Mental health service use and cost by Australian women in metropolitan and rural areas.

INTRODUCTION: The use and costs of mental health services by rural and remote Australian women are poorly understood. OBJECTIVE: To examine the use of the Better Access Scheme (BAS) mental health services across geographical areas. DESIGN: Observational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973-1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services. FINDINGS: 31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively). DISCUSSION: Women in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas. CONCLUSION: Regardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services.

Factors influencing nursing and allied health recent graduates' rural versus urban preferred principal place of practice: A cross-sectional data linkage study.

INTRODUCTION: Disparities between metropolitan and non-metropolitan health workforce must be addressed to reduce inequities in health care access. Understanding factors affecting early career practitioners' choice of practice location can inform workforce planning. OBJECTIVE: To investigate influences on rural practice location preferences of recent graduates. DESIGN: Cross-sectional analysis linked university enrolment, Graduate Outcomes Survey (GOS) and Australian Health Professional Regulation Agency (Ahpra) principal place of practice (PPP) for 2018 and 2019 nursing and allied health graduates from two Australian universities. Chi-squared tests and logistic regression compared rural versus urban PPP and locational preference. FINDINGS: Of 2979 graduates, 1295 (43.5%) completed the GOS, with 63.7% (n = 825) working in their profession and 84.0% of those (n = 693) in their preferred location. Ahpra PPP data were extracted for 669 (81.1%) of those working in their profession. Most reported influences were 'proximity to family/friends' (48.5%), 'lifestyle of the area' (41.7%) and 'opportunity for career advancement' (40.7%). Factors most influential for rural PPP were 'cost of accommodation/housing' (OR = 2.26, 95% CI = 1.23-4.17) and 'being approached by an employer' (OR = 2.10, 95% CI = 1.12-3.92). Having an urban PPP was most influenced by 'spouse/partners employment/career' (OR = 0.53, 95% CI = 0.30-0.93) and 'proximity to family/friends' (OR = 0.41, 95% CI = 0.24-0.72). DISCUSSION: While the findings add strength to the understanding that graduates who originated from a rural area are most likely to take up rural practice in their preferred location, varied social and professional factors are influential on decision-making. CONCLUSIONS: It is imperative to recruit students from non-metropolitan regions into health professional degrees, as well as addressing other influences on choice of practice location.

Profile and rural exposure for nursing and allied health students at two Australian Universities: A retrospective cohort study.

OBJECTIVE: Linking enrolment and professional placement data for students' from 2 universities, this study compares characteristics across universities and health disciplines. The study explores associations between students' location of origin and frequency, duration and type of placements. DESIGN: Retrospective cohort data linkage. SETTING: Two Australian universities, Monash University and the University of Newcastle. PARTICIPANTS: Students who completed medical radiation science, nursing, occupational therapy, pharmacy or physiotherapy at either university between 2 February 2017 and 28 February 2018. INTERVENTIONS: Location of origin, university and discipline of enrolment. MAIN OUTCOME MEASURE(S): Main measures were whether graduates had multiple rural placements, number of rural placements and cumulative rural placement days. Location of origin, discipline and university of enrolment were the main explanatory variables. Secondary dependent variables were age, sex, socio-economic indices for location of origin, and available placements. RESULTS: A total of 1,315 students were included, of which 22.1% were of rural origin. The odds of rural origin students undertaking a rural placement was more than 4.5 times greater than for urban origin students. A higher proportion of rural origin students had multiple rural placement (56.0% vs 14.9%), with a higher mean number of rural placement days. Public hospitals were the most common placement type, with fewer in primary care, mental health or aged care. CONCLUSIONS: There is a positive association between rural origin and rural placements in nursing and allied health. To help strengthen recruitment and retention of graduates this association could be further exploited, while being inclusive of non-rural students.

Destinations of nursing and allied health graduates from two Australian universities: A data linkage study to inform rural placement models.

