Literature / Litterature scientifique
Can J Rural Med 1997; 2 (1): 44
© 1997 Society of Rural Physicians of Canada
People living in rural areas are exposed to numerous risks that are particular to their geography and their occupations, and many recent articles examine these risks.
Machine-related occupational injuries in farm residents. Layde PM, Nordstrom DL, Stueland D, Brand L, Olson KA. Ann Epidemiol 1995;5(6):419-26.
Layde and coauthors examined the factors associated with farm injuries occurring in Wisconsin (from May 1990 through April 1992) that involved machinery or a farm implement and that resulted in medical or chiropractic care.
They found that workers at large farms and dairy farms and nonresident farmhands were at greater risk of injury than workers at farms that had registered cows and those where cows were fed in the barn throughout the year. Furthermore, they found that "Farm safety practices did not appreciably influence the risk of machine-related farm injury."
Lung (agricultural/rural). do Pico GA. Otolaryngol Head Neck Surg 1996;114(2):212-6.
Hazards other than farm machinery exist in the rural environment. Prominent among them are the chemicals to which a farmer may be exposed in the course of farm operations. In this paper do Pico reviews the many sources of environmental exposure that may lead to pulmonary disease.
Illnesses may take the form of occupational asthma, bronchitis or, less commonly, toxic hemorrhagic pulmonary edema (silo-filler's disease). Many agents, including "organic dusts, allergens, chemicals, toxic gases, and infectious agents," are implicated. The author calls for increased education of workers and better compliance with safety regulations.
Lung cancer, smoking, and environment: a cohort study of the Danish population. Engholm G, Palmgren F, Lynge E. BMJ 1996;312(7041):1259-63.
Asthma, airways responsiveness and air pollution in two contrasting districts of northern England. Devereux G, Ayatollahi T, Ward R, Bromly C, Bourke SJ, Stenton SC, Hendrick DJ. Thorax 1996;51(2):169-74.
To add insult to injury, two recent studies throw doubt on the assumption that rural risks are offset by the benefits of a cleaner environment in rural areas, at least in so far as the occurrence of lung cancer and asthma are concerned.
Engholm and associates report in BMJ that the significant difference in the incidence of lung cancer between Copenhagen and rural areas in Denmark can be almost entirely explained by differences in smoking habits, which, they say, "explained about 60% of the excess lung cancer risk in Copenhagen for men and 90% for women." After controlling for smoking, they also found that workers had double the risk for lung cancer that teachers or academics did and that geographic region had only a small independent effect.
In a related study in the United Kingdom, Devereux and colleagues found there was little difference in prevalence of asthma and airway responsiveness between rural West Cumbria and urban, polluted Newcastle, despite the apparent environmental differences. Air pollution due to exhaust fumes from motor vehicles was the most obvious of these differences and was 2 to 10 times greater in the urban centre than in the rural area. The authors suggest that their findings shed some doubt on the role of pollution as a possible agent in the recent increase in prevalance of asthma. They add that "It is possible, however, that an air pollution effect in Newcastle has been balanced by asthmagenic effects of other agents in West Cumbria."
