Respiratory Disease in Migrant Farmworkers.

INTRODUCTION: Respiratory problems are prevalent among persons who work in agriculture, however, publications examining the respiratory status in LatinX farmworkers are limited. The purpose of this study is to assess the respiratory status of LatinX farmworkers across New York State. METHODS: This is a retrospective analysis of data gathered from Spanish language OSHA respiratory questionnaires completed between January 2017 and March 2019. The best of three peak flows were compared with predicted normal values derived from regressions using age, gender, and height. RESULTS: Key information was present in 162 Spanish questionnaires. Rates of reported respiratory symptoms were low, less than 2%; 11.7% farmworkers smoked. Best of three peak flows showed a mean of 97.2 ±â€Š16.8% of predicted. DISCUSSION: New York LatinX farmworkers do not appear to have abnormal rates of respiratory symptoms or low peak flows.

2D-IR Spectroscopy Shows that Optimized DNA Minor Groove Binding of Hoechst33258 Follows an Induced Fit Model.

The induced fit binding model describes a conformational change occurring when a small molecule binds to its biomacromolecular target. The result is enhanced noncovalent interactions between the ligand and biomolecule. Induced fit is well-established for small molecule-protein interactions, but its relevance to small molecule-DNA binding is less clear. We investigate the molecular determinants of Hoechst33258 binding to its preferred A-tract sequence relative to a suboptimal alternating A-T sequence. Results from two-dimensional infrared spectroscopy, which is sensitive to H-bonding and molecular structure changes, show that Hoechst33258 binding results in loss of the minor groove spine of hydration in both sequences, but an additional perturbation of the base propeller twists occurs in the A-tract binding region. This induced fit maximizes favorable ligand-DNA enthalpic contributions in the optimal binding case and demonstrates that controlling the molecular details that induce subtle changes in DNA structure may hold the key to designing next-generation DNA-binding molecules.

Frequency of satisfaction and dissatisfaction with practice among rural-based, group-employed physicians and non-physician practitioners.

BACKGROUND: Widespread dissatisfaction among United States (U.S.) clinicians could endanger ongoing reforms. Practitioners in rural/underserved areas withstand stressors that are unique to or accentuated in those settings. Medical professionals employed by integrating delivery systems are often distressed by the cacophony of organizational change(s) that such consolidation portends. We investigated the factors associated with dis/satisfaction with rural practice among doctors/non-physician practitioners employed by an integrated healthcare delivery network serving 9 counties of upstate New York, during a time of organizational transition. METHODS: We linked administrative data about practice units with cross-sectional data from a self-administered multi-dimensional questionnaire that contained practitioner demographics plus valid scales assessing autonomy/relatedness needs, risk aversion, tolerance for uncertainty/ambiguity, meaningfulness of patient care, and workload. We targeted medical professionals on the institutional payroll for inclusion. We excluded those who retired, resigned or were fired during the study launch, plus members of the advisory board and research team. Fixed-effects beta regressions were performed to test univariate associations between each factor and the percent of time a provider was dis/satisfied. Factors that manifested significant fixed effects were entered into multivariate, inflated beta regression models of the proportion of time that practitioners were dis/satisfied, incorporating clustering by practice unit as a random effect. RESULTS: Of the 473 eligible participants. 308 (65.1 %) completed the questionnaire. 59.1 % of respondents were doctoral-level; 40.9 % mid-level practitioners. Practitioners with heavier workloads and/or greater uncertainty intolerance were less likely to enjoy top-quintile satisfaction; those deriving greater meaning from practice were more likely. Higher meaningfulness and gratified relational needs increased one's likelihood of being in the lowest quintile of dissatisfaction; heavier workload and greater intolerance of uncertainty reduced that likelihood. Practitioner demographics and most practice unit characteristics did not manifest any independent effect. CONCLUSIONS: Mutable factors, such as workload, work meaningfulness, relational needs, uncertainty/ambiguity tolerance, and risk-taking attitudes displayed the strongest association with practitioner satisfaction/dissatisfaction, independent of demographics and practice unit characteristics. Organizational efforts should be dedicated to a redesign of group-employment models, including more equitable division of clinical labor, building supportive peer networks, and uncertainty/risk tolerance coaching, to improve the quality of work life among rural practitioners.

Resilience among Employed Physicians and Mid-Level Practitioners in Upstate New York.