OBJECTIVE: Combined, nursing and allied health constitute most of the Australian health workforce; yet, little is known about graduate practice destinations. University Departments of Rural Health have collaborated on the Nursing and Allied Health Graduate Outcomes Tracking to investigate graduate entry into rural practice. DESIGN: Data linkage cohort study. SETTING: Monash University and the University of Newcastle. PARTICIPANTS: Graduates who completed their degree in 2017 across seven disciplines. MAIN OUTCOME MEASURE(S): The outcome variable was Australian Health Practitioner Regulation Agency principal place of practice data. Explanatory variables included discipline, age, gender, location of origin, and number and duration of rural placements. RESULT: Of 1130 graduates, 51% were nurses, 81% females, 62% under 21 years at enrolment, 23% of rural origin, 62% had at least one rural student placement, and 23% had over 40 cumulative rural placement days. At the time of their second Australian Health Practitioner Regulation Agency registration, 18% worked in a 'Rural principal place of practice.' Compared to urban, rural origin graduates had 4.45 times higher odds ratio of 'Rural principal place of practice.' For graduates who had <20 cumulative rural placement days, compared to zero the odds ratio of 'Rural principal place of practice' was the same (odds ratio = 1.10). For those who had 20-40 rural placement days, the odds ratio was 1.93, and for >40 rural placement days, the odds ratio was 4.54). CONCLUSION: Rural origin and more rural placement days positively influenced graduate rural practice destinations. Outcomes of cumulative placements days may compare to immersive placements.

Rationale and protocol for the Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study: a large-scale longitudinal investigation of graduate practice destinations.

INTRODUCTION: Inequitable distribution of health workforce limits access to healthcare services and contributes to adverse health outcomes. WHO recommends tracking health professionals from their points of entry into university and over their careers for the purpose of workforce development and planning. Previous research has focused on medical students and graduates' choice of practice location. Few studies have targeted nursing and allied health graduates' practice intentions and destinations. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study is investigating factors affecting Australian nursing and allied health students and graduates' choice of graduate practice location over the course of their studies and up to 10 years after graduation by linking multiple data sources, including routinely collected university administrative and professional placement data, surveys of students and graduates, and professional registration data. METHODS: By using a prospective cohort study design, each year a new cohort of about 2000 students at each participating university (Deakin University, Monash University and the University of Newcastle) is tracked throughout their courses and for 10 years after graduation. Disciplines include medical radiation practice, nursing and midwifery, occupational therapy, optometry, paramedicine, pharmacy, physiotherapy, podiatry and psychology. University enrolment data are collected at admission and professional placement data are collected annually. Students' practice destination intentions are collected via questions added into the national Student Experience Survey (SES). Data pertaining to graduates' practice destination, intentions and factors influencing choice of practice location are collected in the first and third years after graduation via questions added to the Australian Graduate Outcomes Survey (GOS). Additionally, participants may volunteer to receive a NAHGOT survey in the second and fourth-to-tenth years after graduation. Principal place of practice data are accessed via the Australian Health Practitioner Regulation Agency (Ahpra) annually. Linked data are aggregated and analysed to test hypotheses comparing associations between multiple variables and graduate practice location. RESULTS: This study seeks to add to the limited empirical evidence about factors that lead to rural practice in the nursing and allied health professions. This prospective large-scale, comprehensive study tracks participants from eight different health professions across three universities through their pre-registration education and into their postgraduate careers, an approach not previously reported in Australia. To achieve this, the NAHGOT study links data drawn from university enrolment and professional placement data, the SES, the GOS, online NAHGOT graduate surveys, and Ahpra data. The prospective cohort study design enables the use of both comparative analysis and hypothesis testing. The flexible and inclusive study design is intended to enable other universities, as well as those allied health professions not regulated by Ahpra, to join the study over time. CONCLUSION: The study demonstrates how the systematic, institutional tracking and research approach advocated by the WHO can be applied to the nursing and allied health workforce in Australia. It is expected that this large-scale, longitudinal, multifactorial, multicentre study will help inform future nursing and allied health university admission, graduate pathways and health workforce planning. Furthermore, the project could be expanded to explore health workforce attrition and thereby influence health workforce planning overall.

