Sexual Harassment Beliefs and Myth Acceptance Among Hispanic and Indigenous Farmworkers in California (USA) and Michoacán (Mexico)

We explore workplace sexual harassment (WSH) myth acceptance, bystander discomfort, and beliefs among farmworkers in California, USA, and Michoacán, Mexico. Surveys were conducted with the guidance of community advisory boards among 197 farmworkers (38 men and 59 women in California; 40 men and 60 women in Michoacán). Men and women in Michoacán had similar discomfort and myth acceptance. California women reported more discomfort than men but were similar in myth acceptance. The highest levels of myth acceptance ranged from 66 to 88%. The majority (85-90%) believed that something must be done to prevent WSH in agriculture.

Lessons From the Field: Rapid Antigen Testing Is Efficient and Practical for Mitigation of Coronavirus Disease 2019 Outbreaks in Long-Term Care Facilities

Background

Mitigation of coronavirus disease 2019 (COVID-19) outbreaks in long-term care facilities (LTCFs) is facilitated by rapid identification and isolation of infectious individuals to interrupt viral transmission. Immunochromatographic (IC) tests, or rapid antigen tests, have high sensitivity and specificity during the contagious period for COVID-19. Mathematical modeling predicts frequent IC surveillance will be more efficient than polymerase chain reaction (PCR)-based strategies, especially during community surges when reporting of PCR results can be delayed. However, there are few published field studies evaluating IC testing strategies in this long-term care setting.

Methods

In fall and winter of 2020, the Marin Health and Human Services Department implemented thrice-weekly IC mass testing by nonlaboratory workers in outbreaks that occurred in 2 LTCFs, in addition to then-standard semiweekly PCR testing. The IC test performance was characterized using same-day PCR specimens as reference standard. Cumulative incidence and duration of transmission for the 2 IC intervention facility outbreaks were compared with 6 reference LTCFs that used weekly to semiweekly PCR alone during an outbreak response.

Results

Of 123 same-day test pairs, IC test sensitivity and specificity were 75% (95% confidence interval [CI], 48%-93%) and 100% (95% CI, 97%-100%), respectively. The median duration of outbreak transmission was 19.5 days in the 2 intervention sites and 28 days in the reference facilities (P = .40). Cumulative incidence for the outbreaks among LTCF residents was 41% in the intervention facilities versus 52% in the reference facilities (P = .04, Fisher 2-sided exact).

Conclusions

Thrice-weekly mass IC testing as used by nonlaboratory personnel can be highly practical and effective for COVID-19 outbreak mitigation in the LTCF setting.

Exposure to Workplace Sexual Harassment among Women and Men Farmworkers in the U.S. and Mexico

HIGHLIGHTS

Women and men farmworkers reported workplace sexual harassment (WSH). WSH occurred as frequently as daily. Both coworkers and leadership were perpetrators of WSH.

ABSTRACT

This study explores experiences relevant to workplace sexual harassment (WSH) in agriculture among men and women farmworkers in California (U.S.) and Michoacán (Mexico). Anecdotal evidence documents women farmworkers having to endure behavioral, verbal, and physical WSH including sexual ogling, degrading language, groping, and requests for sex in exchange for work. We include survey comparisons between men and women in California and Michoacan on WSH among farmworkers. We conducted 197 farmworker surveys (38 men and 59 women in California; 40 men and 60 women in Michoacán). Community advisory boards contributed expertise and input for study strategies, materials, and dissemination. Survey participant ages ranged from 23 to 54 years old. Half worked in Mexico, 68% were married, 80% had children, and 47% had less than 7 years of education. Most farmworkers spoke Spanish and Purhépecha, an indigenous language spoken by the Purhépecha people in Michoacán. We used two strategies to measure WSH exposure in the previous year: (1) direct inquiry-based survey items (asking "Have you ever been the victim of or bystander to workplace sexual harassment?") documenting WSH among women (49%) and men (21%) in California and among women (7%) and men (13%) in Michoacán, and (2) behavior-based WSH items (using explicit examples of WSH behaviors perpetrated against the participant or witnessed by the participant as a bystander) documenting WSH among women (as high as 53%) and men (as high as 45%) in California and among women (as high as 65%) and men (as high as 68%) in Michoacán. Women farmworkers in California reported WSH experiences exceeding those of men. Reported WSH experiences in Michoacán were similar for men and women. Farmworkers identified WSH perpetrators as coworkers more than leadership. The frequency of exposure ranged from daily, weekly, monthly, and up to multiple times a year. Of 46 direct inquiry-based WSH incidents, only one perpetrator was punished, and at least half of all victims said they were forced to change their jobs. The findings of this study inform the development of WSH prevention efforts, such as education tools, support for efforts to facilitate reporting, protections against retaliation for workers, and promoting accountability for perpetrators. This information supports the promotion of policy recommendations and preventive approaches for WSH.

Use of SMS-linked electronic surveys for COVID-19 case investigation and contact tracing - Marin County, CA, USA

Objectives

We sought to quantify the proportion of contacts reported by persons with COVID-19 through a short message service (SMS)-linked survey in comparison to the proportion of contacts reported during a follow-up phone-interview. We also sought to assess improvement in contact tracing timeliness associated with sending SMS-linked surveys.

Study design

During December 4-15, 2020, persons identified as COVID-19 cases whose data was entered into Marin County's contact tracing database on even days received a SMS-linked survey and persons whose data was entered on odd days did not; all were called for case investigation and contact tracing. Chi-square test and Fisher's exact test were used to compare demographic data. Chi-square test was used to contrast categorical outcomes, and Wilcoxon's rank-sum test was used for continuous outcomes.

Results

Among 350 SMS-linked survey recipients, 85 (24%) responded and 4 (1%) reported contacts using the survey; an additional 303 contacts were reported during phone interviews. Without phone interviews, 99% of reported contacts would have been missed. There was no meaningful difference between study arms in the proportion of contacts notified within 48 h.

Conclusions

This SMS-linked survey had low participation and was not useful for identifying contacts. Phone interviews remained crucial for COVID-19 contact tracing.

Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018

To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case-control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.

