Parliament of Australia Media Release – Hearing Health Focus in Victoria & South Australia
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Farmer Health eNews May 2017
Find out all the latest from the National Centre for Farmer Health
- HMF702 Scholarships open today!
- Run 4 Farmer Health 2017
- Digital Storytelling Workshop
- Wellness Wednesday Topics
2017-4-19: New test to reveal pesticide exposure – Deakin Research News
Dr Jacquie Cotton – The National Centre for Farmer Health
A recent study provides new information that may help researchers monitor the effects of common agricultural chemicals on farmers’ health.
Concern over how the regular use of pesticides may affect the health of farmers is not new, but a lack of data specific to the Australian context has hampered efforts to develop evidence-based guidelines.
Now, the results of a study by the National Centre for Farmer Health (NCFH), a partnership between Deakin University’s School of Medicine and Western District Health Service, will help develop a new test to monitor farmers’ exposure to pesticides and provide valuable longitudinal data about Australian farmers and their chemical use.
The study, funded by the Shepherd Foundation Victoria, followed 64 farmers from different regions and farming types over 12 months, testing them each month for levels of cholinesterase enzymes.
Read full article: 2017-4-19: New test to reveal pesticide exposure – Deakin Research News
Farmer Health eNews April 2017
Find out all the latest from the National Centre for Farmer Health
- NCFH attending upcoming conferences
- The Pain Revolution Tour comes to Warrnambool on 5th April
- How often do you get a FREE service for your farm equipment?
- Wellness Wednesday Topics
2017-03-24: Study finds possible link between pesticide exposure and farmer health- ABC Rural
By Jess Davis and Cath McAloon
A study has found farmers’ nervous systems might be impacted by exposure to the some of the most widely used pesticides.
In the first study of its kind, the Victorian-based National Centre for Farmer Health tested a group of farmers once a month over 12 months for levels of cholinesterase enzymes, which are needed for the proper functioning of the nervous system.
Toxicologist John Edwards said preliminary research results found those enzymes were lower in farmers with high exposure to organophosphate pesticides.
“When we look at cholinesterase, what we see is the cholinesterase inhibition is also higher in the farmers with higher chemical use,” Professor Edwards said.
He said researchers also found that farmers in predominantly cropping regions had higher levels of exposure than other regions.
“We’ve been able to show that in terms of chemical exposure it does vary throughout the year,” he said.
“We have some times of relatively intense exposures and other times of less exposure.
“What we identified was the areas that we expected would have the higher levels of chemical exposures have been shown qualitatively to have the highest level of exposure.”
Read more: 2017-03-24: Study finds possible link between pesticide exposure and farmer health- ABC Rural
Skin cancer – risks and early signs
Farming men and women and agricultural workers spend much of their time working outdoors. Not wearing sun protection while outside can increase the risk of skin cancer. Skin cancer can be a life-threatening condition and protecting skin from Ultraviolet (UV) radiation should be taken very seriously.
People who work outdoors get up to10 times more sun exposure than indoor workers. Australia has some of the highest levels of UV radiation and one of the highest rates of skin cancer in the world, accounting for over 80% of all new cases of cancer diagnosed in Australia each year (Cancer Council Australia, 2020).
Skin Cancer – risk factors
Common risk factors for skin cancer include fair skin, many moles and freckles, a personal or family history of skin cancer, excessive UV exposure and solarium use.
Unlike the light or heat from the sun, which we can see and feel, your senses cannot detect UV radiation, so you won’t notice skin damage until it has been done. Some UV radiation from the sun is important for bone and muscle health, but too much UV can cause sunburn, premature ageing of the skin, and damage to the eye. UV levels are affected by the time of day, time of year and cloud coverage. To help prevent skin cancer and high UV exposure try to do outside work when UV levels are at their lowest.
To find out more information on skin cancer risk factors visit Better Health Channel
Skin Cancer – prevention
Fortunately, most skin cancers are preventable. Being SunSmart and protecting your skin using these five sun protection steps is an effective way to reduce your risk of developing skin cancer:
Slip on a long sleeve shirt and long pants
Slop on SPF 50+ sunscreen to all skin not protected by clothing
Slap on a broad brim hat
Seek shade between 11am – 3pm
Slide on 100% UV protective sunglasses
Where possible try to avoid outdoor tasks in the middle of the day, or when UV levels are highest. Download the SunSmart weather app and check out the UV forecasts from the weather bureau on the Farmer Health weather pages.
