Journal of Agromedicine

This article presents proceedings of the first national conference to assemble professionals to address the issue of arthritis in agriculture. The "Arthritis, Agriculture, and Rural Life: State of the Art Research, Practices, and Applications" conference, May 11-13, 2011, at the Purdue University Beck Agricultural Center in West Lafayette, Indiana, focused on increasing awareness and education in the prevention, effects, care, and treatment of arthritis specific to farmers. Presentations included a contextualizing keynote and sessions addressing the prevention and treatment of arthritis in agriculture, including topics such as traditional arthritis therapies, alternative treatments, assistive technology, and ergonomic techniques and modifications. Participants discussed particular issues on a field trip to several Purdue University research farms addressing ergonomics. The conference concluded with a farmer panel, where attendees heard personal stories from farmers suffering from the effects of arthritis.

Unguarded agricultural power take-off (PTO) drivelines and related components, including secondary drivelines powered by the PTO, have been historically recognized as serious farm-related hazards that can cause severe, permanently disabling injuries and death when entanglement occurs. The lack of longitudinal and causative data on these incidents has been a barrier for developing relevant and effective intervention strategies. A study was conducted at Purdue University to design, develop, and test a system to document, code, store, and analyze a large amount of agriculture driveline-related injury and fatality data to allow for identification of causative factors and trends that could be used in developing engineering, educational, and regulatory solutions. This was accomplished by first developing a standardized injury reporting form and coding system and then developing an electronic database, using Microsoft(R) Access 2002,(R) which could be used to document, store, query, and analyze agricultural driveline-related incident data. Incidents resulting in injury or fatality identified between 1970 and 2003 were documented and the available data coded and entered into the database using a systematic approach. A pilot-test of the usability of the database was conducted on data collected from 92 incidents involving children and adolescents. Using the validated data management system, an analysis was conducted on data collected from 674 cases entered into the database. Findings from the analysis of the data included the following: the frequency of documented agricultural driveline-related incidents increased from the 1970s to the 1980s, but then decreased through the 1990s and into the 2000s; the 11 to 15-year-old age group had the highest frequency of cases; incidents occurred more often in the fall season; and augers, elevators, or conveyors were the type of implements most frequently involved. Recommendations were made to reduce the risk of agriculture driveline injuries and for future research.

To further investigate mortality among farm workers, a proportionate mortality ratio (PMR) analysis was conducted among the membership of the United Farm Workers of America (UFW), a farm worker labor union, for the years 1973-2000 in the state of California. This report compares proportionate mortality for 118 causes of death in the UFW and the general United States population, adjusting for age, sex, race and calendar year of death. In addition, an exploratory analysis was conducted comparing deaths in the UFW to deaths in the California Hispanic population. A roster of members of the UFW was compared to the death certificate master files of the state of California for the years 1973 to 2000. Matches were detected using automated techniques and visual review. PMR and associated confidence intervals were calculated using the National Institute for Occupational Safety and Health Life Table Analysis System using deaths in the U.S. as the standard. A similar analysis was conducted limiting attention to the time period 1988-2000 and using deaths in the California Hispanic population as the standard. There were a total of 139,662 members of the union included in the linkage that yielded 3,977 deaths in the time period 1973-2000. Proportionate mortality in the farm workers was significantly elevated for respiratory tuberculosis, malignant neoplasms of the stomach, biliary passages, liver and gallbladder, and uterine cervix, diabetes mellitus, cerebrovascular disease, cirrhosis of the liver, and "other diseases of the digestive system." Transportation injuries including motor vehicles deaths, deaths from machine injuries, unintentional poisonings and assault and homicide were significantly elevated as well. Farm workers were at significantly lower risk of death from HIV-related disease, malignant neoplasms of the esophagus, intestine, pancreas, lung, urinary bladder, melanoma, and brain, all cancer deaths, "other diseases of the nervous system," ischemic heart disease, conductive disorder, "other diseases of the heart," emphysema, "other respiratory diseases," and symptoms and ill-defined conditions. These results were similar when using California Hispanic deaths as the standard for the years 1988-2000. There was still excess proportionate mortality from tuberculosis, cerebrovascular disease and unintentional injuries among the UFW members and lowered mortality from HIV related deaths, all cancer deaths combined and diseases of the heart. These results include some unique findings in regard to both excess and deficits of mortality that may be explained by the Hispanic ethnicity and recent immigration of the cohort.

