A population-based examination of cancer in New South Wales farm residents compared to rural non-farm and urban residents

The cancer indicators and outcomes of rural Australians are generally less favourable than those of their urban counterparts, but the situation for farm residents is less well known. With a focus on farm residents, this study aimed to identify differences between farm, rural non-farm and urban residents in a large NSW cohort, in: (1) incidence and mortality from major cancers; (2) screening rates, stage at diagnosis and selected cancer therapies; and (3) common risk factors associated with these cancers. Cancers of interest were breast, cervical, colorectal, lung and prostate cancers; melanoma and Non Hodgkins Lymphoma. The Sax Institute’s 45 and Up Study was used to define resident groups and to compare baseline cancer-related risk factors. Cancer mortality, incidence, stage at diagnoses, cancer screening practices and selected cancer treatments were compared through data linkage with routine state and national health datasets. Direct age-standardisation, proportional hazards regression and logistic regression were used to compare cancer indicators, controlling for common risk factors. Overall, farm residents had lower all cancer incidence and mortality risk than rural non-farm or urban counterparts, but differences were only significant for all cancer incidence in farm women compared to rural non-farm women. For specific cancers, breast cancer mortality risk was also significantly lower in farm women than rural non-farm women, but incidence and mortality risk for other cancers were not significantly different. However, whilst confidence intervals did not exclude unity, adjusted point estimates for incidence or mortality risk suggest that compared to other groups, farm residents had a similar or reduced risk of breast, colorectal and lung cancer; similar risk of NHL; and farm men similar or slightly raised risk of melanoma and prostate cancer. There were no significant differences in stage at diagnosis for prostate, breast and colorectal cancers. Small case numbers in the farm group were likely to have contributed to lack of significance of findings for some analyses. Screening practices of farm and rural non-farm residents were generally similar; but both rural groups had significantly less frequent PSA tests, Pap tests, mammograms and colonoscopies than urban residents. Cancer-related surgical services for breast and colorectal cancer were comparable between all groups. Some findings for non-surgical therapies should be considered with caution, but both farm and rural non-farm residents were significantly less likely to access chemotherapy for breast cancer and brachytherapy for prostate cancer than urban counterparts. Strengths and limitations of the research are discussed. Pending confirmation of findings in other studies, results have implications for cancer screening and treatment services in rural Australia. The reasons why farm residents may have lower incidence and / or mortality risk for some cancers should also be considered for further research

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

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

The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency

© 2019 Barbara Depczynski et al. The significance of hyperketonemia in adults with diabetes presenting to the emergency department with acute illness, not due to a diabetic hyperglycemic emergency, has not been well characterized. Adult patients with diabetes presenting to the emergency department who had venous blood gas and beta-hydroxybutyrate levels measured whilst in the emergency department were retrospectively evaluated for the relationship between BHB and clinical outcomes. Over 6 months, 404 patients with diabetes had at least one beta-hydroxybutyrate level measured in the emergency department. There were 23 admissions for diabetic ketoacidosis (DKA) or hyperosmolar state. Of the remainder, 58 patients had a beta-hydroxybutyrate≥1 mmol/L; this group had a higher glucose at presentation (19.0 (8.8) versus 10.4 (9.9) mmol/L), higher HbA1c (8.8 (5.4) versus 8.0 (3.3)%), lower bicarbonate (22.6 (6.2) versus 24.8 (4.7) mmol/L), and higher anion gap (14.8 (6.1) versus 12.6 (4.2)) than had those with BHB<1 mmol/L. There was no association between the presence of ketosis and the length of stay (4.2 (7.3) versus (3.0) (7.2) days). Acute illness in those with diabetes associated with ketosis in the absence of DKA is associated with worse glycaemic control than in those without ketosis. Ketosis may represent an intermediate state of metabolic dysregulation rather than being associated with a more severe acute illness, as suggested by no relationship between BHB and length of stay

Alcohol and Farm Workplace Project

Provides a review of literature in relation to the impact of alcohol on farm injury in an Australian setting. Outlines current data within NSW comparing alcohol use between farm and non-farm populationsAlcohol Education and Rehabilitation Foundatio

Farm noise emissions during common agricultural activities

Noise injury in agriculture is a significant yet often unrecognized problem. Many farmers, farm workers, and family members are exposed to noise levels above recommended levels and have greater hearing loss than their non-farming contemporaries. The aim of this study was to gather up-to-date information on farm noise levels and to enhance the quality of information available to assist farmers in reducing noise exposure and meeting Occupational Health and Safety (OHS) regulations regarding noise management. Farm visits were conducted on 48 agricultural establishments that produce a range of commodities. Noise levels were measured at the ears of operators and bystanders involved in typical activities on farms. The average and peak noise levels were measured for 56 types of machinery or sites of farming activity, totaling 298 separate items and activities. Common noise hazards identified included firearms, tractors without cabs, workshop tools, small motors (e.g., chainsaws, augers, pumps), manual handling of pigs, shearing sheds, older cabbed tractors, and heavy machinery such as harvesters, bulldozers, and cotton module presses. We found that use of firearms without hearing protection presents a pressing hearing health priority. However, farming activities involving machinery used for prolonged periods also present significant risks to farmers’ hearing health. Noise management strategies on the farm are essential in order to prevent noise injury among farmers

