The Saskatchewan Farm Injury Cohort (SFIC) is a major new Canadian study that was developed to evaluate potential causes of injury among farmers and their family members. The cohort involves 2,390 farms and 5,492 farm people being followed over a two-year period. The article describes the rationale and methodology for the baseline and longitudinal components of this study. The SFIC is one of the first studies to apply population health theory to the modeling of risks for injury in a defined Canadian population. In doing so, the relative influence of several potential causes of farm injury, including physical, socioeconomic, and cultural factors, will be estimated. Study findings will inform the content and targeting of injury prevention initiatives specific to the farm occupational environment.
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.
In 2010, we conducted a baseline mail-out survey (Saskatchewan Rural Health Study) of 11,982 households located in the province′s 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.
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; CI′ 1.63, 4.04 compared to those aged 18–45). Other known independent risk factors included family history of diabetes (OR 2.50 [CI′s 1.94, 3.23] if father; OR 3.11 [CI′s 2.44, 3.98] if mother), obesity (OR 2.66; CI′s 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; CI′s 1.15, 2.91). Finally, the co-morbidities with the strongest independent association with diabetes were heart disease and hypertension.
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.
Diabetes; Rural; Agriculture; Insecticides; Farm; Exposures
An outbreak of anthrax in Saskatchewan in 2006 affected more than 800 animals at 150 locations. The purpose of this study was to assess the spatial and temporal patterns among the cases to determine if there were any significant trends associated with this outbreak. Case and population data were first analyzed for each individual farm location and then again as aggregate data per rural municipality using spatial and spatiotemporal statistical methods such as Oden’s Ipop, Cuzick-Edwards’ test, spatial scan test, and other mapping techniques. East central Saskatchewan was identified as a primary high risk area, particularly during July 2006. The results of the study led to the conclusion that within this high-risk region, flooding in spring followed by hot and dry conditions could have been a factor in the development of the outbreak.
Antimicrobial resistance (AMR) is an emerging animal welfare and public health issue linked to antimicrobial use (AMU) in livestock. This study was conducted in 2004 on 20 swine farms in Alberta and Saskatchewan. On-farm records and questionnaires were used to retrospectively describe the antimicrobial exposures of pigs through feed, water, and injection. Antimicrobial use in all production categories was described over 12 months. On-farm records and questionnaires provided sufficient data to describe antimicrobial exposure rates through feed and water. In contrast, on-farm records did not supply sufficient data to describe parenteral antimicrobial exposure rates. Records lacked data on the number of exposures per treatment, therefore parenteral AMU was described as an exposure incidence. Parenteral exposure records were often unavailable for pigs less than 22 kg, in which case questionnaires were used. The incidence of parenteral AMU was significantly higher in herds reporting exposure by questionnaire compared with existing records, suggesting that on-farm records did not reliably describe parenteral AMU. However, because antimicrobial exposures in feed and water were markedly more common than through injection, it was concluded that existing on-farm data would be a valuable resource for investigating AMU and AMR in pigs.
Predictors of new and long-term respiratory symptoms for rural residents are not well defined.
To identify early predictors of respiratory symptoms in a rural community population.
The study population consisted of 871 adults living in the rural community of Humboldt, Saskatchewan, who participated in two cross-sectional respiratory studies conducted in 1993 and 2003. Questionnaire information obtained at both time points included respiratory symptoms (cough, phlegm and wheeze), history of allergy, smoking, and information regarding home and farm environments. Transitional modelling, in which measurement in a longitudinal sequence is described as a function of previous outcomes, was used to predict later outcomes of cough, phlegm and wheeze. Asymptomatic individuals in 1993 were assessed to determine factors associated with the development of symptoms during the study period.
The prevalences of cough, phlegm and wheeze in 1993 were 16.1%, 18.1% and 25.5%, respectively. Change in symptoms over time was significant for cough, phlegm and wheeze. The adjusted ORs (95% CI) from separate transitional models for each respiratory outcome in 1993 that predicted the same symptom in 2003 were 6.32 (4.02 to 9.95) for cough, 14.36 (9.01 to 22.89) for phlegm and 6.40 (4.40 to 9.32) for wheeze. For asymptomatic individuals in 1993, home dampness, allergic reaction to inhaled allergens and cigarette smoking were major risk factors associated with respiratory symptoms that were reported in 2003.