OBJECTIVE: To investigate the factors associated with resilience among medical professionals. DATA SOURCES/STUDY SETTING: Administrative information from a rural health care network (1 academic medical center, 6 hospitals, 31 clinics, and 20 school health centers) was triangulated with self-report data from 308 respondents (response rate = 65.1 percent) to a 9/2013-1/2014 survey among practitioners serving a nine-county 5,600-square-mile area. STUDY DESIGN: A cross-sectional questionnaire survey comprising valid measures of resilience, practice meaningfulness, satisfaction, and risk/uncertainty intolerance, nested within a prospective, community-based project. DATA COLLECTION/EXTRACTION METHODS: The sampling frame included practitioners on institutional payroll, excluding voluntary/involuntary attritions and advisory board/research team members. In multivariable mixed-effects models, we regressed full-range and high-/low-resilience scores on demographics, professional satisfaction, workplace needs, risk/uncertainty intolerance, and service unit characteristics. PRINCIPAL FINDINGS: Relational needs, uncertainty intolerance, satisfaction ≥75 percent of the time, number of practitioners on a unit, and workload were significantly associated with resilience. Higher scores were most strongly associated with uncertainty tolerance, satisfaction, and practitioner numbers. Practitioner/unit demographics were mostly nonsignificant. CONCLUSIONS: More resilient practitioners experienced frequent satisfaction, relational needs gratification, better uncertainty tolerance, lighter workloads, and practiced on units with more colleagues. Further studies should investigate well-being interventions based on these mutable factors.

Implementing a National Tractor Safety Program: Using "Whole System in a Room" to Mobilize Partners and Implement Solutions.

Fatalities due to tractor overturns have long plagued the U.S. farm community. Constituting 20% of agricultural fatalities, tractor overturns contribute significantly to high rates of fatal injuries. In the past, many efforts have been directed toward reducing tractor overturns, with one successful US-based program offering rebates to farmers who retrofit their tractors with rollover protective structures (ROPS). In an effort to expand the program, the National Tractor Safety Coalition was formed. This coalition hosted a "Whole System in the Room" workshop to bring 50 stakeholders together. During this workshop, participants worked together to identify a common vision for the future of tractor safety and ROPS programs and commit to action. At the close of the workshop, coalition members set out to begin work on 100 short- and long-term commitments to begin implementing a National ROPS Rebate Program.

Validation of Single-Item Screening Measures for Provider Burnout in a Rural Health Care Network.

We validated three single-item measures for emotional exhaustion (EE) and depersonalization (DP) among rural physician/nonphysician practitioners. We linked cross-sectional survey data (on provider demographics, satisfaction, resilience, and burnout) with administrative information from an integrated health care network (1 academic medical center, 6 community hospitals, 31 clinics, and 19 school-based health centers) in an eight-county underserved area of upstate New York. In total, 308 physicians and advanced-practice clinicians completed a self-administered, multi-instrument questionnaire (65.1% response rate). Significant proportions of respondents reported high EE (36.1%) and DP (9.9%). In multivariable linear mixed models, scores on EE/DP subscales of the Maslach Burnout Inventory were regressed on each single-item measure. The Physician Work-Life Study's single-item measure (classifying 32.8% of respondents as burning out/completely burned out) was correlated with EE and DP (Spearman's ρ = .72 and .41, p < .0001; Kruskal-Wallis χ(2) = 149.9 and 56.5, p < .0001, respectively). In multivariable models, it predicted high EE (but neither low EE nor low/high DP). EE/DP single items were correlated with parent subscales (Spearman's ρ = .89 and .81, p < .0001; Kruskal-Wallis χ(2) = 230.98 and 197.84, p < .0001, respectively). In multivariable models, the EE item predicted high/low EE, whereas the DP item predicted only low DP. Therefore, the three single-item measures tested varied in effectiveness as screeners for EE/DP dimensions of burnout.

The healthy start partnership: an approach to obesity prevention in young families.

This article investigates the impact of community-based interventions developed by the Healthy Start Partnership (HSP) to promote healthy body weights in families. Intercept surveys were conducted to monitor community exposure. A nonconcurrent, no treatment control design was used to assess population-level weight outcomes. Control (n = 219) and intervention (n = 276) cohorts of pregnant women were recruited and followed until 6 months postpartum. Data were collected through 2 self-administered questionnaires and medical record audits. Results indicate community residents were exposed to interventions. However, little evidence of positive effects of interventions on weight outcomes was found for mothers or infants.