Data were compiled and analyzed on the estimated frequency and characteristics of deaths related to on-farm manure storage and handling facilities for the period of 1975 through 2004. Sources included published government reports, national and local media, on-line searches, published farm fatality reports, and prior litigation. No prior research was identified that addressed the magnitude of the problem, nor documented evidence-based intervention strategies. Data from 77 fatalities along with 21 severe injuries and 14 international fatality cases were identified, documented and coded for analysis. Analysis of the 77 fatalities showed that victim characteristics and causative factors did not reflect previously reported patterns; i.e., over half of the fatalities involved dairy operations and 21% involved persons under the age of 16. The largest percentage (34%) of deaths occurred to persons conducting repair or maintenance activities on manure handling equipment, while the second largest group (22%) were attempting to perform a rescue of another person. The most frequently identified cause of death was asphyxiation with elevated levels of sulfide levels in the blood noted in some cases. The peak period of incidents were during the hottest part of the summer and often associated with transferring of manure for application to crop ground. Recommendations included the need to revise ASABE EP470 Manure Storage Safety Practice to include engineering controls that would reduce the need for farmers and farm workers to enter spaces containing toxic manure-related gases. In addition, the need to educate owner/operators and employees concerning the hazards associated with agricultural manure storage structures and equipment, especially those classified as permit-required confined spaces, should be considered, including the need for appropriate warnings and entry procedures. Incorporation of current OSHA confined space entry procedures into these facilities is also recommended.

Since 1978 Purdue University has maintained a national database of agriculture-related engulfment cases that have occurred in loose agricultural material in both commercial and on-farm facilities. The database presently contains 502 documented cases of fatal and non-fatal engulfments from the U.S. and Canada. A review of the more recent on-farm fatal and non-fatal engulfment cases, those occurring in 1980 through 2001, was conducted in order to characterize engulfments and identify contributing factors that would be relevant to future intervention strategy development including the implementation of design standards for on-farm structures. From 1980 through 2001, 197 cases were identified that occurred in on-farm grain bins, 156 of which were fatal and 41 were non-fatal. A rate of approximately seven fatal and two non-fatal cases per year were identified from 1980 through 2001. The magnitude of the engulfment problem is continuing, based on six and seven fatal cases reported in the years 2000 and 2001, respectively. Sixteen percent of fatal and six percent of non-fatal victims were children and adolescents under the age of 16. Fifty percent of the survivors were 60 years of age or older. Engulfments were generally reported more often in the top corn-producing states and involved corn in 76% of the fatal cases when product was known. Seventy-seven percent of the fatal victims were unloading the bin at the time of engulfment in cases where activity at the time of engulfment was known. Forty-one percent of the fatality cases involved corn that was out-of-condition where the condition of the grain was known. In survival cases where information about the presence of co-workers at the time of engulfment was known, it was found that a co-worker was present at the time of engulfment in 86% of the cases. In four cases, a survivor was rescued from a bin after being completely engulfed in grain. In all four cases, a co-worker was present at the time of engulfment and out-of-condition grain was involved. Findings are being used to design new injury prevention strategies, including educational materials and recommendations for engineering controls that focus on primary causative factors.

