1955: The Entre` of Medicine and Public Health into the Field of Agricultural Occupational Safety and Health.

The University of Iowa Institute of Agricultural Medicine (IAM) played a significant role in the development of the field of agricultural medicine. This article is an excerpt from the electronic book The Institute of Agricultural Medicine: an Iowa Idea - Worldwide Impact, 2021 (https://pressbooks.uiowa.edu/agriculturalmedicinehistory/) which provides a detailed history of this story.Olaus Magnus (a clergyman in the Christian Church) in Sweden in 1555, and Bernardon Ramazzini (a physician) in Italy in 1713 wrote of health conditions in farmers. However, there is no evidence found (in the Western Hemisphere) before 1955, where a specific institute was present for the preventive health and medicine for farmers, their families, and their workers. There was an absence of research and outreach in the medical and public health fields in agricultural medicine. The history of the Institute of Agricultural Medicine (IAM) provides a substantive grounding for the field as it stands today. Further, the institute serves as something of a precursor of the One Health Initiative. Here, we trace the history of the institute and highlight its contributions to today's field of agricultural medicine.

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program.

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual's general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.

Trends and Characteristics of Occupational Suicide and Homicide in Farmers and Agriculture Workers, 1992-2010.

OBJECTIVE: We examined work-related homicides and suicides among farm operators/workers in the United States from 1992 to 2010. METHODS: Work-related homicide and suicide cases from 1992 to 2010 were obtained from the Census of Fatal Occupational Injuries. To calculate rates, denominator data on the US working population were also obtained from 2003 to 2010 Current Population Survey. Logistic regression was used to identify factors that were differentially associated with homicide and suicide. RESULTS: Over these 19 years, 171 farm operators/workers died from homicide and 230 died from suicide. When compared to rates of all workers, suicide rates were higher while homicide rates were lower among farm operators/workers. Males (OR = 6.1), whites (OR = 4.7), and 35- to 54-year-old (OR = 2.3) farm operators/workers had increased odds of suicide over homicide compared with their respective counterparts (ie, females, nonwhites, <35-year-olds). Those working in smaller farm operations with <11 employees had 1.7 times the odds of suicide over homicide. CONCLUSIONS: Suicide and homicide are both present in the agricultural industry, with suicide being more common than homicide. Translation of suicide prevention programs should be explored for the agricultural industry.

Translating agricultural health and medicine education across the Pacific: a United States and Australian comparison study.

BACKGROUND: Populations in agricultural communities require health care that is interdisciplinary and cross-sectoral to address the high rate of workplace deaths, preventable injuries and illness. These rates are compounded by limited access to services and the distinctive personal values and culture of farming populations, which both health and rural practitioners must be aware of to reduce the gap between rural and urban population health outcomes. To address the unique health and medical characteristics of agricultural populations, education in agricultural medicine was established through the College of Medicine and the College of Public Health at the University of Iowa in the USA. The course was initially developed in 1974 for teaching medical students, family medicine residents and nurses, and a postgraduate curriculum was added in 2006 to develop medical/health and rural professionals' cultural competence to work in agricultural communities. This article reviews the adaptation of the US course to Australia and the educational and practice outcomes of students who completed the agricultural medicine course in either Australia or the USA. METHODS: Data were collected from students who completed either the Agricultural Medicine: Occupational and Environmental Health for Rural Health Professionals course in the state of Iowa in the USA or the Agricultural Health and Medicine course in the state of Victoria in Australia between 2010 and 2013 (inclusive). Data were analysed using descriptive statistics, frequencies and the χ2 test. Students were invited to make any other comments regarding the course. RESULTS: One hundred and ten students completed the survey (59 from the USA and 51 from Australia) with over a 50% response from both countries, indicating the high level of commitment to this discipline. Responses were consistent across both continents, with more than 91% agreeing that the course improved their abilities to diagnose, prevent and treat rural and agricultural populations. Further, both courses successfully enabled a multidisciplinary and cross-sectoral approach to agricultural health and medicine. CONCLUSIONS: More than 72% of previous students were practising in rural and /or mixed communities at the time of the survey, demonstrating a repeatable and transferable medical education program that supports multidisciplinary care and scholarship while addressing health inequities in agricultural populations. Findings from this study indicate there are opportunities to expand globally.

Detection of Airborne Methicillin-Resistant Staphylococcus aureus Inside and Downwind of a Swine Building, and in Animal Feed: Potential Occupational, Animal Health, and Environmental Implications.

