Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual’s general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.     

Associations between Early-Life Food Deprivation and Risk of Frailty of Middle-Age and Elderly People: Evidence from the China Health and Retirement Longitudinal Study

Background: The association between childhood food deprivation (FD) and health in later life has been extensively studied; however, studies on the association between childhood food deprivation and frailty are scarce. This study assessed the associations between childhood FD and the risk of frailty at middle-age and old age. Methods: Three waves of the China Health and Retirement Longitudinal Study (CHARLS), including 11,615 individuals aged over 45 years, were used for this research. Frailty was operationalized according to the FRAIL scale as a sum of fatigue, resistance, ambulation, illness, and the loss of weight. Childhood FD experiences and levels were measured by self-reported FD and historical content. Logistic mixed-effects models and proportional odds ordered logistic regression models were used to analyse the association between childhood FD and frailty. Findings: Childhood FD increased the odds of frailty at old age (1.30, 95% CI: 1.26–1.36). Compared with subjects with mild FD, those with extreme FD experiences had increased risks of frailty (1.34, 95% CI: 1.26–1.43). Subjects exposed to hunger at different ages all had an increased risk of frailty, and subjects who had FD during ages 6–12 (1.15, 95% CI: 1.09–1.22) were more likely to have an increased risk of frailty than those who had experienced FD in younger ages. The interaction of experience of FD at ages 0–6 and the experience of FD at ages 6–12 is not statistically significant after adjusting all covariates. Conclusions: Our findings suggest that childhood FD exerts long-lasting effects on frailty among older adults in China. The prevention of childhood FD may delay or even avert the emergence of frailty in people of middle-age and old age.     

Benefits Gained,Benefits Lost: Comparing Baby Boomers to Other Generations in a Longitudinal Cohort Study of Self‐Rated Health

Policy Points

• Despite beliefs that baby boomers are healthier than previous generations, we found no evidence that the health of baby boomers is substantially different from that of the previous or succeeding cohorts.
• The effects of increased education, higher income, and lower smoking rates on improving self-rated health were nearly counterbalanced by the adverse effect of increasing body mass index (BMI).
• Assumptions that baby boomers will require less health care as they age because of better education, more prosperity, and less propensity to smoke may not be realized because of increases in obesity.

Context

Baby boomers are commonly believed to be healthier than the previous generation. Using self-rated health (SRH) as an indicator of health status, this study examines the effects of age, period, and birth cohort on the trajectory of health across 4 generations: World War II (born between 1935 and 1944), older baby boomers (born between 1945 and 1954), younger baby boomers (born between 1955 and 1964), and Generation X (born between 1965 and 1974).

Methods

We analyzed Canada’s longitudinal National Population Health Survey 1994-2010 (n = 8,570 at baseline), using multilevel growth models to estimate the age trajectory of SRH by cohort, accounting for period and incorporating the influence of changes in education, household income, smoking status, and body mass index (BMI) on SRH over time.

Findings

SRH worsened with increasing age in all cohorts. Cohort differences in SRH were modest (p = 0.034), but there was a significant period effect (p = 0.002). We found marked cohort effects for increasing education, income, and BMI, and decreasing smoking from the youngest to the oldest cohorts, which were much reduced (education and smoking) or removed (income and BMI) once period was taken into account. At the population level, multivariable analysis showed the benefits of increasing education and income and declines in smoking on the trajectory of improving SRH were almost counterbalanced by the effects of increasing BMI (obesity).

Conclusions

We found no evidence to support the expectation that baby boomers will age more or less healthily than previous cohorts did. We also found that increasing BMI has likely undermined improvements in health that might have otherwise occurred, with possible implications for the need for health care. Period effects had a more profound effect than birth cohort effects. This suggests that interventions to improve health, such as reducing obesity, can be targeted to the entire, or a major portion of the, population and need not single out particular birth cohorts.     

