J. R. Wilkins

A cross-sectional case control study of work-related injuries among Ohio farmers

The agricultural industry has consistently been ranked among the most hazardous in the U.S. To date, few analytic studies of occupational injury among farm operators and workers have been conducted. A case control study was undertaken to investigate risk factors for agricultural work-related injury among Ohio farm operators. Cases were selected from among 1,793 respondents to a questionnaire administered during the first phase of the NIOSH-sponsored Ohio Farm Family Health and Hazard Study (OFFHHS). Analysis consisted of description of the injury experience of the sample as a whole, followed by logistic estimation of prevalence odds ratios (pORs) measuring the effect of potential risk factors on injury risk. The case series consisted of 90 white male principal operators (POs) injured doing farm work in the 12 months prior to questionnaire completion. Controls consisted of 1,475 white male POs who reported no injuries. The overall rate of injury was 5 per 100 person-years. The most notable result is the relationship between self-reported neurotoxic symptoms and injury, suggesting those with more reported symptoms were at greater risk of injury. The crude OR, when compared to the reference score of < or = 27, increased from 1.74 (95% CI = 0.60-5.09) in the 28-30 category, to 1.89 (95% CI = 0.71-5.03) in the 31-35 category, to 2.96 (95% CI = 1.10-7.96) in the highest category of test score. The P value for trend was 0.0218. These associations largely persisted after controlling for potential confounders with multiple logistic regression. Risk was inversely related to age. The results show marked increases in risk of injury associated with farmers younger than 30 and increased severity of self-reported neurological symptoms, controlling for potential confounding.

Airborne Microorganisms, Endotoxin, and (1→3)-β-D-Glucan Exposure in Greenhouses and Assessment of Respiratory Symptoms Among Workers

OBJECTIVES Greenhouse operations are an important sector of the horticulture industry, also known as the Green Industry. The objectives of this study were (i) to investigate exposure levels to airborne culturable fungi, bacteria (total culturable bacteria and actinomycetes), endotoxin, and (1→3)-β-D-glucan in three Midwest greenhouses during summer and winter using multiple exposure assessment methods; (ii) characterize the load of microorganisms on greenhouse floors and determine potential microbial source strengths of the floors for aerosolizing microbial biocontaminants, and (iii) to estimate the prevalence of rhinitis, wheezing, asthma, and other respiratory symptoms/conditions among greenhouse workers. METHODS Stationary inhalable aerosol samples were collected from each greenhouse using Button Inhalable Aerosol Samplers. Control samples were collected from offices and nearby outdoor locations. A microbial source strength tester was used to examine the aerosolization potential of microbial contaminants from greenhouse floors. Additionally, surface samples were collected by sterile cotton swabs. Temperature, relative humidity, and wind velocity were recorded. Airborne culturable fungi, bacteria, and actinomycetes were analyzed in the extracts from field samples by cultivation in nutrient agar media. Endotoxin and (1→3)-β-D-glucan in the extracts from field samples were analyzed by specific kinetic chromogenic Limulus amebocyte lysate assays. The prevalence of respiratory symptoms among greenhouse workers (n = 35) and control subjects (office workers; n = 14) was estimated with a standardized questionnaire. RESULTS AND CONCLUSIONS The collected data indicate that workers employed in Midwest greenhouses may be exposed to elevated levels of inhalable culturable microorganisms (fungi and bacteria collectively on the order of 10(2)-10(5) CFU m(-3)), endotoxin (10(1)-10(3) EU m(-3)), and (1→3)-β-D-glucan (10(1)-10(2) ng m(-3)). Seasonal variations were observed for some bioaerosol components. The prevalence of self-reported respiratory symptoms was generally higher among greenhouse workers compared to controls; however, the differences were not statistically significant, likely due to the relatively low statistical power of the study.

Prevalence of chronic respiratory symptoms among ohio cash grain farmers

BACKGROUND The prevalence of chronic cough, chronic phlegm, dyspnea, and non-cold wheeze was estimated from a mixed-mode survey of Ohio cash grain farmers in 1993. METHODS Personal characteristics of the principal operators (POs) such as age and cigarette smoking, in addition to selected farm characteristics and relevant medical and work history factors potentially associated with both exposure to respiratory irritants and subsequent respiratory symptoms were considered. RESULTS The overall design-adjusted prevalences (and the corresponding 95% confidence intervals (CIs) were: 9.4% (7.6-11.1%) for chronic cough, 10.8% (9.0-12.6%) for chronic phlegm, 16.2% (14.1-18.3%) for dyspnea, and 8.1% (6.4-9.8%) for non-cold wheeze. In univariate and multivariate analyses, smoking status was found, not surprisingly, to be the strongest predictor of increased symptom prevalence compared to all other factors. Other non-occupational factors found associated with increased symptom prevalence include age (cough, phlegm, dyspnea) and pet allergy (non-cold wheeze). Occupational factors found at least weakly associated with increased symptom prevalence include lifetime hours of cab tractor operation (cough); percent time spent farming (phlegm); having livestock other than cattle, cows, and calves (dyspnea); acres of corn for silage or green chop (cough); acres of alfalfa hay (non-cold wheeze); and personal involvement with pesticides (cough). CONCLUSIONS Symptom prevalences reported here are consistent with previous findings from studies of other groups of farmers. Results pertaining to factors found associated with symptom prevalences should be interpreted in light of several sources of potential bias.