Check your skin (including friends and family skin) regularly for any changes in moles or sunspots. Take photographs if this helps. Look for any changes in shape, colour and size. If you notice changes or are concerned take action and see your GP for a skin check or request a review with a skin specialist.
To find out more about this topic go to Better Health Channel
Fast facts:
Skin cancer – risks and early signs
- Farmers spend a lot of time outdoors; this can increase the risk of skin cancer.UV radiation is dangerous. It is unlike sunlight as it can damage skin without us realising.
- Check your skin regularly for any changes, especially moles or freckles that change.
- Have an annual skin review with your GP or skin specialist.
- See your GP if you notice any skin changes between skin reviews,
- Be SunSmart: protect your skin from UV radiation and remember to slip, slop, slap, seek shade and slide on sunglasses during sun protection times.
References used for this topic
More information:
Cancer Council Australia
Causes of skin cancer
Sunsmart Victoria
Protecting your farm’s most important asset. You. (PDF)
Sunsmart Victoria
Checking for skin cancer
Clinical care:
Cancer Council Australia
Skin cancer clinical guidelines
Research & reviews:
Preventative Medicine Reports
Farmers sun exposure, skin protection and public health campaigns: An Australian perspective
Rural and Remote Health
Are farmers more likely to develop skin cancer? RRH: Rural and Remote Health article: 5711 – Are farmers more likely to develop skin cancer?[
American Association for Cancer Research
Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study
Journal of American Academy of Dermatology
Screening, early detection, and trends for melanoma: Current status (2000-2006) and future directions
Journal of American Academy of Dermatology
Rural-urban differences in behaviours to prevent skin cancer: An analysis of the Health Information National Trends Survey
Sunburn
Sunburn occurs when your skin is burned by ultraviolet (UV) radiation from the sun. Sunburn, whether mild or severe, can cause permanent skin damage and increase the risk of wrinkles, freckles, pigmentation, skin lesions, and skin cancer including malignant melanoma.
Whilst we need some exposure to sunlight for Vitamin D production, we don’t need sunburn! In an Australian summer, sunburn can occur within 15 minutes. Skin burnt by UV radiation turns red within hours and the sunburn will continue to develop for the next one to three days. Most people who have been sunburnt will also peel. This is the body’s way of healing and shedding dead and damaged skin cells to make way for new skin underneath.
Farming men, women and agricultural workers are at an increased risk of sunburn as they spend more time working outdoors during peak UV times.
UV radiation levels vary depending on location, time of year, time of day and cloud coverage. The UV index scale tool is a great way for farmers and agricultural workers to check peak UV times during the day and the times sun protection is required. The UV index scale can be accessed by downloading the Sun Smart app on a smartphone or the Bureau of Meteorology website.
Recommendations to prevent sunburn include a combination of five sun protection measures:
- Slip on long clothing,
- Slop on SPF50+ sunscreen,
- Slap on a broad-brim hat,
- Seek shade
- Slide on sunglasses.
Ensure sunscreen SPF 50+ is available in the workshop, work vehicles and machinery. Apply sunscreen 20 minutes before sun exposure to allow time for the sunscreen to absorb and reduce the likelihood of dust sticking to your skin.
Skin damage from sunburn can be mild or severe. To relieve mild discomfort drink plenty of water, gently apply a cool compress and take over-the-counter pain relief.
Seek medical advice if you experience nausea, fever or there is extensive blistering and pain.
Find out more at Better Health Channel
Fast facts:
- Even minor sunburn can lead to skin damage and skin cancer.
- Sunburn can occur in less than 15 minutes.
- Protect your skin – limit exposure, especially in the middle of the day. –
- Use SPF 50+ broad-spectrum sunscreen that filters both UVA and UVB radiation.
- Wear long sleeved shirt and long trousers and a broad brim hat.
- Protect your eyes with AZ/NZS compliant sunglasses with fitted side arms.
- Where possible seek shade and plan indoor activities for the middle of the day.
References used for this topic
More information:
Cancer Council Australia
Vitamin D
What happens when your skin gets sunburnt?