Associations among social capital, parenting for active lifestyles, and youth physical activity in rural families living in upstate New York.

While emerging research supports a positive relationship between social capital and youth physical activity (PA), few studies have examined possible mechanisms explaining this relationship and no studies have focused on rural youth. In this study, we examined parents' support of children's PA as an intermediary factor linking social capital and youth PA in a largely rural cross sectional sample of American children aged 6- to 19-years and their parents/guardians (N=767 families) living in upstate New York. Parents completed a self-administered survey assessing demographic factors, perceived social capital, support for children's PA, and children's PA including time spent outdoors and days per week of sufficient PA. Structural equation modeling was used to test the hypothesis that higher social capital is linked with higher parental support for PA and, in turn, higher PA in children. Analyses were conducted separately for younger (6-12 years) and older (13-19 years) children and controlled for demographic factors (child age, household education, participation in a food assistance program) and perceived neighborhood safety. Anticipated relationships among social capital, parents' activity-related support, and children's PA were identified for older, but not younger children. Findings suggest that parent support for children's PA is one possible mechanism linking social capital and youth PA and the parents of adolescents may rely more heavily on cues from their social environment to shape their approaches to supporting their children's PA than parents of younger children.

Improving agricultural injury surveillance: a comparison of incidence and type of injury event among three data sources.

BACKGROUND: Agriculture ranks as one of the most hazardous industries in the nation. Ongoing injury surveillance is key to identifying and preventing major sources of injury. OBJECTIVE: The objective of this study was to compare the total number and types of injuries identified from community reporting versus two newly available medical data systems. These new systems are important because they are less time consuming and expensive to maintain. METHOD: Farm injury case records from 2007 were collected for 10 NY counties from the following sources: ambulance reports, hospital data, and community surveillance data. RESULTS: For the 107 ambulance report cases, horses (35%), tractors (15%), and livestock (10%) were the three leading injury sources. For the 261 hospital cases, the leading sources were hand tools (24%), farmstead machinery (23%), and buildings/structures/surfaces (22%). Tractor injuries (37%) were the most common source of injuries identified by the 44 community surveillance cases. Struck by object was the most frequent injury event type for hospital and surveillance data (34%, 30%). Falls were the highest category for ambulance reports (36%) and were also common for hospital data (29%). Nine of the 11 fatal cases were found through community surveillance. CONCLUSION: Ambulance reports and hospital data contribute a large number of additional farm injury cases to existing surveillance data. From these cases, horse injuries, falls, and hand tool injuries appear to play a larger role in farm injuries. Future research should explore how to best use these electronic resources for agricultural injury surveillance.

The social marketing of safety behaviors: a quasi-randomized controlled trial of tractor retrofitting incentives.

OBJECTIVES: We assessed the effect of social marketing incentives on dispositions toward retrofitting and retrofitting behavior among farmers whose tractors lacked rollover protective structures. METHODS: From 2006 to 2007, we conducted a quasi-randomized controlled trial with 391 farm owners in New York and Pennsylvania surveyed before and after exposure to 1 of 3 tractor retrofitting incentive combinations. These combinations were offered in 3 trial regions; region 1 received rebates; region 2 received rebates, messages, and promotion and was considered the social marketing region; and region 3 received messages and promotion. A fourth region served as a control. RESULTS: The social marketing region generated the greatest increases in readiness to retrofit, intentions to retrofit, and message recall. In addition, postintervention stage of change, intentions, attitudes, subjective norms, and perceived behavioral control levels were higher among farmers who had retrofitted tractors. CONCLUSIONS: Our results showed that a social marketing approach (financial incentives, tailored messages, and promotion) had the greatest influence on message recall, readiness to retrofit tractors, and intentions to retrofit tractors and that behavioral measures were fairly good predictors of tractor retrofitting behaviors.

Results from inspections of farmer-installed rollover protective structures.

This study sought to assess the feasibility of self-installing rollover protective structures (ROPS) and to identify any patterns of self-installation deficiencies in a sample of New York ROPS Retrofit Rebate Program participants. Inspection engineers looked for/at damage, rust, holes, deteriorated welding, location of attachment, axle housing, the presence of original plates/bolts, and adequate seatbelt installation. Results indicated that only 31% of farmers received correct parts and also installed these parts properly. Ten percent of self-installed tractors had installation problems so severe they were referred to a dealer for correction. Issues with seatbelts, torque, and unmarked or defective bolts in ROPS kits were also detected.