Aerosolized methicillin-resistant Staphylococcus aureus (MRSA) was sampled inside and downwind of a swine facility. Animal feed was sampled before and after entry into the swine facility. Aerosolized particles were detected using an optical particle counter for real-time measurement and with an Andersen sampler to detect viable MRSA. Molecular typing and antimicrobial susceptibility testing were performed on samples collected. Viable MRSA organisms isolated inside the swine facility were primarily associated with particles >5 µm, and those isolated downwind from the swine facility were associated with particles <5 µm. MRSA isolates included spa types t008, t034, and t5706 and were resistant to methicillin, tetracycline, clindamycin, and erythromycin. Animal feed both before and after entry into the swine facility tested positive for viable MRSA. These isolates were of similar spa types as the airborne MRSA organisms. Air samples collected after power washing with a biocide inside the swine facility resulted in no viable MRSA organisms detected. This pilot study showed that the ecology of MRSA is complex. Additional studies are warranted on the maximum distance that viable MRSA can be emitted outside the facility, and the possibility that animal feed may be a source of contamination.

Increasing the number of trained health and safety professionals in agricultural medicine: evaluation of the "building capacity" program, 2007-2013.

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.

Toward a national core course in agricultural medicine and curriculum in agricultural safety and health: the "building capacity" consensus process.

ABSTRACT The agricultural industry poses specific hazards and risks to its workers. Since the 1970s, the University of Iowa has been establishing programs to educate rural health care and safety professionals who in turn provide education and occupational health and safety services to farm families and farm workers. This program has been well established in the state of Iowa as a program of Iowa's Center for Agricultural Safety and Health (I-CASH). However, the National 1989 Agriculture at Risk Report indicated there was a great need for agricultural medicine training beyond Iowa's borders. In order to help meet this need, Building Capacity: A National Resource of Agricultural Medicine Professionals was initiated as a project of the National Institute for Occupational Safety and Health (NIOSH)-funded Great Plains Center for Agricultural Health in 2006. Before the first phase of this project, a consensus process was conducted with a group of safety and health professionals to determine topics and learning objectives for the course. Over 300 students attended and matriculated the agricultural medicine course during first phase of the project (2007-2010). Beginning the second phase of the project (2012-2016), an expanded advisory committee (38 internationally recognized health and safety professionals) was convened to review the progress of the first phase, make recommendations for revisions to the required topics and competencies, and discuss updates to the second edition of the course textbook (Agricultural Medicine: Occupational and Environmental Health for the Health Professions). A formal consensus process was held and included an online survey and also a face-to-face meeting. The group was charged with the responsibility of developing the next version of this course by establishing best practices and setting an agenda with the long-term goal of developing a national course in agricultural medicine.

Work-related musculoskeletal disorders in senior farmers: safety and health considerations.

Aging farmers are at high risk musculoskeletal disorders due to occupational exposures. The development of musculoskeletal conditions can increase older farmers' risk for additional injuries because many older farmers continue to work past typical retirement age. Occupational health nurses with agricultural expertise can assist farmers by evaluating their health and safety needs. Possible interventions include ergonomic improvements in farm equipment, safety improvements in farm environment, and referrals to programs that assist older farmers in modifying their farms to improve safety.

Modifiable risk factors for depressed mood among farmers.

BACKGROUND: Risk for depression among farmers is not fully understood. DSM-IV considers sadness or depressed mood a critical symptom of depression. The aim of this study was to examine risk factors for depressed mood among farmers using a longitudinal study design. METHODS: Participants were principal farm operators in the Iowa Certified Safe Farm study. We identified risk factors for depressed mood by calculating relative risks (RR) using the generalized estimating equations method. RESULTS: In the multivariate model, pesticide exposure (RR = 1.26; 95% CI: 1.04 to 1.53), having an additional job off the farm (RR = 1.32; 95% CI: 1.08 to 1.62), stress (RR = 3.09; 95% CI: 2.55 to 3.75), and previous injury (RR = 1.41; 95% CI: 1.05 to 1.89) prospectively increased the risk of depressed mood. CONCLUSIONS: Consistent with earlier non-longitudinal studies, the results of this study suggest that reducing pesticide exposure, stress, and injury may reduce the risk of depression in the farm setting.

Respirator and hearing protection use in the certified safe farm program.

An evaluation was conducted on the results of the Certified Safe Farm controlled intervention program on a wide range of occupational health and safety outcomes. This report focuses on the outcomes of personal protective equipment (PPE) usage among one cohort of 438 Iowa (owner-operator) farmers in the Certified Safe Farm study during a 5-year period from 2004 to 2008. Intervention farmers reported an 11% increase in regular respirator usage and a 23% increase in regular use of hearing protection relative to comparison groups. Furthermore, it was revealed that personal factors such as smoking and low self-assessment of health status are associated with lower usage of PPE. The authors provide evidence that multiple modalities of intervention are more likely to affect safe behavior changes in the owner-operator farming population compared with single modality interventions. Further, farmers reported that personal factors such as smoking history and low self-assessment of health status are associated with lower usage of PPE.

