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The natural course of childhood asthma, after its onset, is characterized by periods of persistence, relapse and remission. To investigate personal and early life factors associated with new-onset asthma, persistence and remission among children. The study was conducted in the province of Saskatchewan, Canada. Children in grades Kindergarten to Grade 8 (ages 5–14 years) participated in a cross-sectional study in 2013. In 2015, we approached those who gave consent in 2013 to be re-contacted, creating a prospective cohort. Data were collected using questionnaires in both years. Participants in 2013 who also had data in 2015 (25%: n = 324/1,348) had their asthma status reclassified and longitudinal descriptors were applied: "no asthma", "new-onset asthma", "persistent" or "remission". Personal and early life factors associations with asthma outcomes in 2015 were evaluated. Among those without asthma in 2013 (n = 245), the incidence of new-onset asthma in 2015 was 7.2%. Among those with asthma in 2013 (n = 79), 47.1% had remission and 52.9% had persistent asthma in 2015. Parental history of asthma (adjusted odds ratio (aOR): 4.99; 95% confidence interval (CI): 1.88–28.27), early life respiratory infection (aOR: 1.92; 95%CI: 1.47–7.88), early life allergy [aOR: 6.39; 95%CI: 1.34–30.58) and early life infection (aOR: 4.99; 95%CI: 1.19–20.93) were associated with new onset asthma. Similarly, while parental history of asthma (aOR: 1.13; 95%CI: 0.29–4.34), early life respiratory infection (aOR: 2.71; 95%CI: 0.70–10.45), and early life ear infection (aOR: 1.34; 95%CI: 0.36–5.05) were also positively association with persistent asthma, the associations were not statistically significant. Parental history of asthma, early life respiratory infection and allergy might not only influence the onset of childhood asthma but also be associated with asthma persistence. [ABSTRACT FROM AUTHOR]

Objective: Studies have reported lower asthma prevalence in rural compared to urban areas. While environmental factors have mostly been implicated for these differences, the lower asthma prevalence could also be linked to asthma under-diagnosis in rural children. We investigate if rural children experience under-diagnosis of asthma more compared to urban children. Methods: In 2013, we conducted a cross-sectional survey of schoolchildren across an urban-rural gradient in Saskatchewan, Canada. The participants formed sampling frame for future studies. In 2015, we approached those who gave consent in 2013 for further testing, repeated the survey, and conducted clinical testing. Based on survey responses, children were classified into "no asthma," "at-risk-for-asthma," and "diagnosed asthma." We then classified asthma status as either "no asthma" or "probable asthma" based on a validated asthma algorithm. Results: The study population of 335 schoolchildren (aged 7-17 years) comprised of 73.4% from large urban, 13.7% from small urban, and 12.8% from rural areas. Proportion with report of physician-diagnosed asthma was 28.5% (Large urban), 34.8% (Small urban), and 20.9% (Rural). Mean percent predicted FEV1 and FEF25%-75% were lower in rural compared to small urban and large urban children (p < 0.05). Among those not classified as with "diagnosed asthma" by the survey, the algorithm further identified presence of asthma in 5.5% large urban, 8.1% small urban, and 18.8% rural children (p = 0.03). Conclusion: The study revealed evidence of asthma underdiagnosis in rural areas and further supports the use of objective measures in addition to symptoms history when investigating asthma across urban-rural gradients. [ABSTRACT FROM AUTHOR]

Background Studies have reported protective and adverse associations between microbial exposure and childhood asthma. However, among children with asthma the relationships between endotoxin and exercise-induced bronchospasm (EIB) is less clear. Objective We investigated the association between exposure to endotoxin in house dust with atopy and EIB in children with asthma. Methods A cross-sectional survey was conducted among schoolchildren (aged 7–17 years) in the province of Saskatchewan, Canada. A subpopulation with asthma ( n  = 116) were identified from 335 participants using a validated asthma algorithm. We determined atopy among the asthma subpopulation by skin prick testing (SPT) while EIB was evaluated using exercise challenge testing (ECT). Dust samples were collected from mattress and play area floors, and endotoxin was measured in dust extracts. Logistic regression analyses were used to explore associations between endotoxin with atopy and EIB. Results Among the 116 children with asthma, 99 completed SPT and all had completed ECT. Of these, 71/99 (71.7%) were atopic and 26/116 (22.4%) had EIB. Exposure to high play area endotoxin concentration [adjusted odds ratio (aOR) = 0.15, 95% CI: 0.03–0.85] and load (aOR = 0.11, 95% CI: 0.02–0.73) were negatively associated with atopy. In contrast, EIB was positively associated with high mattress endotoxin concentration (aOR = 6.01, 95% CI: 1.20–30.13). Conclusion Indoor microbial endotoxin exposure has varied associations with atopy and exercise-induced bronchospasm among children with asthma. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective The relationship between farming exposures and pulmonary function in a rural paediatric population was evaluated. Methods Baseline data collection records of the Saskatchewan Rural Health Study ( SRHS), a population-based study, were used. A subset of children (6-14 years old) participated in clinical testing, including anthropometric measures and pulmonary function testing ( PFT), using spirometry ( n = 584). PFTs followed ATS criteria and all statistical analyses were controlled for age, sex and height. Results Among clinical testing participants, 47.5% were females and 54.5% were farm dwelling. Of those living on farms, 77.5% were livestock farms. Mean percent predicted value ( PPV) for forced expiratory volume in 1 s ( FEV1 ) and forced vital capacity ( FVC) among children living on a farm were 104.8% and 105.4%, respectively. Mean PPV for FEV1 and FVC among children not living on a farm were 102.7% and 101.4%, respectively. After adjustment, higher FEV1 (=0.079, SE = 0.033, P = 0.03) and FVC (=0.110, SE = 0.039, P = 0.006) were seen among children living on a farm. A trend towards lower FEV1 / FVC ratio (−0.013, SE = 0.008, P = 0.09) among children living on a farm was seen compared with children not living on a farm. Higher FVC and lower FEV1 / FVC ratio were seen in children who regularly emptied grain bins ( P < 0.05). Trends towards higher FEV1 ( P = 0.14) and FVC ( P = 0.08) were also seen with children living on a farm in the first year of life. Since the majority of the population was Caucasian (91%), the results were not race-corrected. Conclusion We addressed the lack of knowledge regarding the association between lung function and rural exposures, and found that differences in lung function were seen between children living on a farm and not living on a farm in rural areas and certain farming activities, specifically emptying grain bins, where lung function was generally better in those living on a farm. [ABSTRACT FROM AUTHOR]

Background: Asthma and hay fever have been found to be both positively and negatively associated with farming lifestyles in adulthood. Lack of congruency may depend upon early life exposure.Objective: To assess the importance of different periods of farm residency for asthma and hay fever in an adult Canadian population.Methods: We conducted a questionnaire survey in rural Saskatchewan, Canada. We assessed a history of asthma and hay fever with five categories of farm residency that were mutually exclusive: first year of life only, currently living on a farm, both first year of life and currently living on a farm, other farm living, and no farm living. Generalized estimating equations were used to adjust for clustering effects of adults within households.Results: Of the 7148 responding, 30.6% had an early farm living experience only, 34.4% had both early and current farm living experiences, while 17.4% had never lived on a farm. The overall prevalence of ever asthma and hay fever was 8.6% and 12.3%, respectively, and was higher in women. Sex modified the associations between ever asthma and hay fever with farm residency variables whereby women had a decreased risk for both asthma [adjusted odds ratio (ORadj): 0.67, 95% confidence interval (CI):0.47–0.96] and hay fever (ORadj: 0.60, 95% CI: 0.44–0.83) with an early farm exposure only. Men currently living on a farm without an early farm exposure had an increased risk for ever asthma (ORadj: 1.82, 95% CI: 1.02–3.24).Conclusion: Farm residency in the first year of life shows a protective effect for adult asthma and hay fever that appears to differ by sex. [ABSTRACT FROM AUTHOR]

