Farming activities and carrying and lifting: the Agricultural Health Study

Application and demonstration of meso-activity exposure factors to advance estimates of incidental soil ingestion among agricultural workers

BACKGROUND

Soil is an understudied and underregulated pathway of chemical exposure, particularly for agricultural workers who cultivate food in soils. Little is known about how agricultural workers spend their time and how they may contact soil while growing food. Exposure factors are behavioral and environmental variables used in exposure estimation.

OBJECTIVES

Our study aimed to derive exposure factors describing how growers engage in different tasks and use those factors to advance the use of time-activity data to estimate soil ingestion exposures among agricultural workers.

METHODS

We administered a meso-activity-based, season-specific soil contact activity questionnaire to 38 fruit and vegetable growers. We asked growers to estimate the frequency and duration of six meso-activities and describe how they completed them. We used questionnaire data to derive exposure factors and estimate empirical and simulated exposures to a hypothetical contaminant in soil via incidental ingestion using daily, hourly, and hourly-task-specific ingestion rates.

RESULTS

We generated exposure factors characterizing the frequency and duration of six meso-activities by season, and self-reported soil contact, glove use, and handwashing practices by meso-activity and season. Seasonal average daily doses (ADDs) were similar across all three forms of ingestion rates. No consistent patterns regarding task-specific contributions to seasonal or annual ADDs were observed.

Agricultural activities and risk of Alzheimer's disease: the TRACTOR project, a nationwide retrospective cohort study

Data regarding Alzheimer's disease (AD) occurrence in farming populations is lacking. This study aimed to investigate whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with AD than others, using nationwide data from the TRACTOR (Tracking and monitoring occupational risks in agriculture) project. Administrative health insurance data (digital electronic health/medical records and insurance claims) for the entire French agricultural workforce, over the period 2002-2016, on the entire mainland France were used to estimate the risk of AD for 26 agricultural activities with Cox proportional hazards model. For each analysis (one for each activity), the exposed group included all FMs that performed the activity of interest (e.g. crop farming), while the reference group included all FMs who did not carry out the activity of interest (e.g. FMs that never farmed crops between 2002 and 2016). There were 5067 cases among 1,036,069 FMs who worked at least one year between 2002 and 2016. Analyses showed higher risks of AD for crop farming (hazard ratio (HR) = 3.72 [3.47-3.98]), viticulture (HR = 1.29 [1.18-1.42]), and fruit arboriculture (HR = 1.36 [1.15-1.62]). By contrast, lower risks of AD were found for several animal farming types, in particular for poultry and rabbit farming (HR = 0.29 [0.20-0.44]), ovine and caprine farming (HR = 0.50 [0.41-0.61]), mixed dairy and cow farming (HR = 0.46 [0.37-0.57]), dairy farming (HR = 0.67 [0.61-0.73]), and pig farming (HR = 0.30 [0.18-0.52]). This study shed some light on the association between a wide range of agricultural activities and AD in the entire French FMs population.

A qualitative study to inform adaptations to a brain health intervention for older adults with type 2 diabetes living in rural regions of Ireland

AIMS

Type 2 diabetes is a risk factor for late-life dementia, but dementia prevention strategies have yet to be comprehensively evaluated in people with diabetes. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated cognitive benefits of a 2-year multidomain lifestyle intervention. However, given the intensive nature of FINGER, there is uncertainty about whether it can be implemented in other high-risk populations. Our aim was to explore attitudes towards dementia risk, and barriers to an intervention based on the FINGER model in older adults with type 2 diabetes living in rural areas of Ireland.

METHODS

Focus groups were conducted with 21 adults (11 men and 10 women) aged 60+ years with type 2 diabetes living in border regions of north and south Ireland. Data were analysed using thematic analysis.

RESULTS

There was limited understanding of diabetes as a risk factor for late-life dementia. The main barriers to engagement with the multidomain intervention were eating foods that were not compatible with cultural norms, time and travel constraints, and perceived lack of self-efficacy and self-motivation for adopting the desired diet, exercise and computerised cognitive training (CCT) behaviours. Facilitators for intervention acceptability included the provision of culturally tailored and personalised education, support from a trusted source, and inclusion of goal setting and self-monitoring behavioural strategies.

CONCLUSIONS

While there was high acceptability for a brain health intervention, several barriers including cultural food norms and low self-efficacy for adopting the diet, exercise and CCT components would need to be considered in the intervention design. Findings from this study will be used to inform local decisions regarding the adaptation of FINGER for people with type 2 diabetes. The feasibility of the adapted multidomain intervention will then be evaluated in a future pilot trial.

