Dean Stueland

Machine-related occupational injuries in farm residents

Farm machinery is an important contributor to the high rates of occupational injury in agriculture. As part of a population-based case-control study, we studied risk factors for machine-related farm injuries. Case patients were farm residents residing in a geographically defined area of central Wisconsin who experienced a farm injury associated with a tractor, farm implement, or other machine which required medical or chiropractic care from May 1990 through April 1992. Controls were selected from an ad hoc census of farm residents in the same area. Telephone interviews regarding demographic characteristics, safety behaviors, and farming practices were completed for 97.8% of 90 case patients and for 82.8% of 221 control subjects. Personal characteristics significantly associated with an increased risk of machine-related injury included the number of hours worked per week and working primarily as a farmer. Dairy farms, farms with nonresident workers, and large farms were associated with an increased risk of injury while farms with registered cows and farms where cows were fed in the barn even in summer experienced fewer injuries. Based on a logistic regression model, the independent risk factors for machine-related farm injury included hours worked per week (2% increased risk/nonresident workers on farm (odds ratio) (OR) = 2.32; 95% confidence interval (CI): 1.07 to 5.06), cows fed in barn in summer (OR = 0.28; 95% CI: 0.12 to 0.64), and registered cows on farm (OR = 0.36; 95% CI: 0.17 to 0.79). Farm safety practices did not appreciably influence the risk of machine-related farm injury.

A population based case-control study of agricultural injuries in children.

OBJECTIVES: To identify preventable risk factors related to agricultural injuries occurring to children on family farms. SETTING: A geographically defined central region of Wisconsin, USA with nearly 1800 family dairy farms. METHODS: A two year, population based incidence study of occupational injuries among farm residents was conducted. For cases, trained staff abstracted information on the nature, severity, and treatment of the injury from the patients medical record. Staff also administered a telephone questionnaire to cases and controls, usually answered by parents. RESULTS: There were 60 cases of farm residents younger than 18 years who sought care for acute agriculture related injuries. Farms on which uninjured children lived served as controls (n = 102). Multivariate analyses of 16 different variables revealed three significantly related to injuries to children: hours worked per week (odds ratio (OR) = 1.05; 95% confidence interval (CI) = 1.01 to 1.08); presence of disabled safety device (OR = 2.64; 95% CI = 1.10 to 6.35); and feeding cows by grazing (OR = 0.22; 95% CI = 0.06 to 8.83). CONCLUSIONS: Interventions designed to reduce the risk of agricultural injuries to farm children should acknowledge the participation of children as productive workers on the farm. Although education has been the standard method for encouraging safe practices in farm work, additional approaches, such as limiting the number of hours a child works, avoiding the disabling of safety devices, and using specific methods of managing cows, should also be adopted to minimize injury risks to farm children.

Fall‐related occupational injuries on farms

We assessed risk factors for fall-related farm injuries in a population-based, case-control study. Cases had to reside in a defined geographic region served by a single medical center. Multiple sources reported cases, and a special farm census enabled random selection of controls, The annual risk of farm fall injury was 7.5 (95% CI: 5.7, 10.0) per 1,000 person-years. The crude incidence rate was higher in men, while the rate based on hours of farmwork was higher in women. In a multivariate analysis of risk factors, three factors were significantly associated with the risk. The risk of fall injury increased 2% (95% CI: 1%, 4%) per hour worked. Residents of farms with some farm workers not living on the farm had a fall injury rate 2.5 (95% CI: 1.0, 6.2) times greater than residents of other farms. Residents of farms with registered cows had one-third (95% CI: 0.14, 0.93) the risk of residents of other farms. To identify environmental hazards for fall injuries, researchers from several disciplines may need to collaborate in the design and conduct of studies that include injury site investigations.

Agricultural injuries in children in central Wisconsin.

Agriculture is widely recognized as one of the most dangerous occupations in the United States. The risk of agricultural trauma extends beyond the adult work force to include farm children. During a 2-year study of agricultural trauma conducted at the Marshfield Clinic/St. Josephs Hospital, 246 (26.9%) of all agricultural injury victims were children (age less than 19 years). Teenagers were at greatest risk, but there were also many injuries among preschool children under the age of 6 years. Injuries occurred most often during the summer months, on weekends, and during the evening hours from 6:00 PM to 10:00 PM. There were relationships between the body part injured and the age of the child as well as between the agent associated with the injury and the age and gender of the child. Preschool farm children are particularly liable to experience head and neck trauma and injuries resulting from falls. Any successful effort to address either the prevention or treatment of agricultural trauma will need to consider that children have a unique pattern of injuries that differs from that of adults.