Associations between farming exposures and atopy can vary by timing of exposure and sex. We examined associations between adult atopy, sex, and farm living in a rural Canadian population. In 2010, we conducted a baseline survey of 11,982 households located in four agricultural regions of Saskatchewan, Canada. Of the 7225 adults aged 18–75, 1658 underwent clinical assessments including skin testing. Of these, 1599 participants underwent skin prick testing to four common allergens. We defined atopy as >3 mm reaction to any of four allergens compared with saline control. Farming exposures were farm living in the first year of life and current farm living. All analyses were stratified by sex. The prevalence of atopy was 17.8% and was higher in men than women (P< .001). The most common allergy was to grasses (8.8%) followed by house dust mite (HDM) mixed (8.1%). Atopy was lower in those subjects with an early farm exposure (P= .08) and who were female (P= .03). After adjusting for education, age, and smoking status, both current and early farm exposures were associated with decreased sensitization to cat atopy in women that was stronger with current exposure (P< .05). Men had significantly decreased atopic sensitization to Alternaria with an early farm exposure and increased atopic sensitization to HDM with a current farm exposure. In this rural population, the protective effect of an early farm exposure for any atopy was weak overall. The impact of farming exposures on atopy was allergen dependent and varied by sex. [ABSTRACT FROM PUBLISHER]

Background: Obesity is prevalent in rural communities in Canada, however little is known about the social determinants of health and obesity in rural populations. Socioeconomic status has been found to be inversely associated with the risk of obesity in developed countries. This study investigated the relationship between income adequacy, education and obesity in a rural setting. Methods: The study used data from 5391 adults aged 18-69 who participated in the Saskatchewan Rural Health Study in 2010. Participants completed a survey that included questions about location of residence, body weight, height, and socio-demographic and behavioral factors. Obesity was defined as body mass index being ≥ 30 kg/m2. Logistic regression using generalized estimating equation was conducted to assess the associations of income adequacy and education level with the prevalence of obesity taking covariates into consideration. Results: Approximately a third of the participants were obese and the prevalence of obesity was similar for men and women. The prevalence of obesity was significantly higher for rural residents not living on farm compared with those living on farm (p < 0.05). After adjustment for potential confounders, the risk of obesity was increased for those with ≤ 12 years of education compared with those with > 12 years of education (aOR: 1.18; 95 % CI: 1.05 - 1.34). Low income adequacy was significantly associated with an increased risk of obesity but only among those not living on farm (aOR: 1.80; 95 % CI: 1.16 - 2.79). Conclusions: Home location was associated with obesity prevalence in rural Saskatchewan and modified the influence of income adequacy, but not the influence of education, on obesity. Adults not living on farm had an increased risk of obesity and showed a significant impact of income adequacy on obesity. [ABSTRACT FROM AUTHOR]

Background: Obesity is prevalent in rural communities in Canada, however little is known about the social determinants of health and obesity in rural populations. Socioeconomic status has been found to be inversely associated with the risk of obesity in developed countries. This study investigated the relationship between income adequacy, education and obesity in a rural setting. Methods: The study used data from 5391 adults aged 18–69 who participated in the Saskatchewan Rural Health Study in 2010. Participants completed a survey that included questions about location of residence, body weight, height, and socio-demographic and behavioral factors. Obesity was defined as body mass index being ≥ 30 kg/m2. Logistic regression using generalized estimating equation was conducted to assess the associations of income adequacy and education level with the prevalence of obesity taking covariates into consideration. Results: Approximately a third of the participants were obese and the prevalence of obesity was similar for men and women. The prevalence of obesity was significantly higher for rural residents not living on farm compared with those living on farm (p < 0.05). After adjustment for potential confounders, the risk of obesity was increased for those with ≤ 12 years of education compared with those with > 12 years of education (aOR: 1.18; 95 % CI: 1.05 - 1.34). Low income adequacy was significantly associated with an increased risk of obesity but only among those not living on farm (aOR: 1.80; 95 % CI: 1.16 – 2.79). Conclusions: Home location was associated with obesity prevalence in rural Saskatchewan and modified the influence of income adequacy, but not the influence of education, on obesity. Adults not living on farm had an increased risk of obesity and showed a significant impact of income adequacy on obesity. [ABSTRACT FROM AUTHOR]

Background. The CD14 gene has an important role in the detection of inflammatory provoking pathogens and in the ensuing signaling of the innate immune response. We assessed the role of CD14 C-159T, G-1359T in the expression of asthma, croup, and allergy in Canadian school children of ages 6 to 14 years. Methods. Children attending schools in a rural community participated in a cross-sectional survey of respiratory health. Following consent, we conducted clinical assessments to collect buccal swabs for genotyping and performskin prick testing (SPT) to determine atopic status. Genotyping and SPT results were available for 533 and 499 children, respectively. Separate multivariable analyses that included both polymorphisms were conducted for each phenotype. Results. The prevalence of asthma, allergy, and croup was 18.6%, 22.4%, and 6.6%, respectively. Children with the T/T variant of CD14 G-1359T were more likely to have physician diagnosed asthma (26.8%). Children with C/C variant of CD14 C-159T had a significantly lower prevalence of croup (2.6%). Haplotype analyses of the two CD14 polymorphisms showed that individuals with the T|T haplotype combination were significantlymore likely to have asthma (?? = 0.014). Conclusions. In this study, CD14 variants are important for the expression of croup and asthma but not atopy. [ABSTRACT FROM AUTHOR]

Introduction. The purpose of this study was to examine levels of physical activity (PA) and screen time (ST) in metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) adolescents and adults. Methods. NHANES data from obese adolescents (12–18 years, BMI z-score ≥ 95th percentile) and adults (19–85 years, BMI ≥ 30 kg/m2) were pooled from 2003–2005 cycles. Metabolic phenotypes were categorized as MHO (0 or 1 cardiometabolic risk factor; triglycerides, HDL-C, blood pressure, or glucose) or MUO (≥2 cardiomObesity has been associated with low diet quality and the suboptimal intake of food groups and nutrients. Two composite diet quality measurement tools are appropriate for Americans 2–18 years old: the Healthy Eating Index (HEI) 2005 and the Revised Children’s Diet Quality Index (RC-DQI). The five components included in both indexes are fruits, vegetables, total grains, whole grains, and milk/dairy. Component scores ranged from 0 to 5 or 0 to 10 points with lower scores indicating suboptimal intake. To allow direct comparisons, one component was rescaled by dividing it by 2; then, all components ranged from 0 to 5 points. The aim of this study was to directly compare the scoring results of these five components using dietary data from a nationally representative sample of children (NHANES 2003–2006, N = 5,936 ). Correlation coefficients within and between indexes showed less internal consistency in the HEI; age- and ethnic-group stratified analyses indicated higher sensitivity of the RC-DQI. HEI scoring was likely to dichotomize the population into two groups (those with 0 and those with 5 points), while RC-DQI scores resulted in a larger distribution of scores. The scoring scheme of diet quality indexes for children results in great variation of the outcomes, and researchers must be aware of those effects.etabolic risk factors). Logistic regression models estimated associations between phenotype and PA/ST adjusted for age, genderAims and Objectives. We investigated associations between weight status, activity level, and diet with asthma or wheeze as well as the interrelationship between these factors. Methods. We conducted a case-control study of 6–18-year olds from 2005 to 2007. Cases (n = 87 ) were subjects reporting episodes or breathing medication use along with doctor-diagnosed asthma or wheeze in the past 12 months. Controls were randomly selected (n = 208 ) and without asthma or wheeze. Data regarding health outcomes, diet, and activity were obtained from questionnaire. Objectively measured height and weight were collected. Results. In the adjusted analysis, there was a trend (P = 0.07) towards an increased risk of asthma or wheeze associated with high fast food and/or pop consumption. Among cases, a significantly lower proportion (66%) classified as overweight participated in hard exercise in ≥9 of the past 14 days compared to those who were not overweight (86%). This pattern was not seen among controls (76% participating in hard exercise versus 78%, resp.). However, based on perceived weight status by the parent, the patterns were similar regardless of case-control status. Conclusions. Overweight status may negatively impact activity level among those with asthma or wheeze. Efforts should be made to encourage healthy food choices, and activity programming must consider the needs of overweight children with asthma. BMI, race/ethnicity, menopausal status, and NHANES cycle. Results. Among adolescents, PA was not associated with MHO. In contrast, MHO adults 19–44 years were 85% more likely to engage in active transportation and 2.7 timesmore likely to be involved in light intensity usual daily activity versus sitting. For each minute per day, adults 45–85 years were 36% more likely to have the MHO phenotype with higher levels of moderate PA. ST was not associated with metabolic phenotypes in adolescents or adults. Conclusion.The current study provides evidence that PA, but not ST, differs between MHO and MUO in adults, but not in adolescents. Future studies are needed to confirm results. [ABSTRACT FROM AUTHOR]

