Farmers' occupational health programme in Finland, 1979-1987.

At the beginning of 1985, the National Board of Health in Finland issued directives for the initiation of farmers' occupational health services in municipal health care centres. The directives were based on the evaluation study on farmers' occupational health services in Finland. The main aim of this study is to analyse the current problems of the farmers' occupational health care system and to analyse how effective the system is. The efficiency of the occupational health services has been surveyed with postal inquiries twice, first in 1982 and later in 1986. The farmers' knowledge of appropriate means for reducing hazardous exposures had improved significantly since the initiation of the occupational health services. The effect of the occupational health services was evident particularly in the more effective use of personal safety devices. The limited resources at the municipal health care centres form the main obstacle in the provision of occupational health services for all farmers who would like to have them. 25-35% of the farmers in Finland (total 45,000 farmers) are willing to participate in the occupational health care system. Participation is voluntary for self-employed farmers.

A feasibility study of organizing occupational health services for farmers.

In Finland the Occupational Health Care Act of 1979 provides farmers the possibility of purchasing occupational health services. The main objective of the present study is to develop national model for the organization of occupational health services for farmers. The problems of providing and specifying occupational health services for farmers can be described by two parameters. The first is the type of farm production. The occupational health services to be provided are though to depend on the occupational health risks. The risks vary with the type of farm production, which in turn depends on the geographic location of the farm. The second parameter represents the supply of occupational services to be provided by the municipal health center. The supply has been characterized as occupational health inspections of farms, health examinations, and health education. For the optimization of the supply and the demand, the experiment consists of three models to be tested in respect to two matrices of risk. The feasibility of the models in the 2-a experiment will be evaluated by pre- and postexperimental surveys.

Serum precipitins against microbes in mouldy hay with respect to the geographical location of the farm and to the work of farmers.

This study was based on a sample of 3,065 farmers from a larger survey population of 12,056 Finnish farmers. Data were gathered in a postal survey conducted by the Social Insurance Institution of Finland. Serum precipitins were determined by a microplate method of immune diffusion. The antigen panel consisted of mycelial antigens of Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus fumigatus, and Aspergillus umbrosus. Geographical variation in the prevalence of precipitins was statistically significant, evidently due to climatic differences. The more intensive the cattle raising, the more commonly were precipitins found in the sera of farmers. For participation in animal tending (cattle, pigs, or poultry) or in plant cultivation work only, the prevalence of precipitins was largest among farmers who tended cattle or swine. According to earlier studies, serum precipitins to Thermoactinomyces vulgaris are associated with farmer's lung. Precipitins to this microbe were most commonly found in farmers who tended pigs and were also very common in farmers who worked only in plant cultivation. These findings imply that farmer's lung may also develop among pig farmers and grain producers. Precipitins to Thermoactinomyces vulgaris were clearly related to the type of grain drier used on the farm. The study failed to identify detailed tasks in farming associated with large prevalence of precipitins, probably owing to considerable overlap in the exposure encountered in different tasks.

Effects of respiratory morbidity on occupational activity among farmers.

Work-related respiratory diseases are common among farmers. Few studies, however, have dealt with the consequences of respiratory diseases for the lives of the afflicted farmers. To estimate the socioeconomic consequences of respiratory diseases in the farming population, we made a cross-sectional study and a follow-up study. In 1979 farmers with farmer's lung were twice as likely as healthy farmers to plan to reduce their farming work or to stop farming completely. Fifteen percent of the farmers who developed chronic bronchitis during a three-year follow-up had decided to reduce farming work, close down the farm or change the line of production on the farm. The respective rate for healthy farmers was 8%. In 1982, after the follow-up study of new cases of respiratory diseases, the rate of giving up occupational activities was twice as great among individuals with farmer's lung or asthma as in the rest of the farming population. Based on this study, we estimated that of the new cases of respiratory diseases, every tenth will stop farming in the near future, owing to one of the respiratory diseases analyzed. In Finland about 300 farmers per 100,000 and a total of about 600 farmers annually reduce their farming work or stop farming due to respiratory diseases.