"It's Wrong because It Could Be My Sister, Wife, or Mother": Workplace Sexual Harassment among Men and Women Farmworkers in USA and Mexico

These findings from focus groups explore attitudes, beliefs, perspectives, and experiences relevant to workplace sexual harassment (WSH) among men and women farmworkers in California, USA, and Michoacán, Mexico. Focus groups are stratified by country and gender, with two in California (10 men and 10 women) and two in Michoacán (8 men and 5 women). This community-based participatory research includes Community Advisory Boards (CABs) consisting of farmworkers, academicians, non-profit organizations, attorneys, industry personnel, and community leaders who took part in strategy and the development of materials. Themes are related to the experience of, responses to, and farmworkers' recommendations for prevention of WSH. Although men and women faced WSH, women's experiences were more severe and frequent. Participants condemned WSH as contrary to principles of caballerosidad, cortesía, respeto - cultural values promoting respect for others and protection for vulnerable persons. Participants endorsed the notion that women are responsible for WSH. Although farmworkers try to resolve WSH on their own with help from co-workers, family, and leadership, they face significant barriers that silence victims and allow WSH to persist. All farmworkers recommended that management set a good example and enforce consequences for offenders. Implications include directly appealing to cultural values (emphasizing respect), incorporating bystander education, and countering the myth that women are responsible for WSH in workplace training. WSH is a recognized occupational hazard that affects all directly or indirectly exposed workers. We emphasize that employers are ultimately responsible for their workers' safety, supported by a governmental regulatory role. Enforcement of existing policy is needed in California , whereas awareness and policy development is needed in Michoacán. These findings will support the researchers, agricultural community, educators, and organizations working to prevent WSH.

Comparison of unsupervised home-based pulmonary rehabilitation versus supervised hospital outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients.Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables.Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity (p = 0.003), quality of life (p = 0.045), FEV1 (p = 0.001), lower pack-year smoking (p < 0.001) than outpatient PR.After home PR, exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea(p < 0.05), anxiety (p < 0.001), depression (p < 0.001) were improved except endurance shutte test. Improvements in exercise capacity (p < 0.05), quality of life (p < 0.001), dyspnea (p = 0.023), anxiety (p < 0.001), depression (p = 0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Non-finishers of home PR had more pack-year smoking than finishers of home PR (p = 0.039); other baseline parameters were similar.Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.

Abortion and public health: Time for another look

Four decades after Roe v. Wade, abortion remains highly contentious, pitting a woman's right to choose against a fetal claim to life. Public health implications are staggering: the US annual total of more than one million induced abortions equals nearly half the number of registered deaths from all causes. Sentiment regarding abortion is roughly evenly split among the general public, yet fundamental debate about abortion is largely absent in the public health community, which is predominantly supportive of its wide availability. Absence of substantive debate on abortion separates the public health community from the public we serve, jeopardizing the trust placed in us. Traditional public health values-support for vulnerable groups and opposition to the politicization of science-together with the principle of reciprocity weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life. Lay Summary: Four decades after Roe v. Wade, abortion remains highly divisive. Public sentiment regarding abortion is roughly evenly split, yet fundamental debate is largely absent in the public health community, which supports abortion's wide availability. Absence of substantive debate separates the public health community from the public it serves. Traditional public health values-support for vulnerable populations and opposition to politicization of science-and the principle of reciprocity ("the Golden Rule") weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life.

Farmworker Housing in the United States and Its Impact on Health

Farmworkers in the United States occupy a range of housing, including both on- and off-farm family and communal dwellings. As the farmworker population is becoming more settled, housing needs are changing. Existing regulations designed originally for grower-supplied migrant housing may need to be expanded. Much of farmworker housing is in poor condition, and likely linked to negative mental and physical health outcomes of residents because of exposures to crowding; mold, mildew, and other allergens; pesticides; and structural deficiencies. The existing research literature, both on housing conditions and their associations with farmworker health, is sparse, and large areas of the country and significant domains of health are omitted. This paper reviews this literature and formulates research and policy recommendations for addressing these deficiencies.

Cohort study of physical activity and injury among Latino farm workers

INTRODUCTION

This study characterized physical activity and its association with injury among Latino farm workers.

METHODS

An interviewer-administered questionnaire was used to collect baseline and follow-up data on 843 and 640 Latino farm workers, respectively. Participants were 18-55 years old, engaged in farm work and residing in Mendota, CA at baseline interview. The questionnaire assessed self-reported physical activity and risk of injury.

RESULTS

The 12 month prevalence of injury decreased from 9.0% at baseline to 6.9% at follow up interview. In GEE models adjusted for age, follow-up time, gender, smoking, income and years working in agriculture, poor/fair self-assessed health status (OR = 1.82, 95% CI: 1.18-2.82) and 2-3 hr per day of sitting/watching TV/using a computer (OR = 0.50, 95% CI: 0.30-0.83) were significantly associated with injury.

CONCLUSIONS

Physical activity was not associated with injury in this population. Efforts to reduce injuries should focus on known risk factors such as poor health status.

Work-related injuries and fatalities on dairy farm operations-a global perspective

Agriculture is among the most hazardous sectors for workers globally, and dairy farming has been associated with a high risk of injury among workers in several countries. The purpose of this paper is to provide an update on what is known about modern dairy farms and related injuries and fatalities in different regions of the world. As in other sectors of agriculture, fatalities appear to be associated with heavy equipment usage, whereas injuries occur at higher rates with animal production, specifically cattle and milk production. Dairy farming is associated with higher rates of injury as compared with other industrial sectors, but a lack of work-related injury reporting continues to be an issue in several countries. Worker fatality associated with heavy equipment use is not a new observation (e.g., tractors); however, manure-handling systems, livestock handling, and quad bike operation continue to be associated with worker injuries and fatalities on modern farms. Opportunities exist for improvement of safety-related equipment to reduce injury and fatality risk during worker interactions with large animals and farm equipment.

Region of birth, sex, and reproductive health in rural immigrant latino farmworkers: the MICASA study

PURPOSE

Characterize sexual and reproductive health among immigrant Latino farmworkers.

METHODS

We surveyed 806 immigrant Latino farmworkers from Mexico and Central America in a rural agricultural community in California's Central Valley.