The presence of previous respiratory symptoms, allergies and environmental exposures can predict the occurrence of future respiratory symptoms in adults.
Cough; Longitudinal respiratory symptoms; Phlegm; Predictors; Wheeze
Surveillance examining the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was conducted over 8 years beginning in 2001 in three health regions covering the northern half of Saskatchewan. The annual rate of individuals reported with CA-MRSA infection in these regions dramatically increased from 8.2 per 10,000 population in 2001 (range to 4.4-10.1 per 10,000) to 168.1 per 10,000 in 2006 (range 43.4-230.9 per 10,000). To address this issue, a team of community members, healthcare professionals, educators and research scientists formed a team called "the Northern Antibiotic Resistance Partnership" (NARP) to develop physician, patient, community, and school based educational materials in an attempt to limit the spread of CA-MRSA.
Posters, radio broadcasts, community slide presentations, physician treatment algorithms, patient pamphlets, and school educational programs Do Bugs Need Drugs http://www.dobugsneeddrugs.org and Germs Away http://www.germsaway.ca were provided to targeted northern communities experiencing high rates of infections.
Following implementation of this program, the rates of MRSA infections in the targeted communities have decreased nearly two-fold (242.8 to 129.3 infections/10,000 population) from 2006 to 2008. Through pre-and post-educational intervention surveys, this decrease in MRSA infections coincided with an increase in knowledge related to appropriate antimicrobial usage and hand washing in these communities.
These educational materials are all freely available http://www.narp.ca and will hopefully aid in increasing awareness of the importance of proper antimicrobial usage and hygiene in diminishing the spread of S. aureus and other infectious diseases in other communities.
Rural Australians face a higher mental health and lifestyle disease burden (obesity, diabetes and cardiovascular disease) than their urban counterparts. Our ongoing research reveals that the Australian farming community has even poorer physical and mental health outcomes than rural averages. In particular, farm men and women have high rates of overweightness, obesity, abdominal adiposity, high blood pressure and psychological distress when compared against Australian averages. Within our farming cohort we observed a significant association between psychological distress and obesity, abdominal adiposity and body fat percentage in the farming population.
Presentation of hypothesis
This paper presents a hypothesis based on preliminary data obtained from an ongoing study that could potentially explain the complex correlation between obesity, psychological distress and physical activity among a farming population. We posit that spasmodic physical activity, changing farm practices and climate variability induce prolonged stress in farmers. This increases systemic cortisol that, in turn, promotes abdominal adiposity and weight gain.
Testing the hypothesis
The hypothesis will be tested by anthropometric, biochemical and psychological analysis matched against systemic cortisol levels and the physical activity of the subjects.
Implications of the hypothesis tested
Previous studies indicate that farming populations have elevated rates of psychological distress and high rates of suicide. Australian farmers have recently experienced challenging climatic conditions including prolonged drought, floods and cyclones. Through our interactions and through the media it is not uncommon for farmers to describe the effect of this long-term stress with feelings of 'defeat'. By gaining a greater understanding of the role cortisol and physical activity have on mental and physical health we may positively impact the current rates of psychological distress in farmers.
OBJECTIVE: To determine the difference in pregnancy outcome between native Indians and the provincial population in Saskatchewan. DESIGN: Retrospective analysis of data collected from all birth and death registration forms. SETTING: Saskatchewan. MAIN OUTCOME MEASURES: Incidence of low birth weight and rates of stillbirth and of neonatal and infant death. RESULTS: The neonatal death rate was higher in the Indian population than in the provincial population during the study period; the difference between the two groups in the rate decreased markedly after 1982. The rates of stillbirth and infant death were also higher among the Indians, and the difference persisted during the study period. The incidence of low birth weight and the rate of stillbirth were highest in the youngest and oldest maternal groups in the provincial population; however, the pattern was markedly different among the Indians, teenaged mothers having the best outcomes. CONCLUSION: Further studies are needed to determine the relation between maternal age and fetal outcome among native Indians.
