Protecting Ourselves from Harm: Voices of Aging Farmers.

Senior farmers suffer the highest fatality risk of any age group in agriculture. The purpose of this exploratory study was to develop a "voice" for senior farmers by examining aging farmers' and their families' perspectives of farm work, associated injury risks, and methods to decrease those risks. Focus groups and personal interviews were used to collect data from 81 participants across seven U.S. states. The findings reflect the collective and verified voice of the study group. The Health Belief Model was applied and revealed differences between farmers and their family members; however, the need and desire to continue self-directed work was ubiquitous. Seniors reported external risks, while family members were more likely to name risks associated with the health of the senior farmer. Both groups cited stress as an injury risk. Posing risk to others was the trigger point for senior farmers to make behavior changes. Family members reported uneasiness in initiating safety conversations. Adaptation of existing interventions for self-assessment of risk was rejected. Use of the popular farm press and respected local resources were desired as avenues for safety education. Humor and stories were highly regarded. Interventions should be tailored for the target audience. These new insights into the risk perceptions of senior farmers and their families may result in more appropriate actions by health professionals, extension staff social workers, vocational rehabilitation specialists, and others who work with farm populations.

Cattle-related injuries and farm management practices on Kentucky beef cattle farms.

While working on farms with livestock increases the risk of injury among farm workers in comparison to other commodity farms, few studies have examined the role offarm management practices in association with the risk of cattle-related injury. We examined the farm management practices of Kentucky beef cattle farms in association with self-reported rates of cattle-related injuries among workers. We conducted a mail survey of a random sample of 2,500 members of the Kentucky Cattlemen's Association. Results from 1,149 farm operators who were currently raising beef cattle and provided complete survey response are reported. During the busy season, the principal operator worked 20 hours per week on the beef operation, and among all farm employees, the beef operation required 35 hours per week (median cumulative hours). There were 157 farms that reported a cattle-related injury in the past year among the principal operator or a family member, yielding an annual cattle-related injury rate of 13.7 beef cattle farms per 100 reporting at least one cattle-related injury. The majority of these injuries were associated with transporting cattle, using cattle-related equipment (head gates, chutes, etc.), and performing medical or herd health tasks on the animal. A multivariable logistic regression analysis of cattle-related injuries indicated that the risk of injury increased with increasing herd size, increasing hours devoted to the cattle operation per week by all workers, and the number of different medical tasks or treatments performed on cattle without the presence of a veterinarian. Farms that performed 9 to 13 tasks/treatments without a veterinarian had a two-fold increased risk of a cattle-related injury (OR = 1.98; 95% Cl: 1.08-3.62) in comparison to farms that performed 0 to 4 tasks without a veterinarian. In adjusted analyses, the use of an ATV or Gator for cattle herding was associated with a significantly reduced risk of cattle-related injury (OR = 0.51; 95% CI: 0.30-0.86) in comparison to other herding methods. This study indicates that a substantial proportion of cattle-related injuries are associated with work activities related to handling practices and cattle restraining equipment.

Farmwork-related injury among farmers 50 years of age and older in Kentucky and South Carolina: a cohort study, 2002-2005.

Farmers in the U.S. are becoming more diverse; the average age of the farmer is increasing, as is the number of women and minority farm operators. There is limited research on injury risk factors in these special populations of farmers. It is especially important to study the risk factors for injury in these growing and at-risk groups. A longitudinal survey was conducted of farmers (n = 1,394) age 50 and older who resided in Kentucky and South Carolina. The questionnaire was administered by telephone and mail surveys four times between 2002 and 2005 to the fixed cohort of farmers, obtained by convenience sample. Approximately half of the cohort was female, and the majority of the cohort worked less than 40 hours per week. This cohort reported a crude, non-fatal injury rate of 9.3 injured farmers per 100 per year. Farmers reporting chronic bronchitis/emphysema (estimated odds ratio [EOR] = 1.57), back problems (EOR = 1.37), arthritis (EOR = 1.31), 3 to 4 restless nights in the past week (EOR = 2.02), or 5 to 7 restless nights in the past week (EOR = 1.82) were at significantly higher odds of sustaining a farmwork-related injury as calculated by the generalized estimating equations (GEE) regression method Farmers operating equipment on highways (EOR = 1.51) or climbing higher than eight feet (EOR = 1.69) were at significantly higher odds of sustaining a farmwork-related injury, and females were at higher risk of injury when performing animal-related tasks (EOR = 3.00) or crop-related tasks (EOR = 2.21). Identified factors associated with farmwork-related injury should better inform agricultural health policies and guidelines for older farmers, such as policies governing the allowable number of hours worked per week and rest breaks, guidelines that advise appropriate types of farm tasks, and ergonomic engineering advances on farming equipment.