FINDINGS

A total of 556 respondents were born in Mexico (272 men, 284 women) and 250 in Central America (135 men, 115 women). The majority entered the United States as young adults, with median age at immigration ranging from 20 (Mexican-born men) to 24 (Central American-born women). Nearly 95% of respondents were married or cohabiting. Median age for sexual debut was 18 for women and was younger for men (adjusted mean difference: -2.1 years, 95% CI: -2.6 to -1.7). Median number of lifetime sexual partners was 1 for women and greater for men (adjusted mean difference: 2.0 partners, 95% CI: 1.3-2.7). Contraception use was less likely among men and among Central American women compared to Mexico-born women. Among sexually active persons not using contraception, the most common reasons for nonuse were "Don't want to"/"Don't like any" followed by desire to become or being pregnant. Women reported a median of 3 pregnancies; there were no significant differences based on respondents' region of birth.

CONCLUSIONS

This group of Latino immigrants demonstrated behaviors conducive to reproductive health: late sexual debut, few lifetime sexual partners, and high prevalence of marriage. Preventive education campaigns should focus on maintaining healthy behaviors, especially in men. Identifying groups with common provenance and cultural heritage may aid in maximizing acceptability and effectiveness of prevention programs.

Region of birth, sex, and agricultural work of immigrant Latino farm workers: the MICASA study

Agricultural work is hazardous, and immigrant workers perform the majority of production tasks, yet there are few data describing agricultural work and use of protective measures by demographic characteristics. We examined cross-sectionally the influence of region of birth (Mexico vs. Central America) and sex on agricultural work and use of protective measures in the MICASA cohort of immigrant Latino farm workers in Mendota, California. Of 445 participants, 293 (65.8%) were born in Mexico (163 men, 130 women) and 152 (34.2%) were born in Central America (80 men, 72 women). Men worked on average 74.4 more days than women (95% CI 62.0, 86.9) and were more likely to perform tasks requiring high levels of training or strength, such as machine operation, pruning, picking, planting, and irrigation; more likely to work in dusty conditions; and more likely to work directly with pesticides. Women predominated in packing. Respondents from Mexico were more likely to work with tomatoes and less likely to work with melon and lettuce. Central America-born respondents were less likely to engage in planting, irrigation, and pesticide use. Use of task-appropriate personal protective measures on at least a half-time basis was rare, with the exception of persons working with pesticides (a group limited to men) and for facial scarves among Central American women. Further work should focus on identifying barriers to use of preventive measures and programs to further their use. Educational models accounting for cultural factors and driving social norm change, employer engagement, and use of community health workers (promotores) may be helpful in promoting use of preventive measures.

Factors associated with agricultural work performed by adolescents from an immigrant farm worker population (MICASA study)

While studies have looked at the relationship of adolescent employment with health outcomes and risk behaviors, few have focused on children of hired farm workers. These children face unique challenges affecting their health and work environment. Exploring the frequency and nature of agricultural work characteristics among adolescent children of Hispanic hired farm workers is important for assessing the potential risks they face.

METHODS

MICASA is a population-based study of settled immigrant Hispanic farm working families in Mendota, California. We selected a cross-sectional random sample of adolescents (ages 11 to 18). Interviews assessed work history, place of birth, and acculturation.

RESULTS

38% of participants were female and 62% were male; 55% were born in the U.S., 38% in Mexico, and 7% in El Salvador; and 49% worked for pay during the last year. Among those who worked, farm work was most frequently reported (73.5%). Among those who had done farm work, the mean age at initiation was 14 years, and they worked a mean of 4.3 weeks during the previous year. Hoeing, picking, and packing/sorting were the most common tasks. In models adjusted for age and sex, low-acculturated adolescents were more likely than moderately acculturated to have worked in the past 12 months, to start work younger than age 14 years, and to do farm work.

SIGNIFICANCE

Farm work is common among adolescents in this Hispanic agricultural community and is strongly associated with foreign birth and low acculturation.

An estimate of the U.S. government's undercount of nonfatal occupational injuries and illnesses in agriculture

BACKGROUND

Debate surrounds the accuracy of U.S. government's estimates of job-related injuries and illnesses in agriculture. Whereas studies have attempted to estimate the undercount for all industries combined, none have specifically addressed agriculture.

METHODS

Data were drawn from the U.S. government's premier sources for workplace injuries and illnesses and employment: the Bureau of Labor Statistics databanks for the Survey of Occupational Injuries and Illnesses (SOII), the Quarterly Census of Employment and Wages, and the Current Population Survey. Estimates were constructed using transparent assumptions; for example, that the rate (cases-per-employee) of injuries and illnesses on small farms was the same as on large farms (an assumption we altered in sensitivity analysis).

RESULTS

We estimated 74,932 injuries and illnesses for crop farms and 68,504 for animal farms, totaling 143,436 cases in 2011. We estimated that SOII missed 73.7% of crop farm cases and 81.9% of animal farm cases for an average of 77.6% for all agriculture. Sensitivity analyses suggested that the percent missed ranged from 61.5% to 88.3% for all agriculture.

CONCLUSIONS

We estimate considerable undercounting of nonfatal injuries and illnesses in agriculture and believe the undercounting is larger than any other industry. Reasons include: SOII's explicit exclusion of employees on small farms and of farmers and family members and Quarterly Census of Employment and Wages's undercounts of employment. Undercounting limits our ability to identify and address occupational health problems in agriculture, affecting both workers and society.

A registry-based cohort study of pulmonary tuberculosis treatment outcomes in Istanbul, Turkey

The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smear- and/or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0%) patients including death (1.8%), treatment default (6.1%), and treatment failure (1.1%). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95% confidence intervals [CI], 3.67-7.91), history of tuberculosis treatment (OR, 3.77; 95% CI, 3.26-4.36), age > 65 years (OR, 2.79; 95% CI, 2.21-3.53), and male gender (OR, 1.91; 95% CI, 1.59-2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95% CI, 27.0-75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95% CI, 8.94-15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95% CI, 6.97-41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95% CI, 8.02-14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.

Investigators' perspectives on translating human microbiome research into clinical practice

BACKGROUND

Human microbiome research has the potential to transform the practice of medicine, fundamentally shifting the ways in which we think not only about human health, illness and disease, but also about clinical practice and public health interventions. Drawing from a larger qualitative study on ethical, legal and social dimensions of human microbiome research, in this article, we document perspectives related to the translation of human microbiome research into clinical practice, focusing particularly on implications for health, illness and disease.

