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ABSTRACT: Beijing strains are speculated to have a selective advantage over other Mycobacterium tuberculosis strains because of increased transmissibility and virulence. In Alberta, a province of Canada that receives a large number of immigrants, we conducted a population-based study to determine whether Beijing strains were associated with increased transmission leading to disease compared with non-Beijing strains. Beijing strains accounted for 258 (19%) of 1,379 pulmonary tuberculosis cases in 1991-2007; overall, 21% of Beijing cases and 37% of non-Beijing cases were associated with transmission clusters. Beijing index cases had significantly fewer secondary cases within 2 years than did non-Beijing cases, but this difference disappeared after adjustment for demographic characteristics, infectiousness, and M. tuberculosis lineage. In a province that has effective tuberculosis control, transmission of Beijing strains posed no more of a public health threat than did non-Beijing strains.
Emerging Infectious Diseases 05/2013; 19(5):701-11. · 6.79 Impact Factor
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ABSTRACT: PURPOSE: Little attention has been paid to the sociodemographic profiles of depressed youth during the vulnerable transition from adolescence to early adulthood. This study aimed to determine and describe the social, demographic, and health outcomes of adolescent depression during a 10-year period of transition into early adulthood, using a population-based cohort of Canadian teenagers. METHODS: Depression status on 1,027 adolescents aged 16-17 years was ascertained from the National Population Health Survey. Social and health outcomes (i.e., employment status, marital status, personal income, education, social support, self-perceived stress, heavy drinking, smoking, migraine headaches, adult depression, antidepressant use, self-rated health, and physical activity) were measured every 2 years until the ages of 26-27 years. Logistic regression was combined with a generalized linear mixed-model approach to determine the odds of health and social outcomes in depressed versus nondepressed adolescents. RESULTS: Proximal effects of adolescent depression were observed (at ages 18-19) on all outcomes with the exception of physical activity. Significant effects that persisted after 10 years included depression recurrence, higher severity of symptoms, migraine headaches, poor self-rated health, and low levels of social support. Adolescent depression did not appear to significantly affect employment status, personal income, marital status, or educational attainment. CONCLUSIONS: The transition from adolescence to adulthood is a particularly vulnerable period due to educational, employment, and social changes that may be occurring. The results of this study indicate that the onset of depression during adolescence may be indicative of problems of adaptation that persist at least a decade into early adulthood.
Journal of Adolescent Health 03/2013; · 3.33 Impact Factor
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ABSTRACT: Workers in swine operations are exposed to indoor dusts and gases and are at increased risk of respiratory problems. Toll-like receptor (TLR) 2 recognizes ligands from gram-positive bacteria, whereas TLR4 responds to endotoxin from gram-negative bacteria.
To investigate the effects of TLR2 and TLR4 polymorphisms on lung function in workers from swine operations and nonfarming rural dwellers.
A total of 374 full-time workers from large swine operations and 411 nonfarming rural dwellers from Saskatchewan were included. Information on demography, lifestyle, and occupation, lung function measurements, and blood samples for genotyping were obtained from the participants. Multiple regression analysis and Bonferroni correction were used in the statistical analysis.
Workers with TLR2-16933T/A polymorphism (AA) had significantly greater mean values of lung function than workers with wild-type genotypes (AT+TT) after controlling for potential confounders (forced expiratory volume in 1 second, 3.7 vs 3.5 L; P=.009; forced expiratory flow between 25% and 75%, 3.7 vs 3.3 L; P=.003; predicted forced expiratory volume in 1 second; 100.3% vs 95.6%; P=.005; forced expiratory flow between 25% and 75%, 92.4% vs 83.4%; P=.009). These results were also observed for TLR2Arg677Trp polymorphism among the workers. No such significant differences were observed among nonfarming rural dwellers. For Asp299Gly and Thr399Ile polymorphisms in the TLR4 gene, no significant differences were observed in the mean lung function values between the polymorphic and wild-type groups in both workers and rural dwellers.
Our study is the first, to our knowledge, to report protective effects of TLR2 polymorphisms on lung function among workers in swine operations and raises the possibility that TLR2 polymorphisms are protective of airway disease in individuals exposed to gram-positive organisms in the inhaled airborne dust.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2013; 110(1):44-50.e1. · 2.83 Impact Factor
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ABSTRACT: Only a few studies have investigated asthma morbidity in Canadian Aboriginal children. In the present study, data from the 2006 Aboriginal Peoples Survey were used to determine the prevalence and risk factors for asthma in Canadian Aboriginal children six to 14 years of age and adults 15 to 64 years of age living off reserve. The prevalence of asthma was 14.3% in children and 14.0% in adults. Children and adults with Inuit ancestry had a significantly lower prevalence of asthma than those with North American Indian and Métis ancestries. Factors significantly associated with ever asthma in children included male sex, allergy, low birth weight, obesity, poor dwelling conditions and urban residence. In adults, factors associated with ever asthma varied among Aboriginal groups; however, age group, sex and urban residence were associated with ever asthma in all four Aboriginal groups. The prevalence of asthma was lower in Aboriginal children and higher in Aboriginal adults compared with that reported for the Canadian population. Variation in the prevalence of and risk factors for asthma among Aboriginal ancestry groups may be related to genetic and environmental factors that require further investigation.
Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2012; 19(6):e68-74. · 1.56 Impact Factor
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ABSTRACT: Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups.
To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations.
MEDLINE, Embase, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis.
Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]).
Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.
Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2012; 19(6):355-60. · 1.56 Impact Factor
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ABSTRACT: There is limited knowledge concerning chronic bronchitis (CB) in Canadian Aboriginal peoples.
To determine the prevalence (crude and adjusted) of CB and its associated risk factors in Canadian Aboriginal children and youth six to 14 years of age.
Data from the cross-sectional Aboriginal Peoples Survey were analyzed in the present study. Logistic regression analysis was used to determine risk factors influencing the prevalence of CB among Aboriginal children and youth. The balanced repeated replication method was used to compute standard errors of regression coefficients to account for clustering inherent in the study design. The outcome of interest was based on the question: "Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis?" Demographics, environment and population characteristics (predisposing and enabling resources) were tested for an association with CB.
The prevalence of CB was 3.1% for boys and 2.8% for girls. Other significant risk factors of CB were age (OR 1.38 [95% CI 1.24 to 1.52] for 12 to 14 year olds versus six to eight year olds), income (OR 2.28 [95% CI 2.02 to 2.59] for income category <$25,000⁄year versus ≥$85,000⁄year), allergies (OR 1.96 [95% CI 1.78 to 2.16] for having allergies versus no allergies), asthma (OR 7.61 [ 95% CI 6.91 to 8.37] for having asthma versus no asthma) and location of residence (rural⁄urban and geographical location). A significant two-way interaction between sex and body mass index indicated that the relationship between the prevalence of CB and body mass index was modified by sex.
The prevalence of CB was related to well-known risk factors among adults, including older age and lower annual income.
Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2012; 19(6):e75-80. · 1.56 Impact Factor
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ABSTRACT: Rural children have lower reported rates of asthma compared with urban children. Although reasons for these differences remain unclear, 3 possible explanations exist: (1) environmental differences, (2) variations in health care access, and (3) variations in health risk behaviors.
We investigated asthma among children living on farms and in small towns and its potential determinants, including personal, behavioral, and environmental factors.
School children (n = 842, ages 6-13; participation rate = 72.0%) were involved in a 2003 cross-sectional study. Their parents completed a lung health survey that included questions about asthma, asthma-like symptoms, and potential determinants of asthma (demographic, environmental, health risk behaviors). Participating children were classified into farm dwellers (live on farm or acreage) and small town dwellers. Multiple logistic regression was used to investigate the association between asthma and wheeze with demographic, environmental, and behavioral exposures with simultaneous adjustment for confounders.
Asthma and wheeze prevalence was not significantly different between farm and small town areas (current asthma: 16% vs 13%, respectively; current wheeze: 27% vs 21%, respectively) and followed consistent patterns. Factors associated with diagnosed asthma were dampness (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 1.08-3.17), with enrollment in daycare found to be protective (OR = 0.53; 95% CI = 0.33-0.85). Being obese or overweight was associated with wheeze (OR = 1.77; 95% CI = 1.06-2.97).
Given the differences between areas and the associations between environmental risk factors and obesity with asthma and wheeze, the study findings support environment and health risk behavior explanations for the observed geographic variations.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 10/2012; 109(4):255-9. · 2.83 Impact Factor
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ABSTRACT: BACKGROUND: The association between endotoxin exposure and asthma is complex and has been associated with rural living. We examined the relationship between domestic endotoxin and asthma or wheeze among rural school-aged children (6--18 years) and assessed the interaction between endotoxin and other characteristics with these outcomes. METHODS: Between 2005 and 2007 we conducted a case--control study of children 6--18 years in the rural region of Humboldt, Canada. Cases (n = 102) reported doctor-diagnosed asthma or wheeze in the past year. Controls (n = 208) were randomly selected from children without asthma or wheeze. Data were collected to ascertain symptoms, asthma history and indoor environmental exposures (questionnaire), endotoxin (dust collection from the play area floor and child's mattress), and tobacco smoke exposure (saliva collection). Statistical testing was completed using multiple logistic regression to account for potential confounders and to assess interaction between risk factors. A stratified analysis was also completed to examine the effect of personal history of allergy. RESULTS: Among children aged 6--12 years, mattress endotoxin concentration (EU/mg) and load (EU/m2) were inversely associated with being a case [odds ratio (OR) = 0.44, 95 % confidence interval (CI) = 0.20-0.98; and OR = 0.38, 95 % CI = 0.20-0.75, respectively]. These associations were not observed in older children or with play area endotoxin. CONCLUSIONS: Our results suggest that endotoxin exposure might be protective for asthma or wheeze. The protective effect is found in younger school-aged, non-allergic children. These results may help explain the inconsistencies in previous studies and suggest that the protective effects of endotoxin in the prevention of atopy and asthma or wheeze are most effective earlier in life.