FS4JK farm safety day camps: who learns the most?

Farm Safety 4 Just Kids uses daylong community-based farm safety day camps as a primary method to instruct children about the hazards in farm environments. This article describes children's knowledge about farm safety before and after a day camp experience and assesses differences in knowledge gain by farm residency status and by gender as a result of their attendance at the camps. Data collection focused on three high-risk farm exposures: tractors, powered equipment, and large animals. A 32-item pre- and post-camp survey developed by the research team measured children's knowledge scores in these three focal areas. The sample consisted of 1,233 children, ranging from 8 to 12 years of age. Mixed models were used to test for changes in knowledge over time and for differences by gender and by farm/nonfarm status of the child. The results were encouraging: both farm and nonfarm children increased their knowledge about farm injury risk. Overall, girls demonstrated greater knowledge than boys on both the pre- and post-tests. Based on these findings, farm safety day camps appear to improve the knowledge of children about the injury risks associated with the farm environment. Refinements to the camp structure may foster greater knowledge gain of children attending the camps. While education of children about farm safety is not the sole answer to decreasing injury, it is a key component that should not be discounted.

Farm safety through the camera's eye.

Farms and ranches constitute one of the most hazardous work environments in America, and perhaps in the world, yet farm scenes are often portrayed as tranquil, picture-perfect settings. A review of 293 photographs that included persons and tractors, livestock, powered equipment, all-terrain vehicles, or bodies of water was undertaken by two independent reviewers. Predetermined criteria that captured best safety practices in agriculture were applied to each photograph. A rating of 1 (best practices), 2 (unsafe practices) or 3 (mixed messages) was given to each photograph. Three popular farm periodicals with various geographic distribution areas across the U.S. were examined. Issues from June 2005 through October 2006 were included in the review. Results revealed that only 56.7% of the photographs illustrated best practices for safety. Of the 27 photographs that included children, only 18.5% depicted best practices. Photographs in advertisements, where the settings can be staged, illustrated best practices 56.5% of the time. Editors, photo-journalists, and advertisers should take every opportunity to promote safety in this high-risk industry through portrayal of safe work practices and safe work environments in photographs that are used in farm periodicals.

Observation study of students who completed a high school agricultural safety education program.

The Agricultural Disability Awareness and Risk Education Project (AgDARE) is a research-based curriculum of agricultural safety instruction based on Prochaska and DiClemente's Transtheroetical Model of Change. The program uses eight reality-based psychomotor and narrative modules to teach safe farm work behaviors. In addition to in-class pencil and paper assessments on safety attitudes and behavior intention, farm visits were made to assess the longer term influence of AgDARE. Visits were made between 11 and 20 months (mean = 14.24 months) after completion of the classroom instruction to 29 students who worked on farms and completed at least one-half of the AgDARE instruction. All but one of the visited students exhibited safe work behaviors addressed by the AgDARE instruction. In addition, 76% of the visited students had made positive changes in their farm work behavior since participating in AgDARE. Changes extended beyond the instruction that students received in class to include other aspects of farm work and other family members. The use of farm visits to evaluate students' safety behaviors was tempered by the challenge of contacting students and obstacles associated with observing work in an environment where little is routine or regular.

Women in agriculture: risks for occupational injury within the context of gendered role.

