Josh Lawson

Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life

BACKGROUND Previous studies have documented similar levels of end-of-life symptom burden for lung cancer and chronic obstructive pulmonary disease (COPD) patients, yet there has been little comparison of health care utilization during this period. This study contrasts health care utilization by people with COPD and those with lung cancer in the 12 months prior to death. METHODS We performed a retrospective cohort study of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer using administrative health data. Our outcomes of interest included acute, long-term and home care service utilization. RESULTS The study population was 42% female with a mean age of 77 years (S.D.=11). In the last 12 months of life, decedents with COPD were more likely to be institutionalized in a LTC setting (41% vs. 12.5%, p<0.05) and to receive long-term home care (26% vs. 9.7%, p<0.05), but were much less likely to receive palliative care in hospital (47.6% vs. 5.1%, p<0.001) or at home (37.4% vs. 2.8%, p<0.05) than people with lung cancer. In contrast, decedents with lung cancer made greater use of acute care services than those with COPD in that they were more likely to be hospitalized (94.2% vs. 80.4%, p<0.05) and had longer median LOS (7.0 vs. 5.7 days, p<0.05) than those with COPD. No differences in the number of out-patient physician visits were noted. CONCLUSIONS Patterns of end-of-life health care utilization differ significantly between people with lung cancer and those with COPD. Further research is needed to establish need and determine gaps in services to better address the needs of people dying with COPD.

Assessment of endotoxin levels in the home and current asthma and wheeze in school-age children

UNLABELLED The relationship between household endotoxin and asthma in children is not clear. To further investigate the relationship between sources of endotoxin and childhood asthma, we conducted a case-control study of children with and without asthma and examined their more frequent household exposures in the home. Children ages 6-13 years with current asthma (n = 70) or wheeze only (n = 19) were sex and age matched (+/-1 year) to 107 controls. Play area and mattress dust were collected for endotoxin analysis. Atopic status was determined by skin prick testing for allergies. A family size of >4 per household was associated with higher endotoxin levels (EU/mg) in the bed dust (P < 0.05). Passive smoking (P < 0.05) and the presence of a cat were associated with higher levels of endotoxin in mattress dust. Endotoxin levels in either the play dust or the bed dust did not differ between cases and controls. Within atopic cases, those with higher endotoxin loads (EU/m2) in bed or play areas were more likely to miss school for chest illness (P < 0.05). In this study, household endotoxin is not a risk factor for current asthma overall but may be associated with increased severity in children with atopic asthma. PRACTICAL IMPLICATIONS This study did not find that household sources of endotoxin were associated with asthma. However, within atopic asthmatics, asthma severity (as measured by a history of being kept home from school because of a chest illness in the past year) was associated with higher levels of endotoxin in dust from the childs bed. There is a need to further investigate the nature of the relationship between household endotoxin and asthma severity in children which could lead to better management of childhood asthma.

Prevalence, risk factors and co-morbidities of diabetes among adults in rural Saskatchewan: the influence of farm residence and agriculture-related exposures

BackgroundAlthough 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.MethodsIn 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.ResultsResponses 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.ConclusionsWhile 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.

Prevalence of High Epworth Sleepiness Scale scores in a rural population

BACKGROUND Increased daytime sleepiness is an important symptom of obstructive sleep apnea (OSA). OSA is frequently underdiagnosed, and the Epworth Sleepiness Scale (ESS) can be a useful tool in alerting physicians to a potential problem involving OSA. OBJECTIVE To measure the prevalence and determinants of daytime sleepiness measured using the ESS in a rural community population. METHODS A community survey was conducted to examine the risk factors associated with ESS in a rural population in 154 households comprising 283 adults. Questionnaire information was obtained regarding physical factors, social factors, general medical history, family medical history, ESS score, and self-reported height and weight. Multivariable binary logistic regression analysis based on the generalized estimating equations approach to account for clustering within households was used to predict the relationship between a binary ESS score outcome (normal or abnormal) and a set of explanatory variables. RESULTS The population included 140 men (49.5%) and 143 women (50.5%) with an age range of 18 to 97 years (mean [± SD] 52.0±14.9 years). The data showed that 79.2% of the study participants had an ESS score in the normal range (0 to 10) and 20.8% had an ESS score >10, which is considered to be abnormal or high sleepiness. Multivariable regression analysis revealed that obesity was significantly associated with an abnormal or high sleepiness score on the ESS (OR 3.40 [95% CI 1.31 to 8.80). CONCLUSION High levels of sleepiness in this population were common. Obesity was an important risk factor for high ESS score.

Factors associated with opioid dispensation for patients with COPD and lung cancer in the last year of life: A retrospective analysis.

Background For patients in late stages of chronic obstructive pulmonary disease (COPD), dyspnea is often refractory to conventional treatment. We know little about the use of opioids in ameliorating dyspnea in this population. In this study we explored factors associated with opioid dispensation within the last year of life and differences in opioid dispensation for persons with lung cancer or COPD. Methods In this retrospective cohort study we used administrative health data gained from 1,035 residents of Saskatchewan, Canada to examine patterns of community opioid dispensation in the last year of life. Factors associated with opioid use were determined using multiple logistic regression. Results When compared with those with lung cancer, fewer patients with COPD were given opioids within the last week of life; the last month of life, and the last 3 months of life. After adjusting for relevant predictors, patients with lung cancer were more than twice as likely as those with COPD to fill prescriptions for the following: morphine (odds ratio [OR] 2.36, 95% confidence interval [CI]: 1.52–3.67); hydromorphone (OR 2.69, 95% CI: 1.53–4.72); transdermal fentanyl (OR 2.25, 95% CI: 1.28–3.98); or any of these opioids (OR 2.61, 95% CI: 1.80–3.80). Conclusion These opioids are dispensed only for a small proportion of patients with COPD at the end of their lives. Future researchers could explore the efficacy and safety of opioid use for patients with advanced COPD, and whether their limited use is justified.

