Agricultural injuries among operation household members: RRIS-II 1999.

The purpose of this study was to determine the magnitude and consequences of agricultural injuries, and to reveal potential risk factors among agricultural household members. The Regional Rural Injury Study (RRIS-II) collected injury and exposure data on agricultural households of 16,538 people in Minnesota, Wisconsin, North Dakota, South Dakota, and Nebraska for each six-month period of 1999. Adjusted injury rates, consequences, and potential risk factors were identified through analyses. Selection of variables for multivariate analyses was based on a causal model. Injuries reported here occurred while the individuals were involved in activities associated with their own farm or ranch, unless otherwise stated. Estimates of injury rates and the effects of various exposures were derived by Poisson and logistic regression. These models accounted for correlation within both subject and household, and were adjusted for non-response. The rate of agricultural injury to household members on their own operation was 74.5 injuries per 1,000 persons per year. Differences in rates due to age and gender diminished when rates were calculated according to hours worked. Although only 5% of injured persons required in-patient hospitalization, 28% required emergency department treatment, and 84% required some type of professional health care. Moreover, 47% of all injuries required time off from agricultural work, and 7% required time off from non-agricultural work. In multivariate analyses, decreased risks were associated with Minnesota, and increased risks were identified for those with prior injuries and for males.This study provides a basis for further research on agricultural injuries and their prevention.

Sports and recreational injuries: regional rural injury study-II: impact on agricultural households and operations.

OBJECTIVES: To identify the incidence, severity, and potential risk factors for sports/recreational injuries incurred by children and adults in a five state, rural, Midwest, agricultural household population. METHODS: Computer assisted telephone interviews that included questions about all injuries were completed for eligible, participating households for 1999; 16,538 people participated, including 8488 children less than 20 years of age. Rates and 95% confidence intervals were calculated, and causal models guided multivariate models. RESULTS: Of a total of 2586 injuries, 1301 (50%) were not related to agricultural activity. Among these, 733 (28%) were associated with sports/recreational activities including multiple person sports (64%), general play activities (19%), and single person sports (14%). The overall rate was 46.4 injury events per 1000 persons per year. Rates for children were 99.4 for boys and 64.3 for girls. For adults (aged 20 and above), rates were 11.9 for men and 4.8 for women. For children, 93% received health care, 44% were restricted for seven or more days, and 18% lost agricultural work time of seven or more days; the respective proportions for adults were 88%, 45%, and 17%. Multivariate analysis for children showed increased risks for Nebraska residents, males, and those 10-14 or 15-19 years. For adults, increased risks were identified for males and those 20-24 years; decreased risks were observed for Nebraska residents and those 45-54 years. CONCLUSIONS: Sports/recreational activities are an important source of injury with relevant consequences for this population, including significant restricted daily activity and lost agricultural work time. Key findings provide a basis for further study to address these burdens.

Design and validation of instruments to measure knowledge.

BACKGROUND: Measuring health care providers' learning after they have participated in educational interventions that use experimental designs requires valid, reliable, and practical instruments. METHODS: A literature review was conducted. In addition, experience gained from designing and validating instruments for measuring the effect of an educational intervention informed this process. RESULTS: The eight main steps for designing, validating, and testing the reliability of instruments for measuring learning outcomes are presented. The key considerations and rationale for this process are discussed. Methods for critiquing and adapting existent instruments and creating new ones are offered. CONCLUSIONS: This study may help other investigators in developing valid, reliable, and practical instruments for measuring the outcomes of educational activities.

Instruments to measure cancer management knowledge of rural health care providers.

BACKGROUND: Instruments to measure cancer management knowledge of rural physicians, nurses, and pharmacists were needed to evaluate the effect of an educational intervention. Since such instruments did not exist, the authors designed and validated a new instrument for each discipline. METHODS: The design and validation process for these instruments are described. RESULTS: These three instruments were shown to be practical and to have high content and construct validity. Content validation demonstrated that all items were rated as essential or useful by 90% or more of the respondents. Construct validation show highly significant differences in mean scores among several levels of learners and practitioners as expected. CONCLUSIONS: These instruments may be useful to other investigators for measuring cancer management knowledge of rural physicians, nurses, and pharmacists.

Injuries among children and youth in farm households: Regional Rural Injury Study-I.

