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 ± 16.8% 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.

Creating a National Coalition to Address Tractor Overturn Fatalities

Tractor overturns continue to be the leading cause of death on U.S. farms. While rollover protective structures (ROPS) are effective in preventing these fatalities, they are underutilized due to a number of barriers. Past programs in the U.S. and abroad have targeted this area of agricultural safety; however, a national program is not yet in place for U.S. farmers. This study seeks to build a national partnership to address tractor overturn fatalities by increasing the number of tractors with ROPS. A diverse, multisector steering committee has been organized and is working together using Whole System in a Room methods. This method brings together partners from nine stakeholder groups to identify and commit to a collaborative solution to the issue.

Predictors of burnout among physicians and advanced-practice clinicians in central New York

Background: Provider wellbeing is a barometer of the strength of healthcare systems/organizations. Burnout prevalence among physicians exceeds that among other adult workers in the United States. Rural-based practitioners might be at greater risk.Objective: We investigated predictors of burnout among group employed providers within an integrated healthcare network.Methods: In a prospective observational study of physicians/advanced-practice clinicians serving an 8-county region of central New York, we linked administrative practice-setting data with responses to a questionnaire-survey comprising validated measures of burnout, resilience, work meaningfulness, satisfaction, risk aversion, and uncertainty/ambiguity tolerance. We included providers on the official payroll, excepting advisory board and/or research team members plus those who retired, resigned or were fired. 308 (65.1%) of 473 eligible clinicians completed the survey. 59.1% of these were physicians/doctoral-level practitioners; 40.9% advanced-practice clinicians. We assessed burnout using a validated 5-level single-item measure formatted as a binary outcome of “burned out/burning out” (levels 3–5) versus not. We derived a parsimonious generalized linear mixed-effects regression of this outcome on provider demographics, work-related needs, risk aversion, satisfaction, and unit characteristics.Results: Perceived workload, relatedness needs, practice satisfaction 75% of the time, dissatisfaction 50%, resilience, and practicing on a small unit were the significant, independent predictors.Conclusions: Heavy workloads, unmet relational needs, frequent dissatisfaction, low resilience, and serving on a small unit were most significantly associated with being “burned out/burning out”. Feeling satisfied most of the time and high resilience were protective. Profession, specialty, autonomy, and support staffing were not statistically significant.

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 χ2 = 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 χ2 = 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.

Increases in ROPS pricing from 2006-2012 and the impact on ROPS demand

In 2006, a social marketing campaign was developed to increase the installation of rollover protective structures (ROPS) on unprotected New York tractors. Using data gathered from the program's hotline, the impact of price increases on farmers' interest in ROPS is examined. Pricing data were obtained for all rigid ROPS kits commercially available in the U.S. since 2006. These data were stratified into two groups of ROPS suppliers: (1) tractor manufacturers that sell ROPS for their own tractors, referred to in this study as original equipment manufacturers (OEMs), and (2) aftermarket (AM) ROPS suppliers. The trend in price increases was contrasted with the change in the consumer price index (CPI), the probability of retrofitting within quintiles of cost was estimated, and the increase in ROPS prices over time was plotted The average price increase for a ROPS kit (excluding shipping and installation) over the six years of the study was 23.3% for OEM versus 60.5% for AM (p < 0.0001). Out-of-pocket expenses held steady for OEM versus a six-year increase of $203 for AM (p = 0.098). The probability of a farmer retrofitting dropped monotonically from 66.9% in the lowest ROPS cost quintile to 23% in the highest. If these trends continue, the proportion of inquiries resulting in a ROPS retrofit will fall below 20% by 2020 for AM ROPS. Based on other trends identified in the literature, it is reasonable to assume that decreases in ROPS installation are likely to affect the tractor owners who are most likely to need these safety devices.

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.

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.

Spanish-Speaking Dairy Workers in New York, Pennsylvania, and Vermont

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).

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.