Short Daily-Life Walking Bouts and Poor Self-Reported Health Predict the Onset of Depression in Community-Dwelling Older People: A 2-Year Longitudinal Cohort Study

ObjectivesThis study aimed to assess whether the amount and quality of daily-life walking obtained using wearable technology can predict depression onset over a 2-year period, independently of self-reported health status.DesignLongitudinal cohort study.Setting and ParticipantsThree-hundred twenty-two community-dwelling older people recruited in Sydney, Australia.MethodsParticipants were assessed at baseline on (1) depressive symptoms using the Patient Health Questionnaire–9; (2) average weekly physical activity levels over the past month using the Incidental and Planned Activity Questionnaire, (3) clinical mobility tests (ie, short physical performance battery, timed up-and-go test, 6-m walk test); and (4) amount and quality of daily-life walking assessed with a trunk accelerometer (MoveMonitor, McRoberts) for 1 week. Participants were followed up for onset of depressive symptoms for 2 years at 6-monthly intervals.ResultsDaily-life walking (ie, gait intensity in the mediolateral axis, daily step counts, duration of longest walk) and self-rated health predicted the new onset of depressive symptoms at 2 years in univariable logistic regression models. In multivariable models containing a self-rated health measure, clinical mobility tests were not predictive of the onset of depressive symptoms. In contrast, a measure of daily-life walking (duration of longest walking bout) was identified as a significant predictor of depressive symptom onset [standardized odds ratio (SOR) 2.44, 95% CI 1.62-3.76] independent of self-rated health (SOR 1.51, 95% CI 1.16-1.96), with these 2 measures achieving a satisfactory prediction accuracy (area under the curve = 0.67, sensitivity: 0.78, specificity: 0.52).Conclusions and ImplicationsA risk algorithm based on daily-life walking bouts and self-reported health demonstrated good accuracy for the prediction of depression onset in older people over 2 years. Wearable sensor data compared favorably with clinical mobility screens and may add important independent information for screening for depression among older people.     

Assessment of Personal Protective Equipment Use Among Farmers in Eastern North Carolina: A Cross-sectional Study

ABSTRACT

Agriculture consistently ranks among the top hazardous occupations, accounting for a significant number of injuries and fatalities in the workplace. Eastern North Carolina has a significant number of small, independent, family-run, owned, and operated farms. However, little is known about perception, behavior, training, accessibility, or purchasing personal protective equipment (PPE) for safety among farmers in the region. In this study, telephone interviews were conducted among participating farmers between March and June 2012 (N = 129). Univariate and bivariate analyses were conducted to examine associations between PPE behavior and workplace hazards, health-related concerns, and wearing and purchasing PPE. Findings indicated that personal behavior of wearing hearing protection devices (HPDs) and protection from the sun among farmers was low. However, a relatively high percentage of farmers reported wearing PPE when working with agricultural chemicals. Most farmers received training from agricultural extension offices. The findings indicate that, in general, farmers are well aware of the risks associated with occupational hazards and recognize concern for health and safety protection in the workplace. Transitioning these concerns into preventative action remains a challenge and priority for the agricultural health professional.     

健康自评指标研究进展

  目的  基于个体差异理论,从个体 – 家庭层面描述我国成人健康自评现状,探讨健康自评的影响因素,为我国成人健康自评研究提供依据。  方法  利用 2016年中国家庭追踪调查（CFPS）数据,描述性分析我国成人健康自评现状,采用有序多分类logistic回归分析方法,将控制变量、自变量先后纳入模型进行检验,探讨家庭因素和个体因素对成人健康自评结果的影响。  结果  22 366名调查对象中自评健康者为16 177人,占72.33 %,自评非健康者为6 189人,占27.67 %。个体 – 家庭成人健康自评有序多分类logistic回归模型对数似然值为 – 29 788.70,LR chi²(116) = 8 143.95,P < 0.001,Pseudo R² = 0.12,说明模型解释能力较强。在家庭因素和个体因素对健康自评的累积效应下,政府补助、同居、锻炼频率、健康变化情况、2周患病情况、半年患慢性病、住院、喝酒频率、是否午休、新农合医疗、农村社会养老保险、是否抑郁是成人健康自评的影响因素。  结论  早识别、早诊断、早介入、早治疗健康自评较差的人群,有利于合理配置社会卫生资源,减少卫生资源的浪费。     

Who are the consistently high users of health and social services? A follow-up study two and a half years later of people aged 85+ at baseline

This paper reports on changes in service use over a 2 1/2-year period among people aged 85+ at baseline. The socio-demographic, social, pyschological and physical characteristics of the consistently high utilizers and the consistently low utilizers of services are described. The strongest predictor of total service use was functional ability. The analyses confirmed that a small proportion of people are likely to account for the most expenditure on health and social services.     

