full article:
Allergy 2002; 57: 1171-1179.
Farm residence and exposures and the risk of allergic diseases in New Zealand children.
Wickens K, Lane JM, Fitzharris P, Siebers R, Riley G, Douwes J, Smith T, Crane J.
BACKGROUND: Studies in Europe have reported a reduced prevalence of allergy in farmers' children. We aimed to determine if there is a similar reduction in allergy among New Zealand farm children. METHODS: Two hundred and ninety-three children participated (60%) aged 7-10 years, from selected schools in small towns and the surrounding rural area. Skin prick tests (SPT) to eight common allergens were performed. Parents completed questionnaires about allergic and infectious diseases, place of residence, exposure to animals, and diet, and they provided dust from the living-room floor. Endotoxin was measured using an Limulus amoebocyte lysate (LAL) assay and Der p 1 using enzyme-linked immunoassay (ELISA). RESULTS: Current farm abode was found to increase the risk of having symptoms associated with allergy, but not SPT positivity. Independent inverse associations were found for early-life exposures: at least weekly consumption of yoghurt with hayfever (odds ratio (OR) = 0.3, 95% confidence intervals (CI) 0.1-0.7) and allergic rhinitis (OR = 0.3, 95% CI 0.2-0.7); any unpasteurized milk consumption with atopic eczema/dermatitis syndrome (AEDS) (OR = 0.2, 95% CI 0.1-0.8); cats inside or outside with hayfever (OR = 0.4, 95% CI 0.1-1.0) and AEDS (OR = 0.4, 95% CI 0.2-0.8); dogs inside or outside with asthma (OR = 0.4, 95% CI 0.2-0.8); and pigs with SPT positivity (OR = 0.2, 95% CI 0.1-0.9). CONCLUSIONS: Despite finding a protective effect of early-life animal exposures, we found a greater prevalence of allergic disease on farms.
Allergy 2002; 57: 1130-1135.
Childhood farm environment and asthma and sensitization in young adulthood.
Kilpelainen M, Terho EO, Helenius H, Koskenvuo M.
BACKGROUND: Farm environment in childhood may protect against sensitization, allergic rhinitis, and asthma. METHODS: Subjects were obtained from 10 667 Finnish first-year university students who responded to a questionnaire survey on IgE-mediated diseases. Two random samples were selected from 1631 respondents in Turku: subjects with asthma or wheezing, and subjects without asthmatic symptoms. A total of 296 subjects (72%) participated. Skin prick tests (SPT), measurements of IgE-antibodies, methacholine challenge, and bronchodilation tests were performed. Weighted occurrence of current asthma and sensitization among students from "childhood farm" and "childhood nonfarm" environments were analyzed. RESULTS: Current asthma was found in 3.1% of subjects with childhood farm environment, and in 12.4% with nonfarm environment (odds ratio (OR) 0.22; 95% confidence interval (CI) 0.07-0.70). There were fewer positive SPT to birch (8.3 vs. 24.2%, OR 0.28, 95% CI 0.07-1.15) and timothy pollen (12.6 vs. 30.3%, OR 0.33, 95% CI 0.09-1.20) among subjects with childhood farm environment, but more sensitization to house-dust mite (22.0 vs. 4.9%, OR 5.43, 95% CI 1.60-18.46). Sensitization to cat (RAST class >/= 3) was less common in subjects with farm compared to nonfarm environments in childhood (1.5 vs. 13.1%; OR 0.10, 95% CI 0.02-0.47). CONCLUSIONS: Farm environment in childhood protects against adult asthma and sensitization-especially to cat-the most important asthma related allergen. In contrast, sensitization to house-dust mite was more common in farming subjects.
Acta Paediatrica 2002; 91: 1163-1169.
Does heredity modify the association between farming and allergy in children?
Reme ST, Pekkanen J, Soininen L, Kajosaari M, Husman T, Koivikko A.