Farming has an enormous impact on the economy of Georgia, with as many as one in six Georgians working in agriculture. The purpose of this study was to compare the risk of death of white and black farmers to non-farmers in Georgia. Mortality data stratified by age and aggregated by race were retrieved from the Georgia Office of Vital Statistics for the years 1985-1994. The classification system used to code occupation on the death certificate was W473-489, which includes farmers and most all other agricultural occupations. For each cause of death, the Breslow-Day Test was used to determine homogeneity of risk across all age strata (alpha=0.05). A common odds ratio (OR) and 95% confidence intervals were calculated for all homogeneous causes of death using the Mantel-Haenzel procedure. Among white farmers, the risk of death was significantly high for tuberculosis [OR=1.64 (1.01, 2.65)], fires [OR=1.60 (1.15, 2.22)], and accidental drowning [OR=1.52 (1.01, 2.28)]. The leading causes of death among black farmers were accidental drowning [OR=1.53 (1.03, 2.26)], cerebrovascular disease [OR=1.27 (1.18, 1.38)], and ischemic heart disease [OR=1.21 (1.14, 1.29)]. Causes of death reported to be significantly low were also investigated. The findings of this study are varied, but trends related to risk of death appear to be similar to observed national trends.

A number of occupational studies have reported high rates of suicide among selected occupations, including farmers. Limited work has focused on occupational exposures that may increase the risk of suicide. The purpose of this study is to describe suicide among individuals potentially exposed to pesticides through their occupation. Data from Colorado death certificate files for the period 1990-1999 were obtained. Eligible records were those individuals who were Colorado residents at the time of death who had an occupation listed on their death certificates. Cases had suicide listed as the primary cause of death on the death certificates. The comparison group included Colorado residents who died from any cause during the same period other than cancer, mental disorders and injuries. A total of 4,991 suicide deaths were included and a total of 107,692 other deaths served as the comparison group. Occupations considered pesticide exposed included: veterinarians; pest control occupations; farmers and farm workers; farm managers and supervisors; marine life cultivators; nursery workers; groundskeepers and gardeners; animal caretakers; graders, sorters and inspectors of agricultural products; and forestry workers, supervisors and loggers. All other occupational categories were coded as unexposed. Logistic regression was used to compare the groups, separately for males and females. After controlling for age, race, Hispanic ethnicity, years of education, and marital status, males who were in pesticide exposed occupations had higher odds of suicide (odds ratio 1.14; 95% confidence interval 0.97, 1.34) and females in pesticide exposed occupations also had higher odds of suicide (odds ratio 1.98; 95% confidence interval 1.01, 3.88).

A pipeline model has been suggested to increase the rural physician supply. This study is an institutional case report used to describe the context, development, and in-house evaluation of the University of Alabama Rural Health Leaders Pipeline, 1990-2005. This program was developed at a University of Alabama School of Medicine branch campus to target rural students at multiple levels, elementary schools through residency, and includes a minority focus. Requirements to enter the medical program include living 8 years in rural Alabama, meeting admission requirements, and affinity for rural lifestyles. Twenty-six percent of 316 high school participants, all 40 students in the minority-focused college program, and 3% of 90 medical program students were African American. The program includes (1) puppet shows in elementary schools depicting different health professions, (2) Rural Health Scholars Program for 11th-grade students, (3) Minority Rural Health Pipeline Program for college students, (4) Rural Medical Scholars Program, a 5-year track of study in rural community health and medicine, and (5) assured admission to family medicine residency. Outcomes studied in this case report included medical school performance, graduation rate, selection of family medicine specialty, and rural practice location. Medical scholars were anticipated to experience academic difficulty, select family medicine specialty, and locate in rural practice more often than peers. Compared to peers, medical scholars showed lower scores on preclinical courses and USMLE steps 1 and 2, reflective of their lower MCAT and GPA scores, but had (1) similar graduation rates (95% vs peers 84%), (2) higher family medicine selection rate (47% vs Huntsville 27% vs Tuscaloosa 12% vs Birmingham 4% [OR compared to Birmingham 22.7, 95% CI 10.5-49.4]), and (3) higher rural practice rate (67% vs peers 14% vs national group 9%) in the first RMSP classes. Based on these important outcomes being better than or equal to the traditional student cohorts, the institution concluded that the Rural Health Leaders Pipeline demonstrates successful use of the rural pipeline model.