Intergenerational effects of old‐age pension on children's health and well‐being

This study estimates the impacts of the basic old‐age pension reform in South Korea on childhood/adolescent health and well‐being. Facing a rapidly aging population and the increasing demand for social security for the elderly, the government introduced the basic pension program in 2007, which covered 70% of citizens 65 years or older. Information is obtained from a nationally representative panel of school‐aged children from 2006 to 2012. A difference‐in‐differences approach exploiting within‐person variation in exposure to the old‐age pension program is used. The unconditional cash transfers for the elderly have substantial impacts on the health of grandchildren. In particular, there is gender‐specific differential impacts. While grandmothers' pensions have positive impacts on granddaughters' heights and drinking participation, grandfathers' pension incomes lower smoking participation of grandsons. Results suggest that grandmothers and grandfathers put their resources for their grandchildren in a different way. It also indicates that household is not a unitary entity.     

Association Between Whole-Body Vibration and Low-Back Disorders in Farmers: A Scoping Review

Introduction: Low-back disorders (LBDs) are the most common musculoskeletal problem among farmers, with higher prevalence rates than in other occupations. Farmers who operate tractors and other types of machinery can have substantial exposure to whole-body vibration (WBV). Although there appears to be an association between LBDs and WBV, the causal relationship is not clear. Objective: This scoping review investigates the association between WBV and LBDs specifically among farmers. Methods: Nine databases were searched using groups of terms for two concepts: ‘farming’ and ‘low back disorder’. Screening, data extraction, and quality assessment were performed by two reviewers independently. Included studies met the following criteria: focused on adult farmers/agricultural workers; assessed exposure to operating farm machinery such tractor, combine, or all-terrain vehicle; assessed LBDs as an outcome; and reported an inferential test to assess the relationship between WBV and LBD. Results: After 276 full texts screened, 11 articles were found to analyze WBV as a risk factor for LBDs. Three were case–control, five cross-sectional, and three retrospective cohorts. Four studies showed no association between WBV and LBDs, four a positive association, and three results were mixed depending on the exposure/outcome measure. Conclusion: A firm conclusion is difficult due to heterogeneity in, LBDs definition, type of farm commodity, study design, and statistical strategy. Direct comparisons and synthesis were not possible. Although retrospective cohort studies tended to show a relationship, future studies with a prospective cohort design could help clarify this association further.     

Socioeconomic Status and Injury in a Cohort of Saskatchewan Farmers

Purpose: To estimate the strength of relationships between socioeconomic status and injury in a large Canadian farm population. Methods: We conducted a prospective cohort study of 4,769 people from 2,043 farms in Saskatchewan, Canada. Participants reported socioeconomic exposures in 2007 and were followed for the occurrence of injury through 2009 (27 months). The relative hazards of time to first injury according to baseline socioeconomic status were estimated via Cox proportional hazards models. Findings: Risks for injury were not consistent with inverse socioeconomic gradients (adjusted HR 1.07; 95% CI: 0.76 to 1.51 for high vs low economic worry; adjusted HR 1.72; 95% CI: 1.23 to 2.42 for completed university education vs less than high school). Strong increases in the relative hazard for time to first injury were identified for longer work hours on the farm. Conclusions: Socioeconomic factors have been cited as important risk factors for injury on farms. However, our findings suggest that interventions aimed at the prevention of farm injury are better focused on operational factors that increase risk, rather than economic factors per se.     