Screening Events to Reduce Farmers' Hazardous Exposures

Dairy farmers may be exposed to high levels of noise and dust. Protections against these hazards exist, but many farmers do not use them. An intervention consisting of hearing and respiratory screenings combined with personalized education was implemented. This study evaluates the impact of this intervention on farmers' self-reported use of personal protective equipment (PPE) and implementation of noise and dust abatement. Participants were screened as to noise (n=209) or dust (n=392) hazards and use of PPE. Following this, they were counseled on PPE use, and identification and reduction of noise or dust hazards. Counselors sought a pledge from the farmers to eliminate hazards and increase PPE use. Farmers were subsequently surveyed and asked whether they had implemented the changes. At baseline, 70% (146/209) of farmers exposed to high levels of noise reported poor use ("sometimes", "rarely", or "never") of hearing protection. Results indicated that two months after intervention, 25.2% (28/111) of these subjects had successfully improved their PPE use. At baseline, 79% (311/392) offarmers reported poor use of respiratory protection, with 27.3% (41/150) showing improvement in PPE use within the same time. Strategies to reduce noise hazards were identified by 92.8% (194/209) of hearing screening attendees; 13.2% (18/136) successfully reduced or removed exposure. These values for dust screening attendees were 98.2% (385/392) and 30.7% (54/176), respectively. Use of this intervention appears to be an effective method for increasing PPE use on the farm. However, it is not effective for reducing noise hazards.

Development and initial assessment of objective fatigue measures for apple harvest work

Previous research has shown that neck, back and shoulder musculoskeletal strain is a major occupational health problem affecting migrant orchard harvest workers. Researchers seek to measure the effect of an ergonomic modification to the apple picking bucket on muscle fatigue, however objective measures for use in the orchard are not yet available. The purpose of this study is to develop simple back, shoulder or arm strength measures, which detect statistically significant drops in strength over one workday. Candidate muscle strength measures were piloted in the laboratory, adapted for the orchard and evaluated (n=102). Data were analyzed for morning to afternoon fatigue, and for correlation between fatigue score and hours worked. In the laboratory, the timed arm hold (35.7% time reduction, 95% CI: 21.81-49.61), and the timed spinal extension (31.8% time reduction, 95% CI: 23.54-39.96) showed significant fatigue. In the orchard (n=102), only the timed arm hold showed significant (11.4%, p<.0001) fatigue. The potential effect of field conditions and subject motivation on these results needs further exploration.

Rollover protection on New York tractors and farmers' readiness for change

Tractor overturns contribute significantly to fatalities in New York State agriculture. On-site inspections a decade ago indicated that approximately 60% of tractors were without effective rollover protection. Our objectives were: to describe the current prevalence and distribution of rollover protective structures (ROPS) on New York farm tractors, to identify characteristics associated with the absence of ROPS, to explore segmenting the New York farm community on readiness for ROPS retrofitting, and to identify demographic characteristics that might assist in this segmenting. A random selection of 644 livestock, dairy, fruit, cash crop, vegetable, and organic farms were contacted for a telephone survey. Of 562 farms (87%) participating, 102 (18.1%) had all tractors equipped with ROPS and 138 (24.6%) had none. A disproportionate number of livestock, cash crop, and organic operations had no ROPS. Rates of ROPS-equipped tractors correlated directly with farm size and annual hours of tractor operation. Older farmers had a lower proportion of ROPS tractors. The presence of a child operator did not affect the proportion of ROPS tractors. After weighting the sample, the total number of non-ROPS tractors in New York is estimated at more than 80,000. In addition to providing key farm demographics, the survey enabled placement of farmers on a "stage of change" continuum related to readiness for retrofitting. Three-quarters of New York farmers are in the "precontemplation" stage of change relative to ROPS retrofitting, and this varies little by size of operation, age of farmer, or the presence of child tractor operators. Stage of change may relate to hours of tractor operation (p = 0.05) and does relate to commodity (p = 0.003) due primarily to the higher proportion of crop farmers in the earliest stage of change. The goal of retrofitting all New York farm tractors with ROPS appears nearly as daunting as it did a decade ago.

