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

An evidence-consultation base for developing child injury prevention priorities for Australian farms

Issue addressed: Child injury on farms is a significant public health problem. This article describes the evidence and consultation base for development of a national strategy for child safety on farms in Australia. \ud \ud Methods: A data profile describing farm child injury was compiled, with evidence for the effectiveness of solutions being defined and the strength of recommendations determined. Representative working groups played a key role in assessing the evidence and advising on the best ways to communicate prevention messages within the farming community. \ud \ud Results: The main risks identified were drowning; farm vehicle and machinery injury; and injury associated with motorbikes and horses. Prevention recommendations were: (1) creating effective safe play areas on farms; (2) use of seatbelts/restraints in farm vehicles, (3) prevention of children riding as passengers on tractors, ATVs or the back of utilities; and (4) use of helmets when riding horses and motorbikes. \ud \ud Conclusions: Evidence on key injury risks and solutions has been a cornerstone to set the agenda for child safety on farms. An evidence-consultation base has achieved credibility with potential partners at all levels for adopting priority child safety messages

Comparison of cancer incidence in Australian farm residents 45 years and over, compared to rural non-farm and urban residents - a data linkage study

Abstract Background It is not known if the incidence of common cancers in Australian farm residents is different to rural non-farm or urban residents. Methods Data from farm, rural non-farm and urban participants of the 45 and Up Study cohort in New South Wales, Australia, were linked with state cancer registry data for the years 2006–2009. Directly standardised rate ratios for cancer incidence were compared for all-cancer, prostate, breast, colorectal cancer, melanoma and non-Hodgkin Lymphoma (NHL). Proportional hazards regression was used to generate incidence hazard ratios for each cancer type adjusted for relevant confounders. Results Farm women had a significantly lower all-cancer hazard ratio than rural non-farm women (1.14, 1.01–1.29). However, the lower all-cancer risk observed in farm men, was not significant when compared to rural non-farm and urban counterparts. The all-cancer adjusted hazard ratio for combined rural non-farm and urban groups compared to farm referents, was significant for men (1.08,1.01–1.17) and women (1.13, 1.04–1.23). Confidence intervals did not exclude unity for differences in risk for prostate, breast, colorectal or lung cancers, NHL or melanoma. Whilst non-significant, farm residents had considerably lower risk of lung cancer than other residents after controlling for smoking and other factors. Conclusions All-cancer risk was significantly lower in farm residents compared to combined rural non-farm and urban groups. Farm women had a significantly lower all-cancer adjusted hazard ratio than rural non-farm women. These differences appeared to be mainly due to lower lung cancer incidence in farm residents