The Agricultural Health Study (AHS) is a large, prospective cohort study in the states of Iowa and North Carolina that has been developed to better understand how pesticides and other agricultural exposures relate to the occurrence of cancer and other diseases. This report compares the characteristics of AHS farmers to the Census of Agriculture to evaluate the generalizability of AHS findings. We restricted the AHS to private pesticide applicators who enrolled in Iowa (n = 31,065) and in North Carolina (n = 17,239) between 1993 and 1997, and who identified themselves as living or working on a farm. We compared their self-reported data with data from the 1992 and 1997 Censuses of Agriculture. AHS farmers in Iowa are younger; live or work on larger farms; more frequently apply herbicides, insecticides, and fungicides; and are more likely to raise beef cattle and swine, and grow corn, soybeans, hay, and oats. AHS farmers in North Carolina are also younger, live or work on larger farms, more frequently reported growing crops commonly seen in the state, and are more frequent pesticide users. However, animals raised are similar to those in the North Carolina Census of Agriculture. AHS farmers likely represent the higher end of pesticide usage in both states in part because AHS farmers have larger farms. Since the health effects of pesticides are best ascertained among pesticide users with the greatest exposure, the AHS cohort should prove to be a valuable resource for health effects research.

Youth working on farms face unique risks that are not present for many other young workers, including machinery, large animals, electrical hazards, chemical hazards and excessive noise. This research identified the number and rate of occupational fatalities for youth working in the agriculture production industry, which is most closely affiliated with farming, for the years 1992-2002. The Census of Fatal Occupational Injuries (CFOI), developed by the Bureau of Labor Statistics (BLS), was the database used for the analysis. There were 310 work-related deaths to youth less than 20 years of age from 1992 through 2002 in the agriculture production sector. This compares to 1,958 total fatalities for all workers less than 20 years of age for the same time period. The number of agricultural production fatalities to youth has shown a general downward trend over this time period. The rates were higher for young workers in agriculture production than for young workers in all industries by a factor of 3.6. Fifteen year olds had the highest fatality rates with the crop production sector having a rate six times that of all 15 year old workers. The objective of this descriptive research was to identify, prioritize and publicize the risks to children and youth who work on farms in order to provide public health and safety professionals relevant information upon which to base decisions for interventions or other prevention activities for this priority population. This research also has direct applications for farm parents and safety and health professionals who work with the priority population of young agricultural workers.

This study compares the hearing status and behaviors of Australian farmers from 1994-2001 with those from 2002-2008. Over this period the authors found (1) there was a 12.5% overall improvement in the proportion of farmers with normal hearing in left ears, with the likelihood of a screening participant having normal hearing improving by almost 9% each year; (2) significant improvements in the mean hearing threshold of both ears from 1 to 6 kHz; (3) significantly higher mean hearing thresholds for 35- to 44-year-old farmers exposed to firearms, chainsaws, workshop tools, heavy machinery, and tractors with cabins compared to nonexposed groups; (4) nonuse of hearing protection devices by young farmers (15 to 24 years old), was associated with hearing loss for those using uncabined tractors. Despite a reduction in noise injury, further adoption of noise reduction strategies for specific agricultural work practices is required.

To obtain sustained injury surveillance data for youth on farms, the National Institute for Occupational Safety and Health developed the Childhood Agricultural Injury Survey (CAIS) in collaboration with the U.S. Department of Agriculture. The first CAIS collected data for youth less than 20 years in 1998 through a regionally stratified telephone survey of 50,000 U.S. farm households; a second CAIS for 2001 was conducted using the same methodology. In 2001, there were approximately 1.2 million youth living on U.S. farms. These youth suffered an estimated 19,397 injuries (15.7/1,000 household youth). Approximately 60% (11,571) of the household youth injuries were to males. For all household youth, 10-15 year olds experienced the most injuries (49%, 9,486). In addition to providing estimates of demographics, injuries, and injury rates for household youth from the 2001 CAIS, this article provides a comparison to results from the 1998 CAIS. The number of household youth injuries on farms from 1998 to 2001 decreased by almost 30% (27,321 vs. 19,397). The results of this study show an overall decrease in the injury rate for youth living on the farm from 1998 to 2001 (18.8/1,000 household youth vs. 15.7/1,000 household youth). However, there was a considerable increase in the number of injuries to household females less than 20 years of age during this same time period. There was also an increase in the number of all terrain vehicle (ATV) and horse-related injuries. Continued surveillance is needed to assess if these are significant trends or the result of changing farm demographics.