"Safety for agricultural educators": evaluation of an intervention to enhance awareness of agricultural hazards

Safety for Agricultural Educators (SAGE) is a two-sided fact sheet on agricultural hazards that has been distributed by the New York Center for Agricultural Medicine and Health (NYCAMH) to Northeastern high school agriculture educators over the past six years. It was intended to supplement and stimulate the teaching of safety principles in agricultural education classes and thus enhance the awareness and knowledge of young people working on farms. This paper describes an evaluation of SAGE's success at achieving these goals. Postal surveys from 29 teachers who had not previously received SAGE gathered data on class demographics and the amount of class time devoted to a variety of agricultural topics including tractor operation and agricultural health and safety. Teachers were asked to assess their students' awareness of safety and health issues and also to estimate the number of students working in the farm environment. Following a year of SAGE mailings, the same information was gathered from the 24/29 post-SAGE responders. Comparison of pre-post responses from the 24 matched responding educators showed: limited increase in the teachers' knowledge of basic agricultural safety information; a decline in the amount of class time devoted to health and safety; a marginal increase in estimated student awareness of health and safety and very little evidence of teacher awareness of SAGE as a safety resource. Most notable was the fact that only 8% of all students were currently working on a farm and teachers estimated that only 6% would be working on farms in five years.

Noise and chemical induced hearing loss: special considerations for farm youth

Farm youth face multiple risks for injury and illness in agriculture. Reviewed here is evidence from current literature illustrating the noise and chemical exposure hearing risks that farm youth potentially face. Sources of noise (e.g., machinery) and potentially toxic chemical exposures (e.g. solvents and pesticides) common in the farm environment are reviewed, illustrating the need for heightened research attention to a problem that may affect up to 2 million children in the United States alone and that requires both public and occupational health solutions. As existing studies have not sufficiently explored potential ototoxic effects of these exposures on children and adolescents, recommendations are outlined for research characterizing both chemical and noise exposures to farm youth and their combined effects on hearing.

Laboratory evaluation of belt usage with apple buckets

BACKGROUND

Migrant and seasonal orchard harvest workers experience musculoskeletal strain caused by carrying heavy loads and holding awkward postures. An ergonomic hip belt designed to redistribute weight from the upper back, neck, and shoulders to the hips was evaluated.

METHODS

A comparison of muscle exertion (using electromyography [EMG]) of four key back and shoulder muscles and shoulder surface pressure (using a surface pressure sensor [PS]) was made among 10 laboratory volunteers under intervention and control conditions, in two postures (standing erect [0 degrees ]) and flexed [45 degrees ]).

RESULTS

All but one measure showed a significant reduction in the flexed posture with the intervention. Two of eight measures showed a significant reduction in the erect posture. Correlations with shoulder discomfort were found for deep shoulder EMG (r=0.71, P=0.021) and shoulder surface pressure (r=0.58, P=0.082).

CONCLUSIONS

The hip belt intervention produces significant reductions in muscle activity while in a posture commonly assumed during orchard work.

Risk Perceptions, Barriers, and Motivators to Tractor ROPS Retrofitting in the New York State Farm Community

The prevalence of tractor rollovers among agricultural workers has made the retrofitting of tractors with rollover protective structures (ROPS) and seat belts a public health priority for agricultural health and safety specialists. To address this concern, the New York Center for Agricultural Medicine and Health (NYCAMH) developed a seven-question survey, designed to assess perceptions of risk as well as potential motivators and barriers to retrofitting. Data from 465 phone surveys were gathered from New York State farmers representing various commodities and farm sizes. Analysis of responses to three qualitative questions contained in the survey indicated that most farmers in New York understand the importance of ROPS but lack the proper motivation to consider retrofitting. It appears that more convenient safety strategies, cost, and age of the tractor compete with a farmer's initiative to retrofit. In addition, survey responses illustrate that although many farmers believe ROPS are important in a general sense, many believe that this safety measure is not necessary for them in particular. Frequent motivators to retrofitting are concerns about safety, although the authors conclude that a more thorough analysis of these "general safety concerns" in qualitative interviews is important.