METHODS

We conducted 60 in-depth, semi-structured interviews (2009-2010) with 63 researchers and National Institutes of Health project leaders ('investigators') involved with human microbiome research. The interviews explored a range of ethical, legal and social implications of human microbiome research, including investigators' perspectives on potential strategies for translating findings to clinical practice. Using thematic content analysis, we identified and analyzed emergent themes and patterns.

RESULTS

We identified 3 themes: (1) investigators' general perspectives on the clinical utility of human microbiome research, (2) investigators' perspectives on antibiotic use, overuse and misuse, and (3) investigators' perspectives concerning future challenges of translating data to clinical practice.

CONCLUSION

The issues discussed by investigators concerning the clinical significance of human microbiome research, including embracing a new paradigm of health and disease, the importance of microbial communities, and clinical utility, will be of critical importance as this research moves forward.

Agricultural work and chronic musculoskeletal pain among Latino farm workers: the MICASA study

BACKGROUND

Agriculture poses varied dangers to hired farm workers in the U.S., but little information exists on occupational risks for chronic musculoskeletal pain. We examined common work positions, such as kneeling, carrying heavy loads, and repetitive motion that may increase the risk for chronic musculoskeletal pain.

METHODS

MICASA is a population-based study of occupational exposures and health in hired farm workers in California. This analysis includes 759 participants, 18-55 years old, engaged in farm work and residing in Mendota, CA. Chronic pain was defined as pain lasting 6 weeks or longer at specific body sites (back, knee, hip, etc.) over the entire farm work career.

RESULTS

Mean age was 37.9 years. Sixty-five percent participants were born in Mexico, 27.7% were born in El Salvador, and 4.2% were U.S-born. Chronic pain was associated with older age and female sex. After adjustment for age, years working in agriculture, and smoking, stooping/bending >30 hr/week among both men (OR = 2.49, 95% CI: 1.03-5.99) and women (OR = 2.15, 95% CI: 1.04-4.46) was associated with chronic hip pain. Driving tractors or other heavy farm equipment >60 hr/week was associated with increased odds of chronic hip pain (OR = 2.16, 95% CI: 1.02-4.54) among men. We also observed significant associations with kneeling or crawling >35 hr/week among women for both chronic back pain (OR = 2.96, 95% CI: 1.27-6.93) and knee pain (OR = 3.02, 95% CI: 1.07-8.50), respectively.

CONCLUSIONS

Chronic musculoskeletal pain is prevalent among farm workers and is associated with common work positions. Further research should focus on developing preventive interventions for tasks associated with increased pain risk. These interventions should be targeted to specific types of agricultural tasks.

Agricultural injury in California Hispanic farm workers: MICASA follow-up survey

The authors report here results from the first follow-up survey of the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) cohort of community-dwelling immigrant Hispanic farm workers in California's Central Valley. Among 560 participants the authors observed cumulative 1-year injury incidence of 6.6% (all injuries) and 4.3% (agricultural injuries). Increased prospective injury risk was associated with males, US birth, years lived in the United States, family income, and poor self-rated health. Agricultural injuries were associated most frequently with being struck by an object, falls, and cutting instruments, whereas over two thirds of nonagricultural injuries involved motor vehicles. Prevention should focus on safe handling of tools and materials, falls, and motor vehicle safety.

Cardiopulmonary fitness and respirator clearance: an update

This review addresses five key questions regarding respirator clearance: What is the efficacy of different methods of respirator clearance? Which diagnostic test is most predictive of cardiac event during respirator use? Is spirometry accurate in predicting respiratory distress/insufficiency during respirator use? Is exercise tolerance testing accurate in predicting cardiac injury during respirator use? Which periodicity of clearance evaluations is most protective against cardiac event during respirator use? The medical literature was searched using PubMed, the Cochrane Library, and Web of Science. Relevant articles were reviewed to assess current recommendations and practices in respirator clearance. Between the years 1970 and 2011, 144 articles were identified, and 21 were included in this review. Current recommendations for respirator clearance are based on consensus rather than outcome studies, and opinions differed between expert sources. Many authors observed the need for cost-effective respirator clearance, but none proposed evidence-based strategies. Prospective studies on respirator clearance that evaluate cardiac and pulmonary outcomes are necessary to establish an evidence base for improving the validity, efficiency, and consistency of respirator clearance testing.

Agricultural injury risk among rural California public high school students: prospective results

OBJECTIVES

To characterize prospective agricultural injury experience among rural California Central Valley public high school students enrolled in agricultural sciences curriculum.

METHODS

The University of California, Davis Youth Agricultural Injury Study (UCD-YAIS) examined prospective farm-work injury among students from 10 California Central Valley public high schools.

RESULTS

Of eligible subjects, 882 (62.5%) completed at least one annual follow-up survey. Of these, 489 reported farm work in the previous year, including 40 (8.2%) with at least one farm work-related injury. Fractures were the most common injury, especially among girls. Girls were more likely to suffer animal-related injury and boys injury from motor vehicles, machinery, or tool use. Prospective injury risk was strongly associated with prior-year farm injury (OR 8.53; 95% CI 4.02, 18.1) and farm work hours. After adjustment for farm work hours, grade level, and sex, risk was significantly associated with machinery operation, applying chemicals, number of hazardous tasks performed, riding motorcycles or mopeds, riding in back of an uncovered pick-up truck, and smoking. Risky attitude toward farm safety was associated prospectively with injury in stepwise fashion.

CONCLUSIONS

Adolescents are at risk for serious farm-work injuries. Although limitations on hazardous tasks and farm work hours are likely to be the most efficacious means for reducing injury, education will play an important role. Education should include inculcating safety-related attitudes and habits and focus on hazardous tasks, such as those involving animals (for girls) and motor vehicles and machinery (for boys), especially among youth with prior farm injury.

Willingness to provide behavioral health recommendations: a cross-sectional study of entering medical students

BACKGROUND

Behavioral factors contribute importantly to morbidity and mortality, and physicians are trusted sources for information on reducing associated risks. Unfortunately, many clinical encounters do not include prevention counseling, and medical school curriculum plays an important role in training and promoting such counseling among medical students.

METHODS

We surveyed all 93 freshman medical students at entry to the University of California, Davis School of Medicine in 2009 to evaluate baseline knowledge of population health principles and examine their approach to clinical situations involving four common behavioral risk factors illustrated in brief clinical vignettes: smoking, alcohol use in a patient with indications of alcoholism, diet and exercise in an overweight sedentary patient, and a 16-year-old contemplating initiation of sexual intercourse. Based on vignette responses, we assessed willingness to (1) provide information on risks, (2) recommend elimination of the behavior as the most efficacious means for reducing risk, (3) include strategies apart from elimination of the behavior for lowering risk (i.e., harm reduction), and (4) assure of their intention to continue care whether or not recommendations are accepted.

