Search

Objective: To gain new insight into contextual factors shaping how physical ill health acts as a stressor in rural suicides—informing the development of appropriate targeted interventions. Design: Retrospective cohort study. Setting: Non‐metropolitan Victoria, Australia. Sample: 802 rural (non‐metropolitan) suicide deaths between the years 2009 and 2015. Main outcome measure: Qualitative data from the Victorian Suicide Register relating to physical ill health of suicide decedents. Results: Thematic analysis identified 4 themes: (a) 'living with physical ill health in a rural area' highlights both practical and cultural challenges associated with managing physical ill health within the context of life in a rural setting; (b) 'causes and experience of chronic pain' highlights rural risk factors for chronic pain, how pain was experienced and treatment managed; (c) 'when living an independent, contributing life is no longer possible' describes the debilitating physical and mental outcomes of chronic ill health and pain; and (d) 'the cumulative impact of physical ill health and other factors on suicide risk' highlights the complexity of risk factors—in combination with (or as a result of) physical ill health—that contribute to a suicide death. Conclusion: Identified themes suggest pathways to improve understanding and support for those experiencing physical ill health and associated suicide risk. These supports include contextually and culturally appropriate rural services to provide effective and necessary treatment, pain relief and mental health support; acknowledgement and response to a culture of alcohol misuse as an (ultimately ineffective) coping strategy; proactive psychosocial support mechanisms; and alternative approaches to support including consideration of innovative peer support models. [ABSTRACT FROM AUTHOR]

In order to implement intervention strategies to prevent falls from height, epidemiological data are needed. The aim of this study was to map emergency presentations for falls from height in residents aged ≥40 yr of the western region of Victoria, Australia. Emergency presentations following a fall from height (≥1 m) were obtained from electronic medical records for 2014–2016 inclusive. For each Local Government Area, age-standardised incidence rates (per 10,000 population/year) were calculated. The age-standardised incidence rate was lowest in the Northern Grampians (3.4 95%CI 0.8–5.9), which has several main industries including health care, agriculture and manufacturing. The highest rates occurred in Corangamite (26.0 95%CI 19.9–32.0), Colac-Otway (23.7 95%CI 18.5–28.8) and Moyne (22.5 95%CI 16.8–28.3), which are sparsely populated (15,000–20,000 people each). Patterns were similar for men and women. Most falls occurred during "leisure" (38.0%), followed by "other work" (15.4%). Men were more likely than women to experience a fall from height while undertaking work activities. Many falls occurred in the home (53.2%). Future research should inform strategies to prevent falls from height in the region. This could include specific locations such as the home or farm, and during leisure activities or work. [ABSTRACT FROM AUTHOR]

In order to develop and implement prevention strategies for falls, comprehensive epidemiological data are required. Therefore, this study mapped emergency presentations for falls across the western region of Victoria, Australia, encompassing urban, regional and rural areas. This cross-sectional study utilised electronic data for emergency presentations following a fall from <1 m for individuals aged ≥40 yr during 2014–2016 inclusive. Age-standardised incidence rates (per 1000 population/year) were calculated for each Local Government Area (LGA). Age-standardised falls incidence varied across the LGAs, with the lowest occurring in the Rural City of Ararat LGA (4.4; 95%CI:3.5–5.4) and the highest for the City of Warrnambool (25.1; 95%CI:23.7–26.6), Colac-Otway (24.7; 95%CI:23.0–26.4) and Moyne (23.0; 95%CI:21.2–24.8). Patterns were similar for men and women when stratified by sex across these LGAs. For men and women combined, most patients arrived at the hospital using private transportation (55.3%) or road ambulance service (43.1%). Most falls occurred during leisure activities (48.0%) in a home setting (54.8%). Higher rates of falls presentations were observed in southern LGAs and most commonly occurred at home, during leisure activity. Future research should identify specific intervention strategies to reduce falls in the region, based on the data reported from this study. [ABSTRACT FROM AUTHOR]