Estimating farmworker population size in New York State using a minimum labor demand method

Assessment of health needs and services for hand-harvest farmworkers requires reliable population estimates. In New York State, the only publicly available source for these is the Department of Labor (DOL). However, published production data exist that may enable estimation of minimum labor demand (MLD) for hand-harvest labor. Our objective was to develop an estimation process for minimum labor demand (MLD) for hand-harvested crops in NYS and contrast the results with DOL estimates. Four crop strata (below ground, ground, bush/vine, and orchard) were identified. MLD (measured in worker-seasons) was estimated by dividing the total annual harvest hours required for each crop stratum by the total hours worked by one worker in a season for that crop stratum. The MLD estimate of the total number of worker seasons combined for all strata (14,121) was higher than that of the DOL (8,230). Harvest acreage was unavailable for 21% of the 991 county-crop combinations studied; therefore, data were imputed from other sources. Within these strata, the greatest difference was found for ground crops, where the DOL count was 28% of the size of the MLD estimate. DOL and MLD estimates were closest in orchard crops (DOL 109% of MLD). Publicly available data provide a potentially valuable source of informationfor estimation of the MLD. Use of these methods implies that the DOL may substantially underestimate the size of this population. Differences seen between the two methods were sensitive to the crop type. County-level farm surveys to verify MLD estimation factors would enhance the method's accuracy.

Chronic disease risk in central New York dairy farmers: results from a large health survey 1989-1999

BACKGROUND

The agricultural workplace presents a variety of health and safety hazards; it is unknown whether farm work may be a risk factor for certain chronic diseases.

METHODS

The health survey data from a large rural population in central New York were used from two studies (1989, 1999) to assess both 1999 prevalence and 10-year incidence of self-reported diabetes, heart disease, hypercholesterolemia, and hypertension among farm (predominantly dairy) and non-farm residents. The 1999 asthma prevalence was also assessed.

RESULTS

Multiple logistic regression models for 1999 prevalence found statistically significant protective effects of farming for hypertension (OR=0.83, P=0.0105) and hypercholesterolemia (OR=0.853, P=0.0522). Non-significant results were seen for heart disease (OR=0.67, P=0.128) and diabetes (OR=0.856, P=0.1358). The model for 1999 asthma prevalence showed a significantly elevated risk for farming (OR=1.542, P=0.0004). Logistic models created for the 10-year incidence of hypertension, hypercholesterolemia, diabetes, and heart disease did not show a significant effect for farming.

CONCLUSIONS

The protective effect of farming observed for the 1999 prevalence of hypertension and hypercholesterolemia was not seen for the 10-year incidence of these diseases.

The Disease-Modifying Effects of Twice-Weekly Oral Azithromycin in Patients with Bronchiectasis

INTRODUCTION

Bronchiectasis is a chronic pulmonary process characterized by recurrent respiratory infections leading to destruction of airways secondary to inflammation. We investigated whether the addition of 6-months' twice-weekly azithromycin to the existing treatment regimen in patients with pulmonary bronchiectasis decreased the number of exacerbations and improved pulmonary function compared with a similar period of time without concurrent azithromycin.

METHODS

Thirty patients with high-resolution computed tomography scan-confirmed bronchiectasis were to be recruited. In random order, patients received usual medications for 6 months, and usual medications plus oral azithromycin 500mg twice weekly for 6 months. Patients receiving azithromycin first had a 1-month washout period prior to entering the second phase. Patients recorded weekly peak flow (PF) measurements. Pulmonary function tests (PFTs), 24-hour sputum volume, and needs for intervention with medication or ancillary support were collected at baseline and every 3 months. Exacerbation incidence and sputum volume measurements were compared from baseline to the end of each study phase.