Sunscreen
Skin cancer
Sunsmart
UV & sun protection
Sun protection for babies and toddlers
Workplaces
Clinical care:
Safer Care Victoria
Burns
Research & reviews:
The Medical Journal of Australia
Estimates of beneficial and harmful sun exposure times during the year for major Australian population centres
Preventive Medicine Reports
Farmers sun exposure, skin protection and public health campaigns: An Australian perspective
World Health Organization (WHO)
Ultraviolet radiation and human health
Trauma – supporting others
Trauma will affect everyone differently and there are a range of emotional, physical and behavioural responses. There is no ‘right’ way to react to trauma. Some people may react with anger, anxiety, exhaustion or sadness, while others might throw themselves into work or practical tasks. Teenagers especially may withdraw and seem not to react. People’s reactions may vary because of past experiences, available support networks, coping strategies, life skills, and in response to the reaction of others around them. While most people will recover with the support of friends and family, some people will need professional support.
Some people who have been through a life-threatening situation may be affected by post-traumatic stress disorder. This could be a natural disaster such as a flood or bushfire, a serious accident, or an assault. Post-traumatic stress disorder can be recognised by a range of signs and symptoms experienced over an extended time period, and may need professional support.
Providing support and comfort is important to help someone who has experienced a traumatic event recover, but don’t assume you know what they need. Ask them how you can help. Offer practical support like taking care of some of the farm chores, looking after the children, or bring some ready-made meals for the family.
Even if you don’t feel like you are doing ‘enough’ be assured that your support is helping them recover, even if you cannot see any immediate effects. Often just sitting with a person over a cuppa, letting them know you are thinking of them, or inviting them to go for a walk with you can be of great benefit. Encourage them to look after themselves by getting plenty of sleep, eating well, keeping physically active and finding ways to relax.
Helping friends and family after a traumatic or distressing event can be difficult, but you can help. It’s always a good idea to ask the person how you can best support them through the trauma. Listening, talking and practical assistance are all important ways to help. It may take some time before people feel ready to talk about the event. Maintain contact over the long term, when the first rush of community support may have passed. Make sure you follow through on any support you promise.
Find out more about this topic on Better Health Channel
Fast facts:
- People’s reactions to trauma vary a great deal. Research shows that support from family and friends do help people recover.
- Children and teenagers may need extra attention if they’ve experienced a traumatic event.
- Don’t leap in and take over in your eagerness to help. Ask what you can do to help. Offer practical support, but don’t push it.
- Give the person the opportunity to talk about what happened, provide comfort if they become upset.
References used for this topic
More information:
Phoenix Australia: Centre for Posttraumatic Mental Health
Recovery: Helping Others
Australian Psychological Society
Trauma
Better Health Channel
Trauma and primary school age children
Better Health Channel
Trauma and children – tips for parents
Mental Health First Aid
Traumatic events, First aid guidelines for assisting adults
Support After Suicide
Support after suicide
Clinical care:
Phoenix Australia – Centre for Posttraumatic Mental Health
Australian Guidelines for the treatment of adults with Acute Stress Disorder and Posttraumatic Stress Disorder
Research & reviews:
Substance Abuse and Mental Health Services Administration (US)
Understanding the Impact of Trauma
Experimental Neurology
Understanding resilience: New approaches for preventing and treating PTSD
12th National Rural Health Conference Presentation
Complex post-traumatic stress disorder—breaking the silence of the fringe dweller
Trauma – reaction and recovery
Traumatic events can be either physical or mental, ranging from farm accidents and car accidents through to bushfires, floods, the death of someone close to you, or relationship problems. Traumatic events can cause immediate, delayed and/or long-term reactions. Each person will react differently to a traumatic event, and no reaction is right or wrong.
You might feel physical reactions like nausea, headaches or lack of appetite. You might also experience psychological reactions like confusion, forgetfulness, ruminating about the event, or a search for answers about why the event happened. Other common reactions to trauma include guilt, depression and anger. You might also feel that getting back into everyday tasks is your way of responding to trauma. You are likely to find that people around you all react to distressing events very differently, and recover in different ways and over different periods of time. Individuals will need different types and levels of support at different points in time. Don’t judge yourself or others for these varied responses. Most people, given time, will recover by using their existing coping strategies or with the support of family and friends.
Beware of stress overload, when your body is pushed beyond its limits. Take time out.