OBJECTIVES: The purpose of this effort was to identify the incidence and consequences of both farming and non-farming related injuries and the potential risk factors for farming related injuries among children and youth, aged 0-19 years, who lived in farm households in a large region of the United States. METHODS: Data were collected from randomly selected farm households during 1990. Rates and rate ratios with 95% confidence intervals were calculated for sociodemographic and exposure variables. Multivariate analyses were conducted, using a priori and backward stepwise logistic regression models. RESULTS: Within the population of 3,939 farm households and 13,144 persons, children and youth accounted for 33%. Injury rates for farming and non-farming sources, respectively, were 1,683 and 6,980 per 100,000 persons. Animals (40%) were the primary sources of the farming operation related injuries; sports/recreation sources (61%) were associated primarily with non-farming related injuries. Of the farming and non-farming operation related injury cases, 83% and 90%, respectively, required some type of health care; moreover, 17% and 24%, respectively, were restricted from regular activities for one month or more. Through multivariate analyses, important increased rate ratios were observed for operating a tractor, working with dairy cattle, and being male. Increased rate ratios for working with beef cattle, operating a harvester, and living on a farm where there were all terrain vehicles in use, and a decreased rate ratio for living on a farm where there were sheep, appeared suggestive. CONCLUSIONS: Based on the relevant rates, injury consequences, and potential risk factors identified, injuries to children and youth on farms represent a significant problem. Future analytic studies are essential to identify more specific risk factors that can serve as a basis for development of appropriate intervention efforts. Given the population at risk, and the opportunity for intervention in this unique occupational setting, many of these injuries may be readily amenable to prevention efforts.

Lake Superior Rural Cancer Care Project, part I: an interventional trial.

PURPOSE: To date, effective cancer care and control intervention studies have been carried out largely in urban and suburban populations. This study was conducted to test innovative interventions, using experimental designs, to improve the care and outcomes of patients with cancer in rural settings. DESCRIPTION OF STUDY: The Lake Superior Rural Cancer Care Project (LSRCCP) tested an innovative, multimodal, multidisciplinary intervention that involved rural healthcare providers and their healthcare system. An experimental design was used, with the rural community as the unit of randomization. Outcomes were measured at three levels: rural providers' knowledge of cancer management, providers' practice performance, and patient outcomes. This 5-year study was conducted in rural areas of northern Minnesota, Wisconsin, and the western part of the Upper Peninsula of Michigan. RESULTS: Baseline data from the study are provided, and details of the design and methods are presented. The study outcomes are reported in part in "Lake Superior Rural Cancer Care Project Part II" in this issue and will be reported further in future issues. CLINICAL IMPLICATIONS: This article describes the hypotheses, design, and methods of the LSRCCP. The design and methods as well as the results of this study may be useful to cancer researchers and clinicians in rural areas across the United States.

Lake Superior Rural Cancer Care Project, part II: provider knowledge.

PURPOSE: The purpose of this article is to report the main learning outcomes of the Lake Superior Rural Cancer Care Project. DESCRIPTION OF STUDY: The authors designed and tested a multimodal intervention directed at rural providers and their healthcare systems in a large rural area in the north central United States. An experimental design was used to randomize rural providers at the group level. The intervention consisted of providing increased education for rural providers with a number of approaches, including the use of clinical opinion leaders. The main outcome of the intervention was knowledge scoring on discipline-specific cancer management tests. RESULTS: Knowledge scores for providers in the experimental group significantly increased from pretest to post-test: 66 to 79 for physicians (and physician assistants) (P=.02); 58 to 71 for nurses (P=.01); and 54 to 64 for pharmacists (P=.01). At post-test, participating providers in the experimental group performed significantly better on the knowledge tests (P <.01) than those in the control groups. CLINICAL IMPLICATIONS: This study may be the first to test educational interventions to improve rural providers' knowledge about cancer practice using an experimental design. The intervention may possibly change provider practice behaviors and, thus, patient outcomes, data that will be reported in a future issue. Finally, this educational intervention may prove useful for providers in other rural areas.

Community-based screening for childhood lead poisoning. Identification of risk factors and susceptible populations in Duluth.

The purpose of this matched case-controlled study was to identify local risk factors and susceptible populations for childhood lead poisoning in Duluth, Minnesota. We mailed questionnaires to the parents of 20 children with known elevated capillary lead levels > or = 10 micrograms/dL; 76 age-matched controls had capillary lead levels < 10 micrograms/dL. The study identified these risk factors for elevated capillary lead levels in children: not attending daycare, having nonwhite parents, living in rental property in central Duluth, and moving with family three or more times in the previous five years. We conclude that these risk factors are related to socioeconomics. Minority children and children living in poverty in the Duluth area should be screened for lead poisoning according to the Centers for Disease Control and Prevention screening guidelines for high-risk lead exposure.