RESULTS

Twelve patients were enrolled; 11 were included in the analysis. Owing to randomization, most patients received the azithromycin first, which was fairly well tolerated. PFTs did not change significantly during either study phase and PFs appeared to remain stable during azithromycin therapy and throughout the subsequent control phase. Azithromycin significantly decreased the incidence of exacerbations compared with usual medications (5 vs 16; p = 0.019). Mean 24-hour sputum volume significantly decreased (15% [p = 0.005]) during the active treatment phase, and remained decreased during the control phase (p = 0.028). Subjectively, patients reported increased energy and quality of life while receiving treatment with azithromycin.

CONCLUSIONS

The addition of twice-weekly azithromycin significantly decreased the incidence of exacerbation and 24-hour sputum volume and may have stabilized the PFTs and PFs in this 11-patient pilot study. The results of this study justify further investigation of adding azithromycin to the treatment regimens of patients with bronchiectasis for its disease-modifying effects.

Prevalence and predictors of respiratory symptoms among New York farmers and farm residents

BACKGROUND

Data from telephone interviews with New York farmers and farm residents were used to study the prevalence and risk factors of symptoms that could be related to asthma and allergies.

METHODS

Participants were asked if they had wheezing or whistling in the chest in the past year and about the occurrence of stuffy, itchy, runny nose or watery, itchy eyes in the past year.

RESULTS

The prevalence of wheeze was 18.2% and of stuffy nose/watery eyes was 57.4% (N = 1,620). Significant risk factors for wheeze were cigarette smoking, a systemic reaction to allergy skin testing, immunotherapy, or insect sting, reactivity to a pet, having goats, and more acreage in corn for silage. Significant risk factors of stuffy nose/watery eyes were younger age, having more than a high school education, being a worker on the farm, and having done spraying.

CONCLUSIONS

Wheeze may be indicative of existing or latent asthma, a potentially limiting respiratory illness. Stuffy, itchy, runny nose or watery, itchy eyes, which may cause irritation and discomfort, may also indicate an increased sensitivity to respirable dusts and chemicals. This cohort of New York farmers had significant farm-related risk factors for wheeze and stuffy nose/watery eyes.

Occupational injury and illness among migrant and seasonal farmworkers in New York State and Pennsylvania, 1997-1999: pilot study of a new surveillance method

BACKGROUND

Traditional worksite injury surveillance methods are often ineffective for Northeastern farms employing seasonal harvest labor. Many are small farms, exempt from mandatory injury reporting. The high proportion of foreign workers and the temporary nature of the work further discourages reporting. Therefore, an alternative migrant health center-based occupational injury and illness surveillance system was piloted during 1997-1999.

METHODS

Anonymous medical chart data from nine migrant health centers and four regional hospital emergency rooms was collected during 1997-1999.

RESULTS

There were 516 injury/illness cases over two seasons. Joint/muscle straining (31%), falling (18%), poison ivy contact (10%), and object strikes (8%) were most common injurious events. The participation rate of health care was 75%; 130 cases were reported by hospital emergency rooms; and optimal health center participation was associated with: being a farmworker-dedicated program, and including the chart reviewer in the health center's decision to participate.

CONCLUSIONS

Further development of a medical records-based surveillance system should include hospital emergency rooms and focus on identified health center performance factors.

An analysis of self-reported joint pain among New York farmers

Data from the telephone interview portion of the New York State Farm Family Health and Hazard Surveillance Project were used to study the prevalence and predictors of joint pain in a cohort of farmers and farm residents. The participants were owner/operators, workers, and residents from a representative sample of farms from 12 New York counties. A total of 1706 participants completed a telephone interview on musculoskeletal conditions. Joint trouble was defined as self-reported aches, pain, or discomfort in the past year in each of five different joint areas. The 12-month prevalence of joint trouble was: lower back 41%, neck/shoulders 35%, knees 29%, hands/wrists 28%, and hips 15%. Using logistic regression modeling, significant risk factors for joint trouble were identified (p < 0.05). Older age and being female increased the risk of aches, pain, or discomfort in most joints. Being the owner/operator increased the risk of neck/shoulder and lower back trouble, and being a worker increased the risk of neck/shoulder trouble. Doing tractor work was associated with trouble in all five joint areas, and milking was associated with knee trouble. These findings indicate that personal risk factors and the intensity and nature of the farm work contribute to joint trouble. Ergonomic improvements to tractors and milking facilities should be a high priority.