Background/Aim: Previous literature on the association between obesity and atopy has been inconsistent. The aim of the study was to determine the relationship between obesity and atopic sensitization in adults. Methods: The study included a total of 1,997 residents aged 18-79 years and was conducted in the town of Humboldt, Sask., Canada in 2003. Body mass index (BMI) and waist circumference (WC) were objectively measured. Allergy skin tests were conducted to determine atopic sensitization. Results: Overall, the prevalence of one or more positive skin tests for atopy was 33.3% among those with a BMI of at least 30.0, 28.2% among those with a BMI of 25.0-29.9 and 27.3% among those with a BMI of less than 25 (p = 0.003). The odds ratio for atopy among those with a BMI of at least 30.0 versus those with a BMI of less than 25.0 was 1.51 (95% confidence interval, CI: 1.17, 1.95) after adjustment for sex, age, and other covariates. Stratified by sex, the adjusted odds ratios for obesity versus normal weight were 1.27 (95% CI: 0.73, 1.93) for men and 1.63 (95% CI: 1.18, 2.26) for women. WC was also significantly associated with the prevalence of atopy in both sexes after controlling for covariates. Conclusion: The data demonstrated a significant association between obesity, defined either by BMI or by WC, and atopy. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To examine the joint effect of family history and BMI on diabetes. Design: Cross-sectional study. Setting: A rural community in Saskatchewan, Canada. Subjects: The analysis was based on data from 2081 adults, 18-79 years of age, who participated in the Humboldt Study conducted in 2003. Doctor-diagnosed diabetes and family history of diabetes of biological parents and siblings were self-reported. Body weight and height were objectively measured. The interaction of family history and BMI on diabetes was assessed on an additive scale. Results: The prevalence of diabetes was 7?9%, and BMI and history of diabetes were two important predictors. The adjusted prevalence ratios were 1·76 (95% CI 1·37, 2·27) and 2·59 (95% CI 2·05, 3·31) for those with a BMI of 25·0-29·9 kg/m2 and of at least 30 kg/m2, respectively, compared with a BMI of less than 25 kg/m2, and was 2·41 (95% CI 2·08, 2·80) for those with a family history of diabetes v. those without. The data indicated an additive interaction of family history and BMI on diabetes. Conclusions: When exposed to both family history and overweight/obesity, individuals would have an increased risk that was greater than the sum of their single effects. Reduction of BMI would also reduce the risk of diabetes associated family history. [ABSTRACT FROM AUTHOR]

Obesity appears more strongly associated with asthma in women than in men. It is hypothesized that a stronger linkage of obesity with nonatopic asthma than with atopic asthma may explain the sex difference. That being the case, we might hypothesize a stronger association between obesity and asthma in nonatopic individuals than in atopic ones. In this analysis, we examined the association between obesity and asthma in atopic and nonatopic people separately. A total of 1997 residents aged 18 to 79 years who participated in the 2003-2004 Humboldt study were included in the analysis. Body mass index (BMI) and waist circumference were objectively measured. Allergy skin tests were conducted to determine atopic sensitization. Respiratory allergy and physician diagnosed asthma were self-reported. Overall, 8% reported having asthma, 30% had atopic sensitization as determined by allergy skin tests, 31% reported a history of respiratory allergy, and 35% were obese defined as BMI equal to or larger than 30 kg/m2. Compared to those with a BMI <25 kg/m2, the odds ratio for asthma for the nonatopic subjects of those with a BMI of at least 30.0 kg/m2 was 2.01 (95% confidence interval [CI]: 1.13, 3.59] after adjustment for sex and age. The association between obesity and asthma was not statistically significant in atopic subjects. The adjusted odds ratios for obesity versus normal weight were 2.56 (95% CI: 1.07, 6.12) and 1.76 (95% CI: 1.04, 3.01) for those without and with a history of respiratory allergy, respectively. The association of asthma with waist circumference was not statistically significant in all the subgroups defined by atopy and respiratory allergy. The data suggested a stronger association between obesity and asthma among nonatopic people than among atopic people. [ABSTRACT FROM AUTHOR]

This study assessed the prevalence of asthma in Canadian children living on and off farms and the risk of asthma and respiratory symptoms of children exposed to certain farming activities. A cross-sectional survey was sent to parents of school children ages 6 to 13 living in an agricultural community in rural Saskatchewan. History of asthma and respiratory symptoms (cough, phlegm, or wheeze), location of home, and exposure to farming activities including haying, harvesting, moving, or playing with hay bales, feeding livestock, cleaning or playing in barns, cleaning pens, and emptying or filling grain bins were assessed. The response rate was 90.6% (n = 553). The prevalence of asthma and respiratory symptoms were 18.8% and 39.8%, respectively, and did not differ by home location (farm/nonfarm). In the adjusted multivariable models conducted with each farming activity separately, children who were exposed to emptying and filling of grain bins had a higher odds of asthma (odds [OR] = 2.18, 95% confidence interval [CI]: 1.03-4.62]. Reports of playing on or near hay bales (OR = 1.89, 95% CI:1.19-3.01), (OR = 2.08, 95% CI:1.07-4.06), and cleaning pens (OR = 2.70, 95% CI:1.05-6.97) were associated with increased respiratory symptoms. Certain farming activities associated with dust and animals appear to be risk factors for asthma and respiratory symptoms in this study population and should be avoided. [ABSTRACT FROM AUTHOR]

Background: It needs to be clarified whether farming is associated with a reduced risk of atopy or allergic condition. There is a lack of consistent evidence for prevalences of atopy, respiratory allergy and asthma in adult farmers. Methods: A cross-sectional study of adults (n = 2,081) was conducted in the town of Humboldt, Sask. Allergy skin prick tests were conducted to determine atopic sensitization. Respiratory allergy and physician-diagnosed asthma were based on self-reporting. Logistic regression was used to assess the associations of atopy, respiratory allergy and asthma with farming practices, adjusting for other important variables. Results: Of 2,081 participants, 27.8% were farmers. Reduced risks of atopic sensitization, respiratory allergy and asthma were observed among farmers compared to non-farmers. After adjustment for sex and age, which are major confounders, the odds ratio for atopic sensitization was 0.79 (95% confidence interval: 0.65, 0.97) for farmers versus non-farmers. Asthma showed a similar trend; however, there was no statistically significant difference in either respiratory allergy or asthma rates observed between farmers and non-farmers. Conclusions: The prevalence of atopy was lower in adult farmers than in non-farmers. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article provides information on a study that investigates the possibility of sex specificity for the association of obesity and asthma using objective measures of body mass index (BMI) and waist circumference. Ever-asthma was defined as lifetime physician-diagnosed asthma, and recent asthma was defined as asthma diagnosed by a physician during the past 12 months. The study demonstrates that the increased risk of asthma associated with obesity was only significant in women but not in men even when BMI was objectively measured, and this association was robust to the anthropometric measures.