Assessment of swine worker exposures to dust and endotoxin during hog load-out and power washing.

Field measurements of personal and area dust and endotoxin concentrations were obtained while agricultural workers performed two work tasks that have been previously unreported: hog load-out and swine building power washing. Hog load-out involves moving hogs from their pens in finishing buildings into a truck for transport to a meat processor. High pressure power washing is conducted for sanitation purposes after a building has been emptied of hogs to remove surface and floor debris. This debris consists of feed, feces, and hog dander as dust or an encrusted form. The hog load-out process necessarily increases pig activity which is known to increase airborne dust concentrations. An unintended consequence of power washing is that the material covering surfaces is forcibly ejected into the atmosphere, creating the potential for a highly concentrated aerosol exposure to workers. The load-out process resulted in a median personal inhalable mass concentration of 7.14 mg m(-) (3) and median endotoxin concentration of 12 150 endotoxin units (EU) m(-) (3). When converted to an 8-h time-weighted average for a 'total' sampler, one of the 19 samples exceeded a regulatory limit of 15 mg m(-) (3). An impinger was used to sample power washing endotoxin concentrations, which resulted in a median personal concentration of 40 350 EU m(-) (3). These concentrations were among the highest found in the literature for any occupation. With the lack of engineering controls present to reduce airborne contaminant concentrations in swine buildings, either respirator use or a reduction in exposure time is recommended while performing these tasks.

Agricultural medicine core course: building capacity for health and safety professionals.

In 1987 the University of Iowa began training health care professionals to care for farmers' occupational health needs. The training enables health professionals from various disciplines to function in the anticipation, diagnosis, treatment, and prevention of occupational illnesses and injuries in the farm community. A grant from National Institute for Occupational Safety and Health (NIOSH) entitled "Building Capacity for Health and Safety Professionals" allowed for the expansion of this training to other states. This paper describes the challenges, successes, and lessons learned from dissemination of Agricultural Medicine Core Course.

Participatory approach to identify interventions to improve the health, safety, and work productivity of smallholder women vegetable farmers in the Gambia.

OBJECTIVE: This paper describes the qualitative, community-based participatory approach used to identify culturally-acceptable and sustainable interventions to improve the occupational health, safety, and productivity of smallholder women vegetable farmers in The Gambia (West Africa). MATERIALS AND METHODS: This approach was used to conduct: 1) analysis of the tasks and methods traditionally used in vegetable production, and 2) selection of interventions. RESULTS: The most arduous garden tasks that were amenable to interventions were identified, and the interventions were selected through a participatory process for further evaluation. CONCLUSIONS: Factors contributing to the successful implementation of the participatory approach used in this study included the following: 1) ensuring that cultural norms were respected and observed; 2) working closely with the existing garden leadership structure; and 3) research team members working with the subjects for an extended period of time to gain first-hand understanding of the selected tasks and to build credibility with the subjects.

Preventing heat-related illness among Hispanic farmworkers.

Hispanic and Latino farmworkers are at risk for negative occupational health and safety outcomes due to issues such as their extreme work conditions, their reliance on employer beneficence, and cultural barriers. The purpose of this article is to explain the unique characteristics of heat-related illness in the Hispanic agricultural work force and to provide an overview of the problems of poor hydration and heat exposure in this population. Culturally appropriate preventive strategies are discussed because industrial-type solutions may not work in a crop production environment where language and beliefs may interfere with adaptation.

Evaluation of long- and short-handled hand hoes for land preparation, developed in a participatory manner among women vegetable farmers in The Gambia.

OBJECTIVE: This study evaluated land preparation interventions (new short- and long-handled hoes), developed in a participatory manner with women vegetable farmers in West Africa, and identified indicators of long-term adoption of these interventions. METHODS: Subjects (n = 48) engaged in timed trials, alternating between using an intervention tool and their traditional hand hoe to till specified plots of land. Heart rates were measured and subjects reported the relative ergonomic comfort and safeness of the tool after each trial. Follow-up interviews and focus groups were held one, two, and three months after the trials. RESULTS: Compared to the traditional hoe, the new long-handled hoe required 22% less time (p = 0.01), while the new short hoe took 20% more time (p = 0.05) to till the standard plots in this study. Two months after the initial trials, 94% of subjects preferred the new hoes over the traditional hoe. Most subjects (75%) preferred the new short hoe over the new long hoe and thought it was faster (81%), despite measurements to the contrary. CONCLUSIONS: While the new long-handled hoe performed better in the timed trials in this study, most subjects preferred the new short-handled hoe. Subjects should be sensitized on the benefits of the long-handled hoe.

Prevention of occupational respiratory symptoms among certified safe farm intervention participants.