A comparison of self-reported hearing loss and audiometry in a cohort of New York farmers

The New York State Farm Family Health and Hazard Surveillance was conducted to assess the health status and safety practices among year-round adult farmers and farm residents in New York State and included a telephone interview survey of 1,727 persons from 552 farms. To determine the extent to which self-reported hearing loss is in agreement with audiometry, a subset of 376 participants who completed a hearing loss interview and pure-tone audiometry was analyzed. Thirty-six percent of the participants had self-reported hearing loss, defined as at least some difficulty hearing in one or both ears. The prevalence of audiometric hearing impairment, defined as a threshold average greater than 25 dB hearing level, was 9% for the binaural low-frequency average (500, 1000, and 2000 Hz), 29% for the binaural mid-frequency average (1000, 2000, 3000, and 4000 Hz), and 47% for the binaural high-frequency average (3000, 4000, 6000, and 8000 Hz). Agreement between self-report and audiometry was highest for the binaural mid-frequency average (kappa statistic 55%, sensitivity 77%, and specificity 82%). Self-reported hearing loss was found to be a moderately good measure of hearing impairment. We conclude that a simple questionnaire focusing on hearing difficulty is a useful and valid tool for conducting epidemiologic studies of farmers. Whenever possible, a substudy using audiometry should be conducted.

Acetylcholine receptor-reactive antibody induces nitric oxide production by a rat skeletal muscle cell line: influence of cytokine environment

The monoclonal Lewis rat skeletal muscle cell line, LE1, responded to the acetylcholine receptor (AChR)-reactive antibody mAb35 by up-regulating levels of mRNA for inducible nitric oxide synthase (iNOS/NOS-II), followed by levels of NO. Interferon-gamma (IFN-gamma) and interleukin-1 (IL-1) were also each capable of inducing iNOS message, and synergistically with mAb35. Finally, myocyte-derived NO was implicated as a possible source of immunomodulation in experimental autoimmune myasthenia gravis (EAMG), as shown by the ability of the culture fluids from IFN-gamma-activated LE1 cells to inhibit the proliferation of AChR-reactive T cells.

Predictors of hearing loss in New York farmers

BACKGROUND

Data from the telephone interview portion of the New York Farm Family Health and Hazard Surveillance were used to study self-reported hearing loss in New York farmers.

METHODS

One thousand six hundred and twenty-two persons completed the hearing loss and noise exposure interview. Hearing loss was defined as at least some trouble hearing in one or both ears. Predictors of hearing loss were determined using logistic regression.

RESULTS

Twenty-two percent of participants reported hearing loss. From the logistic regression, significant confounders are age (P = 0.0001), gender (P = 0.0001), being from a livestock farm (P = 0.012), and loss of consciousness due to head trauma (P = 0.04). Significant noise exposures are more hours of lifetime exposure to noisy farm equipment (P = 0.001) and having had a noisy non-farm job (with some hearing protection P = 0.002, without any hearing protection P = 0.0001).

CONCLUSIONS

Farm noise exposure is a serious risk to the hearing of this population. Although use of hearing protection should be encouraged, replacing and modifying farm equipment to decrease noise at the source should be the first priority.

Severe farm injuries among New York farmers

BACKGROUND

Data from the telephone interview portion of the New York State Farm Family Health and Hazard Surveillance were used to study the incidence and predictors of severe farm injury.

METHODS

One thousand seven hundred and six participants completed two telephone interviews in which they reported all injuries over a 12-month period.