Many senior undergraduate students from the University of Saskatchewan indicated informally that they did not remember much from their first year courses and wondered why we were teaching content that did not seem relevant to later clinical work or studies. To determine the extent of the problem a course evaluation study that measured the knowledge loss of medical students on selected first year courses was conducted.
This study replicates previous memory decrement studies with three first year medicine basic science courses, something that was not found in the literature. It was expected that some courses would show more and some courses would show less knowledge loss.
In the spring of 2004 over 20 students were recruited to retake questions from three first year courses: Immunology, physiology, and neuroanatomy. Student scores on the selected questions at the time of the final examination in May 2003 (the 'test') were compared with their scores on the questions 10 or 11 months later (the 're-test') using paired samples t -tests. A repeated-measures MANOVA was used to compare the test and re-test scores among the three courses. The re-test scores were matched with the overall student ratings of the courses and the student scores on the May 2003 examinations.
A statistically significant main effect of knowledge loss (F = 297.385; p < .001) and an interaction effect by course (F = 46.081; p < .001) were found. The students' scores in the Immunology course dropped 13.1%, 46.5% in Neuroanatomy, and 16.1% in physiology. Bonferroni post hoc comparisons showed a significant difference between Neuroanatomy and Physiology (mean difference of 10.7, p = .004).
There was considerable knowledge loss among medical students in the three basic science courses tested and this loss was not uniform across courses. Knowledge loss does not seem to be related to the marks on the final examination or the assessment of course quality by the students.
Some studies have suggested that young physicians may have different expectations and practice behaviours than their older generational counterparts, including their reasons for wanting to remain or leave a community. This study examined the factors associated with a physician’s decision to leave a work location. We compared different generations of physicians to assess whether these factors have changed over generations.
We conducted semi-structured, qualitative interviews with 48 physicians who graduated from two Canadian medical schools. We asked each physician about the number and nature of work location changes and the factors related to their decisions to leave each location. Interview transcripts and notes were analysed using a thematic analysis approach.
Dissatisfaction with the working environment was the most frequently cited reason for leaving a location for physicians of all generations. Elements which contributed to the quality of the work environment included the collaborative nature of the practice, the relationship with administrators, and access to resources and personnel. For younger physicians, the work environment had to meet their personal expectations for work-life balance. While remuneration level was given by some physicians as the key reason for leaving a location, for others it was the “last straw” if the work environment was poor. A small number of older generation physicians moved in response to political events and/or policies
We documented generational differences in physicians’ reasons for choosing a work location. We found that a poor work environment was universally the most important reason why a physician chose to leave a location. A few physicians who were unsatisfied with their work location identified level of remuneration as an additional reason for leaving. Some older generation physicians cited political climate as a reason for leaving a work location. While economic factors have largely been the focus of recruitment and retention initiatives, our findings highlight the importance of the work environment and organizational culture on the retention of physicians of all generations.
Generations; Physician supply; Retention; Turnover; Qualitative
A retrospective study was designed to determine the background characteristics of 9562 patients hospitalized in Saskatchewan during the calendar years 1958-1959-1960 with a discharge diagnosis of heart disease specified as involving the coronary arteries. The study illustrates the limitations of retrospective analyses, but points out that such analyses may highlight presumptive relevant variables in the search for causes of diseases with multiple possible interacting origins. Single persons, and in particular single females, were significantly much less susceptible than were persons who were married or who had been married. This is a previously unreported finding, to the authors' knowledge. Residents of farms and hamlets were hospitalized significantly less often than were village, town or city residents; it is suggested that this may corroborate the findings of Morris and others who feel that the physical activity of work may be a relevant variable in the etiology of coronary heart disease.