Hearing screening program impact on noise reduction strategies

The objective of this study was to determine the impact of the New South Wales Rural Hearing Conservation Program on the implementation of personal hearing protection (PHP) and noise management strategies among farmers who had participated in this program in New South Wales, Australia. A follow-up survey of a random sample of people screened through the New South Wales Rural Hearing Conservation Program was linked to their baseline data. The use of PHP at baseline was compared to use at follow-up in four specific scenarios: use with non-cabbed tractors, with chainsaws, with firearms, and in workshops. For non-cabbed tractors, the net gain in PHP use was 13.3%; the net gain was 20.8% for chainsaws, 6.7% for firearms, and 21.3% for workshops. Older farmers and those with a family history of hearing loss were less likely to maintain or improve PHP use. Those with severe hearing loss, males, and participants reporting hearing problems in situations where background noise was present were more likely to maintain or improve PHP use. Forty-one percent of farmers had initiated other strategies to reduce noise exposure beyond the use of PHP, which included engineering, maintenance, and noise avoidance solutions. The early (hopefully) identification of hearing deficit in farmers and farm workers can help promote behavior change and help reinforce a farm culture that supports hearing conservation. The continuation and expansion of hearing screening programs such as these should be encouraged as basic public health strategy in farming communities

Macroalgae removal on coral reefs: realised ecosystem functions transcend biogeographic locations

Coral reef ecosystems are at the forefront of biodiversity loss and climate change-mediated transformations. This is expected to have profound consequences for the functioning of these ecosystems. However, assessments of ecosystem function on reefs are often spatially limited, within biogeographic realms, or rely on presumed proxies such as traits. To address these shortcomings and assess the effects of biogeography and fish presence on the critical ecosystem function of macroalgal removal, we used assays of six algal genera across three reef habitats in two biogeographically distinct locations: Little Cayman in the Caribbean and Lizard Island on the Great Barrier Reef (GBR). Patterns of fish feeding and realised ecosystem function were strikingly similar between the two geographic locations, despite a threefold difference in the local diversity of nominally herbivorous fishes, a 2.4-fold difference in the diversity of fishes feeding and differences in the biogeographic history of the two locations. In both regions, a single species dominated the function: a surgeonfish, Naso unicornis, at the GBR location and, surprisingly, a triggerfish, Melichthys niger, at the Caribbean location. Both species, especially M. niger, were relatively rare, compared to other nominally herbivorous fishes, in censuses covering more than 14,000 m(2) at each location. Our study provides novel insights into the critical function of macroalgal removal in hyperdiverse coral reef ecosystems, highlighting: (a) that function can transcend biogeographic, taxonomic and historical constraints; and (b) shortcomings in our assumptions regarding fish presence and realised ecosystem function on coral reefs

Management strategies to minimize the dredging impacts of coastal development on fish and fisheries

Accelerating coastal development and shipping activities dictate that dredging operations will intensify, increasing potential impacts to fishes. Coastal fishes have high economic, ecological, and conservation significance and there is a need for evidencebased, quantitative guidelines on how to mitigate the impacts of dredging activities. We assess the potential risk from dredging to coastal fish and fisheries on a global scale.We then develop quantitative guidelines for two management strategies: threshold reference values and seasonal restrictions. Globally, threatened species and nearshore fisheries occur within close proximity to ports. We find that maintaining suspended sediment concentrations below 44 mg/L (15–121 bootstrapped CI) and for less than 24 hours would protect 95% of fishes from dredging-induced mortality. Implementation of seasonal restrictions during peak periods of reproduction and recruitment could further protect species from dredging impacts. This study details the first evidence-based defensible approach to minimize impacts to coastal fishes from dredging activities

External tagging does not affect the feeding behavior of a coral reef fish, Chaetodon vagabundus (Pisces: Chaetodontidae)

Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of for personal use, not for redistribution. The definitive version was published in Environmental Biology of Fishes 86 (2009): 447-450, doi:10.1007/s10641-009-9545-9.Increasingly, the ability to recognize individual fishes is important for studies of population dynamics, ecology, and behavior. Although a variety of methods exist, external tags remain one of the most widely applied because they are both effective and cost efficient. However, a key assumption is that neither the tagging procedure nor the presence of a tag negatively affects the individual. While this has been demonstrated for relatively coarse metrics such as growth and survival, few studies have examined the impact of tags and tagging on more subtle aspects of behavior. We tagged adult vagabond butterflyfish (Chaetodon vagabundus) occupying a 30-ha insular reef in Kimbe Bay, Papua New Guinea, using a commonly-utilized t-bar anchor tag. We quantified and compared feeding behavior (bite rate), which is sensitive to stress, of tagged and untagged individuals over four separate sampling periods spanning four months post-tagging. Bite rates did not differ between tagged and untagged individuals at each sampling period and, combined with additional anecdotal observations of normal pairing behavior and successful reproduction, suggest that tagging did not adversely affect individuals.The authors gratefully acknowledge funding from the Fulbright Program, National Science Foundation and the Australian Research Council