Purpose: Diabetes self‐management for adolescents with type 1 diabetes (T1D) is a complex and multifaceted process that requires careful consideration of a supportive or shared approach to care. The purpose of this review was to synthesize the qualitative and quantitative evidence regarding the nature of adolescent−parent interactions and relationships in the context of T1D management. Of particular interest was the role of interdependence in this relationship. Methods: An integrative review of the literature was conducted between January 2021 and April 2021 using Whittemore and Knafl's (2005) methodological strategies. Results: Eleven studies published between 2003 and 2018 met the review criteria. Thematic analysis identified the following three themes related to parent−adolescent relationships in care including the Effectiveness of Parental Involvement and T1D Management, Shared Responsibility and T1D Task Management, and Gaining Independence in T1D Management. This review highlights the importance of both parent and adolescent shared involvement in T1D management. In particular, parental involvement appears necessary for improved glycemic control, better adherence to the T1D management regime, and for practicing self‐management in adolescents with T1D. Practice Implications: Better understanding of the parent−child interaction in diabetes care will provide important information to aid family nurses to identify, support, and help maintain the sharing of T1D management responsibilities between parents and their adolescents. [ABSTRACT FROM AUTHOR]

Background: Sleep efficiency and sleep onset latency are two measures that can be used to assess sleep quality. Factors that are related to sleep quality include age, sex, sociodemographic factors, and physical and mental health status. This study examines factors related to sleep efficiency and sleep onset latency in one First Nation in Saskatchewan, Canada. Methods: A baseline survey of the First Nations Sleep Health project was completed between 2018 and 2019 in collaboration with two Cree First Nations. One-night actigraphy evaluations were completed within one of the two First Nations. Objective actigraphy evaluations included sleep efficiency and sleep onset latency. A total of 167 individuals participated, and of these, 156 observations were available for analysis. Statistical analysis was conducted using logistic and linear regression models. Results: More females (61%) than males participated in the actigraphy study, with the mean age being higher for females (39.6 years) than males (35.0 years). The mean sleep efficiency was 83.38%, and the mean sleep onset latency was 20.74 (SD = 27.25) minutes. Age, chronic pain, ever having high blood pressure, and smoking inside the house were associated with an increased risk of poor sleep efficiency in the multiple logistic regression model. Age, chronic pain, ever having anxiety, heart-related illness, and smoking inside the house were associated with longer sleep onset latency in the multiple linear regression model. Conclusions: Sleep efficiency and sleep onset latency were associated with physical and environmental factors in this First Nation. [ABSTRACT FROM AUTHOR]

Workers in swine operations may be at increased risk of developing respiratory problems. These respiratory conditions are more prevalent among workers who are smokers. Tumor necrosis factor (TNF) genes play an important role in human immune responses to various respiratory hazards. This study aimed to investigate whether polymorphisms in TNF genes might alter the effects of smoking on lung function among workers in swine operations. Three hundred and seventy-four full-time workers from large swine operations and 411 non-farming rural dwellers in Saskatchewan were included in this study. Information on demographic and lifestyle characteristics, pulmonary function, and blood samples were obtained. Multiple linear regression analyses were used in the statistical analysis. Three promoter polymorphisms (rs1799724, rs361525, and rs1800629) in the TNF gene were investigated. Only the interaction term between smoking status and rs1799724 was significant in the multiple regression models. Among workers with the rs1799724 polymorphism (TT+TC), current smokers exhibited significantly lower lung function than nonsmokers. These associations were not observed among workers with the wild-type (CC). These findings were not observed among non-farming rural dwellers. Data demonstrated the possible involvement of TNF gene in (1) development of adverse respiratory conditions among workers who are smokers, (2) importance of smoking cessation among workers, especially those with polymorphisms in the TNF gene, and (3) potential implications in treatment, screening, and prevention. [ABSTRACT FROM AUTHOR]

Workers in swine operations are exposed to dust, bacteria, and virus, and are at increased risk of respiratory problems. Toll-like receptors (TLR) play an important role in human immune responses to respiratory hazards. Worker gender and age may significantly modify the involvement of TLR in the etiology of these respiratory outcomes. The aim of this study was to investigate whether modification effects of worker gender and age altered associations between polymorphisms in the TLR genes and lung function. This study included 374 full-time workers from large swine operations from Saskatchewan. Information on demography, lifestyle, pulmonary function,  and blood samples were obtained. Multiple linear regression and decision tree model were used in the analysis. Among females aged <45.8 years, workers with polymorphisms of rs4696480 in the TLR2 gene exhibited markedly better lung function than workers with wild-type. These associations were not observed among female workers aged ≥45.8 years and males. Among males, workers with polymorphisms of rs187084 in the TLR9 gene displayed significantly lower lung function than those with wild-type. This male-specific association was not dependent on worker age. This is the first study to report gender-specific correlations between lung function and polymorphisms of TLR genes, and modification effects of worker age on these associations, suggesting the importance of considering gender and age in genetic association studies of airway diseases due to exposure of high concentration of respiratory hazards. [ABSTRACT FROM AUTHOR]

Background: Obesity is prevalent in rural communities in Canada, however little is known about the social determinants of health and obesity in rural populations. Socioeconomic status has been found to be inversely associated with the risk of obesity in developed countries. This study investigated the relationship between income adequacy, education and obesity in a rural setting.Methods: The study used data from 5391 adults aged 18-69 who participated in the Saskatchewan Rural Health Study in 2010. Participants completed a survey that included questions about location of residence, body weight, height, and socio-demographic and behavioral factors. Obesity was defined as body mass index being ≥ 30 kg/m(2). Logistic regression using generalized estimating equation was conducted to assess the associations of income adequacy and education level with the prevalence of obesity taking covariates into consideration.Results: Approximately a third of the participants were obese and the prevalence of obesity was similar for men and women. The prevalence of obesity was significantly higher for rural residents not living on farm compared with those living on farm (p < 0.05). After adjustment for potential confounders, the risk of obesity was increased for those with ≤ 12 years of education compared with those with > 12 years of education (aOR: 1.18; 95% CI: 1.05-1.34). Low income adequacy was significantly associated with an increased risk of obesity but only among those not living on farm (aOR: 1.80; 95% CI: 1.16-2.79).Conclusions: Home location was associated with obesity prevalence in rural Saskatchewan and modified the influence of income adequacy, but not the influence of education, on obesity. Adults not living on farm had an increased risk of obesity and showed a significant impact of income adequacy on obesity. [ABSTRACT FROM AUTHOR]

This study was conducted to estimate farm fatality rates and to describe patterns of fatal agricultural injuries on Saskatchewan farms from 2005 to 2019. Data on work-related farm fatalities was collected from January 2005 to December 2019 in the Province of Saskatchewan as a part of the injury and mortality surveillance for the Canadian Agricultural Injury Reporting (CAIR) program. Data were abstracted from records made available by the Provincial Coroner's Office. There were 166 farm work-related fatalities recorded between 2005 and 2019 in Saskatchewan. The majority (93.4%) of work-related fatalities were in males. The overall work-related fatality rate was 10.5 (95% CI: 8.9–12.1) per 100,000 farm population. The overall age-adjusted work-related fatality rate was 18.1 (95% CI: 15.2–20.9) per 100,000 farm population among males and 1.4 (95% CI: 0.6–2.3) per 100,000 farm population among females. Age-adjusted rate decreased from 91.2 (95% CI: 69.4–117.66) per 100,000 farm population in 2005–2009 to 89.7 (95% CI: 64.9–120.2) per 100,000 farm population in 2015–2019 in males. Trend analysis of the work-related fatality rate in all cases showed a non-significant average annual decline of 2.6% (p = 0.156). Rollover injuries contributed to a high proportion of fatalities in children (30.0%) and the elderly population (14.9%). The most common causative agent was a tractor, and the most common location of injury was the farmyard or field. The burden of mortality in this industry is still substantial. There was a non-significant decreasing trend in the injury rate over the 15-year period. Elderly farmers continue to be at high risk for fatality, while the rates for children have declined. Application of prevention approaches could reduce the risk of fatal injury, and in particular the high proportion of rollover injuries in children and the elderly population. [ABSTRACT FROM AUTHOR]

The article presents a letter to the editor about the reliability of cigarette consumption.