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland. Sami.Remes@ktl.fi
AIM: It has been suggested that living on a farm decreases the risk of childhood allergy, especially if farming involves livestock. The aim of this study was to examine the association between farming and allergy in children, and the influence of atopic heredity in this association. METHODS: The cross-sectional data of the 7981 children aged 13-14 y who participated in the Finnish ISAAC study between the years 1994 and 1995 were used to evaluate the association between farming and allergy. RESULTS: Living on a farm was associated with a decreased risk of current symptoms of allergic rhinoconjunctivitis among all children (aOR 0.79; 95% CI 0.63, 0.99), and with a decreased risk of hay fever, especially among those children with a parental history of hayfever (aOR 0.60; 95% CI 0.40-0.89, p = 0.072 for interaction). The children of farmers with a history of hay fever also had a decreased risk of current wheeze (aOR 0.38; 95% CI 0.12-1.24, p = 0.040 for interaction). No significant association was found between farming and either asthma or eczema. Children living on a farm with livestock had the lowest risk of allergic rhinoconjunctivitis (aOR 0.69), followed by those living on a farm without livestock (aOR 0.89) compared with the non-farming children (p-value for trend 0.024). CONCLUSION: Our results support the recent findings on a decreased risk of allergy among the children living on farms. A possible differential effect of parental history of hay fever on the relation of farming environment and the risk of allergic symptoms warrant further investigation.
Canada Family Physician 2002; 48: 1476-1480.
Research electives in rural health care.
Kelly L, Rourke J.
McMaster University, Sioux Lookout, Ontario, Canada.
PROBLEM BEING ADDRESSED: As academic medical institutions being to address the education and service needs of rural Canadians, research will make its way to the foreground. Rural physicians are well positioned to lead in this venture, but often have little time or energy to take on extra duties. Rural populations differ in essential ways from urban populations. Certainly, the limitations of geography, funding, and population density alter medical surveillance, treatment, and research in ways that are largely undocumented. OBJECTIVE OF PROGRAM: To undertake research projects of interest to our group of rural clinicians and to expose medical students to both research and rural practice. MAIN COMPONENTS OF PROGRAM: Seven rural family physicians welcomed medical students into their group practice for summer research electives. Topics were chosen in advance by the medical group, and one member was designated as supervisor for each student. A local nurse educator also provided support to students and to clinicians after the students' departure. Several projects were undertaken simultaneously each summer; the result was several published peer-reviewed articles and good teaching and learning experiences. CONCLUSION: Rural research electives provide a valuable experience for students and preceptors. Such initiatives deserve broad promotion and support.
Nurse Education Today 2002; 22: 387-392.
An interdisciplinary rural health course: opportunities and challenges.
Racher FE.
School of Health Studies, Brandon University, Brandon, Manitoba, Canada. racher@brandonu.ca
What is the potential of courses designed for nursing students to meet the learning priorities of other disciplines? Who could benefit? Nursing students at Brandon University interested in the 'community as client' concept requested a course that focused on the health of rural residents and the communities in which they live. Questions about (1) measuring the health of rural populations; (2) comparing health status, health resources and health care utilization of rural and urban populations; and (3) determining the health of rural communities emerged. As a result the course, 'Health of Rural Populations and Communities', was created. The Director of the Rural Development Institute examined the syllabus for the new course and asked that Rural Development students be allowed to enroll. This paper focuses on the challenges and opportunities for nursing education to address learning needs of other disciplines by sharing health and nursing knowledge. In doing so the learning of nursing students is also advanced. The development and delivery of a rural health course is used as a case study to illustrate the potential of this approach for nursing and interdisciplinary education.
Proceedings AMIA Symposium 2002; (in process): 325-329.
Professional's Information Link (PiL): A Web-Based Asynchronous Consultation Service.
Hersh WR, Miller R, Olson D, Sacherek L, Cross P.
Medical Informatics, Oregon Health and Science University, School of Medicine, Portland, OR, USA.
Despite the massive growth of on-line information resources, many clinicians still prefer to obtain information from other clinicians, particularly those to whom they refer patients. Based on this notion and an information needs assessment, we developed the Professional's Information Link (PiL), a Web-based asynchronous consultation service to facilitate question answering between rural clinicians and an academic medical center. The system aims to provide answers to questions within two working days. It also includes patient handouts and continuing medical education resources. Our preliminary evaluation demonstrates modest but enthusiastic use of the system.
Sexually Transmitted Diseases 2002; 29: 775-779.
High Prevalence of Neisseria gonorrhoeae and Multiple Sexually Transmitted Diseases Among Rural Women in the Eastern Highlands Province of Papua New Guinea, Detected by Polymerase Chain Reaction.