This report describes a 20 class-hour, 10-session seminar on agromedicine-oriented topics, delivered as part of a basic science course for medical students (biochemistry) at the Medical University of South Carolina. The course was initiated in 1998 and continued through 2004. The preceptors are family medicine and agricultural research professors. Concepts from primary care, epidemiology, entomology, toxicology, and food science appeal strongly to the first-year medical student group (limited to 10 students). The agromedicine/environmental medicine seminar series is one of 16 research seminars available for in-depth study. As part of the course in biochemistry, this seminar has earned positive evaluations from medical students who expect to widen their perspective on global health and the environment. Seminar topics include food safety, farm trauma, nutraceuticals, crop protection, insect-borne disease, occupational health and safety, diet and cancer, birth defects, and bioengineering. Seventy medical students have participated in the interdisciplinary seminar. They perceive environmental science as affecting the health of their patients and as an essential part of their preparation for curative and preventive medicine. Readers may find medical school curriculum committees more receptive to accepting and continuing an agromedicine offering if it can be incorporated in a basic science course such as biochemistry or pharmacology.

In 2000, there were an estimated 7,381 youth living on 9,556 U.S. farms operated by Native Americans. Most of these youth (5,454, 74%) lived on livestock operations (6,833 farms, 72%). In that year, youth living on Native American operated farms sustained an estimated 177 nonfatal injuries. The majority of all injuries to household youth (147, 83%) occurred on livestock operations. Males accounted for 112 (63%) of the injuries to household youth. Overall, household youth on Native American operated farms had an injury rate of 24.0 injuries per 1,000 household youth compared to a rate of 8.1 injuries per 1,000 household youth on all other minority-operated farms. The rate ratio for work-related injuries to household youth on Native American farms compared to other minority-operated farms was 2.1. Although female youth on these farms experienced a similar non-work injury rate of 13.8 injuries per 1,000 female household youth compared to a rate of 15.1 injuries per 1,000 male household youth, the work-related injury rate for male youth (30.2 per 1,000 male household youth) was substantially higher than the work-related injury rate for female household youth (18.3 per 1,000 female household youth). These data indicate an elevated risk of injury for youth living on farms operated by Native Americans. This result is attributed to the large percentage of livestock operations for this population and the hazards associated with this type of farming. However, further research is needed to more fully understand these results and to guide culturally appropriate interventions within this population.

The occupational fatality rate among commercial fishermen decreased in the United States during 1992-2008; however, commercial fishing continues to be one of the most dangerous occupations in the United States, with an average annual fatality rate of 129 deaths per 100,000 fishermen in 2008. By contrast, the average annual occupational fatality rate among all US workers during the same period was four deaths per 100,000 workers. During the 1990s, numerous safety interventions were developed for Alaska fisheries that resulted in a significant decline in the state's commercial fishing fatality rate. In 2007, the National Institute for Occupational Safety and Health (NIOSH) expanded surveillance of commercial fishing fatalities to the rest of the United States. The purpose of this report is to identify the hazards and risk factors for all causes of occupational mortality in the US commercial fishing industry, and to explore how those hazards and risk factors differ among fisheries and locations. During 2000-2009, 504 commercial fishing fatalities occurred in the United States. Most (261, 52%) occurred following a vessel disaster (defined as a sinking, capsizing, or other event in which the crew was forced to abandon ship) or a fall overboard (155, 31%). Fatalities occurred in Alaska (133, 26%), Northeast (124, 25%), Gulf of Mexico (116, 23%), West Coast (83, 16%), and the Mid- and South Atlantic (41, 8%) regions. Fatalities occurred most commonly while fishing for shellfish (226, 47%), groundfish (144, 30%) and pelagic fish (97, 20%). Average annual fatality rates were calculated for selected fisheries. The Northeast multispecies groundfish fleet had the highest average annual fatality rate (600 deaths per 100,000 full-time equivalent [FTE] fishermen) followed by the Atlantic scallop fleet (425 deaths per 100,000 FTE fishermen) and the West Coast Dungeness crab fleet (310 deaths per 100,000 FTE fishermen). To reduce fatalities among fishermen at greatest risk, additional prevention measures tailored to specific high-risk fisheries should be considered.