Epidemiologic studies of farm children are of international interest because farm children are less often atopic, have less allergic disease, and often have less asthma than do nonfarm children—findings consistent with the hygiene hypothesis. We studied a cohort of rural Iowa children to determine the association between farm and other environmental risk factors with four asthma outcomes: doctor-diagnosed asthma, doctor-diagnosed asthma/medication for wheeze, current wheeze, and cough with exercise. Doctor-diagnosed asthma prevalence was 12%, but at least one of these four health outcomes was found in more than a third of the cohort. Multivariable models of the four health outcomes found independent associations between male sex (three asthma outcomes), age (three asthma outcomes), a personal history of allergies (four asthma outcomes), family history of allergic disease (two asthma outcomes), premature birth (one asthma outcome), early respiratory infection (three asthma outcomes), high-risk birth (two asthma outcomes), and farm exposure to raising swine and adding antibiotics to feed (two asthma outcomes). The high prevalence of rural childhood asthma and asthma symptoms underscores the need for asthma screening programs and improved asthma diagnosis and treatment. The high prevalence of asthma health outcomes among farm children living on farms that raise swine (44.1%, p = 0.01) and raise swine and add antibiotics to feed (55.8%, p = 0.013), despite lower rates of atopy and personal histories of allergy, suggests the need for awareness and prevention measures and more population-based studies to further assess environmental and genetic determinants of asthma among farm children.
agricultural occupational exposures; ammonia; animal feeding operations; asthma; asthma diagnosis and treatment; asthma health care policy; asthma school screening; asthma underdiagnosis; asthma undertreatment; children; chronic wheeze; cough with exercise; farming; genetic selection; hydrogen sulfide; hygiene hypothesis; odor; rural
Self-rated health (SRH) is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity) were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%), 790 (52%) and 237 (15.6%) rated their health as “very good”, “good” and “poor” respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed.
self-rated health; determinants; lifestyle; sleep; religiosity; cross-sectional
The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. The relative magnitude of health care utilization and expenditures between Aboriginal and non-Aboriginal populations is uncertain, however. Our objective was to compare health care utilization and per capita expenditures according to Registered Indian and diabetes status in the province of Saskatchewan.
Administrative databases from Saskatchewan Health were used to identify registered Indians and the general population diabetes cases and two controls for each diabetes case. Health care resource utilization (physician visits, hospitalizations, day surgeries and dialysis) and costs for these individuals in the 2001 calendar year were determined. The odds of having used each resource category, adjusted for age and location of residence, was assessed according to Registered Indian and diabetes status. The average number of encounters for each resource category and per capita healthcare expenditures were also determined.
Registered Indian diabetes cases were younger than general population cases (45.7 ± 14.5 versus 58.4 ± 16.4 years, p < 0.001) and fewer were male (42.3% versus 53.2%, p < 0.001). Registered Indians were more likely to visit a physician, be hospitalized or receive dialysis than the general population, regardless of diabetes status. Diabetes increased the probability of having used all resource categories for both Registered Indians and the general population. Per capita health care expenditures for the diabetes subgroups were more than twice that of their respective controls and were 40% to 60% higher for registered Indians than the general population, regardless of diabetes status.
Relative to individuals without the disease, both registered Indians and the general population with diabetes had substantially higher health care utilization and costs. Excess hospitalization and dialysis suggested that registered Indians with and without diabetes experienced greater morbidity than the general population.
A survey was carried out to identify disease conditions occurring in adult and feeder sheep in Saskatchewan. Necropsies were performed on 50 adult sheep submitted to the Western College of Veterinary Medicine during the period July 1976 to June 1977 and data were assembled from necropsy records of sheep submitted between January 1975 to December 1976. The diseases encountered were briefly described. Conditions of the respiratory and digestive systems were the most significant as causes of mortality. Burdens of helminth endoparasites were generally low. In the flocks included in the necropsy survey, annual mortality among adult and feeder sheep was estimated to be three percent.
In 1995 Saskatchewan adopted a district health board structure in which two-thirds of members are elected and the rest are appointed. This study examines the opinions of board members about health care reform and devolution of authority from the province to the health districts.
All 357 members of Saskatchewan district health boards were surveyed in 1997; 275 (77%) responded. Analyses included comparisons between elected and appointed members and between members with experience as health care providers and those without such experience, as well as comparisons with hypotheses about how devolution would develop, which were advanced in a 1997 report by another group.