Background: Residents of rural and regional areas, compared to those in urban regions, are more likely to experience geographical difficulties in accessing healthcare, particularly specialist services. We investigated associations between region of residence, socioeconomic status (SES) and utilisation of all-cause revision hip replacement or revision knee replacement surgeries.Methods: Conducted in western Victoria, Australia, as part of the Ageing, Chronic Disease and Injury study, data from the Australian Orthopaedic Association National Joint Replacement Registry (2011-2013) for adults who underwent a revision hip replacement (n = 542; 54% female) or revision knee replacement (n = 353; 54% female) were extracted. We cross-matched residential addresses with 2011 census data from the Australian Bureau of Statistics (ABS), and using an ABS-derived composite index, classified region of residence according to local government areas (LGAs), and area-level SES into quintiles. For analyses, the control population (n = 591,265; 51% female) was ABS-determined and excluded adults already identified as cases. Mixed-effects logistic regression was performed.Results: We observed that 77% of revision hip surgeries and 83% of revision knee surgeries were performed for residents in the three most socially disadvantaged quintiles. In adjusted multilevel models, total variances contributed by the variance in LGAs for revisions of the hip or knee joint were only 1% (SD random effects ±0.01) and 3% (SD ± 0.02), respectively. No differences across SES or sex were observed.Conclusions: No differences in utilisation were identified between SES groups in the provision of revision surgeries of the hip or knee, independent of small between-LGA differences. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the experiences of farmers on returning to farming following a serious farm-related injury. Methods: Patients who had sustained major trauma on a farm in Victoria, Australia, were identified using the Victorian State Trauma Registry (VSTR). In depth, semistructured phone interviews were conducted with 31 participants. Interview data were subjected to thematic analysis to identify important recurring themes. Interviews continued until data saturation was achieved. Results: Interviewees included self-employed full-time farmers, part-time farmers with a supplementary income, and agricultural employees. Analysis of participant responses connected to returning to farming after a serious farm-related injury identified five major interconnected themes: (i) effect on farm work, (ii) farming future, (iii) safety advocacy, (iv) changes to farming practices, and (v) financial ramifications. Conclusion: Farmers who have sustained a serious farm-related injury are an important resource; their experiences and perspectives could assist in the development of educational and transitional support services from recovery back to working at a preinjury level, while ensuring farming production is sustainable during this period. Furthermore, farm safety programs can be enhanced by the engagement of farmers, such as participants in this study as advocates for improved farm safety practices. [ABSTRACT FROM AUTHOR]

Objective The objective of this present study was to describe the initial destination hospital of paediatric patients transported by Ambulance Victoria paramedics within the South Western area of Victoria to determine the proportion of patients that bypassed their closest hospital. Methods All Ambulance Victoria primary ambulance transports for paediatric patients aged 1 month to 14 years in the Barwon South West region between 1 April 2008 and 28 February 2011 were reviewed. Each case was examined to determine the destination hospital location relative to the case scene location, and the overall nature of each case was grouped into one of seven categories (medical respiratory, medical cardiac, medical neurological, medical other, trauma time critical, and trauma non-time critical). Results There were 1191 cases identified, with 978 (82%) being taken to the closest hospital and 213 (18%) to a more distant facility. The average distance travelled from the scene to the destination hospital was 15.2 km, and almost 90% of patients transported to the nearest hospital were within 15 km of that hospital. Time critical trauma cases and respiratory-related medical cases had higher rates of transport to more distant hospitals as their initial destination (26% to non-closest and 23% to non-closest, respectively). Conclusion The patient's condition and their location relative to the larger medical facilities appear to influence the decision of destination hospital. Uncertainty regarding the availability of 24 h hospital services and staffing details may contribute to longer transfers. [ABSTRACT FROM AUTHOR]