Comparison of cancer incidence in Australian farm residents 45 years and over, compared to rural non-farm and urban residents - a data linkage study.

BACKGROUND: It is not known if the incidence of common cancers in Australian farm residents is different to rural non-farm or urban residents. METHODS: Data from farm, rural non-farm and urban participants of the 45 and Up Study cohort in New South Wales, Australia, were linked with state cancer registry data for the years 2006-2009. Directly standardised rate ratios for cancer incidence were compared for all-cancer, prostate, breast, colorectal cancer, melanoma and non-Hodgkin Lymphoma (NHL). Proportional hazards regression was used to generate incidence hazard ratios for each cancer type adjusted for relevant confounders. RESULTS: Farm women had a significantly lower all-cancer hazard ratio than rural non-farm women (1.14, 1.01-1.29). However, the lower all-cancer risk observed in farm men, was not significant when compared to rural non-farm and urban counterparts. The all-cancer adjusted hazard ratio for combined rural non-farm and urban groups compared to farm referents, was significant for men (1.08,1.01-1.17) and women (1.13, 1.04-1.23). Confidence intervals did not exclude unity for differences in risk for prostate, breast, colorectal or lung cancers, NHL or melanoma. Whilst non-significant, farm residents had considerably lower risk of lung cancer than other residents after controlling for smoking and other factors. CONCLUSIONS: All-cancer risk was significantly lower in farm residents compared to combined rural non-farm and urban groups. Farm women had a significantly lower all-cancer adjusted hazard ratio than rural non-farm women. These differences appeared to be mainly due to lower lung cancer incidence in farm residents.

Stage of diagnosis of prostate, breast and colorectal cancer in farm residents compared with other rural and urban residents in New South Wales.

OBJECTIVE: To determine if stage at diagnosis of prostate, breast and colorectal cancers differs between farm, rural non-farm and urban residents. DESIGN: Data linkage of baseline survey information from a large cohort study, with state cancer registry records from 2006 to 2009. SETTING: New South Wales, Australia. PARTICIPANTS: New South Wales residents enrolled in the 45 and Up Study cohort. MAIN OUTCOME MEASURES: Adjusted odds ratio of non-localised cancer stage was modelled using binary logistic regression, controlling for commonly known cancer risk factors. RESULTS: Overall differences in the odds ratios for later stage prostate, breast and colorectal cancer diagnosis in farm men and women compared with rural non-farm and urban counterparts were not statistically significant, although farm men had twice the odds of either group of being diagnosed at later stage colorectal cancer. The odds of later stage prostate cancer for farm and urban men were similar, but rural non-farm men were significantly less likely than urban men to be diagnosed at later stage. Higher household income was associated with later stage breast and prostate cancer; and private health insurance with extras was negatively associated with later stage prostate cancer. CONCLUSIONS: Differences in stage of cancer diagnosis, particularly between farm and rural non-farm men, remain unexplained but were not statistically significant. Farm men may be at higher risk of later stage colorectal cancer diagnosis, which if confirmed has implications for research on possible reasons, and for the delivery of appropriate cancer diagnostic services in rural areas.

Farmers' knowledge of Q fever and prevention approaches in New South Wales.