Prevalence and incidence of chronic bronchitis and farmer's lung with respect to the geographical location of the farm and to the work of farmers.

Prevalence and incidence of chronic bronchitis and farmer's lung in the Finnish farming population were studied by cross-sectional and follow-up surveys of 12,056 farmers. Occurrence of both these diseases varied greatly according to geographical location of the farm. The incidence of chronic bronchitis (2,687 new cases annually per 100,000 farmers) was twice as large in southwestern as in northern Finland. Chronic bronchitis was more common among farmers in livestock production than among those in grain production. The definition of farmer's lung adopted confined the occurrence of the disease among farmers engaged in animal tending. In livestock production, chronic bronchitis was strongly associated with swine tending, but farmer's lung with both cattle and swine tending. Use of a harvester with a sack loader turned out to be characteristic of the chronic bronchitis cases, and the number of new cases was largest among farmers who used a batch type cell drier. The farmers with grain driers that use unheated air most frequently suffered from farmer's lung. Of all (147) the characteristics of farming occupation analyzed, the methods of grain handling and drying were the most important factors for predisposing farmers to chronic bronchitis and farmer's lung.

Prevalence of serum precipitins against microbes in mouldy hay, and of chronic bronchitis and farmer's lung with respect to farmers' occupational health hazards.

During the farmers' occupational health study 1979-82, the work conditions of 3,358 randomly selected farmers were investigated with respect to occurrence of work-related health hazards. The farmers also underwent a health examination in their local health centre, and precipitating antibodies against four microbes present in mouldy hay were analyzed. Results of the precipitin tests and the symptoms of chronic bronchitis and farmer's lung were analyzed with respect to the occurrence of work-related exposures to biological agents and dust in farming. The prevalence of antibodies against Aspergillus umbrosus was largest (6.9%) among farmers with biological health hazards. The occurrence of antibodies against any of the four microbes was associated more with work-related biological agents than with dust exposures. Chronic bronchitis and farmer's lung were also more common among farmers with exposures to biological agents and dust than among those without such exposures. The work conditions were investigated independently of the results of the health examinations. Occurrence of chronic bronchitis and farmer's lung are associated with the work-related health hazards in farming. For proper delivery of occupational health services methods of investigating work-related health hazards need to be improved.

Farmers' occupational health program in Finland, 1979-1988: from research to practice.

The Kuopio Regional Institute of Occupational Health, in collaboration with the Social Insurance Institution and the National Board of Health, conducted and evaluated a national model for the farmers' occupational health services. In January 1985 the National Board of Health instructed the Finnish municipal health centers to start the provision of farmers' occupational health services based on the recommendation given by the research group. The service was evaluated by experiments carried out during 1982, 1985, and 1986. The main problem in function of the services was that the health hazards (exposures) were difficult to observe and evaluate. The system of how the occupational health nurse evaluates the working conditions should be further developed. The efficiency of the services was studied by postal inquiries in 1982 and 1986. Farmers' knowledge about the appropriate means of reducing hazardous exposures had increased significantly due to the occupational health services. At the local level, the main problem in providing services for occupational farmers is that health centers do not have the resources to offer services for all farmers at the same time. Altogether by the end of 1986, about 30% of all active farmers in Finland (45,000 farmers) were willing to have occupational health services, which is voluntary for self-employed farmers.

Characteristics of farmers who have obtained personal dust respirators.

A postal survey was used to investigate the characteristics of farmers who have acquired dust respirators. In 1979 about a quarter of the farmers were using dust respirators, men more often than women. The more vocational training the farmer had and the larger the area of land under cultivation the more likely he was to own a dust respirator. Grain producers had purchased the protective devices more frequently than other farmers had. Farmers who participated in the occupational health intervention during 1980-82 had acquired dust respirators considerably more often than those in the control group. In the intervention group men under 30 years had most frequently purchased the dust respirators. Participation in the intervention influenced the acquisition of dust respirators more than did occurrence of symptoms of chronic bronchitis or farmer's lung.