Objective This study aims to understand the extent of farmers' exposure to hazardous noise, and trial and test the ability of an on-farm noise audit report to improve awareness and preventative action towards farm based noise hazards. Design Visits were made to working farms where noise and dosimetry measurements undertaken. During return visits, the noise measurements were explained in a brief report. A follow-up questionnaire was implemented gathering feedback on the use or otherwise of the report. Setting Working farms in Western Victoria and SE Queensland including dairy, beef, wool, prime lamb and cropping. Participants Participants were 14 female and 37 male farm workers. Interventions Noise exposure assessment of daily activities through dosimetry; measurements of noisy tasks and machinery; supply and interpretation of a noise audit report. Main outcome measures Participants were supplied with a 'noise report' of their workplace together with an explanation of the report's meaning to farm workers. Results Men and women have similar at risk exposures. The average noise exposure was 1.09 Pa2h (LAeq,8h = 85.3 dB). This implies 163 000 Australian agricultural workers are at risk from hazardous noise. On-farm noise audit reports were a relevant and valuable feedback to farmers in relation to their potential noise hazards. Conclusions Of those measured 51%, and by extrapolation 163 000 Australian agricultural workers, have noise exposure levels greater than the recommended Australian Standard of 1.01 Pa2h (85 dB). Men and women are equally exposed. On-farm noise audit reports are an effective feedback to increase awareness and improve hearing health. [ABSTRACT FROM AUTHOR]

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program ( AITP). Design and Sample Qualitative interviews of 15 rural and remote nurses. Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP-an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse. Results Nurses found the training provided new-or built on existing-knowledge of alcohol misuse and offered practical hands-on 'real life' skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended. Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice. [ABSTRACT FROM AUTHOR]

This pilot study examines the prevalence of cardiac risk factors in a cohort of agricultural workers, assesses their knowledge of local emergency health services and investigates their decision-making abilities with regard to when and how they would seek help when experiencing chest pain. Farm men and women were recruited from 20 rural Victorian sites and underwent health assessments for total cholesterol, blood glucose, weight, height and blood pressure. Participants completed a survey to determine their knowledge of chest pain treatment, local emergency services and likely response to chest pain. Cardiac risk factors within this cohort of 186 adult farming men and women were common, with 61% of men (58/95, 95% confidence interval [CI] 51-70) and 74% of women (68/91, 95% CI 65-83) either overweight or obese. When asked to name their nearest ED, 10% of participants (19/184, 95% CI 7-16) nominated health services or towns where no ED exists. Furthermore, 67% of respondents (123/185, 95% CI 59-73) believed it was safe to travel to hospital by car while potentially having a myocardial infarction. This cohort of agricultural workers were at considerable risk of experiencing acute coronary events, but many would make decisions about when and how to seek medical help for chest pain that are at odds with published community guidelines. These results highlight the need for education to improve knowledge of local emergency services and address behavioural barriers to accessing care. [ABSTRACT FROM AUTHOR]

The 10MMM multimedia project began in late 2002 in a rural region of western Victoria and has now entered its second stage. it is an interagency initiative intended to decrease the social isolation of rural young people and stimulate the expression of youth 'voice' and leadership using multimedia tools. As the process of working with rural young people unfolds over time, it provides an opportunity for ongoing reflection on the extent to which the project can become truly driven by young people, and whether it can enable them to take a stronger leadership role in their rural communities. [ABSTRACT FROM AUTHOR]