Trauma – reaction and recovery
It is normal to have strong emotional or physical reactions following a distressing event. The intensity of a reaction differs from person to person, but some reactions last for days, weeks or even longer. On most occasions though, these reactions subside as a part of the body’s natural healing and recovery process. Your own coping style is likely to have an influence on how your child or teenager responds to a traumatic event.
There are strategies to help people cope with and recover from these experiences. Find out more about this topic on Better Health Channel
Sometimes reactions to trauma are delayed or are experienced over a longer period of time and may develop into post traumatic stress disorder (PSTD). This is when a person continues to relive the traumatic event through upsetting memories, nightmares or flashbacks and feels physically and emotionally distressed when reminded of the event. Other symptoms of PTSD can include memory loss about the event, feeling socially isolated, sleep difficulties, feeling anxious and becoming angry easily. You may be experiencing post traumatic stress disorder if you have experienced these symptoms for longer than a few weeks. Effective treatments are available to help people through this.
Be aware of your reactions, your stress levels and your ability to cope following a traumatic experience and seek support if difficulties persist over time.
If you are struggling to cope after a traumatic event, make an appointment with your GP.
Fast facts:
- Trauma can cause strong physical, psychological and emotional reactions. This is a normal reaction to events that cause shock and extreme stress.
- Everyone will react differently—but support (in many forms) is important for everyone immediately after the event and further down the track.
- Don’t hesitate to seek professional help if you feel you need it immediately or if you don’t begin to return to normal after three or four weeks.
- Avoid stress overload—you need to rest, eat well, sleep well and still find things to enjoy after a traumatic experience.
- Avoid unnecessary exposure to social media/media commentary of a traumatic event—it can become overwhelming.
- Sometimes traumatic experiences can affect us for a long time.
References used for this topic
More information:
Trauma and Grief Network
Kids in rural and remote areas: Coping with tough times
Beyond Blue
What is PTSD?
Phoenix Australia – Centre for Posttraumatic Mental Health
Posttraumatic stress disorder (PTSD)
Phoenix Australia – Centre for Posttraumatic Mental Health
Recovering from Trauma
Australian Psychological Society
Understanding and managing psychological trauma
Better Health Channel
Trauma – reaction and recovery
Clinical care:
Phoenix Australia: Centre for Posttraumatic Mental Health
Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder
Medical Journal of Australia
Treating adults with acute distress disorder and post-traumatic stress disorder in general practice
Research & reviews:
International Journal of Environmental Research and Public Health
Key Risk Factors Affecting Farmers’ Mental Health: A Systematic Review
The Medical Journal of Australia
Drought-related stress among farmers: findings from the Australian Rural Mental Health Study
BMC Public Health
Long-term effects of lifetime trauma exposure in a rural community sample
Experimental Neurology
Understanding resilience: New approaches for preventing and treating PTSD
Skin cancer prevention
Rural and agricultural populations across the globe have higher skin cancer risks due to the nature of their work.
Australia has the highest rate of skin cancer in the world. Farmers have a 60% higher death rate from melanoma compared to the general population and skin cancer deaths in farmers over 65 are double compared to other Australians.
Hazards and risks
Farmers spend significant time working outdoors during peak ultraviolet (UV) times. Sun protective behaviours are vital to prevent skin cancer, however skin protection behaviours in farm men and women are often low. (Smit-Kroner & Brumby, 2015)
UV index measures UV levels on a scale from 0 (low) to 11+ (extreme). Sun protection is recommended when UV levels are 3 (moderate) or higher. Factors including the time of day, time of year, cloud cover, altitude, and reflection will affect UV levels.
Skin cancer is preventable. The majority of skin cancers can be successfully treated, if found early. Be familiar with your skin and look for any changes, suspicious lumps or spots and act on any changes as soon as they develop. Don’t just rely on an annual skin check to detect any suspicious spots as skin spots can change between reviews.
Skin protective practice in farmers and agricultural workers includes wearing protective clothing such as long sleeved shirts and trousers, a broad brim hat and sunglasses.)
Recommendations to reduce skin cancer with other sun protection strategies for farmers and agricultural workers to prevent skin cancer include:
- Become familiar with the UV index predicted for the day. Download an UV app onto your mobile device
- Seek shade and avoid working outdoors in the middle of the day if possible.
- Slide on sunglasses, ensuring they are AS/NZS compliant and fitted with side arm, as melanoma can also develop in eyes.