Mgone CS, Lupiwa T, Yeka W.
BACKGROUND In a previous community-based study among rural women in the Eastern Highlands Province (EHP) of Papua New Guinea we determined that the prevalences of infection, infection, and syphilis were 46%, 26%, and 4%, respectively. Surprisingly, however, the prevalence of infection was only 1%, which we considered low in consideration of the high prevalence of other sexually transmitted diseases (STDs). The aim of the current study was to reexamine samples that were collected in that survey and retest them with use of polymerase chain reaction (PCR). STUDY DESIGN Using a cluster-sampling method, we surveyed 201 women aged 15 to 45 years in a population of approximately 19,000 people. In addition, 243 other women living in the same area who wished to be screened for STDs were included in the study. METHODS Endocervical samples that were stored frozen at -80 degrees C were retested with multiplex PCR (M-PCR) for the detection of both and and with a separate PCR for the detection of. RESULTS A total of 373 samples that were still available were analyzed. The prevalences of, and infections were 42.6%, 26.5%, and 18.2%, respectively; 59.8% of the women had at least one STD, while 21.7% had mixed infections, 5.9% of them with all three pathogens. CONCLUSIONS STDs are very common among rural women in the EHP of Papua New Guinea and often present as multiple infections.
New England Journal of Medicine 2002; 347: 555-560.
Comment in: N Engl J Med. 2002; 347: 608-609.
An outbreak of Escherichia coli O157:H7 infections among visitors to a dairy farm.
Crump JA, Sulka AC, Langer AJ, Schaben C, Crielly AS, Gage R, Baysinger M, Moll M, Withers G, Toney DM, Hunter SB, Hoekstra RM, Wong SK, Griffin PM, Van Gilder TJ.
Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta 30333, USA. jcrump@cdc.gov
BACKGROUND: Outbreaks of Escherichia coli O157:H7 infections have involved direct transmission from animals and their environment to humans. We describe an outbreak among visitors to a Pennsylvania dairy and petting farm that provides public access to animals. METHODS: We conducted both a case-control study among visitors to a farm to identify risk factors for infection and a household survey to determine the rates of diarrheal illness among these visitors. We performed an extensive environmental study to identify sources of E. coli O157:H7 on the farm. RESULTS: Fifty-one patients with confirmed or suspected E. coli O157:H7 infection were enrolled in the case-control study. The median age of the patients was four years, and the hemolytic-uremic syndrome developed in eight. Contact with calves and their environment was associated with an increased risk of infection, whereas hand washing was protective. The household survey indicated that visitors to the farm during the outbreak had higher than expected rates of diarrhea. Environmental studies showed that 28 of the 216 cattle on the farm (13 percent) were colonized with E. coli O157:H7 that had the same distinct pattern on pulsed-field gel electrophoresis that was found in isolates from the patients. This organism was also recovered from surfaces that were accessible to the public. CONCLUSIONS: In a large outbreak of E. coli O157:H7 infections among visitors to a dairy farm, predominantly children, high rates of carriage of E. coli O157:H7 among calves and young cattle most likely resulted in contamination of both the animals' hides and the environment. © 2002 Massachusetts Medical Society, reproduced under 'fair use' provisions.
New Zealand Medical Journal 2001; 114: 519-521.
Outbreak of cryptosporidiosis linked with a farm event.
Stefanogiannis N, McLean M, Van Mil H.
Regional Public Health, Wellington.
AIM: To investigate an outbreak of cryptosporidiosis linked to a two-day farm educational event in the Wellington region. Methods. The outbreak was investigated by carrying out a site visit and interviewing cases (or their parents) identified through notifications to Wellington Regional Public Health. RESULTS: Twenty confirmed cases were linked to the event. Nineteen were aged under seven years. The most likely route of infection was the hand-to-mouth transfer of the parasite after touching an infected animal. CONCLUSIONS: To our knowledge this is the first outbreak of cryptosporidiosis associated with a farm event reported in New Zealand. Farm animals, particularly calves, are likely to carry cryptosporidiosis and other microorganisms that are pathogenic in humans. This outbreak highlights the need for organisers of similar events to implement preventive measures such as hand washing facilities and reminders. Adults supervising young children should also be vigilant in enforcing hand washing following animal contact.