Most respondents felt that devolution had resulted in increased local control and better quality of decisions. Ninety-two percent of respondents believed extensive reforms were necessary and 83% that changes made in the previous 5 years had been for the best. However, 56% agreed that there was no clear vision of the reformed system. A small majority (59%) perceived health care reform as having been designed to improve health rather than reduce spending, contrary to a previous hypothesis. Many respondents (76%) thought that boards were legally responsible for things over which they had insufficient control, and 63% perceived that they were too restricted by rules laid down by the provincial government, findings that confirm the expectation of tensions surrounding the division of authority. Respondents with current or former experience as health care providers were less likely than nonprovider respondents to believe that nonphysician health care providers support decisions made by the regional health boards (45% v. 63%, p = 0.02), a result that confirmed the contention that the role of health care providers on the boards would be a source of tension.
Members of Saskatchewan district health boards supported the general goals of health care reform and believed that changes already undertaken had been positive. There were few major differences in views between appointed and elected members and between provider and nonprovider members. However, tensions related to authority and representation will require resolution.
Fifty-nine million Americans (21% of the US population) live in rural areas of the United States. Compared to persons living in urban areas of the US, rural populations have lower income, a higher rate of government versus private insurance, and decreased access to health care. While there are reports of lower asthma prevalence in rural areas, the majority of this data has been published on international populations, with little available data looking at American urban versus rural asthma prevalence on a national scale or comparing rural to nearby urban cohorts in the US. A large body of literature, mainly generated from studies of rural Europe, suggests that lower prevalence may be due to beneficial effects of exposure to farm environments, but the extent to which this applies to the rural US, where a smaller proportion of the population engages in farming, is unclear. The United States has the additional covariate of having a higher proportion of African-Americans, who have a greater asthma burden than whites independent of socioeconomic status, clustered in cities. There is data indicating that rural patients have increased difficulty obtaining healthcare in general, and limited data suggesting that they receive inferior care for asthma. Future work is needed to more clearly define asthma prevalence and morbidity among residents of the rural US, as well as to identify interventions effective in this population.
asthma; rural health disparities; hygiene hypothesis
We report the results of a joint human-animal health investigation in a Dene community in northern Saskatchewan, where residents harvest wildlife (including moose, bear, elk, and fish), live in close contact with free roaming dogs, and lack access to permanent veterinary services. Fecal analysis of owned and free-roaming dogs over two consecutive years (N = 92, 103) identified several parasites of public health concern, including Toxocara canis, Diphyllobothrium spp., Echinococcus/Taenia, Cryptosporidium spp. and Giardia spp. Administration of pyrantel pamoate to a subset of dogs (N = 122) in the community in the first year was followed by reduced shedding of T. canis and other roundworms in the second year, demonstrating the potential utility of canine de-worming as a public health intervention. Using direct agglutination tests with confirmatory indirect fluorescent antibody test, 21% of 47 dogs were sero-positive for exposure to Toxoplasma gondii. Using enzyme-linked immunosorbent assay (ELISA) sero-prevalence rates in 201 human volunteers were as follows: Toxoplasma gondii (14%), Echinococcus granulosus (48%), Toxocara canis (13%) and Trichinella spp. (16%). Overall 65% of participants were sero-positive for at least one parasite. A survey administered to volunteers indicated few associations between widely accepted risk factors for parasite exposure and serological status, emphasizing the importance of environmental transmission of these parasites through soil, food, and waterborne routes.
