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Interventions for preventing injuries in the agricultural industry

  • Review
  • Intervention

Authors


Abstract

Background

Agriculture is more hazardous than most other industries. Many strategies have been introduced to reduce injuries in the field, yet the effectiveness of different interventions on occupational injuries still remains unclear.

Objectives

This review aims to determine the effectiveness of interventions to prevent occupational injuries among workers in the agricultural industry compared to no interventions or to alternative interventions.

Search methods

Cochrane Central Register of Controlled Trials, Cochrane Injuries Group's specialised register, MEDLINE, EMBASE, PsychINFO, OSH-ROM (including NIOSHTIC and HSELINE) databases were searched up to June 2006. Reference lists of selected articles, relevant reviews and additional topic related databases and web sites were also searched. The searches were not restricted by language or publication status.

Selection criteria

Randomised controlled trials, cluster-randomised controlled trials, prospective cohort studies with a concurrent control group, and interrupted time series studies assessing any type of intervention aiming to prevent fatal or non-fatal injuries among workers in agriculture.

Data collection and analysis

Two reviewers conducted data extraction and study quality assessment independently. Rate ratios of randomised controlled trials were calculated and the effect sizes were combined in a meta-analysis. Interrupted time series studies were reanalysed and each of them studied for having an immediate and a progressive effect.

Main results

Five randomised controlled trials (RCTs) with 11,565 participants and three interrupted time series studies (ITSs) with 26.3 data points on average met the criteria.

For educational interventions aiming at reducing injury rates among adults the pooled rate ratio after recalculation from effect sizes in three RCTs was 1.02 (95% CI 0.87 to 1.20). For educational interventions aiming at children the pooled rate ratio for injury rates in two RCTs was 1.27 (95% CI 0.51 to 3.16).

One ITS study that evaluated the effect of an intervention that included financial incentives decreased the injury level immediately after the intervention with an effect size of -2.68 (95% CI -3.80 to -1.56) but did not have a significant effect on the injury trend over time with an effect size of -0.22 (95% CI -0.47 to 0.03).

One ITS study that evaluated the effect of legislation to ban Endosulfan pesticide on fatal pesticide poisonings increased the level of poisonings immediately after the introduction with an effect size of 2.20 (95% CI 0.97 to 3.43) but led to decrease in the trend of poisonings over time with an effect size of -2.15 (95% CI -2.64 to -1.66).

One ITS study documented four different regulations aiming to increase the use of rollover protective structures (ROPS) on tractors and their effect on injuries and fatal injuries. The introduction of two different pieces of legislation requiring ROPS on new tractors sold after a certain date was associated with a decrease of fatal injuries over the long term (effect size -0.93 95% CI -1.82 to -0.03). Otherwise the introduction of legislation was associated with an increase of injury rates. Introduction of legislation requiring ROPS on all tractors, old tractors included, was not associated with a decrease but with an increase of injuries and fatal injuries over the long term.

Authors' conclusions

The selected studies provided no evidence that educational interventions are effective in decreasing injury rates among agricultural workers. Financial incentives could reduce injury rates. Legislation to ban pesticides could be effective. Legislation expanding the use of safety devices (ROPS) on new tractors was associated with a decrease in fatal injuries.

摘要

背景

避免農業產業傷害的干預(介人)

農業的危險性比起其他產業更高。許多的策略用在於降低這個領域的傷害。雖然如此,降低職業傷害的不同干預,成效在上仍是未知。

目標

評論的重點以決定干預的成效為目的。對於農業產業的工作者,比較避免職業傷害的各種干預,以及沒有干預之間的成效。

搜尋策略

搜索以下資料庫:Cochrane Central Register of Controlled Trials, Cochrane Injuries Group specialised register, MEDLINE, EMBASE, PsychINFO, OSHROM (including NIOSHTIC and HSELINE)。資料收集到2006年6月。所選文章的參考文獻目錄,相關評論和其他主題相關的數據庫和網站也搜查。這次搜索不限語言或出版狀態。

選擇標準

隨機控制組實驗,群聚隨機控制組,前瞻性 世代研究,同期的控制組,時間間斷系列研究(ITS),以評估任何型式的干預,避免農業的工作者致命或非致命的傷害的成效。

資料收集與分析

兩位獨立審核者執行數據拮取,評估實驗的品質。計算隨機控制組的Rate ratios,以metaanalysis評估綜合性的影響層面。時間間斷系列研究,重新分析每一個研究,拮取立即性及逐步性的影響。