Women continue to make significant contributions to farming. Not only do women participate in the traditional roles of homemaker, caregiver, and wife, they also work side-by-side with their spouses in keeping the farm viable. More daughters are entering the farming business, either as partners with other family members or as independent operators. Each year since the United States Department of Agriculture began including gender in the Census of Agriculture, the percentage of women engaged in agriculture has increased, and women's participation in agriculture is increasing faster than in other business segments. This article examines the role of women in agriculture and how sociocultural, economic, and physical factors may affect women's exposure to injury-producing events and their knowledge and beliefs about injury prevention. To date, few studies have examined work-related unintentional injuries among farm women. Even less is known about the extent to which occupational risks are recognized when women seek medical care. Differences in size and stature, increased physical strain, and low maximal oxygen uptake may predispose women to ergonomic-related injuries. Limitations of current research and recommendations for future analyses are discussed.

Agricultural Disability Awareness and Risk Education (AgDARE) for high school students.

OBJECTIVE: Develop and test a farm health and injury prevention educational intervention for high school agriculture students. SETTING: Twenty one high schools in Kentucky, Iowa, and Mississippi. METHODS: A quasiexperimental crossover design was used to test the effectiveness of two sets of instructional materials designed through participatory action research with agriculture teachers and students. Narrative simulations based on farm work stories and simulations of farm work while students pretended to have a disability were completed in 14 schools (n = 373) over the academic year. Students in seven control schools (n = 417) received no intervention but completed, in the same time frame as students in the treatment schools, demographic surveys and premeasures and post-measures of farm safety attitudes and intent to change safety behaviors. One year after the intervention, 29 students from the treatment group received farm visits to measure their farm safety behaviors. RESULTS: Students engaged in hazardous work on farms. Thirty two were involved in tractor overturns and 11 had received injuries from rotating power take-off mechanisms. One fourth reported hearing problems, and 21% had respiratory symptoms after working in dusty farm surroundings. Students who completed at least two physical and two narrative simulations of the Agricultural Disability Awareness and Risk Education (AgDARE) curriculum showed statistically significant positive changes in farm safety attitude and intent to change behaviors. CONCLUSIONS: Adolescents engage in farm work that places them at risk for injury and illness. The AgDARE curriculum may be an effective and efficient method of teaching farm safety in high school agriculture classes.

Paramedic use of endotracheal tube introducers for the difficult airway.

OBJECTIVE: To evaluate the ability of paramedics to learn and apply the skill of introducer-aided oral intubation in the setting of the simulated "difficult airway." The authors hypothesized that, following a brief introduction to the device, intubation success rates would not differ for traditional and introducer-aided intubations of an immobilized airway mannequin. METHODS: During a paramedic recertification class, experienced paramedics were given a brief didactic introduction to the "bougie-like" Flex Guide endotracheal tube introducer (ETTI). The participants were then asked to intubate adult mannequins immobilized in the head-neutral position, with and without the ETTI. "Successful placement" was defined as completion of the procedure within 30 seconds and endotracheal tube position confirmed by the investigator with direct visualization. RESULTS: For both traditional and ETTI intubations, 34 (97%) of the 35 paramedics successfully intubated within 30 seconds. The two unsuccessful intubation attempts were recognized by the paramedic as esophageal intubations, and correct tube placement was obtained within an additional 30 seconds. CONCLUSION: In this study, use of the ETTI was mastered by the participants after only a brief didactic introduction to the device, with their ability to intubate an immobilized mannequin using the ETTI being equal to their ability to perform traditional intubation. These results suggest that use of the ETTI is easily learned, and may support the device's role in the prehospital management of the difficult airway.

Nonfatal farm injury incidence and disability to children: a systematic review.