RESULTS

Students answered correctly 71.4 % (median; interquartile range 66.7 % - 85.7 %) of clinical prevention and population health knowledge questions; men scored higher than women (median 83.3 % vs. 66.7 %, p<0.02). Students showed high willingness to provide information and strategies for harm reduction apart from risk elimination, while respecting patient autonomy. Willingness to recommend elimination of high-risk behaviors "always or nearly always" was high for smoking (78.5 %), alcohol consumption in a patient with indications of alcoholism (64.5 %), and diet and exercise in a sedentary and overweight individual (87.1 %), and low for the 16-year-old considering initiating sexual intercourse (28.0 %; Friedman test, p<0.001). Willingness was not associated with the respondent's background knowledge of population health principles or gender.

CONCLUSION

Students showed high willingness to educate and respect patient autonomy. There was high willingness to recommend elimination of risk behaviors for smoking, alcohol, and poor diet/exercise, but not for sexual intercourse in an adolescent considering sexual debut. Further research should address promoting appropriate science-based preventive health messages, and curriculum should include explicit discussion of content of recommendations.

Ethnic and gender differences in farm tasks and safety practices among rural California farm youth

Agricultural work is hazardous and is common among rural youth, especially those living on farms or ranches. Previous work has shown differences in farm work and injury patterns between boys and girls, but little data exist addressing ethnic differences. This study examined ethnic and gender differences in farm tasks, safety attitudes, and use of protective measures among rural California youth working on farms or ranches. The University of California, Davis Youth Agricultural Injury Study is a longitudinal study focusing on agricultural work experience among youth enrolled in an agricultural sciences curriculum in 10 public high schools in California's Central Valley during the 2001-2005 school years. Using cross-sectional data from the initial entrance survey, we studied 946 participants who reported farm work in the previous year. Median annual hours of farm work varied significantly between boys and girls (p < 0.001) and between ethnic groups (p < 0.05) (Hispanic boys: 624 hr; Hispanic girls: 189 hr; White/Other boys: 832 hr; White/Other girls: 468 hr). Girls and Hispanic students were less likely than boys and White/Other students, respectively, to perform hazardous tasks involving tractors, machinery, and chemicals. Median age for initiating work on selected hazardous tasks was up to 3 years later for Hispanic students. Use of task-appropriate safety measures was low in all groups for most hazardous tasks. Boys were more likely than girls to use task-appropriate safety measures, with the exception of seatbelt use when in a car or truck. Hispanic students were more likely than White/Other students to employ safety measures. Girls and Hispanic youth worked fewer farm hours and had reduced exposure to selected hazardous tasks. Use of task-appropriate safety measures was low for all groups but increased for Hispanic students. Further study should explore reasons for low use of safety measures and develop educational efforts to bring about social norm changes promoting their use.

Agricultural injury among rural California public high school students

OBJECTIVES

The University of California, Davis Youth Agricultural Injury Study characterized the farm work and agricultural injury experience among rural California Central Valley public high school students enrolled in an agricultural sciences curriculum.

METHODS

We conducted a cross-sectional survey of agricultural injury among students from 10 California Central Valley high schools during the 2001-2005 school years.

RESULTS

Of 1,783 subjects, 946 (53.1%) reported farm work in the previous year, including 97 (10.3%) reporting at least one farm work-related injury in the preceding year. After adjustment for sex, ethnicity, and hours spent in farm work, injury risk was associated with large-animal operations (OR 4.15; 95%CI: 1.18, 14.65), feeding large animals (OR 2.38; 95%CI: 1.15, 4.96), mixing chemicals (OR 1.86; 95%CI: 1.15, 3.03), welding (OR 2.09; 95%CI: 1.17, 3.72), non-use of seatbelts, and frequent riding in the back of an uncovered pick-up truck. Risky attitudes toward farm safety were significantly associated with injury. Girls were more likely to suffer an animal-related injury and boys to suffer injury related to motor vehicles, machinery, or tool use.

CONCLUSIONS

Adolescents are at similar risk to adults for agricultural injury. Although limitations on hazardous tasks and time spent on farm work are likely to be the most efficacious means for reducing injury, education will play an important role. Educational measures should include inculcating healthy safety-related attitudes and focus on hazardous tasks, such as those involving animals (for girls) and motor vehicles and machinery (for boys).

The health of California's immigrant hired farmworkers

BACKGROUND

Hispanic immigrant workers dominate California's hired farm workforce. Little is known about their health status; even less is known about those lacking employment authorization.

METHODS

The California Agricultural Workers Health Survey (CAWHS) was a statewide cross-sectional household survey conducted in 1999. Six hundred fifty-four workers completed in-person interviews, comprehensive physical examinations, and personal risk behavior interviews.

RESULTS

The CAWHS PE Sample is comprised mostly of young Mexican men who lack health insurance and present elevated prevalence of indicators of chronic disease: overweight, obesity, high blood pressure, and high serum cholesterol. The self-reported, cumulative, farm work career incidence of paid claims for occupational injury under workers compensation was 27% for males and 11% for females.

CONCLUSIONS

The survey finds elevated prevalence of indicators of chronic disease but lack of health care access. Participants without employment authorization reported a greater prevalence of high-risk behaviors, such as binge drinking, and were less knowledgeable about workplace protections.