Parasites are ubiquitous, and while some parasitize only one host, others are capable of crossing species barriers. Zoonotic parasites move between animals and people, and in some cases cause significant veterinary, medical and/or public health problems. Such parasites may be more prevalent in areas where veterinary and medical services are scarce, and especially if sanitation infrastructure is suboptimal. Additional risk factors include reliance on country foods, proximity to pets that come in contact with wildlife, and eating undercooked or raw fish and game. We visited one northern Indigenous community over two consecutive years to determine the prevalence of internal parasites in dogs, as well as to demonstrate the effect of selective deworming on reducing environmental contamination by zoonotic parasites. In addition, we collected blood samples and administered surveys to human volunteers in order to explore the relationship between exposure to four zoonotic parasites and several widely accepted risk factors for exposure (e.g. pet ownership). Our findings indicate that levels of parasite exposure in this community were higher than similar studies conducted in other Canadian Indigenous communities. Public health interventions that utilize a one health strategy by integrating medical, veterinary and environmental expertise may be the most effective approach in reducing human and animal exposure to parasites in this community.
OBJECTIVE—To study the mortality experience of workers at a hydrometallurgical nickel refinery and fertiliser complex in Fort Saskatchewan, Alberta, Canada.
METHODS—A total of 1649 male employees of Sherritt International who worked for at least 12 continuous months during the years 1954 to 1978 at the Fort Saskatchewan, Alberta hydrometallurgical nickel refinery and fertiliser complex were followed up for an additional 17 years. Mortality was ascertained from the Canadian mortality data base maintained by Statistics Canada and covered the years 1954-95. Statistics were analysed with Monson's computer program.
RESULTS—Total mortality, when compared with the Canadian population, was significantly below expectation. Fewer deaths were found for circulatory disease, ischaemic heart disease, respiratory disease, neoplasms, digestive cancer, and accidents, poisonings, and violence. Among the 718 men in the group exposed to nickel, there were no deaths due to nasal cavity or paranasal sinus cancer. Fewer deaths were found for all causes, circulatory disease, ischaemic heart disease, neoplasms and digestive cancer. Lower death rates were observed than expected for respiratory malignancies and cancer of the bronchus and lung.
CONCLUSION—No association was found in this study between exposure to nickel concentrate or metallic nickel in the hydrometallurgical refining process and the subsequent development of respiratory cancer.
Keywords: epidemiology; nickel workers; mortality
The rising epidemic of diabetes imposes a substantial economic burden on the Middle East. Using baseline data from a population based cohort study, we aimed to identify the correlates of diabetes mellitus (DM) in a mainly rural population from Iran. Between 2004 and 2007, 50044 adults between 30 and 87 years old from Golestan Province located in Northeast Iran were enrolled in the Golestan Cohort Study. Demographic and health-related information was collected using questionnaires. Individuals' body sizes at ages 15 and 30 were assessed by validated pictograms ranging from 1 (very lean) to 7 in men and 9 in women. DM diagnosis was based on the self-report of a physician's diagnosis. The accuracy of self-reported DM was evaluated in a subcohort of 3811 individuals using fasting plasma glucose level and medical records. Poisson regression with robust variance estimator was used to estimate prevalence ratios (PR's). The prevalence of self-reported DM standardized to the national and world population was 5.7% and 6.2%, respectively. Self-reported DM had 61.5% sensitivity and 97.6% specificity. Socioeconomic status was inversely associated with DM prevalence. Green tea and opium consumption increased the prevalence of DM. Obesity at all ages and extreme leanness in childhood increased diabetes prevalence. Being obese throughout life doubled DM prevalence in women (PR: 2.1; 95% CI: 1.8, 2.4). These findings emphasize the importance of improving DM awareness, improving general living conditions, and early lifestyle modifications in diabetes prevention.
Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements.
The evaluation framework aims to examine the health service over a six-year period in terms of: (a) Structural domains (health service performance; sustainability; and quality of care); (b) Process domains (health service utilisation and satisfaction); and (c) Outcome domains (health behaviours, health outcomes and community viability). Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions.
This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how; what benefits have been realised and for whom; the level of community satisfaction with the service; and the impact of a health service on community viability. While the need to reduce the rural-urban health service disparity in Australia is pressing, the evidence regarding how to move forward is inadequate. This comprehensive evaluation will add significant new knowledge regarding the characteristics associated with a sustainable rural primary health care service.