The objective of this study was to determine the extent of machine learning (ML) application in asthma research and to identify research gaps while mapping the existing literature. We conducted a scoping review. PubMed, ProQuest, and Embase Scopus databases were searched with an end date of September 18, 2020. DistillerSR was used for data management. Inclusion criteria were an asthma focus, human participants, ML techniques, and written in English. Exclusion criteria were abstract only, simulation-based, not human based, or were reviews or commentaries. Descriptive statistics were presented. A total of 6,317 potential articles were found. After removing duplicates, and reviewing the titles and abstracts, 102 articles were included for the full text analysis. Asthma episode prediction (24.5%), asthma phenotype classification (16.7%), and genetic profiling of asthma (12.7%) were the top three study topics. Cohort (52.9%), cross-sectional (20.6%), and case-control studies (11.8%) were the study designs most frequently used. Regarding the ML techniques, 34.3% of the studies used more than one technique. Neural networks, clustering, and random forests were the most common ML techniques used where they were used in 20.6%, 18.6%, and 17.6% of studies, respectively. Very few studies considered location of residence (i.e. urban or rural status). The use of ML in asthma studies has been increasing with most of this focused on the three major topics (>50%). Future research using ML could focus on gaps such as a broader range of study topics and focus on its use in additional populations (e.g. location of residence). Supplemental data for this article is available online at http://dx.doi.org/. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the association of individual and contextual exposures with lung function by gender in rural-dwelling Canadians. Methods: A cross-sectional mail survey obtained completed questionnaires on exposures from 8263 individuals; a sub-sample of 1609 individuals (762 men, 847 women) additionally participated in clinical lung function testing. The three dependent variables were forced expired volume in one second (FEV), forced vital capacity (FVC), and FEV/FVC ratio. Independent variables included smoking, waist circumference, body mass index, indoor household exposures (secondhand smoke, dampness, mold, musty odor), occupational exposures (grain dust, pesticides, livestock, farm residence), and socioeconomic status. The primary analysis was multiple linear regression, conducted separately for each outcome. The potential modifying influence of gender was tested in multivariable models using product terms between gender and each independent variable. Results: High-risk waist circumference was related to reduced FVC and FEV for both genders, but the effect was more pronounced in men. Greater pack-years smoking was associated with lower lung function values. Exposure to household smoke was related to reduced FEV, and exposure to livestock, with increased FEV. Lower income adequacy was associated with reduced FVC and FEV. Conclusion: High-risk waist circumference was more strongly associated with reduced lung function in men than women. Longitudinal research combined with rigorous exposure assessment is needed to clarify how sex and gender interact to impact lung function in rural populations. [ABSTRACT FROM AUTHOR]

The STOP-Bang questionnaire is an easy-to-administer scoring model to screen and identify patients at high risk of obstructive sleep apnea (OSA). However, its diagnostic utility has never been tested with First Nation peoples. The objective was to determine the predictive parameters and the utility of the STOP-Bang questionnaire as an OSA screening tool in a First Nation community in Saskatchewan. The baseline survey of the First Nations Sleep Health Project (FNSHP) was completed between 2018 and 2019. Of the available 233 sleep apnea tests, 215 participants completed the STOP-Bang score questionnaire. A proportional odds ordinal logistic regression analysis was conducted using the total score of the STOP-Bang as the independent variable with equal weight given to each response. Predicted probabilities for each score at cut-off points of the Apnea Hypopnea Index (AHI) were calculated and plotted. To assess the performance of the STOP-Bang questionnaire, sensitivity, specificity, positive predictive values (PPVs), negative predictive values (NPVs), and area under the curve (AUC) were calculated. These data suggest that a STOP-Bang score ≥ 5 will allow healthcare professionals to identify individuals with an increased probability of moderate-to-severe OSA, with high specificity (93.7%) and NPV (91.8%). For the STOP-Bang score cut-off ≥ 3, the sensitivity was 53.1% for all OSA and 72.0% for moderate-to-severe OSA. For the STOP-Bang score cut-off ≥ 3, the specificity was 68.4% for all OSA and 62.6% for moderate-to-severe OSA. The STOP-Bang score was modestly superior to the symptom of loud snoring, or loud snoring plus obesity in this population. Analysis by sex suggested that a STOP-Bang score ≥ 5 was able to identify individuals with increased probability of moderate-to-severe OSA, for males with acceptable diagnostic test accuracy for detecting participants with OSA, but there was no diagnostic test accuracy for females. [ABSTRACT FROM AUTHOR]

Background. Ear infections in children are a major health problem and may be associated with hearing impairment and delayed language development. Objective. To determine the prevalence and the associated risk factors of ear infections in children 6–17 years old residing on two reserves and rural areas in the province of Saskatchewan. Methodology. Data were provided from two rural cross-sectional children studies. Outcome variable of interest was presence/absence of an ear infection. Logistic regression analysis was conducted to examine the relationship between ear infection and the other covariates. Results. The prevalence of ear infection was 57.8% for rural Caucasian children and 43.6% for First Nations children living on-reserve. First Nations children had a lower risk of ear infection. Ear infection prevalence was positively associated with younger age; first born in the family; self-reported physician-diagnosed tonsillitis; self-reported physician-diagnosed asthma; and any respiratory related allergy. Protective effect of breastfeeding longer than three months was observed on the prevalence of ear infection. Conclusions. While ear infection is a prevalent condition of childhood, First Nations children were less likely to have a history of ear infections when compared to their rural Caucasian counterparts. [ABSTRACT FROM AUTHOR]

Research has shown that respiratory symptoms, including chronic cough, chronic phlegm, shortness of breath, and wheeze, are important markers that contribute to hospitalization, lung function decline, and other respiratory illness. This report aims to estimate the prevalence of respiratory symptoms and associated environmental risk factors in farming and nonfarming rural-dwelling people. A baseline mail-out questionnaire to assess respiratory health outcomes as well as individual and contextual determinants in farm and small town cohorts was sent to 11,004 households within four geographical regions of Saskatchewan, Canada, in 2010. Completed questionnaires were received from 4624 households (8261 individuals). Outcome variables examined for this report were chronic cough, chronic phlegm, shortness of breath, and ever wheeze. Clustering effect within households was adjusted using generalized estimating equations. The prevalence of respiratory symptoms was chronic cough, 9.2% (farm vs. nonfarm: 8.1% vs. 10.0%); chronic phlegm, 8.2% (farm vs. nonfarm: 6.7% vs. 9.3%); shortness of breath, 29.1% (farm vs. nonfarm: 25.5% vs. 31.6%); and ever wheeze, 40.6% (farm vs. nonfarm: 38.1% vs. 42.5%). There was a significantly higher prevalence of each respiratory symptomin the nonfarming population compared with the farming population (P< .01). Respiratory symptoms were positively associated with smoking, allergic reaction to inhaled allergens, and other environmental factors for farming and nonfarming populations. The prevalence of respiratory symptoms was higher in the nonfarming rural population compared with the farming rural population. Environmental exposures such as work-related or home environment play an important role in the increased prevalence of respiratory symptoms in farming and nonfarming populations. [ABSTRACT FROM PUBLISHER]

Sleep disorders have been related to body weight, social conditions, and a number of comorbidities. These include high blood pressure and type 2 diabetes, both of which are prevalent in the First Nations communities. We explored relationships between obstructive sleep apnea (OSA) and risk factors including social, environmental, and individual circumstances. An interviewer-administered survey was conducted with adult participants in 2018–2019 in a First Nations community in Saskatchewan, Canada. The survey collected information on demographic variables, individual and contextual determinants of sleep health, and objective clinical measurements. The presence of OSA was defined as an apnea–hypopnea index (AHI) ≥5. Multiple ordinal logistic regression analysis was conducted to examine relationships between the severity of OSA and potential risk factors. In addition to the survey, 233 men and women participated in a Level 3 one-night home sleep test. Of those, 105 (45.1%) participants were reported to have obstructive sleep apnea (AHI ≥ 5). Mild and moderately severe OSA (AHI ≥ 5 to <30) was present in 39.9% and severe OSA (AHI ≥ 30) was identified in 5.2% of participants. Being male, being obese, and snoring loudly were significantly associated with severity of OSA. The severity of OSA in one First Nation appears relatively common and may be related to mainly individual factors such as loud snoring, obesity, and sex. [ABSTRACT FROM AUTHOR]