Certified Safe Farm (CSF) is a multifaceted intervention including clinical Occupational and wellness screening, education, and on-farm safety audits with set safety standards, and performance incentives. Five years of respiratory health outcomes are reported in 150 CSF intervention farmers and 158 matched controls. Standardized health interviews and occupational histories were analyzed with descriptive statistics to determine prevalence rates. There was a 100% response rate from the standardized telephone interviews, and respectively a 94% and 89 % response rate from the self-administered occupational health history questionnaire for the CSF intervention and the comparison population. The overall rate for occupational respiratory conditions was 17/100 person-years. At baseline there was no difference between the prevalence of respiratory symptoms between the CSF and control groups. However, over the course of the intervention, the CSF farmers increased their use of personal protective respiratory equipment at work, and experienced fewer episodes of acute symptoms of organic dust toxic syndrome (ODTS). The Certified Safe Farm intervention appeared to affect increased use of respiratory protection and decreased symptoms of ODTS.

Unintentional needlestick injuries in livestock production: a case series and review.

Livestock producers and their employees sometimes experience unintentional needlestick injury (NSI) while vaccinating or injecting medications into animals. There is little published regarding the medical complications that can develop from this occupational exposure. The objectives of this study were to (1) perform a retrospective review of animal-related NSIs treated at a tertiary medical center of a rural state; and (2) review the risks of NSI and measures to decrease their occurrence. Medical records of patients with NSI related to animal injection were identified from the University of Iowa Hospitals and Clinics database from 2002 to 2008 and reviewed. Nine patients received medical care for NSI that occurred while vaccinating farm animals. Most common NSI site was the nondominant hand and most occurred while attempting to inject the animal. Soft tissue infection was common and all nine received oral and/or intravenous antibiotics. Two thirds required hospital admission. Three required surgery and one had a bedside incision and drainage procedure. One patient had a serious inflammatory reaction with necrosis in the leg due to the oil adjuvant in the animal vaccine. Another case had a probable mycetoma with osteomyelitis and soft tissue infection due to the bacteria Streptomyces, which is a NSI complication not previously reported. Although medical complications from farm-related NSIs do not appear to be common, this case series illustrates how these injuries can be debilitating, costly, and lead to loss of work time and productivity. Producers and employees who inject livestock need to be aware of the risks and utilize measures to decrease unintentional NSI.

Methicillin-resistant Staphylococcus aureus in pork production shower facilities.

As methicillin-resistant Staphylococcus aureus (MRSA) has been found in pigs, we sought to determine if MRSA is present in pork production shower facilities. In two production systems tested, 3% and 26% of shower samples were positive for MRSA. spa types identified included t034, t189, t753, and t1746.

Self-reported methicillin-resistant Staphylococcus aureus infection in USA pork producers.

Pork producers selected from the National Pork Board`s producer database were surveyed. Five (3.7%) reported being diagnosed with a MRSA infection. Risk factors related to swine farm biosecurity were examined. None were statistically significant predictors of MRSA infection.

Evaluation of the Limulus amebocyte lysate and recombinant factor C assays for assessment of airborne endotoxin.

As a potent inflammatory agent, endotoxin is a key analyte of interest for studies of lung ailments in domestic environments and occupational settings with organic dust. A relatively unexplored advance in endotoxin exposure assessment is the use of recombinant factor C (rFC) from the Limulus pathway in a fluorometric assay. In this study, we compared airborne endotoxin concentrations in laboratory- and field-collected parallel air samples using the kinetic Limulus amebocyte lysate (LAL) assay and the rFC assay. Air sampling was performed using paired Institute of Occupational Medicine (IOM) samplers, Button samplers, closed-face cassettes, and cyclone samplers. Field sampling was performed in 10 livestock production facilities, including those housing swine, chicken, turkey, dairy cows, cattle, and horses. Laboratory sampling was performed in exposure chambers using resuspended airborne dust collected in five livestock facilities. Paired samples were extracted in pyrogen-free water with 0.05% Tween 20 and analyzed using LAL and rFC assays. In 402 field sample pairs there was excellent agreement between endotoxin concentrations determined by LAL and rFC (r = 0.93; P < 0.0001). In 510 laboratory sample pairs there was also excellent agreement between the two assays (r = 0.86; P < 0.0001). Correlations for subgroups of facility or dust type ranged from 0.65 to 0.96. Mixed-model analysis of variance (ANOVA) for the field studies showed significant interactions of facility-sampler and facility-assay. rFC/LAL ratios of the geometric means were 0.9 to 1.14 for the samplers (not significantly different from 1.0). The data from this study demonstrate that the LAL assay and the rFC assay return similar estimates of exposure in livestock facilities. Both methods provided suitable lower limits of detection such that all but 19 of 1,824 samples were quantifiable.