OBJECTIVE: To summarize the literature on farm child nonfatal injury incidence and the subsequent disability to children. SEARCH STRATEGY: We used a systematic process to search the following databases: MEDLINE, EMBASE, ERIC, NTIS and NIOSHTIC. The reference lists from each potentially eligible study were checked and experts in the field contacted for additional reports. SELECTION CRITERIA: Studies for selection had to meet the following criteria: published in the last 20 years (1979-1998); located in North America; and include nonfatal farm injury cases for children under age 20. DATA COLLECTION AND ANALYSIS: Thirty-two studies met the inclusion criteria and were examined for study design, location, sample size, injury rate, injury sources, and functional outcomes. RESULTS: Among the 32 studies, there were 9 case series, 11 secondary analyses of administrative databases, 2 case-control studies, 6 cross-sectional surveys, one mixed-method study, 2 prospective case series reports, and 1 cohort study. Twenty-two of the studies confined the sample to agriculture, but nine of these combined children within a larger sample, creating considerable difficulty in examining only agricultural injuries to children. Only one study focused on outcome measurement. Although nearly all the reports provided some discussion about injury severity, these comments were generally limited to injury severity scores or injury type. CONCLUSIONS: Despite increasing attention on farm-related child injury, the literature continues to report primarily descriptive studies that rely on small samples focusing on the nature of the injury event and immediate consequences. Analysis of larger databases, such as worker compensation claims, trauma registries, and agricultural injury surveillance, still lacks valid denominators; thus, incidence rates cannot be calculated. Very little was found regarding disability among children who experienced agricultural injury, even though the literature clearly proclaims the severity and seriousness of child injury on farms. To complete the portrait of the burden of this continuing problem, research must include functional outcome measures.

Prehospital consideration of sildenafil-nitrate interactions.

OBJECTIVE: To determine whether paramedics and on-line physicians screen patients for use of sildenafil citrate (Viagra) prior to prehospital administration of nitrates. METHODS: A prospective, observational study was performed over a one-month period in three EMS systems. Consecutive radio communications between on-line physicians and paramedics concerning male patients with cardiac complaints were monitored. Investigators observed the frequency with which on-line physicians screened for sildenafil use prior to ordering nitrates. After observation of the radio communications was completed, a written survey was distributed to all paramedics in the three EMS systems. RESULTS: Seventy-six physician-paramedic interactions were monitored. Nitrates were ordered by on-line physicians in 56 cases. No paramedic reported sildenafil use/nonuse, and no on-line physician inquired about the patient's potential use of the drug. Only half of the surveyed paramedics reported that they routinely screen for sildenafil use, and approximately a fourth reported that its use would not alter their management of chest pain patients. CONCLUSION: In this study, on-line physicians in three EMS settings did not screen for sildenafil use prior to ordering nitrates. While some paramedics do screen for sildenafil use, practice patterns among paramedics in these three systems were inconsistent.

Proper depth of placement of nasotracheal tubes in adults prior to radiographic confirmation.

OBJECTIVE: To determine the optimal initial depth of tube placement in nasotracheal intubation (NTI) of adult patients, measured at the naris, prior to obtaining a chest radiograph (CXR). METHODS: Part 1: A prospective, observational study was performed to compare the initial depth of NTI, measured at the naris, with the observed height of the endotracheal tube (ETT) tip above the carina on the initial CXR. Optimal depths were predicted by gender. Part 2: Results from Part 1 were prospectively validated by measuring the frequency of adequate placement when ETTs were placed to this depth. ETT placement was considered adequate if the tip was at least 2 cm above the carnia and below the larnx on the CXR. RESULTS: Part 1: The mean depth measured at the naris was 27.5 +/- 1.5 cm in women (n = 50) and 27.8 +/- 1.0 cm in men (n = 74). The mean distance of the tip of the ETT to the carina was 3.9 +/- 2.7 cm in women and 6.4 +/- 2.2 cm in men. Initial tube position was adequate in 39 (78%) of the women and 72 (97%) of the men. It was determined that if a depth of 26 cm had been used in the women and 28 cm in the men, 45 (90%) of the women and 70 (95%) of the men would have had adequate tube placement, resulting in statistically significant improvement in the women (p < 0.05; McNemar chi 2). Part 2: These calculated depths (26 and 28 cm) were then prospectively applied in 26 women and 52 men. Twenty-five (96%) of 26 women and 51 (98%) of 52 men had adequate placement, with a mean height above the carina of 4.5 +/- 1.4 cm in women and 5.6 +/- 1.8 cm in men. CONCLUSION: Initial placement of NTI at 26 cm in women and 28 cm in men, measured at the naris, resulted in adequate initial placement for most adult patients.