Dealing with pre-ROPS tractors: is a trade-in program the solution?

Tractor overturns are the leading cause of work-related death in an industry with the highest occupational fatality rate. Rollover protective structures (ROPS) and seatbelts are 99% effective in reducing the risk of an overturn fatality. However, kits are not available for 20% of tractors currently lacking ROPS. For these tractor owners, two potential solutions have been discussed: (1) technology for reinforcing tractor axles to accommodate ROPS and (2) a pre-ROPS tractor removal program. The purpose of this study was to conduct preliminary research to assess the feasibility of a tractor trade-in program. Focus groups were conducted with pre-ROPS tractor owners and tractor dealers. The data were analyzed using a concept development analytical approach and results were reviewed in an industry stakeholder's workgroup session. Data from the research indicates that tractor owners and dealers would need persuasive financial incentives to participate in a trade-in program. The workgroup session also indicated that it would be difficult to fund or support a large-scale initiative, and the economics of removing a large group of older tractors from the marketplace may exacerbate financial roadblocks. However, the data from this study could be used to pilot test a small-scale, focused, tractor buy-back program.

Community collaborations for farmworker health in New York and Maine: process analysis of two successful interventions.

We conducted a process evaluation of 2 successful farmworker community-based participatory research intervention development projects (in Maine and New York State). Participant surveys measured satisfaction with the program process. We used qualitative methods to analyze free-text responses. Respondents indicated high satisfaction levels overall. The main concern was long-distance project coordination. Community-based participatory research programs in which (1) the work team defines the target health issue, (2) agricultural employers are meaningfully included, and (3) interventions are carried through to completion, warrant further study.

Occupational injury and treatment patterns of migrant and seasonal farmworkers.

Migrant and seasonal farmworkers are thought to be at increased risk for occupational injury and illness. Past surveillance efforts that employed medical chart review may not be representative of all farmworkers, since the proportion of farmworkers using migrant health centers (MHCs) and area hospital emergency rooms (ERs) was unknown. The purpose of the current study was to determine the proportion of workers using MHCs versus other sources of occupational health care, and to use these data to correct previous occupational injury and illness rate estimates. Researchers conducted a survey of migrant and seasonal farmworkers in two sites: the Finger Lakes Region of New York and the apple, broccoli, and blueberry regions of Maine. Researchers also conducted MHC and ER medical chart reviews in these regions for comparison purposes. Proportions of occupational morbidity by treatment location were calculated from the survey, and a correction factor was computed to adjust chart review morbidity estimates for Maine and New York State. Among 1103 subjects, 56 work-related injuries were reported: 30 (53.6%) were treated at a MHC, 8 (14.3%) at an ER, 9 (16.1%) at some other location (e.g., home, relative, chiropractor), and 9 (16.1%) were untreated. Mechanisms of injuries treated at MHCs versus all other sources did not differ significantly. The survey-based multiplier (1.87) was applied to previous statewide MHC chart review injury counts from Maine and New York. The corrected injury rates were 7.9 per 100 full-time equivalents (FTE) per year in Maine, and 11.7 per 100 FTE in New York. A chart-review based surveillance system, combined with a correction factor, may provide an effective method of estimating occupational illness and injury rates in this population.

Growth of the Spanish-speaking workforce in the Northeast dairy industry.

The Spanish-speaking proportion of the Northeast dairy industry workforce is believed to be increasing. This study quantifies the extent of this increase over time in New York, Pennsylvania, and Vermont, and compares demographics between English- and Spanish-speaking workers. A total of 293 farms were followed for 21 months via telephone. The proportion of the Spanish-speaking dairy workforce was measured. Differences in demographic characteristics were assessed. The proportion of Spanish-speaking workers increased linearly for both large and small farms. The rate of increase was much greater on large farms. Linear models predicted that 53.2% of the large and 18.1% of the small farm workforce would be Spanish speaking within 5 years. Spanish-speaking workers worked significantly longer weeks than their English-speaking counterparts. The Occupational Safety and Health Administration (OSHA) monitoring cutoff for number of employees is currently 10. Consequently, the increase in the proportion of Spanish-speaking workers in dairy, who have been shown to work more hours per week, is likely to result in fewer workers per farm. This could have implications for farms currently under OSHA regulations based on having 10 or more workers, because farms with workers working longer hours per week will employ fewer workers overall. In addition, according to section 330 of the Public Health Service Act, these workers do not currently meet the migrant farmworker definition that would qualify them to receive primary health services from federally funded migrant health centers. New legislation is needed to formally qualify this growing indigent population to receive healthcare via channels that are currently available to migrant and seasonal farmworkers.