主要結論

5個隨機控制組(RCT)臨床實驗(共11,565個參與者)和3個時間間斷系列研究(ITSs) (數據點的平均值為26.3)符合篩選標準。對於旨在降低成年人傷害率的教育干預,在3個RCT 中以effect sizes 重新計算後,pooled rate ratio是1.02 (95% CI 0.87 to 1.20)。而在兒童的教育干預,在2個RCT 中以傷害率重新計算後,pooled rate ratio是1.27 (95% CI 0.51 to 3.16)。 1個評估經濟誘因干預的ITS研究,在實施誘因後立刻降低傷害,effect size為−2.68 (95% CI −3.80 to −1.56),但以長期的時間趨勢而言,並沒有明顯效果,effect size 為 −0.22 (95% CI −0.47 to 0.03)。1個評估立法禁用Endosulfan殺蟲劑,對致命殺蟲劑的中毒結果的ITS研究,新實施時,增加中毒的水平,effect size 為 2.20 (95% CI 0.97 to 3.43),但隨著時間中毒的趨勢下降,effect size 為 −2.15 (95% CI −2.64 to −1.66)。一個ITS研究記載了目的為增加在拖拉機上使用傾翻防護結構(ROPS)的4個不同規定,及其對傷害及致命傷害的效果。採用兩種不同的新立法,要求ROPS實施於新的拖拉機販賣,經過一段時間後,與降低致命傷害有關effect size −0.93 (95% CI −1.02 to −0.03)。但也與一般致命及非致命的綜合影響增加有關。新法要求ROPS適用所有的拖拉機(也包括舊的在內),經長期評估並沒有降低卻增加致命傷害。

作者結論

篩選的研究沒有証據顯示:教育性干預對農業產業的工作者,可以有效降低傷害比例。經濟誘因能夠降低傷害比例。立法禁止殺蟲劑可能有效降低傷害比例。立法增加使用安全措施(ROPS)在新的拖拉機與降低致命傷害有關。

翻譯人

本摘要由高雄榮民總醫院陳淑梅翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

農夫有高的職業傷害比例。在傷害控制的策略上,採用許多預防計畫及立法,但其在降低傷害的成效仍未知。以系統性的文獻檢索,尋找可降低農業職業傷害的干預研究。8600篇參考文獻找出8個研究。評估相關研究的品質評估以及結果的拮取,隨機控制組的臨床數據以metaanalysis混合交叉分析。時間間斷系列研究重新評估干預後的改變趨勢。共5個隨機控制組實驗(11565位參與者)和1個時間間斷系列研究(有14項測量點),使用不同教育干預及經濟誘因。其中的兩個研究著重於預防兒童或青少年的傷害,其餘與預防成年人的傷害有關。評估兩個(平均為32.5個測量點)時間間斷系列研究其立法的成效。一個研究評估瑞典避免拖拉機翻覆傷害的法規,另一個研究評估斯里蘭卡的法規,在降低致命殺蟲劑中毒的成效。方法學的品質評價分數不是很高。研究數據無法提供:教育性的干預有較佳的降低傷害效果。然而,來自一個研究的宣稱,保險費的優待是一個降低傷害的經濟誘因。在一個研究指出,特殊法令強制要求增加拖拉機ROPS的使用,與降低傷害並沒有關連。另一個長期的研究指出,立法限制Endosulfan殺蟲劑的使用與降低致命中毒有關。

Plain language summary

Interventions for preventing injuries in the agricultural industry

Occupational injury rates among farmers are high. Many prevention programs and laws have been introduced as injury control strategies in this field, but the effectiveness of many of these strategies in reducing injuries is still unknown.

A systematic literature search was conducted to find studies on interventions to reduce occupational injuries in agriculture. Eight studies were found from over 8600 references. The quality of the relevant studies was assessed and their results extracted. Randomised controlled trial data were combined across studies in a meta-analysis. Interrupted time series studies were reanalysed to assess if there was a change in the level or trend of injuries associated with the intervention.

Five randomised controlled trials with 11,565 participants and one interrupted time series study with 14 measurement points used combinations of various educational interventions and financial incentives. Two of these studies concentrated on injury prevention among children or adolescents and the rest dealt with injury prevention among adults. The effect of legislation was evaluated in two interrupted time series studies with on average 32.5 measurement points. One study evaluated regulations to prevent tractor rollover injuries in Sweden and another study evaluated regulation to reduce fatal pesticide poisonings in Sri Lanka.

The methodological quality was rated as less than high for all included studies.

The studies provided no evidence that the educational interventions had an injury reducing effect. However, insurance premium discounts as a financial incentive decreased injuries claims in one study. Specific legislative mandates expanding the use of Rollover Protective Structures (ROPS) on tractors were not associated with a reduction of injuries in one study. Legislation to ban Endosulfan pesticides was associated with a reduction in fatal poisonings in the long term in another study.

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