Background: Cancer is a leading burden of disease in Australia and worldwide, with incidence rates varying with age, sex and geographic location. As part of the Ageing, Chronic Disease and Injury study, we aimed to map the incidence rates of primary cancer diagnoses across western Victoria and investigate the association of age, accessibility/remoteness index of Australia (ARIA) and area-level socioeconomic status (SES) with cancer incidence.Methods: Data on cancer incidence in the study region were extracted from the Victorian Cancer Registry (VCR) for men and women aged 40+ years during 2010-2013, inclusive. The age-adjusted incidence rates (per 10,000 population/year), as well as specific incidence for breast, prostate, lung, bowel and melanoma cancers, were calculated for the entire region and for the 21 Local Government Areas (LGA) that make up the whole region. The association of aggregated age, ARIA and SES with cancer incidence rates across LGAs was determined using Poisson regression.Results: Overall, 15,120 cancer cases were identified; 8218 (54%) men and 6902 women. For men, the age-standardised rate of cancer incidence for the whole region was 182.1 per 10,000 population/year (95% CI 177.7-186.5) and for women, 162.2 (95% CI: 157.9-166.5). The incidence of cancer (overall) increased with increasing age for men and women. Geographical variations in cancer incidence were also observed across the LGAs, with differences identified between men and women. Residents of socioeconomically disadvantaged and less accessible areas had higher cancer incidence (p < 0.001).Conclusion: Cancer incidence rates varied by age, sex, across LGAs and with ARIA. These findings not only provide an evidence base for identifying gaps and assessing the need for services and resource allocation across this region, but also informs policy and assists health service planning and implementation of preventative intervention strategies to reduce the incidence of cancer across western Victoria. This study also provides a model for further research across other geographical locations with policy and clinical practice implications, both nationally and internationally. [ABSTRACT FROM AUTHOR]

Introduction: Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation., Objective: This study identified regions with high farm-related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr., Design: Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017-2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age-standardised incidence rates (per 1000 population/year) were calculated., Findings: For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm-related. The overall age-standardised rate for farm-related injury presentations was 2.6 (95% CI 2.4-2.7); men had a higher rate than women (4.1, 95% CI 3.9-4.4 versus 1.2, 95% CI 1.0-1.3, respectively). For individual LGAs, the highest rates of farm-related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two-thirds of farm-related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as "other" (including private car, 83.3%). There were also several common injury causes identified: "other animal related injury" (20.2%), "cutting, piercing object" (19.5%), "fall ⟨1 m" (13.1%), and "struck by or collision with object" (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%)., Discussion and Conclusion: This study provides data to inform future research and resource allocation for the prevention of farm-related injuries., (© 2024 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Purpose: Research examining psychological well-being associated with COVID-19 in rural/regional Australia is limited. This study aimed to assess the extent of psychological distress, fear of COVID-19, and coping strategies among the attendees in COVID-19 screening clinics at 2 rural Victorian settings., Methods: A cross-sectional study was conducted during July 2020 to February 2021 inclusive. Participants were invited to fill in an online questionnaire. Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale, and Brief Resilient Coping Scale were used to assess psychological distress, fear of COVID-19, and coping, respectively., Findings: Among 702 total participants, 69% were females and mean age (±SD) was 49 (±15.8) years. One in 5 participants (156, 22%) experienced high to very high psychological distress, 1 in 10 (72, 10%) experienced high fear, and more than half (397, 57%) had medium to high resilient coping. Participants with mental health issues had higher distress (AOR 10.4, 95% CI: 6.25-17.2) and fear (2.56, 1.41-4.66). Higher distress was also associated with having comorbidities, increased smoking (5.71, 1.04-31.4), and alcohol drinking (2.03, 1.21-3.40). Higher fear was associated with negative financial impact, drinking alcohol (2.15, 1.06-4.37), and increased alcohol drinking. Medium to high resilient coping was associated with being ≥60 years old (1.84, 1.04-3.24) and completing Bachelor and above levels of education., Conclusion: People who had pre-existing mental health issues, comorbidities, smoked, and consumed alcohol were identified as high-risk groups for poorer psychological well-being in rural/regional Victoria. Specific interventions to support the mental well-being of these vulnerable populations, along with engaging health care providers, should be considered., (© 2021 The Authors. The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)