CATCH: process evaluation of environmental factors and programs.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multicenter trial designed to test the effectiveness of school and family-based cardiovascular health promotion for preadolescents. CATCH interventions target multiple cardiovascular health behaviors such as dietary intake of fat and sodium, physical activity, and tobacco use. Evaluation includes physiological, psychosocial, behavioral, and process measures. An important aspect of the process evaluation is the assessment of environmental factors and "secular events" in both intervention and control schools that may affect outcomes independently of the CATCH interventions. With such information, CATCH investigators are able to isolate the impact of the CATCH intervention from competing (non-CATCH) factors as well as "track" proximal (i.e., immediate and short term) changes related to the intervention that may in turn lead to "distal" (long-term) behavior change. The School Health Questionnaire, the major process evaluation tool for monitoring secular and environmental changes in the schools, is described in detail, and data describing tobacco-related environmental factors and secular events are presented.

Comparison of a food frequency questionnaire using reported vs standard portion sizes for classifying individuals according to nutrient intake.

Individual intakes of retinol, carotene, vitamin C, and folacin calculated from a food frequency questionnaire using reported portion size were compared with intakes calculated using standard portion size information. Data from a case-control study to determine the association of nutrient intake and risk of cervical dysplasia were supplemented by standard portion size information from the US Department of Agriculture and reanalyzed. Significant mean differences were found between intake calculated from reported portion size data and that calculated from standard portion size data for all nutrients. Correlation of nutrient intakes obtained by the two methods of data collection ranged from .73 to .92. Calculation of the rho statistic, measuring the consistency of classification of participants into groups of high, medium, and low nutrient intake, led to values ranging from .55 to .71, indicating some misclassification of study participants. To determine the effect misclassification had on the study outcome, odds ratios were calculated using nutrient amounts obtained from both methods of collecting portion size data. Results indicate that replacing reported portion size data with standard portion size data may lead to conflicting outcomes for specific nutrients in research concerning the relationship between diet and disease.

Luque interpeduncular segmental fixation of the lumbosacral spine.

Interpeduncular segmental fixation of the lumbar and lumbosacral spine with Luque screws and plates is becoming increasingly popular. In this retrospective study, 52 consecutive patients treated with this technique were followed for 16 to 44 months (average, 21). Indications for surgical arthrodesis included lumbar instability from degenerative disease (16 cases), spondylolisthesis (25 cases), pseudarthrosis (eight cases), fracture (two cases), and tumor (one case). Fusion with instrumentation spanned one level in nine patients, two in 38 patients, three in four patients, and four in one patient. Patients wore a rigid lumbar orthosis for an average of six months (range, two to 16). Ten complications occurred in nine patients: two superficial wound infections, four neurologic complications, three loosened screws, and one broken screw. An overall fusion rate of 96% was achieved; pseudarthrosis is suspected in one case and failed arthrodesis secondary to trauma in a second patient. At four months postoperatively, solid unions had resulted in most of the cases, as seen roentgenographically. All patients reported decreased back pain; however, one patient is addicted to narcotics. Twenty-five of the 29 patients employed were able to return to work at an average of six months postoperatively.

Intake and food sources of dietary fat among schoolchildren in The Woodlands, Texas.

To investigate the nutrient intake and food use patterns among schoolchildren, diet was assessed among 138 children and adolescents in grades 5 through 12 using three random, nonconsecutive, 1-day food records. Mean intake of total fat, saturated fat, and polyunsaturated fat as percent of calories was 35.6%, 13.4%, and 6.6%, respectively. Among all subjects, 17% consumed diets containing less than 30% of calories from fat, 34% consumed greater than or equal to 38% of calories from fat, 7% consumed less than 10% of calories from saturated fatty acids, and greater than 97% ate less than 300 mg of cholesterol per day. While intake of calories, sodium, and beta-carotene per 1000 kcal was higher in subjects consuming higher fat diets, intake of other micronutrients was either higher among those eating low-fat diets or did not differ by level of fat intake. Differences were seen in the amount of saturated fat and cholesterol that individual food sources contributed to the diets of subjects eating high and low fat diets. These cross-sectional data show that a substantial proportion of children and adolescents in this population are consuming diets low in fat and cholesterol without systematic differences in intake of other nutrients, suggesting that current dietary guidelines regarding fat intake are attainable within the current food use pattern of healthy, school-aged children and adolescents.