社区高血压患者健康素养与基本公共卫生服务利用的相关性研究

  目的  了解高血压患者基层医疗机构就诊情况及其影响因素,为促进高血压患者利用基层卫生服务以及分级诊疗试点工作提供科学依据。  方法  收集2016年居民卫生服务利用行为监测中江苏、湖北、四川、广东4个省8个县1 597例高血压患者的调查数据,分析高血压患者的基层医疗机构就诊情况及其影响因素。  结果  调查的1 597例高血压患者中,选择到基层医疗机构就诊患者611例,基层医疗机构就诊率为38.26 %;多因素非条件logistic回归分析结果显示,文化程度中学及以上、家庭年均收入≥4万元和居住在农村的高血压患者到基层医疗机构的就诊率较低。  结论  高血压患者基层医疗机构就诊率较低,尤其是文化程度和收入水平较高和居住在农村的高血压患者。     

福州市老年大学中老年人慢性病现状及其影响因素

[目的]掌握老年大学中老年人的慢性病患病患病情况及其影响因素。[方法]制定专门调查表于2001年4月对福州市老年大学所有学员进行慢性病及其影响因素问卷调查。[结果]402名中老年人慢性病患病率为83.6%，有44.5%患2种以上，居于前5位的最高血压，冠心病，骨质疏松，骨关节病和慢性胃炎，且高血压，冠心病和白内障的患病率随着年龄的增加而升高，女性前5位为骨质疏松，高血压，冠心病，颈椎病和慢性胃炎；男性为高血压，冠心病，骨质疏松，慢性胃炎和白内障，与老年人健康状况有关的因素是生活自理能力，睡眠情况，文化程度，年龄和锻炼。[结论]福州市老年大学的中老年人群中，慢性病主要以心血管疾病和肌肉骨骼系统疾病为主，高血压，冠心病，骨质疏松，白内障应作为老年病防治重点，而骨质疏松在女性中的防治尤其重要。     

Bidirectional Associations between Handgrip Strength and Depressive Symptoms: A Longitudinal Cohort Study

ObjectivesThis study aimed to examine the bidirectional associations between handgrip strength and depressive symptoms in a nationally representative sample.DesignCohort study with a 4-year follow-up.Setting and ParticipantsA total of 13,208 participants from the China Health and Retirement Longitudinal Study were included in the analyses.MethodsDepressive symptoms were assessed using the 10-item Center for Epidemiological Studies–Depression Scale. Separate generalized estimating equations were used to analyze the cross-sectional and longitudinal associations between handgrip strength and depressive symptoms. Restricted cubic spline models were performed to explore the shape of the dose-response relationship.ResultsDecreased handgrip strength was related to subsequent increased risk of depressive symptoms, such that participants in the lowest quartile of handgrip strength were found to have an approximately 36% increased in their risk of depressive symptoms compared with those in the highest quartile [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.17, 1.58]. There was a linear dose-response relationship between handgrip strength and risk of depressive symptoms (P_nonlinearity = .25), in that a 5-unit increment in handgrip strength may lead to an 11% decrease in the risk of depressive symptoms (OR 0.89, 95% CI 0.85, 0.92). Conversely, depressive symptoms were prospectively associated with subsequent decreased handgrip strength (β = −0.84, 95% CI –1.13, −0.55). An approximatively L-shaped dose-response pattern was found for the association between depressive symptoms level and handgrip strength (P_nonlinearity = .02).Conclusions and ImplicationsThe present study identified bidirectional associations between handgrip strength and depressive symptoms, and the associations were found to have a dose-response pattern. It provides important insights into integrated mental and physical health intervention strategies that simultaneously promote handgrip strength and depressive symptoms.     

福州地区军队离退休老年人健康状况调查分析

目的：研究福州地区军队离休老年人的健康状况及其影响因素,为制订相应的防治对策提供依据。方法：对福州地区军队１０８４名年龄≥６０岁老年人的健康状况进行流行病学调查,采用中华老年医学流行病学组设计的“老年人生活质量调查表”及评价标准,以问郑访问和体格检查相结合的方法获得数据,应用ＳＰＳＳ软件包进行统计分析。结果：军队离退休老年人总体健康状况较好,评价为良好及中等的占８９．２１％,但老年人患慢性病情况相