OBJECTIVE: To identify what New South Wales (NSW) farmers know about Q fever to inform preventive approaches. DESIGN: Thematic analysis of qualitative data gathered through semi-structured individual interviews, focus groups and a community meeting. SETTING: Rural communities in NSW, Australia. PARTICIPANTS: A total of 25 farmers participated in individual interviews (n = 4) or three focus groups, each with seven participants (n = 21). A further 27 persons, were involved in a community meeting. MAIN OUTCOME MEASURES: Themes derived from the interviews, focus groups and community meeting. RESULTS: Knowledge variations regarding Q fever risk and transmission highlight a need for improved risk communication. Vaccination was viewed as the preferred prevention approach; barriers were raised including time, costs, access to screening/vaccination and General Practitioner (GP) knowledge about Q fever. Local vaccination initiatives were supported. CONCLUSIONS: Strengthening existing GP knowledge and services leading to expanded provision of screening/vaccination could improve the coverage of Q fever vaccine in endemic NSW farming and rural communities.

Safe play areas on farms in New South Wales.

OBJECTIVE: To assess the prevalence and security of fenced house yards on NSW farms and rural properties with a view to providing information to increase the development of safe play areas on farms. DESIGN: A cross-sectional stratified study using computer-assisted telephone interviewing. SETTING: Interviews were conducted in the four rural Area Health Services throughout February to December 2008. PARTICIPANTS: Randomly selected sample of 1117 adults living on a farm or rural property in the study areas. MAIN OUTCOME MEASURES: Self-reported issues involving fenced house yards or safe play areas for children. RESULTS: Overall, 79.8% of farm respondents reported that they had a fenced house yard or safe play area. For those respondents with a fenced house yard, 66.6% reported that it was secure enough to prevent /make it difficult for a young child to wander away unsupervised. Based on these figures, it is estimated that only 53.1% of all farms or rural properties have a secure fenced house yard or safe play area. There were statistically significant variations between geographic locations, with the North Coast (37.7%) being lower. CONCLUSIONS: This study illustrates a need across rural NSW to further promote, install or upgrade secure fenced house yards or safe play areas. While all geographic regions of the state could improve provision to protect children, there may also be some that are in need of more intensive intervention programs to enhance compliance. Such a proposition may also be relevant on a national level.

Factors influencing medical radiation science graduates' early career principal place of practice: a retrospective cohort study.

INTRODUCTION: While studies have investigated influences on graduate practice locations of other health professionals, especially medicine, none have investigated practice locations of medical radiation science (MRS) graduates. This study aimed to explore factors influencing the registered principal place of practice (PPP) of diagnostic radiography, radiation therapy and nuclear medicine graduates from the University of Newcastle (UON), Australia, in their second post-graduate year. METHODS: Data were extracted from the UON enrolment and clinical placement databases and linked to Australian Health Practitioners Regulation Agency (Ahpra) registration data for PPP location in 2019 for 187 graduates who completed their studies in 2017. Explanatory variables included age at enrolment, gender, MRS discipline, location of origin, socio-economic index for location of origin, and locations and duration of undergraduate professional placements. Descriptive statistics, tests of association and logistic regression compared rural and non-rural origin, and professional placement locations with Ahpra PPP. RESULTS: Factors related to non-metropolitan PPP were location of origin (P = 0.002), number (P = 0.002) and duration (P = 0.007) of rural placements, and MRS discipline (P = 0.033). Controlling for other variables, location of origin and MRS discipline remained significant. Graduates of rural origin had up to 3.54 (95%CI = 1.51-8.28) times the odds of a rural PPP. Diagnostic radiography graduates had up to 5.46 (95%CI = 1.55-19.20) times the odds of nuclear medicine of a rural PPP. CONCLUSION: To help reduce the gap between rural and metropolitan medical radiation service availability, there is a need for targeted recruitment of rural origin students. Further investigation of the effect of rural undergraduate MRS placements is justified.

Medical treatment decision-making in rural cancer patients: A qualitative systematic review and meta-synthesis.