In Canada, the increase in childhood obesity has been greater in youth than in adults and in rural populations versus urban. The prevention of childhood obesity is crucial and warrants an approach that increases our understanding of children's perspectives of health. This study used an emic perspective to discover children's meaning of health and determined health behaviors of children in rural Saskatchewan, Canada. An explanatory sequential design and Creswell's five criteria for designing mixed methods studies provided a framework for this study, which addressed (a) What are the health characteristics of the study population?, (b) What is the rural context of children participating in the study, (c) What is the cultural meaning of health from the perspectives of this group of children?, and (d) Is the meaning of health thematically congruent from the perspective of healthy weight and unhealthy weight children? The prevalence of overweight and obesity was high. The meaning of health was multidimensional with the psychosocial dimension being most important to children. The rural environment contributed to children's health. Obesity places the present and future health of rural children at risk. The findings illustrate children are adept research participants. A mixed methods approach enhanced our understanding of children's health and provided insight into potential approaches for future health promotion programs. The study design was straightforward and practical to use with children. [ABSTRACT FROM PUBLISHER]

The relationship between endotoxin exposure and asthma severity (wheeze and airways obstruction) is not well described. The effects of endotoxin and tobacco smoke exposure on self-reported wheeze and diurnal PEF variability (DV-PEF) were examined in children aged 6-18 years with asthma or wheeze. A cross-sectional study was performed in a rural area. From this study, children who reported wheeze in the previous 12 months or a physician diagnosis of asthma ( n = 98) were selected for a case-control study. These subjects, who were the basis for the present analysis, completed: (i) a home environmental assessment, including dust collection to measure endotoxin levels: (ii) a clinic visit, including saliva collection to measure cotinine levels; and (iii) 2 week monitoring of twice daily symptom records, including wheeze, and PEF to calculate DV-PEF. Among these children, 22.4% reported wheeze during the monitoring period. Greater DV-PEF was associated with higher endotoxin loads in play areas ( P < 0.05). The association between salivary cotinine levels and high DV-PEF was modified by gender. In females, higher cotinine levels were associated with an increased risk of high DV-PEF compared with lower cotinine levels ( P < 0.05), but this was not observed among males. Higher endotoxin exposure was associated with greater DV-PEF among children with asthma or wheeze. While previous studies have suggested that endotoxin exposure protects against the development of asthma, individuals with the disease should avoid high exposure levels to limit exacerbations. The effect of tobacco smoke exposure on lung health may differ between male and female children. Associations between domestic endotoxin exposures and wheezing symptoms and diurnal peak flow variation were examined among children with reported asthma or wheeze. The association between endotoxin exposure and exacerbations in children with asthma has been infrequently studied and the findings suggest that endotoxin exposure may worsen asthma in this group. [ABSTRACT FROM AUTHOR]

The effects of passive smoking on asthma are well documented, however there is limited research conducted to study the relationship of asthma and smoking among adult populations. This article aims to investigate the gender differences when studying the relationship of asthma prevalence and smoking and further explore if rural/urban living affects the relationship over time. The longitudinal National Population Health Survey (NPHS) dataset was used. For analytic purposes five time periods were used. Generalized estimating equation (GEE) approach was used to obtain the odds ratios and 95% confidence intervals. A total of 11,223 participants ranging in age from 18 to 64; 5,382 men and 5,841 women, were included in the baseline time point (1994–1995). Rural/urban living for the present analysis was an effect modifier for the relationship of asthma prevalence and smoking, and this was true only for women. The results showed that female smokers and ex-smokers residing in rural locations were 1.4 times (95% CI: Rural Smokers = 1.02–1.94, and Rural Ex-smokers = 1.02–2.02) more likely to be diagnosed with asthma compared to non-smoking urban women. Results indicate that the combination of living in a rural area and smoking increases the risk of asthma prevalence among women but not among men. [ABSTRACT FROM AUTHOR]

Objectives: Inhaled corticosteroids (ICS) and inhaled short-acting β2-agonists (ISABA) are the most commonly used medications for management of asthma. Increased asthma morbidity and mortality have been reported with excess use of ISABA in several studies. In these studies, authors have used different indicators to control for the potential confounding by asthma severity. The objective of this study was to determine the effect of ICS use on the association between use of ISABA and first hospitalization for asthma after controlling for several indicators of asthma severity. Design: An inceptional cohort study using Saskatchewan Health databases. Setting: The Province of Saskatchewan, Canada. Participants: A total of 29,957 persons aged 5 to 54 years who had at least five asthma-related visits to physicians between 1991 and 2000. Results: Among the subjects with increased asthma severity, indicated by one or more average number of asthma-related physician visits per 3 months during the follow-up, high use of ISABA was a risk factor for hospitalization when no ICS were used (rate ratio [RR], 2.16; 95% confidence interval [CI], 1.51 to 2.95). There was a beneficial effect of ISABA when there was low use of ICS (RR, 0.65; 95% CI, 0.42 to 0.93) or high use of ICS (RR, 0.23; 95% CI, 0.12 to 0.41). Among the subjects with less severe asthma, indicated by less than one asthma-related physician visits per 3 months, on average, during the follow-up, the risk of hospitalization was even greater for high use of ISABA when no ICS were used (RR, 10.06; 95% CI, 6.99 to 14.47). This was reduced but not abolished when there was low use of ICS (RR, 3.24; 95% CI, 2.29 to 4.59) and negated altogether by high use of ICS (RR, 1.10; 95% CI, 0.39 to 3.12). Conclusion: Among both severe and less severe asthma groups, high use of ISABA was associated with an increased risk of asthma hospitalization in the absence of any use of ICS, which was progressively reduced with low and high use of ICS. This finding was independent of asthma severity and could result from lack of control through over reliance on ISABA in asthma management. [ABSTRACT FROM AUTHOR]

Sleep is crucial for maintaining the recovery and restoration of the body and brain. Less sleep is associated with poor mental and physical performance. Seasonal changes in sleep patterns can be observed. This paper examines seasonal effects on sleep timing, duration, and problems in two Cree First Nation communities in Saskatchewan, Canada. Data were available from a community survey of 588 adults aged 18 years and older (range: 18-78 years) with 44.2% males and 55.8% females. Results are presented using descriptive statistics and a binary logistic-regression model to identify the association between seasonal changes in sleep patterns, and demographic, social, and environmental factors. The participants reported sleeping the least during the spring and summer months and sleeping the most during the fall and winter months. This was further confirmed by sleep hours and the lower proportion of recommended hours of sleep during the spring and summer, and a higher proportion of longer sleep duration during the fall and winter months. There was no significant variation in sleeping onset and wake-up times by season. Overall, there were no significant differences in the prevalence of sleep deprivation, insomnia, and excessive daytime sleepiness by season. When stratified by age group and sex, some differences existed in the prevalence of sleep problems by season. More than two-thirds (68.6%) of the participants reported that there was a change in sleep patterns across seasons, and about 26.0% reported a very or extremely marked change in sleep patterns across seasons. Changes in sleep patterns by season were related to money left at the end of the month and damage caused by dampness in the house. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of asthma, bronchitis, and COPD using the physician services database of the Saskatchewan Health Department from 1991 to 1998. Design: Descriptive population-based study. Setting: The Province of Saskatchewan, Canada. Participants: Residents of Saskatchewan covered by universal health care in the province. Results: In all age groups, asthma prevalence increased between 1991 and 1995 and either was stable or declined between 1996 and 1998. Preschool children had the highest asthma prevalence during the study period, followed by children aged 5 to 14 years, young adults aged 15 to 34 years, and adults aged 35 to 64 years. Children aged 0 to 4 years and adults aged 35 to 64 years in the Registered Indian population had greater asthma prevalence than persons in other urban or rural populations during the study period. Asthma prevalence rates in rural populations were less than or similar to the rates of urban populations in all age groups during the study period. The prevalence of bronchitis was greater in the Registered Indian population than in urban and rural populations in all age groups throughout the study period. When persons who had visited a physician for bronchitis were excluded from the prevalence calculation, the original increases seen in asthma prevalence among very young children and older adults of Registered Indian origin disappeared, with the urban population having greater asthma prevalence in all age groups. In the Registered Indian population, adults aged 35 to 64 years had almost twofold increases in the prevalence of COPD in comparison to other Saskatchewan populations. Conclusions: Asthma prevalence, which had been on the increase in the 1980s and early 1990s, was either stable or declining during the latter part of 1990s in Saskatchewan. Preschool children and older adults from the Registered Indian population had greater asthma prevalence than did those from other Saskatchewan populations. Asthma prevalence among the rural populations was either similar or lower in comparison to the rates for the urban populations in all age groups during the study period. Further research is required to elucidate the findings in this study. [ABSTRACT FROM AUTHOR]