Agriculture is one of the most hazardous industries in the United States. It is crucial to analyze the previously collected farm fatality data in Pennsylvania involving youth to identify fatality sources and to delineate prevention strategies to mitigate future occurrences. The Penn State Farm and Agricultural Injury Database was updated to include the Occupational Injury and Illness Classification System (OIICS) for source and event or exposure. Occupational and nonoccupational incidents were compared based on age groups, religious sect, source of injury, and the injury event or exposure. A total of 82 fatalities to youth under 20 years were identified. Youth under 5 years old had the highest fatality rate of 87.1 fatalities per 100,000 farm household youth per year. The percentages of occupational and nonoccupational fatalities were 30.5% and 62.2%, respectively. Three primary sources accounted for 76% of the 82 farm fatalities: vehicles, machinery, and structures and surfaces. The majority of fatally injured youth (78%) were Anabaptist. The Anabaptist youth were 7 times more likely to be involved in occupational incidents than the non-Anabaptist youth. Youth <10 years of age who were not alone at the time of the fatal incident accounted for about half of the deaths, indicating the peril of adults attempting to supervise youth in the workplace. This fatal injury analysis to youth has identified common fatality injury patterns and risk factors to youth. The data can be used to identify intervention strategies for youth and underserved populations (Anabaptists) and can be used to help motivate adults and parents to adopt safety practices to prevent future injury occurrences. This paper also helps to illustrate the value of state-based monitoring of farm injury to youth using methods available to many states and territories.

The objective of this study was to estimate prevalence of asthma and asthma attacks among youth (0-19 years old) working and/or living on Hispanic-operated farms. The 2000 U.S. Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS) data were used to calculate prevalence of asthma, asthma attacks and serious asthma attacks among youth (0 to 19 years) living on Hispanic-operated farms. Age-specific asthma prevalence rates with corresponding 95% confidence intervals (CIs) were calculated for working and nonworking youth. In 2000, an estimated 17,573 youth lived on Hispanic-operated farms; 7.4% had asthma ever diagnosed, 8.1% had an asthma attack while at work in the last year, and 1.4% had a serious asthma attack. Asthma prevalence was highest among youth aged 16-19 (9.1%), males (8.6%), and those driving tractors (9.7%). Serious asthma attacks that required an emergency room visit or hospitalization in the last year were most prevalent among youth aged 0-9 years (1.8%), males (1.7%), and those riding horses (1.7%). Compared with nonworking youth, prevalence of asthma (8.9% versus 6.1%; p < .05) and serious asthma attacks (1.6% versus 1.3%; p > .05) was higher among working youth. Prevalence of asthma attacks in the last year while at work was also significantly higher among males than females (8.6% versus 6.0%; p < .05) and among youth living on livestock farms than among youth on crop farms (9.4% versus 7.4%; p < .05). These findings contribute to the limited information on asthma among youth working on Hispanic-operated farms, and indicate the need for asthma prevention programs on farms and intervention studies targeting farming youth populations.