OBJECTIVE: Rural cancer patients have unique care needs which may impact upon treatment decision-making. Our aim was to conduct a qualitative systematic review and meta-synthesis to understand their perspectives and experiences of making treatment decisions. METHODS: A systematic search of MEDLINE, PsycINFO, CINAHL and RURAL was conducted for qualitative studies in rural cancer patients regarding treatment decision-making. Articles were screened for relevance, and data from the included articles were extracted and analysed using meta-thematic synthesis. RESULTS: Twelve studies were included, with 4 themes and 9 subthemes identified. Many studies reported patients were not given a choice regarding their treatment. Choice, if given, was influenced by personal factors such as finances, proximity to social supports, convenience, and their personal values. Patients were also influenced by the opinions of others and cultural norms. Finally, it was reported that patients made choices in the context of seeking the best possible medical care and the patient-clinician relationship. CONCLUSIONS: In the rural context, there are universal and unique factors that influence the treatment decisions of cancer patients. PRACTICAL IMPLICATIONS: Our findings are an important consideration for clinicians when engaging in shared decision-making, as well as for policymakers, to understand and accommodate the unique rural perspective.

Beyond 50. Challenges at work for older nurses and allied health workers in rural Australia: a thematic analysis of focus group discussions.

BACKGROUND: The health workforce in Australia is ageing, particularly in rural areas, where this change will have the most immediate implications for health care delivery and workforce needs. In rural areas, the sustainability of health services will be dependent upon nurses and allied health workers being willing to work beyond middle age, yet the particular challenges for older health workers in rural Australia are not well known. The purpose of this research was to identify aspects of work that have become more difficult for rural health workers as they have become older; and the age-related changes and exacerbating factors that contribute to these difficulties. Findings will support efforts to make workplaces more 'user-friendly' for older health workers. METHODS: Nurses and allied health workers aged 50 years and over were invited to attend one of six local workshops held in the Hunter New England region of NSW, Australia. This qualitative action research project used a focus group methodology and thematic content analysis to identify and interpret issues arising from workshop discussions. RESULTS: Eighty older health workers from a range of disciplines attended the workshops. Tasks and aspects of work that have become more difficult for older health workers in hospital settings, include reading labels and administering medications; hearing patients and colleagues; manual handling; particular movements and postures; shift work; delivery of babies; patient exercises and suturing. In community settings, difficulties relate to vehicle use and home visiting. Significant issues across settings include ongoing education, work with computers and general fatigue. Wider personal challenges include coping with change, balancing work-life commitments, dealing with attachments and meeting goals and expectations. Work and age-related factors that exacerbate difficulties include vision and hearing deficits, increasing tiredness, more complex professional roles and a sense of not being valued in the context of greater perceived workload. CONCLUSIONS: Older health workers are managing a range of issues, on top of the general challenges of rural practice. Personal health, wellbeing and other realms of life appear to take on increasing importance for older health workers when faced with increasing difficulties at work. Solutions need to address difficulties at personal, workplace and system wide levels.

Mortality patterns of Australian male farmers and farm managers.

OBJECTIVE: To compare the all-cause and specific-cause death rates of Australian male farmers and farm managers aged 25-74 years, with other Australian men. METHODS: Data were extracted from the Australian Bureau of Statistics Death Registration Collection covering the calendar years of 1999-2002. Denominator data for male farmers and farm managers were drawn from the 2001 Australian Population Census. Direct age-standardized death rates were calculated and compared with the general Australian male population. RESULTS: The 4025 male farmers or farm managers who died in this period represented 3.35% of all male deaths in the 25-74 year age range. The all-cause death rate for farmers and farm managers (730/100,000) was 33% higher than that of the Australian male population of the same age (549/100,000) (standardized mortality ratio (SMR)=1.33). Causes of death related to neoplasms (SMR=1.37), circulatory disease (SMR=1.40) and all external causes (SMR=1.37), were all statistically higher than the comparison population. Within these groupings, ischaemic heart disease (SMR=1.39), other circulatory disease (SMR=1.42), prostate cancer (SMR=2.40), lymphohaematopoietic cancer (SMR=1.80) and transport injuries (SMR=2.06), were all significantly higher. CONCLUSION: These data indicate that Australian male farmers and farm managers are a disadvantaged group in terms of health status. The elevated rates of all-cause and specific-cause mortality compared with the Australian comparison population, illustrate both the need and scope for further investigation of these issues.