A Biopsychosocial Profile of Adult Canadians with and without Chronic Back Disorders: A Population-Based Analysis of the 2009-2010 Canadian Community Health Surveys

Chronic back disorders (CBD) are a significant public health concern. Profiling Canadians with CBD and the associated biopsychosocial factors at a national population level is important to understand the burden of this condition and how clinicians, health systems, and related policies might address this potentially growing problem. We performed a secondary analysis of the 2009 and 2010 Canadian Community Health Surveys to calculate prevalence and to better understand the differences between people with and without CBD. An estimated 20.2% of the adult Canadian population reports having back problems lasting for 6 months or more. Among people with CBD, there was significantly greater likelihood of living in a more rural or remote location, being Aboriginal, being a former or current smoker, being overweight, having other chronic health conditions, having greater activity limitations, having higher levels of stress, and having lower perceived mental health. People who were single/never married or had an ethnicity other than Caucasian or Aboriginal were less likely to report having CBD. These results contribute to a growing body of research in the area that may assist with strategic prioritization and tailoring of health promotion efforts and health services for people with CBD, particularly among vulnerable groups.

Three new cases of apparent occupational asthma in swine confinement facility employees

To the Editors: In a previous issue of the European Respiratory Journal , Dosman et al. 1 reported on four cases of occupational asthma in newly employed workers in the large, recently developed, swine production facilities in Saskatchewan (Canada). All were full-time employees and all developed symptoms suggestive of asthma within a short time of commencing employment. None of the cases had a history of asthma, allergy symptoms or previous exposure to indoor air contaminants of swine confinement facilities. Work in swine buildings has been associated with respiratory symptoms, reductions in mean and across-shift lung function values 2, and increased bronchial responsiveness 3, 4. Asthma has been reported in swine workers, but this has typically occurred in workers with lengthy employment 5, 6. Cases 1–3 in our initial report showed some reaction to …

Exploring Diversity in Socioeconomic Inequalities in Health Among Rural Dwelling Canadians

PURPOSE To describe the patterning of socioeconomic inequalities in health among rural dwelling women and men in a Canadian province, exploring diversity in associations by measure of socioeconomic position, health outcome, and demographic characteristics. METHODS Baseline data from the Saskatchewan Rural Health Study was used, an ongoing prospective cohort study examining the health of rural people in Saskatchewan, Canada. Of the 11,004 eligible addresses, responses to mailed questionnaires were obtained from 4,624 (42%) households, representing 8,261 women and men. Multiple logistic regression was the primary method of analysis; generalized estimating equations were utilized to account for household clustering. Associations between 5 health outcomes (self-rated health, chronic obstructive lung disease, diabetes, heart attack, high blood pressure) and 4 indicators of socioeconomic position (income, education, financial strain, occupational skill level) were assessed, with age and gender as potential effect modifiers. FINDINGS With the exception of occupational skill level, socioeconomic position (SEP) indicators were strongly and inversely related to most health outcomes, often in a graded manner. Associations between SEP and several health outcomes were weaker for older than younger participants (heart attack, high blood pressure, lung disease) and stronger among women compared to men (high blood pressure, lung disease). CONCLUSIONS The patterning of SEP-health associations observed in this rural Canadian sample suggests the need for health promotion strategies and policy initiatives to be broadly targeted at individuals and families occupying a wide range of socioeconomic circumstances.

Agreement between questionnaire report of allergy‐related outcomes in school‐age children and objective measures of atopy: the Saskatchewan rural health study

In population‐based studies, questionnaires remain the most efficient tool to assess the presence of allergy and atopic conditions, but the quality of the information obtained needs to be validated. We sought to evaluate the agreement and predictive values of a questionnaire to assess atopy in rural children, an understudied population with regard to atopy and allergic disease.

Impact of excessive daytime sleepiness on the safety and health of farmers in Saskatchewan.

BACKGROUND Sleep disorders may negatively impact the health and well-being of affected individuals. The resulting sleepiness and impaired cognitive functioning may also increase the risks for injury. OBJECTIVE To examine the relationship between daytime sleepiness, defined as an Epworth Sleepiness Scale score >10, and self-reported sleep apnea, as potential determinants of farming-related injury and self-perceived physical health. METHODS Phase 2 of the Saskatchewan Farm Injury Cohort Study (2013) involved a baseline survey that included 2849 individuals from 1216 farms. A mail-based questionnaire was administered to obtain self-reports regarding sleep, demographics, farm injuries and general physical health. Multilevel logistic regression was used to quantify relationships between excessive daytime sleepiness and health. RESULTS The prevalence of excessive daytime sleepiness was 15.1%; the prevalence of diagnosed sleep apnea was 4.0%. Sleepiness was highest in the 60 to 79 (18.7%) and ≥80 (23.6%) years of age groups, and was higher in men (19.0%) than in women (9.3%). Injuries were reported by 8.4% of individuals, and fair or poor health was reported by 6.2%. Adjusting for confounding, individuals with excessive daytime sleepiness appeared more likely to experience a farming-related injury (OR 1.34 [95% CI 0.92 to 1.96]) and were more likely to report poorer physical health (OR 2.19 [95% CI 1.45 to 3.30]) than individuals with normal daytime sleepiness. CONCLUSION Excessive daytime sleepiness, a potentially treatable condition, appeared to be common in farmers and to negatively affect their health. Sleep disorder diagnosis and treatment programs did not appear to be used to their full potential in this population.