RESULTS

Nine percent of participants reported at least one severe farm injury. Using logistic regression the significant risk factors for sustaining at least one severe farm injury are younger age, the presence of hearing loss or joint trouble, working more hours per day, being the owner/operator of the farm, and being from a farm with higher gross sales.

CONCLUSIONS

There needs to be continuing education of all farmers as to the risks of injury. However, when resources are limited, we recommend that injury education and interventions in this farming population should target younger farmers, those who work longer hours, owner/operators, farmers from higher grossing farms, with special attention to farmers who have physical impairments.

The dhb operon of Bacillus subtilis encodes the biosynthetic template for the catecholic siderophore 2,3-dihydroxybenzoate-glycine-threonine trimeric ester bacillibactin

Bacillus subtilis was reported to produce the catecholic siderophore itoic acid (2,3-dihydroxybenzoate (DHB)-glycine) in response to iron deprivation. However, by inspecting the DNA sequences of the genes dhbE, dhbB, and dhbF as annotated by the B. subtilis genome project to encode the synthetase complex for the siderophore assembly, various sequence errors within the dhbF gene were predicted and confirmed by re-sequencing. According to the corrected sequence, dhbF encodes a dimodular instead of a monomodular nonribosomal peptide synthetase. We have heterologously expressed, purified, and assayed the substrate selectivity of the recombinant proteins DhbB, DhbE, and DhbF. DhbE, a stand-alone adenylation domain of 59.9 kDa, activates, in an ATP-dependent reaction, DHB, which is subsequently transferred to the free thiol group of the cofactor phosphopantetheine of the bifunctional isochorismate lyase/aryl carrier protein DhbB. The third synthetase, DhbF, is a dimodular nonribosomal peptide synthetase of 264 kDa that specifically adenylates threonine and, to a lesser extent, glycine and that covalently loads both amino acids onto their corresponding peptidyl carrier domains. To functionally link the dhb gene cluster to siderophore synthesis, we have disrupted the dhbF gene. Comparative mass spectrometric analysis of culture extracts from both the wild type and the dhbF mutant led to the identification of a mass peak at m/z 881 ([M-H](1-)) that corresponds to a cyclic trimeric ester of DHB-glycine-threonine.

Safety awareness among New York farmers

BACKGROUND

This study was conducted to assess the health status and safety practices among year-round adult farm workers and residents and included a telephone interview survey of 1,727 persons from 552 farms.

METHODS

Logistic regression was used to analyze four safety questions.

RESULTS

Among 541 farm owner/operators significant predictors of making substitutions in the use of chemicals and major changes to equipment include younger age, more persons assisting on the farm, and higher gross sales. Having training is associated with having more than a high school education. Among all participants the perception that personal protective equipment are useful is associated with being younger, male, an owner/operator or worker, and having at least a high school education.

CONCLUSIONS

These findings suggest that older and less educated farmers should be targeted for health and safety programs.

Occupational hearing loss

Hearing loss is a significant and unfortunately common occupational malady. Over the past several decades both the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) have initiated efforts to better understand and to limit the occurrence of occupational hearing loss, particularly as it relates to excessive noise exposure. This paper briefly addresses the pathophysiology of noise-induced hearing loss and then describes the occupational and non-occupational factors which influence a worker's risk of hearing loss. The primary foci of this discussion are the clinical evaluation, diagnosis, and management of occupational hearing loss. Issues of prevention, OSHA-mandated hearing conservation efforts and compensation are reviewed.

Farm tractors, and the use of seat belts and roll-over protective structures

Roll-over protective structures (ROPS) on farm tractors could significantly reduce the rate of fatal occupational injury on farms, but comparatively few tractors have them. Many of the policy discussions have focused on trying to identify the percentage of tractors that do not have ROPS, even though such a focus probably does not accurately represent effective protection by ROPS. This study investigates whether including differences in hours of usage, tractor activities, and seat belt use affects estimates of farm operators' protection by ROPS. In general, tractors used more hours a year were more likely to have ROPS. ROPS status also varied by tractor activity. When adjusting for seat belt use, effective ROPS protection is much less than when considering just ROPS status. Measures of the effective coverage of ROPS and policy responses should reflect these differences in hours, activities, and seat belt use.