Comparative use of cancer therapies in Australian farm, rural nonfarm and urban residents aged 45 years and older.

Objectives and importance of the study: To determine whether use of selected therapies for prostate, breast and colorectal cancer in farm residents differs from that in rural nonfarm and urban counterparts. Little is known about cancer therapies used by farm residents. STUDY TYPE: Data linkage cohort study. METHODS: Baseline survey information from the Sax Institute's 45 and Up Study cohort was linked with data from the New South Wales Admitted Patient Data Collection for 2006-2012. Adjusted odds of receiving surgery, chemotherapy, radiotherapy and/or brachytherapy for each cancer were compared between groups, controlling for selected variables. RESULTS: Differences in the likelihood of surgery for breast and colorectal cancer between groups were not significant. However, for prostate cancer, farm men had 35% greater odds of prostatectomy than rural nonfarm men (odds ratio [OR] 1.35; 95% CI 1.05, 1.72). Urban men were most likely to have had brachytherapy, with three times greater odds of treatment than farm men (OR 2.90; 95% CI 1.51, 5.56). Urban women were most likely to have had chemotherapy for breast cancer, having twice the odds of receiving this treatment as farm women (OR 2.24; 95% CI 1.25, 4.04). The odds of chemotherapy for colorectal cancer among rural nonfarm residents were two-thirds the odds among urban men (OR 0.62; 95% CI 0.44, 0.90) and urban women (OR 0.57; 95% CI 0.37, 0.88). Age, distance, income and health insurance factors contributed to differences in nonsurgical care between groups. CONCLUSIONS: Cancer-related surgical services for breast and colorectal cancer were comparable between groups. Farm and rural nonfarm residents may have been disadvantaged in relation to nonsurgical therapies for prostate, breast and colorectal cancer compared with urban counterparts.

An evidence-consultation base for developing child injury prevention priorities for Australian farms.

ISSUE ADDRESSED: Child injury on farms is a significant public health problem. This article describes the evidence and consultation base for development of a national strategy for child safety on farms in Australia. METHODS: A data profile describing farm child injury was compiled, with evidence for the effectiveness of solutions being defined and the strength of recommendations determined. Representative working groups played a key role in assessing the evidence and advising on the best ways to communicate prevention messages within the farming community. RESULTS: The main risks identified were drowning; farm vehicle and machinery injury; and injury associated with motorbikes and horses. Prevention recommendations were: (1) creating effective safe play areas on farms; (2) use of seatbelts/restraints in farm vehicles, (3) prevention of children riding as passengers on tractors, ATVs or the back of utilities; and (4) use of helmets when riding horses and motorbikes. CONCLUSIONS: Evidence on key injury risks and solutions has been a cornerstone to set the agenda for child safety on farms. An evidence-consultation base has achieved credibility with potential partners at all levels for adopting priority child safety messages.

A review of prostate cancer incidence and mortality studies of farmers and non-farmers, 2002-2013.

OBJECTIVES: To review the recent literature on the incidence and mortality of prostate cancer in farmers compared to non-farmers. METHODS: Searches were conducted in seven electronic databases for observational studies published from 2002 to 2013. Studies were assessed against eligibility criteria and a narrative summary of findings presented. RESULTS: Eighteen primary research articles were included in the review. Four of ten mortality studies and two of nine incidence studies reported statistically significant increases in prostate cancer risk in farmers. However, nearly half of all studies reported non-significant reductions in farmers' risk. Additionally, one study reported significantly increased and decreased risk using different outcome measures. Results varied considerably by geographic region, study design and degree of control for confounders, affecting comparability and strength of findings. CONCLUSIONS: The overall evidence for increased prostate cancer risk in farmers was weak.

Changes in the hearing status and noise injury prevention practices of Australian farmers from 1994 to 2008.

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.