Allergic and non-allergic wheeze among farm women in the Agricultural Health Study (2005-2010)

BACKGROUND

Farms represent complex environments for respiratory exposures including hays, grains and pesticides. Little is known about the impact of these exposures on women's respiratory health. We evaluated the association of farm exposures with allergic and non-allergic wheeze among women in the Agricultural Health Study, a study of farmers and their spouses based in Iowa and North Carolina.

METHODS

We used self-reported data (2005-2010) on current use (≤12 months) of 15 pesticides (selected based on frequency of use) and occupational farm activities from 20 164 women. We defined allergic wheeze as reporting wheeze and doctor-diagnosed hay fever (7%) and non-allergic wheeze as wheeze but not hay fever (8%) in the past 12 months. Using polytomous logistic regression, we evaluated associations of wheeze subtypes with pesticides and other farm exposures (eg, raising farm animals) using no wheeze/hay fever as the referent, adjusting for age, body mass index, state, current asthma, glyphosate use and smoking.

RESULTS

Current use of any pesticide, reported by 7% of women, was associated with both allergic (OR: 1.36, 95% CI: 1.10 to 1.67) and non-allergic (OR: 1.25, 95% CI: 1.04 to 1.51) wheeze. Four pesticides were associated with at least one wheeze subtype: glyphosate, with both wheeze subtypes; diazinon and fly spray with only allergic wheeze; carbaryl with only non-allergic wheeze. Working weekly with mouldy hay was associated with allergic (OR: 1.88, 95% CI: 1.26 to 2.80) and non-allergic wheeze (OR: 1.69, 95% CI: 1.18 to 2.42).

CONCLUSION

Use of specific pesticides and certain farm activities may contribute to wheeze among farm women.

Occupational health and safety in agriculture. A systematic review

Introduction: The prevalence of occupational diseases in the agricultural sector is higher than in other industries, since agricultural workers are at higher risk of exposure to different chemicals and pesticides, and are more prone to occupational accidents.Objective: To conduct a review of recent literature on occupational health and risk in agriculture.Materials and methods: A literature search was conducted in PubMed, SciencieDirect and Scopus using the following search strategy: type of articles: original research papers; language: English; publication period: 2006-2016; search terms: "agricultural health", "agrarian health", "risk factors", "epidemiology", "causality" and "occupational", used in different combinations ("AND" and "OR").Results: The search yielded 350 articles, of which 102 met the inclusion criteria. Moreover, 5 articles were found in grey literature sources and included in the final analysis. Most research on this topic has been conducted in the United States, which produced 91% (97/107) of the articles included.Conclusions: Most studies on health and safety in agriculture focused primarily on the harmful effects of occupational exposure to agrochemicals and pesticides, and the consequences of occupational accidents. However, since more than 90% of these studies come from the United States, a more comprehensive approach to health in agriculture is required, since what is reported here may be far from the reality of other regions, especially Latin America.

The effect of physical strain on breeders patients with obstructive sleep apnea syndrome

AIM

The purpose of this study was to investigate the cardiopulmonary exercise testing (CPET) in breeders patients with obstructive sleep apnea syndrome (OSAS).

METHOD

Thirty-two male participants (Age: 42.2 ± 7.3yrs, BMI: 29.5 ± 2.2 kg/m²) underwent full overnight polysomnography (PSG) and were divided into two groups (OSAS group: n = 20 vs. Control group: n = 12). 72-hours after the PSG study, they were subjected to CPET. The Independent t-test was used to measure the differences between the groups. Pearson's correlation coefficient was used among the parameters of CPET and PSG study.

RESULTS

The results showed difference between the groups (OSAS vs. Control) during CPET in end-tidal, CO₂ pressure in the peak of the exercise (38.7 ± 3.0 vs. 35.4 ± 5.5 mmHg, p = 0.031) and mean arterial pressure (122.7 ± 10.6 vs. 113.7 ± 11.8 mmHg, p = 0.035). Correlation results showed differences between the physical strain and the polysomnography study in physical strain parameters "walking duration per day with the herd" and oxygen desaturation index during sleep (r = 0.370, p = 0.037) and minimum oxygen saturation during sleep (r=-.374, p = 0.035), in the parameter "milking duration" and apnea (r = 0.392, p = 0.048), AHI (r = 0.374, p = 0.035) and oxygen desaturation index during sleep (r = 0.434, p = 0.013). The physical strain parameter "working hours per day" wasn't related to any parameter of the polysomnography study.