Escalator-Related Injuries Among Children in the United States, 1990–2002

OBJECTIVE. We describe the epidemiology of escalator-related injuries among children 0 to 19 years of age in the United States, with a focus on the pediatric population that is younger than 5 years. METHODS. We conducted a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Reported cases were used to project national estimates and rates of escalator-related injuries in the United States. The analysis included all patients who were 0 to 19 years of age in the National Electronic Injury Surveillance System database and were seen in an emergency department for an escalator-related injury during the 13-year period 1990–2002. RESULTS. There were an estimated 26000 escalator-related injuries among children who were 0 to 19 years of age in the United States during 1990–2002, yielding an average of 2000 of these injuries annually (rate = 2.6 per 100000 population per year). The mean age was 6.5 years at the time of injury, and 53.4% of the patients were male. When comparing cases by 5-year age groups, children who were younger than 5 years had the highest estimated number of injuries (12000), as well as the highest annual escalator-related injury rate (4.8 per 100000). The most common mechanism of injury for all age groups was a fall, accounting for 13000 (51.0%) injuries. Entrapment accounted for 29.3% of all injuries and 36.5% of injuries among children who were younger than 5 years. Six percent (723) of injuries to children who were younger than 5 years involved a stroller, with most injuries occurring when a child fell out of the stroller while on the escalator. The most common body part injured for all ages was the leg, accounting for 27.7% of all injuries. Among children who were younger than 5 years, the hand was the most common injury site (40.6%), with hand injuries frequently occurring as a result of entrapment (72.4%). A laceration was the most common type of injury, accounting for 47.4% of escalator-related injuries. Amputations and avulsions were uncommon; however, 71.4% (595 of 833) occurred among children who were younger than 5 years. CONCLUSIONS. There was a disproportionate number of escalator-related injuries among children who were younger than 5 years. Entrapment occurred more frequently among children who were younger than 5 years than in any other age group, which may explain the increased number of hand injuries in this age group. Escalator designs that reduce the gap between the steps and sidewall or shield against access to the gap may decrease entrapment risk. Young children should be supervised properly and should not be transported in a stroller while riding on an escalator. All passengers should use caution and remain alert when riding an escalator to avoid injuries related to falls or entrapment. Additional research is needed to determine the relationship among passenger behavior, escalator design, and escalator-related injury.

Illness and injury among children attending summer camp in the United States, 2005

OBJECTIVES. The purpose of this work was to describe illnesses and injuries sustained by campers at summer camps, calculate illness and injury rates, and identify risk factors for camp-related illness and injury. METHODS. A convenience sample of camps selected from the US summer camp population participated in this pilot illness and injury surveillance study. Camps completed weekly reports detailing the number of campers on site and the number of adverse events sustained and provided specific information about each adverse event. RESULTS. A total of 177 camper illnesses and injuries occurred during 122379 camper-days, with a median rate of 1.15 adverse events per 1000 camper-days. The majority of reported events were illnesses (68.0%), 11.8% of which were communicable and seen in multiple individuals at camp. Of the injury events (32.0%), cut/scratch/scrape were the most common diagnoses (33.3%), followed by fracture (14.6%) and sprain/strain (10.4%); horseback riding and capture the flag were identified as injury-producing activities. CONCLUSIONS. Internet- and telephone-based surveillance systems can be successfully used to conduct illness and injury surveillance among children attending summer camp. Data collected via such systems can be used to calculate illness and injury rates, to describe patterns of illness and injury, and to identify risk factors for camper-related illness and injury. Given the millions of children attending summer camp yearly, a surveillance system such as this can provide the data needed to develop evidence-based prevention interventions to decrease the number of youth whose camp experiences are negatively affected by illness and injury.

