective vehicle for promoting voluntary farm safety and health behavior change while empowering farm families to achieve measurable reductions in important health risk factors.     

The SOMERS Index: a simple instrument designed to predict the likelihood of rural career choice

Objective: The World Health Organization has drawn up a set of strategies to encourage health workers to live and work in remote and rural areas. A comprehensive instrument designed to evaluate the effectiveness of such programs has not yet been tested. Factors such as Stated rural intention, Optional rural training, Medical sub‐specialization, Ease (or self‐efficacy) and Rural Status have been used individually or in limited combinations. This paper examines the development, validity, structure and reliability of the easily‐administered SOMERS Index. Design: Limited literature review and cross‐sectional cohort study. Setting: Australian medical school. Participants: A total of 345 Australian undergraduate‐entry medical students in years 1 to 4 of the 5‐year course. Main outcome measures: Validity of the factors as predictors of rural career choice was sought in the international literature. Structure of the index was investigated through Principal Components Analysis and regression modelling. Cronbach's alpha was the test for reliability. Results: The international literature strongly supported the validity of the components of the index. Factor analysis revealed a single, strong factor (eigenvalue: 2.78) explaining 56% of the variance. Multiple regression modelling revealed that each of the other variables contributed independently and strongly to Stated Rural Intent (semi‐partial correlation coefficients range: 0.20–0.25). Cronbach's alpha was high at 0.78. Conclusions: This paper presents the reliability and validity of an index, which seeks to estimate the likelihood of rural career choice. The index might be useful in student selection, the allocation of rural undergraduate and postgraduate resources and the evaluation of programs designed to increase rural career choice.