Animal-related Occupational Injuries in Farm Residents

Animal-related injuries are an unusual hazard of farming that have received little study.We studied risk factors for animal-related injury as part of a population-based, case-control study of agricultural injuries. Cases were farm residents living in a geographically defined area of central Wisconsin who had injuries associated with farm animals from May 1990 to April 1992 which required medical or chiropractic care. Controls were selected at random from a special census of farm residents in the area. Telephone interviews regarding demographic characteristics, farming practices, and safety behaviors were completed for 70 of 71 cases (98.6%) and 183 of 221 potential controls (82.8%). Based on a multivariable logistic regression model, the only statistically significant risk factor for animal-related farm injury was the number of hours worked per week (3% increased risk per hour). Several farm characteristics were linked with animal-related injury, but the associated 95% confidence limits included 1.0: non-resident workers on the farm (OR=2.20; 95% C.I.: 0.93-5.21), use of all-terrain vehicles for chores (OR=0.47; 95% C.I.: 0.22- 1.04), and feeding cows in the barn in summer (OR=0.39; 95% C.I.: 0.15-1.00). Future studies of animal-related farm injury should obtain more specific information on animal husbandry practices.

The spectrum of emergency care of agricultural trauma in central Wisconsin

Agriculture is among the most dangerous occupations in the United States. When injuries do occur, the emergency department (ED) is the primary source of care. Over a 2-year period, the emergency medicine section of the Marshfield Clinic/St Josephs Hospital, cared for 913 victims of agricultural trauma. Although 11% were initially admitted and 4% were later treated, the remainder received their care solely in the ED. Unlike most occupational injuries, people of any age may be involved in agricultural injuries; 27% in this series were less than 18 years of age and 5% were 65 years or older. Just over half of all injuries were from mechanical devices, including tractor and farm machinery. The remainder were from animals, falls, or exposure. Although several different types of injuries occurred, the most common diagnoses were soft tissue injuries and fractures and the most common procedure was diagnostic radiography followed by wound and fracture care. An ED in a rural setting should be prepared to deal with agricultural trauma.

Representativeness of trauma center registries for farm injury surveillance.

Trauma center registries are the foundation for many surveillance systems that attempt to define the frequency and spectrum of various types of injuries. To assess the representativeness of trauma center-based farm injury surveillance, we evaluated data for 1986-1991 from the Marshfield Clinic/St Josephs Hospital, a major trauma center located in Central Wisconsin. We compared the pattern of farm injuries seen in residents of the Marshfield Epidemiologic Surveillance Area (MESA), a geographically defined, population-based surveillance area, with those from outside MESA, a nonpopulation-based mix of primary care and referral patients typical of most trauma registries. The population-based and nonpopulation-based surveillance data suggested similar patterns with respect to seasonality, circumstances of injury, and source of injury. There were significant differences with respect to the body part injured, severity of injury, and selected aspects of acute medical care. While useful for many purposes, trauma center-based injury surveillance data should be interpreted cautiously.

Rural Health Care Providers’ Educational Needs Related to Agricultural Exposures

The wide spectrum of agricultural diseases and injuries, combined with the changes in health care delivery, underscores the need for rural health care providers to maintain competency in occupational medicine pertaining to agriculture. Educational needs and training preferences of rural health care providers were determined through mail survey research conducted among a random sample of Midwest physicians, physician assistants, nurses, veterinarians, and chiropractors. Data from 1,237 survey participants revealed the most common agricultural exposures experienced by their patients/clients include heavy lifting, environmental dusts or irritants, and hazardous machinery. Minimal clinical competency was reported for exposures to pesticides, noxious gases, and volatile organic chemicals. Textbooks and journals were the most commonly used reference sources of the providers. Family and professional obligations along with cost and difficulty acquiring practice coverage, were the major barriers to participation in continuing education programs. Survey results suggest methods to maximize professional education and training experiences relevant to agricultural exposures.

Relationship of sociodemographic and drinking variables to differentiated subgroups of alcoholics

In an effort to demonstrate that alcoholics are a heterogeneous group, the strength of the relationship between sociodemographic and drinking variables to five differentiated homogeneous groups of alcoholics was assessed. Results of a χ2 analysis and ϕ test indicated that the majority of the variables were moderately to highly related to the derived typology. The results were interpreted as indicating that a distraught life situation (that is, the lack of social and demographic assets-marriage, education, vocational skills, and so on) contributes to an alcoholics self-perceived psychological need deprivation and not solely to aberrant drinking.

A canonical correlation analysis of the Alcohol-Use Inventory and the Human Service Scale

The responses of 312 persons with alcoholism to the Alcohol-Use Inventory and Human Service Scale were subjected to canonical correlation analysis. Results indicate that the relationship between alcohol-use constructs and psychological need satisfaction can be explained by two axes: a personal securitysocial dimension and a personal stress-environmental dimension. Microanalysis of the variates indicated that emotional need satisfaction was differentially influenced by social and physiological variables.