The objective of this study was to estimate the annual incidence and cost of nonfatal farm youth injury in the United States for the period 2001-2006. The authors used 2001-2006 Childhood Agricultural Injury Survey data to estimate the annual incidence of farm youth nonfatal injury. To estimate the costs for injuries suffered by youth working/living on the farm, the number of injuries was multiplied by published unit costs by body part, nature of injury, and age group. The annual number of nonfatal injuries to youth (ages 0-19) on farms in 2001-2006 was 26,570. The annual cost of nonfatal farm youth injuries was $1 billion (in 2005 dollars), with 26% of costs related to working on the farm and 47% on beef cattle farms. Around 9.3% of the cost was medical costs, 37.2% work and household productivity loss, and 53.5% quality of life loss.

The field of agromedicine faces numerous policy and organizational development challenges as it enters the 21st Century. To gauge these, the authors surveyed attendees of the 14th Annual Meeting of the North American Agromedicine Consortium (NAAC) in Charleston, South Carolina, in November 2001. Survey questions dealt with agromedicine policy issues, organizational/programmatic issues, the agromedicine core areas, the usefulness of state reports at the meeting, and important policy, organizational and programmatic issues that were missing from, or insufficiently covered at the meeting. While respondents clearly saw serious obstacles facing agromedicine as it continues to develop, they also felt that the NAAC and the profession served important roles in furthering education, research and client service.

To evaluate the health effects of methyl isothiocyanate (MITC) and other byproducts resulting from the soil-incorporated (shank) application of 25,000 pounds of metam-sodium on July 8, 2002, near the community of Arvin, California. Residents in a four-block area were interviewed regarding eye and upper respiratory irritation, non-specific systemic symptoms, and lower respiratory complaints. The distribution of cases was compared to results of Industrial Source Complex (ISC3) air dispersion modeling for the metam-sodium byproduct, methyl isothiocyanate (MITC). The 1-hour 200 ppb no-observed-effect- level (NOEL) and 800 ppb lowest-observed-effect level (LOEL) from a previous human eye irritation study were used to interpret the results of the air modeling estimates. Peak concentrations were compared to the 4-minute NOEL of 600 ppb and the LOEL of 1.9 ppm. Two-hundred-fifty-two cases of irritant, non-specific systemic, and respiratory symptoms were associated with the metam-sodium application. These included 178 community residents or visitors and 74 employees of a carrot packing operation located in the affected neighborhood of Arvin. The most severe reported illness occurred in a community visitor with a history of pre-existing pulmonary disease, who was hospitalized for a week with respiratory distress. ISC3 Modeling indicated 1-hour MITC concentrations in the affected community ranged from 0.8-1.0 ppm, in the range of the LOEL, with peak concentrations between 2.4 and 3.2 ppm. Estimated MITC concentrations during the episode exceeded both the 4-minute NOEL and 1-hourNOELby approximately four fold. The high concentrations of MITC present in the affected neighborhood may have been partially attributable to failure to immediately complete a required post-application water-treatment on 15 of the 100 treated acres. However, because of the limited area involved, the violation was unlikely to have accounted for the entire incident. Similar episodes may occur when metam-sodium fumigants are used adjacent to other rural communities.

The average age of United States farmers has been increasing for 20 years. The objective is to examine the factors associated with hours worked among farmers age 50 and older. A cohort of Kentucky and South Carolina farmers (n = 1394) over age 50 were surveyed annually during 2002-2005. Of those that reported any farm work, males worked 24 mean hours/week and females worked 14 mean hours/week. Greater satisfaction and more experience farming, increased acreage, and presence of animals significantly increased estimated hours farmed, whereas chronic health problems, although prevalent, had a minor role in determining work hours.