Effectiveness of a training program to increase the capacity of health care providers to provide HIV/AIDS care and treatment in Swaziland

Implementation of HIV care and treatment programs in sub-Saharan Africa is a complex undertaking that requires training of health care providers (HCPs). Many sub-Saharan African countries have introduced training programs to build human resources for health. Evaluation of the ongoing trainings is warranted so that programs can be improved. The purpose of this study was to evaluate Baylor International Pediatric AIDS Initiative's (BIPAI) HCP training program in Swaziland. The specific aims were: (1) to assess coverage and delivery of the training program; and (2) to determine the impact of the training program on HCPs' knowledge about HIV and pediatric practices, attitudes toward HIV/AIDS patients, and self-efficacy to provide antiretroviral therapy (ART). The evaluation was a multimethod design with two types of data collection and analysis: (1) one-group pretest-posttest survey with 101 HCPs; and (2) semi-structured in-depth interviews with seven trainers from Baylor College of Medicine and 16 local HCPs in Swaziland. Quantitative data were analyzed using Stata Statistical Software version 8.2 for descriptive and multivariate analysis while factor analysis was done using Statistical Program for Social Sciences version 14. The transcribed interviews were analyzed using a didactic approach. Process evaluation showed that the training had good coverage, was delivered as intended, and improved as the work progressed. The training program led to a significant increase (p=0.0000) in HCPs' knowledge about HIV/AIDS, ART, and relevant clinical pediatrics practices between pretest (mean 68.7% SD 13.7) and post training (mean 84.0% SD 12.0). The training program also increased trainees' self-efficacy to provide ART and their attitudes toward AIDS patients (p=0.0000 and 0.02, respectively). In conclusion, BIPAI training program in Swaziland had good coverage of all health care facilities and HCPs in Swaziland. The training was effective in imparting knowledge and skills to HCPs and in their attitudes toward HIV/AIDS patients.

Medical education for a healthier population: reflections on the Flexner Report from a public health perspective

Abraham Flexner's 1910 report is credited with promoting critical reforms in medical education. Because Flexner advocated scientific rigor and standardization in medical education, his report has been perceived to place little emphasis on the importance of public health in clinical education and training. However, a review of the report reveals that Flexner presciently identified at least three public-health-oriented principles that contributed to his arguments for medical education reform: (1) The training, quality, and quantity of physicians should meet the health needs of the public, (2) physicians have societal obligations to prevent disease and promote health, and medical training should include the breadth of knowledge necessary to meet these obligations, and (3) collaborations between the academic medicine and public health communities result in benefits to both parties. In this article, commemorating the Flexner Centenary, the authors review the progress of U.S. and Canadian medical schools in addressing these principles in the context of contemporary societal health needs, provide an update on recent efforts to address what has long been perceived as a deficit in medical education (inadequate grounding of medical students in public health), and provide new recommendations on how to create important linkages between medical education and public health. Contemporary health challenges that require a public health approach in addition to one-on-one clinical skills include containing epidemics of preventable chronic diseases, reforming the health care system to provide equitable high-quality care to populations, and responding to potential disasters in an increasingly interconnected world. The quantitative skills and contextual knowledge that will prepare physicians to address these and other population health problems constitute the basics of public health and should be included throughout the continuum of medical education.

Smoking prevalence and tobacco control measures in Kenya, Uganda, the Gambia and Liberia: a review

BACKGROUND

Smoking prevalence is increasing in developing countries. These resource-poor countries will have to battle tobacco-related diseases before they have eliminated common communicable diseases.

METHODS

We conducted a computerised search of PubMed to identify published estimates of smoking prevalence in Kenya, the Gambia, Uganda and Liberia. We also reviewed tobacco control measures in each country using information provided by the respective health departments.

RESULTS

We noted a high prevalence of smoking in Kenya, Uganda and the Gambia. There were no published data on tobacco use prevalence for Liberia. Tobacco control measures were inadequate.

CONCLUSION

Standardised prevalence studies involving general populations should be conducted. Tobacco control efforts need to be reinforced.

Health-seeking behaviour for sexually transmitted infections and HIV testing among female sex workers in Vietnam

This qualitative study was conducted to explore health-seeking behaviour for sexually transmitted infections (STIs) and HIV testing among female sex workers (FSWs) in the cities of Hanoi and Da Nang, Vietnam. Data were gathered from in-depth interviews, focus groups and participant observation. Results suggest that women's decision to seek STI treatment and HIV testing is influenced by the complex interplay of personal risk perceptions, social relationships and community discourse. The women exhibited adequate knowledge of HIV while their knowledge of STIs was limited. They demonstrated high-risk perceptions of HIV, but they showed little concern for STIs. Most women sought treatment at pharmacies when they noticed symptoms of the genital tract. Their decision to seek care in health facilities and HIV testing was hampered by the high costs of treatment, judgmental attitudes of service providers, and a lack of information on testing services. Future interventions need to focus on strengthening knowledge of STIs and the STI-HIV association, and increasing awareness of HIV counselling and testing services. Training for STI service providers including pharmacies and private practitioners on sex-worker friendly and non-judgmental services and counselling skills should be emphasized to provide timely diagnosis and treatment of STIs, and to refer women to HIV testing.

Public health education at the University of California, Davis: past, present, and future programs

This article reviews the history of public-health education at the University of California, Davis, from the inception of the Master of Preventive Veterinary Medicine Program in the School of Veterinary Medicine through the creation of the Master of Public Health Program offered jointly by the Schools of Medicine and Veterinary Medicine. The long history of collaborative teaching and research between the schools, as well as the university's close proximity to and relationship with numerous university-affiliated and state public-health agencies, has created remarkable opportunities for novel and creative public-health education. The university is already anticipating the approval of a School of Public Health on its campus, which will create even more educational opportunities in both human and veterinary public-health disciplines. Given the projected shortfall of veterinarians entering such fields, the opportunity of a novel Doctor of Public Health degree program specifically suited to the needs of veterinary medicine is also discussed as a means of addressing this shortage.

The prevalence of suicidal behaviours in a group of HIV-positive men

We studied a convenience sample of 54 HIV-positive men, recruited from HIV/AIDS community based service organizations. Data were collected on HIV risk factors and suicidal behaviours. Fifty-nine percent of the sample reported ever thinking about suicide, and 50% of those individuals reported attempting suicide at some point in their lives. Suicide ideation and attempts were more common among white participants. Suicidal behaviours were prevalent in this sample suggesting a need for mental health and suicide interventions targeted for this population.

Costs differences across demographic groups and types of occupational injuries and illnesses

BACKGROUND

Little is known about cost differences for demographic groups or across occupational injuries and illnesses.

METHODS

In this incidence study of nationwide data for 1993, an analysis was conducted on fatal and non-fatal injury and illness data recorded in government data sets. Costs data were from workers' compensation records, estimates of lost wages, and jury awards.