Machinery-related injuries: regional rural injury study--I (RRIS--I).

Although it is known that farm machinery is a source of serious and catastrophic farm work-related injuries, little is known about the magnitude of, and potential risk factors for, this problem. The study population is from the five-state Regional Rural Injury Study--I (RRIS--I) that included 3,939 farm households and 13,144 persons who were interviewed about their injury experience and farming operation-related exposures during 1990. Rates were calculated for sociodemographic variables and various exposures pertinent to large farm machinery (excluding tractors). Multivariate analyses were conducted using logistic regression, based on a model developed a priori and further confirmed using backward stepwise logistic regression. Among the total farming-related injury events (n = 764), 151 (20%) were related to large machinery use (1,127 injured persons per 100,000 persons per year). Through multivariate analyses, several variables were associated with elevated rate ratios that were important in both models: hours worked per week on the farm (40-59, 60-79, 80+); operation of an auger; field crops as the enterprise requiring the most time; and male gender. In addition, in the backward stepwise model, certain marital status categories (married; separated/widowed/divorced) were also associated with elevated rate ratios that were important. The majority of injury events occurred while persons were lifting, pushing, or pulling (21%), adjusting a machine (20%), or repairing a machine (17%). While only 5% of the cases were hospitalized, 79% required some type of health care. Among all injured persons, 34% were restricted from regular activities for 1 week or more and 19% were restricted for 1 month or more; 25% continued to have persistent problems. In summary, the RRIS-I permitted one of the most comprehensive studies of agricultural machinery-related injuries, to date. The findings indicate that these injuries represent a significant problem, based on the relevant rates, potential risk factors, and consequences from trauma.

A population-based study of tractor-related injuries: Regional Rural Injury Study-I (RRIS-I).

Although tractors account for the majority of fatal farming-related injuries, little is known about the magnitude of this problem. The study population in this article was obtained from the five state Regional Rural Injury Study-I (RRIS-I) database that included 3939 farm households and 13,144 persons interviewed during 1990. Rates were calculated for sociodemographic variables and various exposures; logistic regression was used to calculate the relative risks and respective confidence intervals. Among the total farming-related injury events (n = 764), 65 (8.4%) were related to regular tractor (> or = 20 horsepower) use (495 injured persons per 100,000 persons per year). The rates increased incrementally for those persons working between 20 to 39 and 60 to 79 hours per week (range, 529 to 1430 per 100,000 persons). Among the 12 rollover events, there were only three injuries. The majority of injury events occurred while persons were mounting or dismounting the tractor (42%). Although only 7% of the cases were hospitalized, 83% required some type of health care. Among all injured persons, 43% were restricted from regular activities for 1 week or more and 20% were restricted for 1 month or more; 28% continued to have persistent problems. The finding of the large proportion of events associated with activities of mounting and dismounting suggests a need to investigate specific design characteristics of the tractors associated with these events and, in general, the tractors to which the population is exposed.

Data on prior pesticide use collected from self- and proxy respondents.

Proxy respondents have often been used in case-control studies of cancer and pesticides. To evaluate the effect of exposure misclassification, we compared data collected during 1981-1983 from participants interviewed for a case-control study of leukemia and non-Hodgkin's lymphoma with data collected during 1990-1991 from proxy respondents for participants who died or became incompetent since the initial interview (328 self-proxy pairs). As questions increased in detail, agreement percentages decreased. Agreement percentages were highest for demographic and general farming information (averages = 88-90%) and lowest for specific pesticide use (averages = 68-74%). Generally, odds ratios calculated from proxy respondent data were less than those from self-respondent data; however, several exceptions occurred. The findings indicate that pesticide data provided by proxy respondents will not necessarily result in the same estimate of risk and/or lead to the same conclusions as data provided by self-respondents.

Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids).

This study was designed to look at the effect of evening primrose oil (linoleic and gamma-linolenic acids) as an oral supplement for patients with atopic eczema. We used a double-blind, blocked crossover design with random assignment of patients to treatment groups. We used Wilcoxon's signed-ranks method of comparing changes during the trial. We observed no significant effect on erythema, scale, excoriation, lichenification, or overall severity in 123 patients with atopic eczema of average severity while they took oral doses of evening primrose oil (2 or 4 gm in children, 6 or 8 gm in adults).