- Slop on SPF 50+ sunscreen and remember to reapply during the day. Putting sunscreen on the skin before heading out in to the sun will allow it to dry effectively and reduce dust sticking to the skin.
- Slap on a broad-brimmed hat as it provides more protection than a peak cap
- Seek regular skin checks with your GP or skin specialist.
- Ensure you apply a duty of care to farm workers by providing sun protection.
For more information on protecting outdoor workers visit Better Health Channel
Find out more information about skin cancer prevention visit Cancer Council Australia.
Fast Facts
- Farmers and agricultural workers have an increased risk of developing skin cancer.
- UV levels are highest during the middle of the day
- Sun protection is required when the UV index is predicted to be 3 or above.
- Use the five sun protection combinations of: Slip on a long sleeve shirt and/or trousers, Slop on SPF 50+ sunscreen, Slap on a broad-brim hat, Slide on sunglasses and Seek shade.
- Download the free SunSmart App on your mobile to access the UV index throughout the day.
- If possible leave an outdoor task to later in the day or another day when the UV index is not as high.
- Monitor changes in your skin and have regular skin checks to assist with early detection of skin cancers.
References used for this topic
More information:
SafeWork Australia
Protection of workers from the ultraviolet radiation in sunlight [PDF]
Better Health Victoria
Skin cancer – risk factors
Cancer Council
UV radiation at work
Clinical care:
Royal Australian College of General Practitioners (RACGP)
Early detection of cancers – skin cancer
Research & reviews:
Cancer Council Victoria
Farmers’ and outdoor workers’ beliefs about skin cancer and protection [PDF 257kb]
Preventive Medicine Reports
Farmers sun exposure, skin protection and public health campaigns: An Australian perspective
Heat stress and heat stroke
Heat stress is common during Australian heat waves. Hot weather places extra strain on your body as it tries to cool itself to its preferred temperature of 37C. Farmers working outside, or in farm buildings or sheds which have poor cooling methods, are at particular risk. Older people (aged 65 years and over) are at greater risk as your sense of thirst decreases and your kidneys are not as able to conserve body water as easily. There are three stages of heat stress: heat cramps, heat exhaustion and heat stroke.
Heat stroke is a medical emergency and occurs when you become dehydrated and your body temperature rises above 40.5C. Heat stroke is fatal in up to 80% of cases. If you work in a hot environment you should drink plenty of water, try to stay indoors during the hottest part of the day and develop a heat stroke prevention plan.
Symptoms of heat exhaustion include dizziness, headache, sweaty skin, rash and a weak fast pulse. These signs occur when a person becomes dehydrated and people have difficulty keeping themselves cool. If you are organising a large event or sports activity, working in a hot environment or firefighting, you should develop a heat stroke prevention plan and learn to recognise the early signs of heat exhaustion.
Planning for hot days:
Plan your outdoor work so you can work in the cool of the day (early morning or evening). Use shade cloth when working outdoors or under roofs in stockyards, and move hot equipment and engines away from where people are. Wear light cool clothing and a hat but ensure skin coverage to protect from UV radiation. Know what your policy is for workers to stop working during days of heat.
Find out more about this topic on Better Health Channel and review the information provided by the Bureau of Meteorology. You can also:
- subscribe to the heat health alerts, advisories and newsletters for regular monitoring of outdoor weather conditions through the Health Vic website
- download and subscribe to the VicEmergency App
- set up a ‘watch zone’ as per advice within the VicEmergency App, to receive these heat health alerts.
Signs of Health stress:
Fainting, heat exhaustion, heat cramps, heat fatigue, worsening of pre-existing illnesses and conditions.
Signs and symptoms of heat illness include feeling sick, nauseous, dizzy or weak.
Serious signs are clumsiness, collapse and convulsions (fitting) which may be experienced as a result of heat illness. Anyone with these signs or symptoms needs to seek immediate medical attention.
- Remember Heat stroke is a medical emergency, ring triple zero (000) if someone with you is not physically coping with the heat.
Fast facts:
Heat stress and heat stroke
- There are three stages to heat stress – heat cramps, heat exhaustion, and heat stroke.
- Heat stroke occurs when the body’s core temperature rises above 40.5 degrees Celsius.