Heat kills more Australians than any other natural disaster. Previous Australian research has identified increases in Emergency Department presentations in capital cities; however, little research has examined the effects of heat in rural/regional locations. This retrospective cohort study aimed to determine if Emergency Department (ED) presentations across the south-west region of Victoria, Australia, increased on high-heat days (1 February 2017 to 31 January 2020) using the Rural Acute Hospital Data Register (RAHDaR). The study also explored differences in presentations between farming towns and non-farming towns. High-heat days were defined as days over the 95th temperature percentile. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes associated with heat-related illness were identified from previous studies. As the region has a large agricultural sector, a framework was developed to identify towns estimated to have 70% or more of the population involved in farming. Overall, there were 61,631 presentations from individuals residing in the nine Local Government Areas. Of these presentations, 3064 (5.0%) were on days of high-heat, and 58,567 (95.0%) were of days of non-high-heat. Unlike previous metropolitan studies, ED presentations in rural south-west Victoria decrease on high-heat days. This decrease was more prominent in the farming cohort; a potential explanation for this may be behavioural adaption.

Rural Australians experience a range of health inequities-including higher rates of suicide-when compared to the general population. This retrospective cohort study compares demographic characteristics and suicide death circumstances of farming- and non-farming-related suicides in rural Victoria with the aim of: (a) exploring the contributing factors to farming-related suicide in Australia's largest agricultural producing state; and (b) examining whether farming-related suicides differ from suicide in rural communities. Farming-related suicide deaths were more likely to: (a) be employed at the time of death (52.6% vs. 37.7%, OR = 1.84, 95% CIs 1.28-2.64); and, (b) have died through use of a firearm (30.1% vs. 8.7%, OR = 4.51, 95% CIs 2.97-6.92). However, farming-related suicides were less likely to (a) have a diagnosed mental illness (36.1% vs. 46.1%, OR=0.66, 95% CIs 0.46-0.96) and, (b) have received mental health support more than six weeks prior to death (39.8% vs. 50.0%, OR = 0.66, 95% CIs 0.46-0.95). A range of suicide prevention strategies need adopting across all segments of the rural population irrespective of farming status. However, data from farming-related suicides highlight the need for targeted firearm-related suicide prevention measures and appropriate, tailored and accessible support services to support health, well-being and safety for members of farming communities.

Introduction: The psychological response to injury is an important factor in recovery, and the development of psychological problems can result in a delay or inability to return to pre-injury function, including return to work. Farming is widely acknowledged as a stressful occupation, with non-injured farmers already at an increased risk of developing significant psychological problems, including high levels of stress and depression, and increased rates of suicide. This study aimed to investigate the psychological effects of serious farm-related injury on farmers, and how this influences their recovery., Methods: This was a qualitative study of 31 farmers in the state of Victoria, Australia, who sustained major trauma between 2007 and 2013. Participants were identified using the Victorian State Trauma Registry and underwent an in-depth, semi-structured telephone interview. Recruitment continued until data saturation was achieved, and thematic analysis was used to identify important themes from the data., Results: For many farmers, the traumatic circumstances and ongoing impact of their injury are life-changing. In this study, the psychological effects of sustaining a major farm-related injury varied between participants; however, four major interconnected themes were identified: importance of a pragmatic outlook; grief, helplessness and loss of independence; traumatic thoughts post-injury; and the importance of the support network and community. The findings of this study highlight both a reluctance for psychological assistance as well as the importance of psychological resilience and support networks to recovery., Conclusion: Overall, a positive outlook was found to be the primary enabler in the farmers' recovery. It is recommended that injured farmers should be provided with additional psychological support and advice to aid in their recovery. Additionally, psychological support services should be extended to include both the family network and the broader farming community, as these were found to experience significant short- and long-term stress following farmers' injury.