RESULTS

The youngest (age < or = 17) and oldest (age > or = 65) workers had exceptionally high fatality costs. Whereas men's costs for non-fatal incidents were nearly double those for women, men's costs for fatal injuries were 10 times the costs for women. The highest ranking occupation for combined fatal and non-fatal costs--farming, forestry, and fishing--had costs-per-worker (5,163 US dollars) over 18 times the lowest ranking occupation-executives and managers (279 US dollars). The occupation of handlers, cleaners, and laborers, ranked highest for non-fatal costs. Gunshot wounds generated especially high fatal costs. Compared to whites, African-Americans had a lower percentage of costs due to carpal tunnel syndrome, circulatory, and digestive diseases.

CONCLUSIONS

Costs comparisons can be drawn across age, race, gender, and occupational groups as well as categories of injuries and illnesses.

Heroin and HIV risk in Dar es Salaam, Tanzania: Youth hangouts, mageto and injecting practices

HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighbourhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the 'geto' (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin 'ghettoes' are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.

Agricultural dust exposure and respiratory symptoms among California farm operators

OBJECTIVE

To study whether dust exposure in California agriculture is a risk factor for respiratory symptoms.

METHODS

A population-based survey of 1947 California farmers collected respiratory symptoms, occupational and personal exposures. Associations between dust and respiratory symptoms were assessed by logistic regression models.

RESULTS

The prevalence of persistent wheeze was 8.6%, chronic bronchitis 3.8%, chronic cough 4.2%, and asthma 7.8%. Persistent wheeze was independently associated with dust in a dose-response fashion odds ratio, 1.2 (95% confidence interval[CI]=0.8-2.0) and 1.8 (95% CI=1.1-3.2) for low and high time in dust. A borderline significant association between chronic bronchitis and dust exposure was found. Asthma was associated with keeping livestock, but not with dust exposure.

CONCLUSIONS

Occupational dust exposure among California farmers, only one third of whom tended animals, was independently associated with chronic respiratory symptoms.

Differences in Workers??? Compensation Disability and Impairment Ratings Under Old and New California Law

BACKGROUND

California's workers' compensation law experienced an historic change on January 1, 2005. Previous methods used to rate permanent disability were replaced by new methods to rate permanent impairment. We sought to estimate the difference in ratings under the old and new law.

METHODS

We obtained 218 reports on injured workers from attorneys who represented injured workers. A disability expert rated disability and 15 physicians rated impairment.

RESULTS

Average percentage point ratings for impairment under the 2005 law were approximately one third the size of ratings for disability under the old law. This estimate showed little variation across demographic groups, physician-evaluators, or injured body part.

CONCLUSION

Because cash benefits are keyed to impairment ratings, benefits for permanently disabled workers may decrease as much as 60% under the new law.

The prevalence of partner violence in a group of HIV-infected men

There is a paucity of literature regarding partner violence among males that identifies the sex and relationship of their partner(s). We studied a convenience sample of 54 HIV-infected men, recruited from HIV/AIDS service organizations. Using a standard questionnaire, we collected data on HIV risk behaviours and self-reports of acts of partner violence and forced sex. Physical violence perpetrated by a primary or a casual partner was reported by 39% and 17% of the sample, respectively. Life-time forced sex by a primary or casual partner was reported by 32% and 15% of the sample, respectively. Forced sex was more commonly reported by participants who were non-white and reported a higher number of primary partners in the previous 12 months. We recommend that health care providers be aware of the high rates of intimate partner violence among men infected or at risk of infection with HIV.

Nonfatal Occupational Injury Among California Farm Operators

We conducted a population-based telephone survey addressing farm-work-related (FWR) injuries among California farm operators. Of 1947 participants (80.4% response), 135 farm operators reported 160 FWR injuries in the preceding year, yielding a one-year cumulative incidence for any FWR injury of 6.9% (95% CI 5.8%-8.2%), or a mean 8.2 FWR injuries per 100 farmers in the preceding year (95% CI 6.8-9.7). Multiple injury events in the same individual occurred more frequently than predicted by chance. Sprains and strains (29.4%) were the most frequently reported injury and predominantly involved the back. Overexertion represented the most frequent external cause (24.2%), followed by machinery (14.3%), falls (13.0%), and animals (12.4%). Factors associated with FWR injury included white ethnicity (OR 3.19; 95% CI 1.38-7.36), increased annual hours worked on the farm, low levels of administrative work, and increased percentage of time working with livestock. FWR injury experience of California farm operators is comparable with that reported for other agricultural populations. Above-expected frequency of multiple injuries supports involvement of personal or environmental risk factors. Preventive efforts should focus on higher-risk groups and preventing overexertion and muscle strain and injury related to machinery, falls, and animals, especially livestock.

Smoking and occupation from the European Community Respiratory Health Survey

BACKGROUND

Smoking is among the most important personal and modifiable risk factors for adverse health outcomes. The workplace offers a potentially effective venue for tobacco prevention programmes; identifying occupational groups with high smoking prevalence may assist in targeting such programmes.

AIMS

To examine smoking prevalence among occupational groups in the European Union.

METHODS

The European Community Respiratory Health Survey (ECRHS), a cross sectional health survey conducted in 1992-93, was used to examine smoking prevalence by occupation among 14 565 subjects from 30 centres in 14 participating countries.

RESULTS

There was an approximately twofold range in smoking prevalence by occupation. For occupational groups with at least 50 subjects, the highest smoking prevalence was seen in metal making and treating for men (54.3%) and cleaners for women (50.7%). Increased smoking prevalence by occupation persisted after adjustment for age, country, and age at completion of education. Smoking was also increased among occupations with high exposure to mineral dust and gas or fumes.

CONCLUSIONS

Smoking rates vary significantly by occupation. Prevention efforts in the workplace should focus on occupations with high smoking prevalence and large employment bases.

Agricultural injury in California migrant Hispanic farm workers

BACKGROUND

Agriculture is among the most hazardous industries in the United States.

METHODS

A longitudinal study of injury among migrant Hispanic farm workers residing in six Northern California Migrant Family Housing Centers (MHCs) during the 1997 harvest season was conducted. Participants completed an initial interviewer-administered work-and-health questionnaire at the beginning of the harvest season addressing the preceding year; there were three periodic follow-up surveys.

RESULTS

There were 1,201 adult farm workers (participation 85.2%) who completed the initial questionnaire. Of these, 837 (69.7%) completed the final follow-up survey. There were 86 agricultural injuries (incidence 9.3/100 full-time equivalent employees (FTEs), 95% CI 7.5-11.5/100 FTE). Increased risk for agricultural injury occurred among women paid piece-rate (RR 4.9, 95% CI 1.8-12.8). Sprains and strains were most common (31%), followed by lacerations (12%).