Insomnia is a common problem in Canada and has been associated with increased use of health care services and economic burden. This paper examines the prevalence and risk factors for insomnia in two Cree First Nation communities in Saskatchewan, Canada. Five hundred and eightyeight adults participated in a baseline survey conducted as part of the First Nations Sleep Health Collaborative Project. The prevalence of insomnia was 19.2% among participants with an Insomnia Severity Index score of -15. Following the definition of nighttime insomnia symptoms, however, the prevalence of insomnia was much higher, at 32.6%. Multivariate logistic regression modeling revealed that age, physical health, depression diagnosis, chronic pain, prescription medication use for any health condition, and waking up during the night due to terrifying dreams, nightmares, or flashbacks related to traumatic events were risk factors for insomnia among participants from two Saskatchewan Cree First Nation communities. [ABSTRACT FROM AUTHOR]

Objectives: Less is known about the respiratory health of general farming and non-framing populations. A longitudinal Saskatchewan Rural Health Study (SRHS) was conducted to explore the association between individual and contextual factors with respiratory health outcomes in these populations. Hence, the objectives are to: (i) describe the updated methodology of longitudinal SRHS--an extension of baseline survey methodology published earlier; (ii) compare baseline characteristics and the prevalences of respiratory health outcomes between drops-outs and completers; and (iii) summarize key findings based on baseline survey data. Results: The SRHS was a prospective cohort study conducted in two phases: baseline survey in 2010 and a followup in 2014. Each survey consisted of two components, self-administered questionnaire and clinical assessments. At baseline, 8261 participants (≥ 18 years) (4624 households) and at follow-up, 4867 participants (2797 households) completed the questionnaires. Clinical assessments on lung functions and/or allergies were conducted among a subgroup of participants from both the surveys. To date, we published 15 peer-reviewed manuscripts and 40 abstracts in conference proceedings. Findings from the study will improve the knowledge of respiratory disease etiology and assist in the development and targeting of prevention programs for rural populations in Saskatchewan, Canada. [ABSTRACT FROM AUTHOR]

Background: Aboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization. The purpose of this study was to investigate the possible role of discrimination, residential school attendance and cultural disruption on diabetes occurrence among First Nations adults.Methods: This 2012/13 cross sectional survey was conducted in two Saskatchewan First Nations communities comprising 580 households and 1570 adults. In addition to self-reported diabetes, interviewer-administered questionnaires collected information on possible diabetes determinants including widely recognized (e.g. age, sex, lifestyle, social determinants) and colonization-related factors. Clustering effect within households was adjusted using Generalized Estimating Equations.Results: Responses were obtained from 874 (55.7 %) men and women aged 18 and older living in 406 (70.0 %) households. Diabetes prevalence was 15.8 % among women and 9.7 % among men. In the final models, increasing age and adiposity were significant risk factors for diabetes (e.g. OR 8.72 [95 % CI 4.62; 16.46] for those 50+, and OR 8.97 [95 % CI 3.58; 22.52] for BMI 30+) as was spending most time on-reserve. Residential school attendance and cultural disruption were not predictive of diabetes at an individual level but those experiencing the most discrimination had a lower prevalence of diabetes compared to those who experienced little discrimination (2.4 % versus 13.6 %; OR 0.11 [95 % CI 0.02; 0.50]). Those experiencing the most discrimination were significantly more likely to be married and to have higher incomes.Conclusions: Known diabetes risk factors were important determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not predictive of diabetes on an individual level. In contrast, those experiencing the highest levels of discrimination had a low prevalence of diabetes. Although the reasons underlying this latter finding are unclear, it appears to relate to increased engagement with society off-reserve which may lead to an improvement in the social determinants of health. While this may have physical health benefits for First Nations people due to improved socio-economic status and other undefined influences, our findings suggest that this comes at a high emotional price. [ABSTRACT FROM AUTHOR]

Background: To date, determinants of respiratory health in First Nations people living on reserves and means of addressing and redressing those determinants have not been well established. Hence the Saskatchewan First Nations Lung Health Project (FNLHP) is a new prospective cohort study of aboriginal people being conducted in two First Nations reserves to evaluate potential health determinants associated with respiratory outcomes. Using the population health framework (PHF) of Health Canada, instruments designed with the communities, joint ownership of data, and based on the 4-phase concept of the First Nations Regional Longitudinal Health Survey, the project aims to evaluate individual factors, contextual factors, and principal covariates on respiratory outcomes. The objective of this report is to clearly describe the methodology of (i) the baseline survey that consists of two components, an interviewer-administered questionnaire and clinical assessment; and (ii) potential intervention programs; and present descriptive results of the baseline data of longitudinal FNLHP. Methods: The study is being conducted over 5 years (2012-2017) in two phases, baseline and longitudinal. Baseline survey has been completed and consisted of (i) an interviewer-administered questionnaire-based evaluation of individual and contextual factors of importance to respiratory health (with special focus on chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea), and (ii) clinical lung function and allergy tests with the consent of study participants. The address-redress phase consists of potential intervention programs and is currently being rolled out to address-at community level (via green light program and environmental study), and redress-at policy level (via obesity reduction and improved diagnosis and treatment of obstructive sleep apnea) the issues that have been identified by the baseline data. Results: Interviewer-administered surveys were conducted in 2012-2013 and collected data on 874 individuals living in 406 households from two reserve communities located in Saskatchewan, Canada. Four hundred and forty six (51%) females and 428 (49%) males participated in the FNLHP. Conclusions: The information from this project will assist in addressing and redressing many of the issues involved including the provision of adequate housing, health lifestyle practices, and in planning for health service delivery. [ABSTRACT FROM AUTHOR]

An abstract of the article "Delivering a Farm Safety Plan Through the Saskatchewan Agricultural Health and Safety Network" by Bonita Mechor, Niels Koehncke and Donna Rennie is presented.