OBJECTIVE: To determine the rates and outcomes of diabetic end-stage renal disease (ESRD) among registered native people and non-native people in Saskatchewan. DESIGN: Retrospective population-based study using data from the Canadian Organ Replacement Registry. SETTING: Saskatchewan. PATIENTS: All patients with diabetic ESRD diagnosed between Jan. 1, 1981, and Dec. 31, 1990. MAIN OUTCOME MEASURES: Incidence rates of diabetic ESRD in the general population, rates of diabetic ESRD among patients with diabetes mellitus, nature of initial dialysis treatment, length of survival from start of dialysis, cause of death and renal transplant rates. RESULTS: The 10-year incidence rates of diabetic ESRD were higher among all age groups among registered native people than among non-native people. The overall relative risk ratio for native people was 16.2. When a higher prevalence of diabetes among native people was taken into account, native diabetic people were still seven times as likely as non-native diabetic people to manifest diabetic ESRD. The median survival from start of dialysis was under 2 years in both groups, but more native people died of stroke and more non-native people died of heart disease. Non-native diabetic people were more likely than native diabetic people to receive renal transplants. CONCLUSIONS: Although the overall incidence of diabetic ESRD in Saskatchewan is increasing, registered native people have a disproportionate risk for this serious complication.
A longitudinal study combining multilocus sequence typing with molecular evolutionary analysis determined the distribution, population structure, and evolution of antibiotic resistance in Neisseria gonorrhoeae isolates in Saskatchewan that were collected between 2005 and 2008. Of 195 gonococcal isolates examined, 29 sequence types (STs) were identified with 3 major circulating strains (ST-1 through ST-3) comprising 52% of all gonococcal isolates studied. The prevalences, persistence, distribution patterns, and clonalities of these isolates strongly suggest that gonorrhea endemicity within this broad geographic region was driven by these 3 circulating strains. ST-1 exhibited a significantly (P = 0.001) higher prevalence throughout the study than did the others, accounting for ∼25% of the tested isolates each year. The spatial distributions of the gonococcal strains indicated that ST-1 in 2007 entered a linear component of the sexual network, reaching the remote north and resulting in the further spread and maintenance of infection. Ciprofloxacin and azithromycin resistances were observed in distantly related gonococcal lineages, clearly indicating the convergent acquisition of these antibiotic-resistant phenotypes. In addition, all ciprofloxacin- and azithromycin-resistant lineages were found at the edges of the minimum spanning tree, far from the major lineages, suggesting that these antibiotic phenotypes were most likely introduced into the province. In contrast, resistance to penicillin was found mostly in the endemic gonococcal lineages, suggesting that penicillin resistance was probably acquired in Saskatchewan as a result of spontaneous mutations in already-established lineages. Tetracycline resistance was present in all STs except one, indicating its ubiquitous nature in the gonococcal population studied.
Using all the readily available sources of information, a study was designed to describe the changes in supply and distribution of physicians in Saskatchewan during the inception of the Province's controversial Medical Care Insurance Act. Baselines were obtained in January 1962, and comparisons made in June 1963 and June 1964. The physician:population ratio was 1:1037 in January 1962 and 1:980 in June 1964. The average yearly physician turnover rate of 10% was exceeded in 1960 and in 1961 and then levelled off. The levelling off continued from January 1962 to June 1963. But between June 1963 and June 1964 the total number of physicians was sufficient both to re-establish the rising trend of the previous decade and to offset some of the losses of 1960-1962.
In the beta chain of normal adult hemoglobin, the amino acid residues in positions six and seven are glutamic acid. In hemoglobin C, lysine replaces the glutamic acid residue in position six. Two hemoglobin variants have been described in which lysine replaces the glutamic acid residue in position seven.
During a search for abnormalities of hemoglobin synthesis detectable by conventional electrophoretic techniques, some 20,000 blood samples were screened from the population of Saskatchewan. Two specimens gave an electrophoretic pattern of hemoglobins A and C. The abnormal hemoglobin was purified and “finger printed” and found to be the same as classical hemoglobin C (i.e. α2β2 6 glu → lys). Both specimens had originated from healthy blood donors, one a Ghanaian student and the other a young white man of immigrant Irish-Scottish parents living near Saskatoon.