CONCLUSIONS

Agricultural injury experience in this cohort is comparable to that of agricultural workers in other U.S. settings. Increased risk among women paid piece-rate suggests further study and potential policy changes regarding payment regimens. Heterogeneity of injury in this population presents a major prevention challenge. In view of high frequency of strain and sprain injuries, ergonomic interventions deserve further study.

Preventive medicine teaching cases in the preclinical undergraduate medical curriculum

The implementation of the Case-Based Series in Population-Oriented Prevention (C-POP) at the University of California at Davis Medical School is described. The implementation and planning for the integration of a case-based curriculum into a previously didactic-focused preventive medicine course are discussed. Issues include flexibility of the curriculum, student acceptance of case-based learning, and effect of preceptor availability and training on the successful implementation of the C-POP curriculum.

Costs of occupational injuries in agriculture

OBJECTIVE

This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992.

METHODS

The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance.

RESULTS

Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion.

CONCLUSIONS

The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.

Injury risks in children of California migrant Hispanic farm worker families

BACKGROUND

Few data are available addressing occupational and other injury risks among children of migrant Hispanic farm workers.

METHODS

We conducted the U.C. Davis Farm Worker Injury Study (UCD-FWIS), a longitudinal follow-up study of injury among migrant Hispanic farm worker families living in six Northern California Migrant Housing Centers (MHCs). Nine hundred forty-one children (age < 18 years) were interviewed through parental proxy.

RESULTS

Fifty-one injuries resulting in medical care or at least one-half day of lost or restricted work or school time occurred among 49 children (3.8 injuries/100 person-years). Open wounds (31.4%) and fractures (29.4%) were most common. Falls comprised over one-third of the cases, followed by being struck and bicycle injuries. Over three-quarters of subjects never use a helmet when riding a bicycle. Seventy-eight (8.3%) children reported employment in the preceding year, typically involving manual agricultural tasks. Two injury cases were occupational and involved agricultural work.

CONCLUSIONS

Occupational injury was uncommon in this group of children in migrant Hispanic farm worker families. Injury prevention in this population should include a focus on the home and surrounding environment as well as the work place.

Medical surveillance of clandestine drug laboratory investigators

Law enforcement officers investigating clandestine drug laboratories may be exposed to a wide range of hazardous chemicals. This study was conducted to determine the extent of persistent health effects seen in California drug laboratory investigators after occupational exposure. Study participants with a minimum of 1 year of laboratory investigations completed a questionnaire evaluating occupational and personal health history and consented to review of their medical surveillance examinations and administrative records. The 40 participating investigators averaged 6.1 +/- 2.5 annual medical evaluations for the period 1991 to 1998. Average annual decline in forced expiratory volume in 1 second (FEV1) was 64.0 +/- 138.0 mL/year (median, 40.0 mL/year). For 34 subjects with valid exposure data, longer duration use of respiratory protection was associated with a less rapid decline in FEV1, whereas lack of respiratory protection during the processing phase of laboratory investigation was associated with a more rapid annual decline. There were no significant longitudinal changes in serum alanine aminotransferase, serum aspartate aminotransferase, hemoglobin, and white blood cell count, although platelets declined slightly. Law enforcement personnel investigating clandestine drug laboratories may have long-term respiratory effects from chemical exposure, for which more assiduous use of respiratory protection is recommended.

Costs of occupational injuries in agriculture

OBJECTIVE

This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992.

METHODS

The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance.

RESULTS

Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion.

CONCLUSIONS

The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.

Agricultural injury

BACKGROUND

Agriculture is one of the most hazardous industries in the US.

METHODS

We reviewed MEDLINE and NIOSHTIC to identify English-language studies addressing occupational injury among agricultural populations, focusing on North America. Additional references were identified from the reference lists of identified studies and from contacts with experts in the field.

RESULTS

U.S. data indicate up to approximately 780 deaths and 140,000 cases of nonfatal disabling injuries in 1998. Risk of agricultural injuries is approximately 5-10/100 persons per year, but is higher in certain risk groups, such as males and cattle workers. Falls, machinery, and animals are among the most common causes. Unique features of the agricultural workplace and exposed population combine to increase risk and hinder accurate measurement. These features include a wide range of activities, hazards, and dispersed work places in agriculture; a seasonal hired work force that often has brief tenure, poor English skills, and a distrust of officialdom; and a history of exemption regarding occupational health and safety regulations.

CONCLUSIONS

Research in agricultural injury should include epidemiologic study of risk factors and evaluation of interventions. Although only limited data are available documenting efficacy of specific preventive approaches, prevention should focus on engineering controls, regulatory approaches, and education.

Health and safety risks in production agriculture

Production agriculture is associated with a variety of occupational illnesses and injuries. Agricultural workers are at higher risk of death or disabling injury than most other workers. Traumatic injury commonly occurs from working with machinery or animals. Respiratory illness and health problems from exposures to farm chemicals are major concerns, and dermatoses, hearing loss, certain cancers, and zoonotic infections are important problems. Innovative means of encouraging safe work practices are being developed. Efforts are being made to reach all groups of farmworkers, including migrant and seasonal workers, farm youth, and older farmers.

Occupational history collection by third-year medical students during internal medicine and surgery inpatient clerkships

Occupational history is fundamental for the evaluation of possible workplace influences on health. We reviewed 2,922 initial history-and-physical reports from 137 third-year medical students to examine occupational history collection. Overall reporting frequencies were recorded as the following: industry, 55.8%; occupation, 70.0%; specific occupational exposure, 8.4%; smoking status, 91.4%. Patients younger than 40 years of age and women were significantly less likely than other older patients and men to have notations of occupation and industry. Surgery students were less likely than internal medicine students to collect data for industry (41.6% vs 66.6%, P < 0.001), occupation (57.4% vs 79.7%, P < 0.001), and smoking (88.1% vs 94.0%, P < 0.001). The highest frequencies of notation were those for circulatory and respiratory conditions. No significant differences were noted for student gender, academic quarter, or week of clerkship. Clinical occupational medicine teaching should emphasize the need to collect occupational information from all patients, including women and young persons.