- Heat stroke is a medical emergency, ring triple zero (000) if someone with you is not physically coping with the heat.
- Avoid working outdoors in the hottest times of the day, drink plenty of water, and stay in a cool place.
- Make sure you keep up to date with heat alerts.
References used for this topic page
More information:
Better Health Channel
Australian Centre for Agricultural Health and Safety
Heat stress on the farm [PDF]
Department of Health and Human Services (VIC)
Caring for animals during extreme heat
NHS
Heat exhaustion and heat stroke
Research & reviews:
BMJ Journals
The impact of heatwaves on mortality in Australia: a multicity study
New England Journal of Medicine
Heat stroke; review article
Stress and your health
A little stress can keep you on your toes, keep motivation levels high, and help you get things done, but persistent high-level stress reduces productivity, impairs decision making and is probably doing you damage. Stress is also a contributing factor to many farm injuries.
Farm life is busy and often stressful. Stress can be caused by everyday issues like farm finances, machinery breakdowns, family and relationship pressures, workforce shortages, or managing livestock. Extreme events like bushfires, droughts and floods can be particularly stressful.
Stress can affect many areas of the body including the nervous system, memory, the ability to fight off infection, cardiovascular health, pain and gut problems. Everyone reacts differently to potentially stressful situations. This can depend on your personality, the extent of your support network or other things that are going on in your life.
Learning to recognise your stress triggers is an important step in developing your coping skills. The Farmer Health ‘Steering Straight’ plan can help you achieve this.
Try to:
- Think about your thinking: Consciously focus on identifying and halting unhelpful patterns of thinking (e.g. ‘I will never get this job done’) and replace this with helpful thinking patterns (e.g. ‘This job might take me a while, but if I break it into chunks and get someone to give me a hand, I can get it done’).
- Talk positively to yourself: Instead of getting annoyed and irritable when things go wrong, tell yourself you won’t let this get to you. Try it, it works.
- Talk to your friends: Chances are you’re not the only one who feels the way you do, and talking may help you find solutions you hadn’t thought of on your own.
- Talk to a professional: If you feel you need a hand, talk to an expert (for farm tasks as well as your own personal wellbeing). If there are not many services in your area, or you’d prefer something more private, there are confidential phone lines and online services you can use to support your social and emotional wellbeing.
- Talk to your pet: They are always pleased to see you and great listeners! While pets may not have the answers, often the process of talking about a challenge can help identify solutions.
- Write a list: Sometimes thinking of all the jobs you need to do can seem overwhelming. Writing a list and prioritising tasks can increase your sense of control. Make sure you tick off items and reward yourself as you achieve them!
- Don’t avoid making decisions: Stress can lead to poor decision making or—worse still—failure to make any decisions. Seek information and make decisions early to ensure you have options in difficult times.
- You need to look after yourself, it’s a critical element of looking after your farming business.
Some key things to reduce stress and improve your health include:
- Get adequate sleep
- Eat healthy meals
- Take time to do something you enjoy
- Take time away from the farm
- Remain involved in your community
- Find things to laugh about
These are the things that we often neglect when life gets stressful, but are also some of the simplest and most effective strategies to help us get through tough times.
Fast facts:
- Farming life and work can be hectic and stressful.
- Long-term stress can damage your health, personal life and contribute to farm accidents. Stress needs to be recognised, understood and managed.
- Understand your stress triggers and develop your coping skills (this needs practice).
- Maintain a healthy lifestyle, find things that make you happy, rest, relax and take a few breaths before you respond to a stressful situation
References used for this topic
More information:
National Centre for Farmer Health
Managing Stress on the Farm
Beyond Blue
Stress and Mental Health
Black Dog Institute
Hints to avoid harmful stress
Black Dog Institute
Happiness
Reach Out
Coping with the Drought
Research & reviews:
Australian Journal of Rural Health
Why are some drought-affected farmers less stressed than others? The association between stress, psychological distress, acceptance, behavioural disengagement and neuroticism
Rural Society Journal
Enduring Drought Then Coping With Climate Change: Lived Experience and Local Resolve in Rural Mental Health
The American Institute of Stress
Stress and heart disease
Journal of Rural Health
Alcohol consumption, obesity, and psychological distress in farming communities-an Australian study
The Medical Journal of Australia
Drought-related stress among farmers: findings from the Australian Rural Mental Health Study