Objective: Hospitalisation rates for many chronic conditions are higher in socioeconomically disadvantaged and less accessible areas. We aimed to map diabetes hospitalisation rates by local government area (LGA) across Western Victoria, Australia, and investigate their association with socioeconomic status (SES) and accessibility/remoteness., Design: Cross-sectional study METHODS: Data were acquired from the Victorian Admitted Episodes Dataset for all hospitalisations (public and private) with a diagnosis of type 1 or type 2 diabetes mellitus during 2011-2014. Crude and age-standardised hospitalisation rates (per 1000 population per year) were calculated by LGA for men, women and combined data. Associations between accessibility (Accessibility/Remoteness Index of Australia, ARIA), SES (Index of Relative Socioeconomic Advantage and Disadvantage, IRSAD) and diabetes hospitalisation were investigated using Poisson regression analyses., Results: Higher LGA-level accessibility and SES were associated with higher rates of type 1 and type 2 diabetes hospitalisation, overall and for each sex. For type 1 diabetes, higher accessibility (ARIA category) was associated with higher hospitalisation rates (men incidence rate ratio [IRR]=2.14, 95% CI 1.64 to 2.80; women IRR=2.45, 95% CI 1.87 to 3.19; combined IRR=2.30, 95% CI 1.69 to 3.13; all p<0.05). Higher socioeconomic advantage (IRSAD decile) was also associated with higher hospitalisation rates (men IRR=1.25, 95% CI 1.09 to 1.43; women IRR=1.32, 95% CI 1.16 to 1.51; combined IRR=1.23, 95% CI 1.07 to 1.42; all p<0.05). Similarly, for type 2 diabetes, higher accessibility (ARIA category) was associated with higher hospitalisation rates (men IRR=2.49, 95% CI 1.81 to 3.43; women IRR=2.34, 95% CI 1.69 to 3.25; combined IRR=2.32, 95% CI 1.66 to 3.25; all p<0.05) and higher socioeconomic advantage (IRSAD decile) was also associated with higher hospitalisation rates (men IRR=1.15, 95% CI 1.02 to 1.30; women IRR=1.14, 95% CI 1.01 to 1.28; combined IRR=1.13, 95% CI 1.00 to 1.27; all p<0.05)., Conclusion: Our observations could indicate self-motivated treatment seeking, and better specialist and hospital services availability in the advantaged and accessible areas in the study region. The determinants for such variations in hospitalisation rates, however, are multifaceted and warrant further research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Australian farmers are routinely exposed to a wide variety of agrichemicals, including herbicides and insecticides. Organophosphate (OP) insecticides are widely used for agricultural production, horticulture and animal husbandry practices. Symptoms of OP toxicity are the results of inhibition of the enzyme acetylcholinesterase (AChE) which is found in many types of conducting tissue in human bodies such as nerve and muscle, central and peripheral tissues, motor and sensory fibres. Cholinesterase can be measured in red blood cells/erythrocytes (AChE) and plasma (PChE). This study aims to explore integration of AChE monitoring into routine health checks for those at risk and also to examine any association between AChE activity and agrichemical use in a Victorian farming community in Australia., Methods: This was a prospective cohort study, where farmers and non-famers were compared on the levels of AChE at four time points of baseline, 3-4 weeks, 6-weeks and at 9-weeks. Study participants (N = 55) were residents from South West Victoria, aged between 18 and 75 years, spoke English, and had not had a previous known acute chemical accident. A total of 41 farming (had been farming for more than 5 years) and a convenience sample of 14 non-farming individuals met the inclusion criteria. Testing of AChE was repeated for all participants with a maximum of three times over 10 weeks., Results: The integration of AChE monitoring was very well accepted by all participants. There was no significant difference in average AChE activity between farming and non-farming participants (one-way ANOVA p > 0.05) in this study. There was no significant difference between personal use of agricultural chemicals on farm and the levels of AChE at baseline (measurement 1) or any of the follow up periods (p > 0.05). However, the mean activity of AChE was significantly lower within follow up periods [F (2.633, 139.539) = 14.967, p < 0.001]. There was a significant reduction of AChE between the follow up at 3-weeks and 6-weeks period (p = 0.015)., Conclusions: The routine monitoring of AChE may allow for early recognition of chronic low-level exposure to OPs when they are used by farmers, provided a reasonable estimate of baseline AChE is available. This work provides an evidence for recommending the integration of AChE monitoring into point of care (POC) procedures in rural health clinics and quantifying pesticide exposure and personal protection both on the farm and in the home. Farmer engagement is crucial to the successful integration of AChE monitoring into rural health clinics in Australia., Trial Registration: ACTRN12613001256763 .