Electromyographic assessment of apple bucket intervention designed to reduce back strain.

The authors previously developed an apple bucket that was modified by use of a hip belt to reduce muscle fatigue. The intervention of belt use was accepted by workers and shown not to interfere with productivity. However, use of this intervention did not appear to reduce muscle fatigue when measured by tests of voluntary muscle strength. The purpose of the present study was to evaluate the intervention's effect on muscle fatigue employing surface electromyographic (EMG) amplitude. Amplitude measurements on 15 muscles were taken from 10 laboratory volunteers who were carrying a full bucket of apples, once while wearing the intervention belt and once without the intervention. These measurements were taken for seven different postures (four angles of trunk flexion (0 degrees , 20 degrees , 45 degrees , 90 degrees ) and three raised-arm positions (both up, dominant up, non-dominant up)) common to apple harvest work. Participants were measured in these conditions both with the bucket carried in front and with the bucket carried to the side. Significant reductions in amplitude favouring the intervention were seen for 11 of the 15 muscles in models considering the four body flexion angles. Ten of these were of the middle and lower back. These control/intervention differences were seen with both bucket-carrying positions (front vs. side) and tended to increase with increasing flexion angle. In contrast, no significant intervention effects were observed in models considering treatment by arm-raised position. One significant main effect (upper trapezius, side bucket) showed an amplitude reduction in the treatment condition. Another main effect showing increased amplitude in the intervention condition use was observed in the dominant levator scapulae (side bucket). Thus, the use of the intervention belt reduces EMG amplitude among a number of mid- and lower-back muscles. This is suggestive of a protective effect against back strain.

Estimating the occupational morbidity for migrant and seasonal farmworkers in New York state: a comparison of two methods.

PURPOSE: Compare occupational morbidity estimates for migrant and seasonal farmworkers obtained from survey methods versus chart review methods and estimate the proportion of morbidity treated at federally recognized migrant health centers (MHCs) in a highly agricultural region of New York. METHODS: We simultaneously conducted 1) an occupational injury and illness survey among agricultural workers, 2) MHC chart reviews, and 3) hospital emergency room (ER) chart reviews. RESULTS: Of the 24 injuries reported by 550 survey subjects, 54.2% received treatment at MHCs, 16.7% at ERs, 16.7% at some other facility, and 12.5% were untreated. For injuries treated at MHCs or ERs, the incidence density based on survey methods was 29.3 injuries per 10,000 worker-weeks versus 27.4 by chart review. The standardized morbidity ratio for this comparison was 1.07 (95% confidence intervals = 0.65-1.77). CONCLUSIONS: Survey data indicated that 71% of agricultural injury and illness can be captured with MHC and ER chart review. MHC and ER incidence density estimates show strong correspondence between the two methods. A chart review-based surveillance system, in conjunction with a correction factor based on periodic worker surveys, would provide a cost-effective estimate of the occupational illness and injury rate in this population.

Spanish-speaking dairy workers in New York, Pennsylvania, and Vermont: results from a survey of farm owners.

A New York Center for Agricultural Medicine and Health (NYCAMH) study surveyed 294 dairy farms in New York, Pennsylvania, and Vermont. The study utilized a quarterly telephone survey to assess the proportion of Spanish-speaking workers on these farms, and also to contrast the hazard level of work tasks and prevalence of lost work time between Spanish- and English-speaking workers. The total workforce followed in the study was comprised of 14.4 percent Spanish-speaking workers, with larger farms having a higher proportion than smaller farms (19.9% versus 4.6%, respectively). Of the 294 farms, 22.5 percent had at least one Spanish-speaking worker, which differed, greatly between larger and smaller farms (51.5% versus 7.3%). Spanish workers were significantly younger, worked significantly longer hours and had significantly fewer years of employment than their English-speaking counterparts. Work hour differences were more pronounced on the larger farms. Lost work time, due to on-farm injuries, did not differ between the Hispanic workers and the non-Hispanic workers. After correcting for both age and length of farm employment, Spanish-speaking workers were far less likely to perform managerial functions than their English-speaking counterparts (OR = . 22 p < .01).