Short- and Long-Term Effects of Ambient Ozone and Fine Particulate Matter on the Respiratory Health of Chronic Obstructive Pulmonary Disease Subjects

To date, no study has evaluated the short- and long-term effects air pollution exposure on emphysematous subjects who have undergone lung volume reduction surgery (LVRS). Data from the National Emphysema Treatment Trial study (1998–2003) included 1,218 subjects, aged 39 to 84. Daily values of ambient fine particulate matter (aerodynamic diameter < 2.5 μm; PM2.5) and ozone were obtained. Mixed-effects models tested the association between short- and long-term pollutant concentrations and changes in pulmonary function. Cumulative air pollution exposure was strongly associated with worsened respiratory function and symptoms. Mean PM2.5 was associated with poorer lung function. Lagged exposures were poorly associated with respiratory health outcomes. There were detrimental respiratory and pulmonary effects observed in response to even low levels of ambient air pollutants among study participants. These results are indicative that exposures even below those of air quality standards may still pose significant risks to severe chronic obstructive pulmonary disease (COPD) subjects.

Hearing loss among Ohio farm youth: A comparison to a national sample

BACKGROUND Hearing loss is prevalent among adults in the farming community, with some evidence it begins in childhood. Our objective was to compare hearing thresholds of Ohio farm youth to published data on national norms. METHODS Baseline data were collected on youth (n = 212) in 1994-1996 with follow-up (n = 132) in 2003-2004 including pure-tone air conduction thresholds at 0.5, 1, 2, 3, 4, 6, and 8 kHz. RESULTS When compared to nationally-representative data, study youth had a higher prevalence of hearing loss. The high-frequency range was most affected, particularly at 6 kHz where nearly 50% of the farm youth exhibited some degree of hearing loss at baseline testing. The prevalence of noise-induced threshold shifts, characterized by an audiometric notch, was nearly twice that of the national sample. CONCLUSIONS These data suggest that hearing loss, which is common among adult farmers, may be problematic for farm youth as well.

Nonoccupational Table Saw-Related Injuries Treated in US Emergency Departments, 1990-2007

BACKGROUND Table saws are associated with more injuries than any other type of woodworking tool. There are no published national epidemiologic studies of table saw-related injuries. METHODS A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990 to 2007. Sample weights provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding table saw-related injuries. RESULTS An estimated 565,670 (95% confidence interval [CI]: 473,442-657,898) table saw-related injuries were treated in US Emergency Departments from 1990 to 2007. Children (younger than 18 years) were more likely to be injured at school (p < 0.01; relative risk = 68.79; 95% CI: 46.58-101.61), whereas adults were more likely to be injured at home (p < 0.01; relative risk = 2.05; 95% CI: 1.82-2.32). Fingers/thumbs were injured most often (86%; 486,181 of 565,670) and lacerations were the most common type of injury (66%; 373,319 of 565,360). Amputations were associated with 10% (56,848 of 565,360) of the injuries, and most of the amputations involved the finger/thumb (56,817 of 56,848). Eight percent (47,916 of 565,458) of patients were hospitalized. CONCLUSIONS Most table saw-related injuries result from contact with the saw blade. Passive injury prevention strategies focusing on preventing finger/thumb/hand contact with the blade need to be implemented.

Protecting young workers in agriculture: participation in tractor certification training

Tractor-related injuries among youth are an important public health problem. The major objectives of this study were to (1) provide a rigorous estimate of the number of youth operating tractors in Ohio and (2) assess the extent to which these youth are participating in federally mandated tractor safety training. A self-administered questionnaire was completed by approximately 4,000 students ages 14 or 15 years who were enrolled in a stratified cluster sample of 99 Ohio schools. Almost one-third of the youth (30%) reported having operated tractors, with 19% having operated a tractor on a farm not owned by a parent or guardian. More than half of the youth (52%) reported having operated a tractor and/or other hazardous machinery, with 25% having operated the machinery on a farm not owned or operated by a parent or guardian. Extrapolating from 4-H records and Ohio census data, fewer than 1% of the youth who are operating tractors or other hazardous machinery have participated in tractor certification training. Increasing participation in mandated training may be an important step in protecting the health of our nations young agricultural workers.

Using Participant Event Monitoring in a Cohort Study of Unintentional Injuries Among Children and Adolescents

OBJECTIVES We conducted a 3-year cohort study of 407 youths aged 9 to 18 years to develop multivariable risk prediction models of agriculture-related injuries. METHODS Data were obtained via participant event monitoring, with youths self-reporting injuries and exposures in daily diaries over a 13-week period. We evaluated data quality by comparing injury self-reports with other injury data. RESULTS Semilogarithmic plots of rates of all unintentional injuries combined (US data from 2000) as well as of agriculture-related injuries (US and Canadian data from 19 previous studies) graphed as a function of injury severity exhibited linearity, as did plots based on the present results. Severity-specific unintentional injury rates were 1.4- to 4.3-times higher than national rates, suggesting that our methodology can significantly reduce injury underreporting. In addition, at each severity level, estimated agriculture-related injury rates were 5.8- to 9.3-times higher than rates from previous national, regional, and state-based studies. CONCLUSIONS Our approach to participant event monitoring can be implemented with youths aged 9 to 18 years and will yield reliable daily data on unintentional injuries.