Background: Hip fractures are associated with considerable morbidity and mortality. Hip fracture incidence varies across different levels of accessibility/remoteness and socioeconomic status (SES). As part of the Ageing, Chronic Disease and Injury Study, we aimed to map the pattern of hip fractures across the western region of the Australian state of Victoria, which contains a range of remoteness levels and SES., Methods: Data on hip fractures resulting in hospital admission were extracted from the Victorian Admitted Episodes Dataset (VAED) for men and women aged 40+years during 2010-2013 inclusive. An age-adjusted incidence rate (per 10,000population/year) was calculated for the entire region. Crude incidence rates and length of acute care hospital stay (excluding rehabilitation) were calculated for each Local Government Area (LGA). The impact of aggregated age, accessibility/remoteness index of Australia (ARIA) and SES on hip fracture rates aggregated across LGAs was determined using Poisson regression., Results: For men, the age-standardised rate of hospitalisations for hip fracture across the whole region was 19.2 per 10,000population/year (95%CI 18.0-20.4) and for women, 40.0 (95%CI 38.3-41.7). The highest incidence rates for both sexes occurred in the less accessible LGAs of Yarriambiack and Hindmarsh, as well as the LGA with the lowest SES, Central Goldfields. In both sexes, approximately two thirds of individuals were discharged from acute hospital care within 14days. Increasing age, higher remoteness and lower SES were all associated with higher hip fracture rates., Conclusion: Crude incidence rates varied by location. Given that a high proportion of patients had acute hospital care of ≤14days, and accessibility and SES were associated with hip fracture rates, these results can inform policy and provide a model for other groups to conduct similar research in their local environment., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Studies have confirmed that the rate of mental illness is no higher in rural Australians than that of urban Australians. However, the rate of poor mental health outcomes, and in particular suicide, is significantly raised in rural populations. This is thought to be due to lack of early diagnosis, health service access, the distance-decay effect, poor physical health determinants and access to firearms. Research conducted by the National Centre for Farmer Health between 2004 and 2009 reveals that there is a correlation between obesity and psychological distress among the farming community where suicide rates are recognised as high. Chronic stress overstimulates the regulation of the hypothalamic-pituitary-adrenal (HPA) axis that is associated with abdominal obesity. Increasing physical activity may block negative thoughts, increase social contact, positively influence brain chemistry and improve both physical and mental health. This paper describes the design of the Farming Fit study that aims to identify the effect of physical activity on psychological distress, obesity and health behaviours such as diet patterns and smoking in farm men and women., Methods/design: For this quasi-experimental (convenience sample) control-intervention study, overweight (Body Mass Index ≥25 kg/m(2)) farm men and women will be recruited from Sustainable Farm Families™ (SFF) programs held across Victoria, Australia. Baseline demographic data, health data, depression anxiety stress scale (DASS) scores, dietary information, physical activity data, anthropometric data, blood pressure and biochemical analysis of plasma and salivary cortisol levels will be collected. The intervention group will receive an exercise program and regular phone coaching in order to increase their physical activity. Analysis will evaluate the impact of the intervention by longitudinal data (baseline and post intervention) comparison of intervention and control groups., Discussion: This study is designed to examine the effect of physical activity on psychological health and other co-morbidities such as obesity, impaired glucose tolerance, hypertension and dyslipidaemia within a high-risk cohort. The outcomes of this research will be relevant to further research and service delivery programs, in particular those tailored to rural communities., Trial Registration: ACTRN12610000827033.