Developmentally regulated expression of a mouse germ cell nuclear antigen examined from embryonic day 11 to adult in male and female mice

A rat IgM monoclonal antibody has been developed which recognized a mouse germ cell nuclear antigen (GCNA1). GCNA1 is present in prospermatogonia (gonocytes) in males and in oogonia and oocytes of females within the gonadal ridge from Embryonic Day 11.5 onward, but rarely in primordial germ cells prior to their arrival at the gonadal ridge. Immunolocalization demonstrates that GCNA1 is abundant in nuclei of spermatogonia and early spermatocytes, but decreases during subsequent spermatocyte and round spermatid development, and is not detected beyond step 10 elongating spermatids. The antigen is approximately 80-110 kDa on immunoblots of isolated pachytene spermatocytes and round spermatids. However, GCNA1 appears to be absent from sperm in the epididymis and vas deferens, Sertoli cells, TM3 cells (Leydig-like) and TM4 cells (Sertoli-like), lung, liver, kidney, spleen, heart, skin, brain, epididymis, and ovary. GCNA1 is present in prepuberal male mice (Days 2-14) in all stages of prespermatogonial and spermatogonial development. It is also present in prepuberal male mice (Days 2-14) in all stages of prespermatogonial and spermatogonial development. It is also present in oocytes of neonatal females until Postpartum Day 12. GCNA1 is first lost from oocytes in the medulla of the ovary as they arrest at the dictyate stage and gain a layer of granulosa cells. In addition, antigen is present in moderate amounts in F9 embryonal carcinoma cells and SCC-PSA1 pluripotent terato-carcinoma cells. Thus, GCNA1 serves as a common marker of the germ cell lineage in male and female mice after primordial germ cells arrive in the gonadal ridge until they reach the diplotene/dictyate stage of the first meiotic division.

Silo filler's disease in New York State

Twenty new cases of Silo filler's disease (SFD) have been collected, documenting the incidence and clinical features of exposure to nitrogen oxides present in freshly filled silos. Cases of SFD were identified using a statewide computerized discharge diagnosis system. Fifteen of these were identified in the index period, allowing us to calculate an approximate annual incidence of 5.0 cases/100,000 silo-associated farm workers/yr in New York State. All cases occurred during harvest periods, with 80% in September and October. Corn silage was the gas source in 18 (90%). All cases involved young white men (mean age, 31.5 yr). The most common presenting feature was dyspnea. All victims entered a silo during the peak danger period, and only one used recommended ventilation techniques. Four cases ended in death (20% mortality). Silo filler's disease, although rare, is a potentially devastating disease involving otherwise young, healthy farm workers. It is readily prevented.

The dangers of dairy farming: the injury experience of 600 workers followed for two years

In order to better understand the work-related injuries sustained on central New York dairy farms, we undertook a two-year population-based study of 600 farmers and farm workers on 201 dairy farms. During the observation period, 1984-1986, 151 persons had 200 injuries, giving an injury rate of 16.6%/year (166 injuries/1,000 workers/year). Men were injured more often than women (p less than or equal to 0.01). Injured workers were older (p less than or equal to 0.01), worked more hours (p less than or equal to 0.001), and had heavier workloads than noninjured workers (p less than or equal to 0.001). The growing and harvest seasons had the most injuries; winter the fewest. More than 2/3 of the injuries occurred in the afternoon. Owners/operators, often the most experienced, knowledgeable people on the farms, were most often hurt. Those working more than 60 hours/week, with greater than 30 acres under tillage/worker, had a relative risk of 2.76 compared with all other workers. The attributable risk for this group was 51%. There were two fatalities, both involved owner/operators. Our findings suggest that previous studies may have underestimated the risks faced by farmers. Dairy farming in central New York is very dangerous work. Those who own and operate these dairy farms are most often hurt and killed. Analysis of events on individual farms will be reported separately.