CONCLUSION

The daily physical activity may have a protective role during the course of the disease in patients with OSAS.

Observational Surveillance Approach to Detect Novel Work-Related Diseases and Hazards: An Application to a Belgian Occupational Health and Safety Database

OBJECTIVES

Rapid changes in working conditions give rise to new occupational health risks. We applied the Spectrosome approach, a network-based analysis, to investigate associations between disease and multiple occupational exposures.

METHODS

We investigated work and health's associations in a specific sector: the agricultural sector and for a specific and frequent health complaint: sore throat; using PRECUBE dataset of the Belgian Occupational Health and Safety, containing 381.615 occupational health observations. We compared the results of the spectrosome with classic frequency analyses.

RESULTS

Spectrosome approach reports more significant signals of multiple associations of agents compare to the frequency analysis.

CONCLUSION

This difference justifies the usefulness of taking into account the multiplicity of causes leading to a health event, which is a clear asset of the Spectrosome method.

Are Structural Changes in Polish Rural Areas Fostering Leisure-Time Physical Activity?

Background: In this study, we analyze the determinants of leisure-time physical activity (LTPA) of farmers and non-farmers living in rural areas. Methods: We use statistical analysis to describe urban and rural populations, as well as econometric techniques (Heckman regressions and propensity score matching) to assess the role of rural lifestyle in physical activity. Results: World Health Organization (WHO) pro-health PA (physical activity) recommendations are not met by 66% of farmers and 49% of other dwellers in rural areas. Approximately two thirds of them are completely inactive. Farmers enjoy vigorous PA (VPA), cycling and recreational walking less than their non-farming counterparts and are 46% less likely to be active than them; however the difference disappears when they take up an activity. The amount of PA is negatively correlated with age, but tends to increase for older people compared to those in middle age. Women are 6%–7% less active than men, yet the odds of being active at all are higher for women than for men. Household size is negatively correlated with LTPA. Conclusion: Considering the structural changes, rural area dwellers, especially farmers, require public intervention aimed at increasing their awareness of the advantages of LTPA.

Acceptability of mHealth Technology for Self-Monitoring Eating and Activity among Rural Men

OBJECTIVE

To examine rural men's use and perceptions of mobile and wireless devices to self-monitor eating and physical activity (mHealth).

DESIGN AND SAMPLE

Men in this 3-week pilot study used FitBit One^® to log daily food intake and monitor activity. A companion application (app) allowed activity monitoring of fellow participants. Health-related text messages were received 1-3 times daily. A purposive sample of 12 rural men (ages 40-67) was recruited by community leaders.

MEASURES

(1) baseline heart rate, blood pressure, and BMI, (2) FitBit One^® usage, (3) investigator-generated surveys on acceptability of mHealth, and (4) focus group on experience with mHealth.

RESULTS

Men were overweight (n = 3) or obese (n = 9) and 9 of 12 were hypertensive. Nine of twelve wore FitBit One^® all 21 days. Eleven of 12 men logged food, with 9 of 12 doing this at least 15 of 21 days. Self-monitoring and daily text messaging increased awareness of energy intake and output. Companion app's food log needed targeting for rural foods. Rotating seasons (occupational, religious, recreational) and weak cellular signals created contextual barriers to self-monitoring eating and activity.

CONCLUSIONS

FitBit One^® and text messaging were perceived as useful among the rural men, while the companion apps require adaptation to reflect dietary norms.

Physical activity patterns in healthy middle-aged women

Exercise in healthy female adults around the menopausal transition has been routinely examined in leisure activities alone, potentially discounting the physical activity (PA) that is accumulated in household and outdoor domains. The purpose of this study was to quantify PA in healthy middle-aged women and to examine the extent to which the Center for Disease Control (CDC) PA guidelines were met through leisure, household, and outdoor activities.

METHODS

440 healthy women, 51-64 years old, BMI ≥18.5 or < 40 kg/m², participated in the study using the Lifetime Physical Activity Questionnaire (LPAQ) to quantify PA.

RESULTS

25.91% met the CDC PA guidelines if leisure time alone was examined. When multiple domains were included, 73.41% of the women met the PA guidelines. This percentage is much higher than the reported 20.6% of U.S. adults who met the guidelines in 2011. PA in women may be underrepresented in data limited to leisure time PA.