ABSTRACT The objective of this study was to estimate the national prevalence of respirator use among primary farm operators in the United States. The authors analyzed the 2006 Farm and Ranch Safety Survey data collected for 12,278 actively farming primary farm operators. Weighted prevalence and adjusted prevalence ratios (PRs) of respirator use were calculated by farm operator characteristics, farm characteristics, and selected exposures/hazards. Of the estimated 2.1 million farm operators, 37.2% used a respirator on their farm. Respirator use prevalence was significantly higher among operators aged 16-34 years than those aged ≥65 years (46.9% vs. 30.0%; PR = 1.6); male than female operators (39.0% vs. 24.4%; PR = 1.6); operators managing crop farms than operators managing livestock farms (40.9% vs. 33.7%; PR = 1.2); and operators managing farms with value of sales ≥$100,000 than operators managing farms with value of sales ≤$9999 (57.4% vs. 31.4%; PR = 1.8). Of the operators who used a respirator, 69.9% used while working in a dusty environment, 22.6% used while applying/handling pesticides, and 30.4% used while doing other farm-related activities. These results show that an estimated one third of operators used respirators in 2006, and respirator use is most frequent among operators working in a dusty environment. Additional research identifying specific exposures for which respirators or dust masks are used, barriers to respirator or dust mask use, motivators for wearing respirators, and opportunities to increase the use of respiratory protection among farm operators, particularly on smaller farms, is needed.

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

ABSTRACT To gain better insight into the problem of accidental occupational exposure to phytosanitary products, a retrospective study of experience at the Poison Control Center in Marseille, France, was conducted for the period between January 1, 2008, and December 31, 2010. A 129-case series was compiled. The study population was overwhelmingly male (83%), and the most common cause was insecticides (56.6% with a half pyrethrin and 21% organophosphate) and herbicides (26%). Although various exposure routes were observed, the most common were inhalation (43%) and skin contact (34%). The symptoms were mainly neurologic, digestive, and/or cutaneous. The severity of poisoning was generally mild, with no deaths or sequels. Only 5% of cases required hospitalization.

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

In 1996 the US launched a National Childhood Agricultural Injury Prevention Initiative, guided by an action plan generated by a 42-member multidisciplinary committee. A major update to the plan was released following the 2001 Summit on Childhood Agricultural Injury Prevention. From the year 2010 through 2011 a comprehensive assessment of progress to date was conducted followed by the drafting, review and finalizing of a new action plan-"The 2012 Blueprint for Protecting Children in Agriculture." This paper briefly describes the purpose and process for generating the new action plan then provides a listing of the 7 goals and 26 strategies within the plan. These goals and strategies account for trends in childhood agricultural injuries, changes in agricultural production and the demographics of its workforce, effectiveness of interventions, and the increasing use of social media, marketing and social networking. Primary funding for this project was provided by the National Institute for Occupational Safety and Health (NIOSH), which continues to serve as the lead federal agency for the national initiative.

The objectives of this study were to recruit agricultural workers in Costa Rica to participate in a 24-hour urine collection for paraquat exposure assessment and to compare the 24-hour sampling to end-of-shift sampling. The authors recruited 187 handlers and 54 nonhandlers from coffee, banana, and palm oil plantations. The completeness of 24-hour urine samples collected (a total of 393 samples) was confirmed by questionnaire and urinary creatinine level. For a subset of 12 samples, the absorbed paraquat level was determined in 24-hours and end-of-shift spot urine samples. The participation rate for handlers was approximately 90%. The completeness of 24-hour urine collections was verified as the overall average of creatinine levels from 393 urines (1.11+/-0.50 g/L). A total of 92.4% to 96.7% of urine samples were considered within the acceptable range of urinary creatinine, whereas 94.7% of the samples were described as "complete" from the questionnaire. Measured creatinine correlated well to predicted values (r=.327, p=.0024, 95% CI .12-.51). Detected paraquat levels in spot urine samples had a sensitivity of 96.9% at the high specificity of 100% compared to 24-hour urine samples as the gold standard. There was a significant (p<.0001) correlation between spot and 24-hour urine paraquat levels (r=.7825, 95% CI .61-.88). The recruiting strategy was successful in getting 24-hour urine samples from a farm worker population. Comparison between the paraquat levels in spot and 24-hour urine samples demonstrated that for this compound, end-of-shift spot urine samples would be an appropriate substitute for 24-hour collections.