Background: Although rural Canadians are reported to have higher rates of diabetes than others, little is known about the relative influence of known versus agriculture-related risk factors. The purpose of this research was to carry out a comprehensive study of prevalence, risk factors and co-morbidities of diabetes among adults in rural Saskatchewan and to determine possible differences between those living on and off farms. Methods: In 2010, we conducted a baseline mail-out survey (Saskatchewan Rural Health Study) of 11,982 households located in the province0s four agricultural quadrants. In addition to self-reported physician-diagnosed diabetes, the questionnaire collected information from farm and small town cohorts on possible diabetes determinants including lifestyle, family history, early life factors and environmental/agricultural-related exposures. Clustering effect within households was adjusted using Generalized Estimating Equations approach. Results: Responses were obtained from 4624 (42%) households comprising 8208 males and females aged 18 years or older and 7847 self-described Caucasian participants (7708 with complete information). The overall age-standardized diabetes prevalence for the latter was 6.35% but people whose primary residence was on farms had significantly lower diabetes prevalence than those living in non-farm locations (5.11% versus 7.33% respectively; p<0.0001). Diabetes risk increased with age and affected almost 17% of those older than 65 (OR 2.57; CI0 1.63, 4.04 compared to those aged 18-45). Other known independent risk factors included family history of diabetes (OR 2.50 [CI0s 1.94, 3.23] if father; OR 3.11 [CI0s 2.44, 3.98] if mother), obesity (OR 2.66; CI0s 1.86, 3.78), as well as lower socioeconomic status, minimal/no alcohol intake and smoking. The most original finding was that exposure to insecticides conferred an increased risk for diabetes among males (OR 1.83; CI0s 1.15, 2.91). Finally, the co-morbidities with the strongest independent association with diabetes were heart disease and hypertension. Conclusions: While known diabetes risk factors are important determinants of diabetes in the agricultural zones of Saskatchewan, on-farm residence is protective and appears related to increased outdoor activities. In contrast, we have now shown for the first time that exposure to insecticides is an independent risk factor for diabetes among men in rural Canada. [ABSTRACT FROM AUTHOR]

The article reports a study which was conducted to determine the prevalence of chronic bronchitis (CB) and associated risk-factors in farm and non-farm rural residents in Saskatchewan, Canada. The results revealed greater prevalence of CB. The results indicated that greater household income and reducing smoking could be primary, modifiable determinants of CB prevalence.

A common source of bias in epidemiological studies is self-selection or volunteer bias. The self-selection into cohorts for further investigation or for participation in a substudy may be an important source of selection bias. The objectives of this paper were to identify differences in selected demographic characteristics, individual and contextual factors, and variables related to respiratory health between study participants who were willing to participate in subsequent clinical and allergy testing and those who were not willing to participate. One hundred and fourteen households (207 individuals) from a small town and 54 households (99 individuals) from a nearby rural municipality participated in this study. One key informant from each household provided information about each adult in that household. The question being studied was: “We wish to find out more about respiratory health of rural people. We would like to invite you to perform breathing and allergy tests. Would you be willing to be contacted for breathing and allergy tests in a nearby location?” One hundred and four participants said “Yes” they would participate in the clinical studies, 144 said “No” they would not participate in the clinical studies, and 52 said “Would like more information” about the clinical studies. More than one half (53.8%) of male participants and 46.2% of female participants indicated that they would like to participate in breathing and allergy tests. A higher proportion of study participants (26.1% males, 30.8% females) in the lowest income category requested more information compared to those answering either “Yes” (15.7% for males, 20.5% for females) or “No” (18.5% males, 23.3% females) to the question being studied. Study participants who were willing to participate in further breathing and allergy tests had a higher proportion of self-reported chronic phlegm and ever had allergic reaction to things eaten than those who either said “No” or “Would like more information.” Among male study participants who said “Yes” to further participation, a higher proportion was exposed to one of the occupational exposures of interest compared to those who said either “No” or “Would like more information.” This pattern was not observed for females. [ABSTRACT FROM PUBLISHER]

Background: Respiratory disease can impose a significant burden on the health of rural populations. The Saskatchewan Rural Health Study (SRHS) is a new large prospective cohort study of ages 6 and over currently being conducted in farming and non-farming communities to evaluate potential health determinants associated with respiratory outcomes in rural populations. In this article, we describe the rationale and methodology for the adult component. The study is being conducted over 5 years (2009-15) in two phases, baseline and longitudinal. The baseline survey consists of two components, adults and children. The adult component consists of a questionnaire-based evaluation of individual and contextual factors of importance to respiratory health in two sub populations (a Farm Cohort and a Small Town Cohort) of rural families in Saskatchewan Rural Municipalities (RMs). Clinical studies of lung function and allergy tests are being conducted on selected sub-samples of the two cohorts based on the positive response to the last question on the baseline questionnaire: "Would you be willing to be contacted about having breathing and/or allergy tests at a nearby location?". We adopted existing population health theory to evaluate individual factors, contextual factors, and principal covariates on the outcomes of chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea. Findings: Of the RMs selected to participate, 32 (89%) out of 36 RMs and 15 (94%) out of 16 small towns within the RMs agreed to participate. Using the mail out survey method developed by Dillman, we obtained completed questionnaires from 4264 households (8261 individuals). We obtained lung function measurements on 1609 adults, allergy skin test information on 1615 adults; both measurements were available on 1549 adults. We observed differences between farm and non-farm rural residents with respect to individual, contextual factors and covariates. Discussion: There are differences between farm and non-farm rural residents with respect to individual and contextual factors and other variables of importance. The findings of the SRHS will improve knowledge of respiratory disease etiology, assist in the development and targeting of prevention programs, and in planning health services with farm and small town populations. [ABSTRACT FROM AUTHOR]

Background: Currently, one out of every seven Canadians is affected by limitations to their participation and activity. This study describes the self-reported main causes of these limitations in a national sample. Methods: The 2006 Participation and Activity Limitation Survey was a two-phase stratified survey based on filter questions posed in the 2006 Census of Population conducted by Statistics Canada. Respondents to the survey represent 5 185 980 Canadian adults with activity and participation limitations. We used these data to develop a profile of our population of interest: adult Canadians with activity and participation limitations. Associations between demographic variables and self-reported causes of activity and participation limitations were assessed using multiple logistic regression. Results: One quarter of participants did not attribute their disability to any medical cause. The most prevalent medical conditions to which disabilities were attributed were musculoskeletal (46.1%), cardio/cerebrovascular (12.3%), mental health (8.4%), neurologic (6.0%), endocrine (6.0%) and respiratory (4.5%) conditions. Significant associations were noted between sociodemographic variables and participants' attributions of medical conditions as cause of disability. Multiple logistic regression with bootstrapping showed that people who reported a medical cause for their limitation were more likely (p < 0.05) to be female, widowed, 40 years of age or older, born in Canada or white and were less likely (p < 0.05) to be in the highest income category or to be employed (i.e., to work more than 0 h/w). Interpretation: Most people living with activity and participation limitations report having a musculoskeletal disorder. However, a significant proportion of respondants did not attribute their limitations to a medical cause. [ABSTRACT FROM AUTHOR]

To assess concordance of prevalence rates of asthma, allergic rhinoconjunctivitis and atopic eczema symptoms among adolescents in five Canadian cities. The International Study of Asthma and Allergies in Childhood Phase 3 written questionnaires were answered by 8334 adolescents aged 13 to 14 in Vancouver, Saskatoon, Winnipeg, Hamilton and Halifax, Canada. Prevalence rates of current symptoms ranged from 13.7-33.0% for wheezing, 14.6-22.6% for allergic rhinoconjunctivitis and 8.2-10.4% for atopic eczema. Using Hamilton as reference, the prevalence of wheezing was significantly higher in Halifax (OR = 1.58; 95% CI 1.36-1.84) and Saskatoon (1.27; 1.07-1.50) and significantly lower in Vancouver (0.51; 0.44-0.59). In contrast, allergic rhinoconjunctivitis was significantly more prevalent in Winnipeg (1.39; 1.16-1.68) and Halifax (1.36; 1.14-1.61) and trended lower in Saskatoon (0.81; 0.66-1.00). Atopic eczema was significantly more prevalent in Winnipeg (1.31; 1.01-1.69) and Vancouver (1.28; 1.04-1.58). Multivariable logistic regression analyses showed the region of residence, being born in Canada, recent use of acetaminophen and heavy exposure to traffic exhaust were significantly associated with all three allergic conditions, while obesity and having two or more smokers at home was only associated with increased risk for wheezing. Chinese ethnicity decreased that risk. Among five Canadian centres, the highest prevalence rates of allergic rhinoconjunctivitis or atopic eczema were not observed in the same regions as the highest prevalence rates of wheezing. This disparity in regional variations in the prevalence rates suggests dissimilar risk factors for the development or expression of wheezing (asthma), allergic rhinoconjunctivitis and atopic eczema. [ABSTRACT FROM AUTHOR]