Pesticide Exposures and Body Mass Index (BMI) of Pesticide Applicators From the Agricultural Health Study

Endocrine-disrupting chemicals, including pesticides, may be associated with weight gain. This is the first longitudinal study to examine a potential association between weight gain and pesticides using data on 8,365 male pesticide applicators from the Agricultural Health Study (AHS) cohort established in 1993. The relationship between total cumulative days of exposure to pesticide functional/chemical classes and to the four most frequently used individual pesticides was studied in relation to body mass index (BMI) at the time of 5-yr follow-up (beginning in 1998) with the length of the exposure period dating back to age 20 yr. Multiple regression, Spearman correlation, ordinal logistic regression, and logistic regression models all utilized a Bonferroni-adjusted p value, were adjusted for relevant covariates, and were stratified by state of residence (Iowa/North Carolina) and presence/absence of weight-related health conditions. Adjusted multiple regression yielded statistically significant positive parameter estimates for the study sample and Iowa subgroups with consistent findings for triazine herbicides and atrazine: Change in BMI per 100 cumulative pesticide exposure days ranged from 0.07 to 0.11 for triazine herbicides and from 0.10 to 0.19 for atrazine. Ordinal logistic regression compared normal weight with overweight and with obese using the zero exposure category as referent. Statistically significant adjusted odds ratios identified for the study sample and both state subgroups for the highest level of atrazine exposure ranged from 1.4 to 1.7. Further investigation is warranted to evaluate the associations identified here.

Health risks faced by Turkish agricultural workers

Background. Individuals who make a living through agriculture and animal husbandry are faced with a variety of physical and psychological health risks. In many international studies, it has been shown that these risks can result in disease. The purpose of this study is to summarize the health risks faced by Turkish agricultural workers. Materials and Methods. This study used a nonrandom, convenience sample. The biopsychosocial health statuses of 177 farmers from 11 central villages in Kars, Turkey, were examined. Results. It was determined that the depression rate among the study group was 62.1%, the rate of physical health problems was 52.0%, and the rate of social isolation was 53.7%. There was a statistically significant difference between the depression scale scores and lower education levels, having ≥ three children, and physical health problems, as well as the physical condition of the farmers' homes. There was a significant difference between poor physical health and older age, lower education levels, having ≥ three children, and social isolation. Conclusions. In providing data-based evidence, it is believed that this study will contribute considerably to understanding the causality of health problems in this population and in planning the development of public health and veterinary services based on regional needs.

Health and aging in elderly farmers: the AMI cohort

Background

The health of the agricultural population has been previously explored, particularly in relation to the farming exposures and among professionally active individuals. However, few studies specifically focused on health and aging among elders retired from agriculture. Yet, this population faces the long-term effects of occupational exposures and multiple difficulties related to living and aging in rural area (limited access to shops, services, and practitioners). However, these difficulties may be counter-balanced by advantages related to healthier lifestyle, richer social support and better living environment. The general aim of the AMI cohort was to study health and aging in elderly farmers living in rural area through a multidisciplinary approach, with a main focus on dementia.

Methods/design

The study initially included 1 002 participants, randomly selected from the Farmer Health Insurance rolls. Selection criteria were: being 65 years and older; living in rural area in Gironde (South-Western France); being retired from agriculture after at least 20 years of activity and being affiliated to the Health Insurance under own name. The study started in 2007, with two follow-up visits over 5 years. Baseline visits were conducted at home by a neuropsychologist then by a geriatrician for all cases suspected of dementia, Parkinson’s disease and depression (to confirm the diagnosis), and by a nurse for others. A large panel of data were collected through standardised questionnaires: complete neuropsychological assessment, material and social living environment, psychological transition to retirement, lifestyle (smoking, alcohol and diet), medications, disability in daily living, sensory impairments and some clinical measures (blood pressure, depression symptomatology, anxiety, visual test, anthropometry…). A blood sampling was performed with biological measurements and constitution of a biological bank, including DNA. Brain MRI were also performed on 316 of the participants. Finally, the three-year data on health-related reimbursements were extracted from the Health System database (medications, medical and paramedical consultations, biological examinations and medical devices), and the registered Long-Term Diseases (30 chronic diseases 100% covered by the Insurance System).

Discussion

AMI is the first French longitudinal study on health and aging set up in a population of elderly farmers living in rural area through a multidisciplinary approach.