BMC Pulmonary Medicine 09/2012; 12(1):56. · 1.33 Impact Factor
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ABSTRACT: 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.
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.
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.
BMC Research Notes 08/2012; 5:400.
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Journal of the American Geriatrics Society 06/2012; 60(6):1181-3. · 3.74 Impact Factor
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ABSTRACT: The provinces of Saskatchewan, Alberta, and British Columbia are major oil- and gas-producing regions in western Canada. With
increasing oil and gas production activities, there has been a growing concern of the effect of oil and gas industry emissions
on health. Nevertheless, lack of proper tools to estimate the exposure to these emissions has been a hindrance to epidemiological
studies and risk assessment. This paper presents a spatiotemporal modeling approach to estimating ambient sulfur dioxide (SO2) levels based on environmental monitoring data (N = 10,295), which were collected at rural sites (591 per month on average) of this region from June 1, 2001 to May 31, 2002.
Based on the model, illustrative maps consistently revealed high and low SO2 concentration sub-regions. The sub-regions with elevated SO2 concentrations had increased levels during the winter months from December 2001 to March 2002 and then decreased during the
spring of 2002. This statistical modeling approach may help researchers estimate the SO2 levels within the study area for their epidemiological studies or risk assessment.
KeywordsAir pollution-Exposure assessment-Spatiotemporal model-Sulfur dioxide
Environmental Modeling and Assessment 04/2012; 15(2):137-146. · 0.97 Impact Factor
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ABSTRACT: Homes contain low but measurable concentrations of endotoxin that have been linked to household conditions such as the presence of animals, smoking, crowding, and farm living. While endotoxin exposure in early life appears to have a protective effect for childhood asthma; the evidence from prospective cohort studies of young children suggests that endotoxin exposure contributes to early development of wheeze. Higher domestic endotoxin levels are linked to greater asthma severity in school age children unless children are farm residents where, higher doses of farm-related endotoxin seem to offer some protection against asthma. Currently there are inconsistencies between epidemiological studies examining the role of endotoxin and children's respiratory health that may be due, in part, to selection bias of study populations, timing between measurement of endotoxin levels and the assessment of asthma symptoms. Although there is good evidence to demonstrate that endotoxin exposure in homes is associated with wheeze in children, and less likely to be associated with asthma, understanding the mediating roles of atopy, genetic and other environmental factors requires further and extensive exploration.
Frontiers in bioscience (Elite edition) 01/2012; 4:56-73.
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ABSTRACT: In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda.
The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatment-naïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL) after two years of treatment. Adherence was determined through weekly pill counts.
Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospital-based cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p = 0.12), and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560). In multivariate analysis patients in the HC/community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04).
Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a hospital-based ART program run primarily by doctors.
PLoS ONE 01/2012; 7(7):e40902. · 4.09 Impact Factor
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ABSTRACT: Many people with depression experience repeated episodes. Previous research into the predictors of chronic depression has focused primarily on the clinical features of the disease; however, little is known about the broader spectrum of sociodemographic and health factors inherent in its development. Our aim was to identify factors associated with a long-term negative prognosis of depression.
We included 585 people aged 16 years and older who participated in the 2000/01 cycle of the National Population Health Survey and who reported experiencing a major depressive episode in 2000/01. The primary outcome was the course of depression until 2006/07. We grouped individuals into trajectories of depression using growth trajectory models. We included demographic, mental and physical health factors as predictors in the multivariable regression model to compare people with different trajectories.
Participants fell into two main depression trajectories: those whose depression resolved and did not recur (44.7%) and those who experienced repeated episodes (55.3%). In the multivariable model, daily smoking (OR 2.68, 95% CI 1.54-4.67), low mastery (i.e., feeling that life circumstances are beyond one's control) (OR 1.10, 95% CI 1.03-1.18) and history of depression (OR 3.5, 95% CI 1.95-6.27) were significant predictors (p < 0.05) of repeated episodes of depression.
People with major depression who were current smokers or had low levels of mastery were at an increased risk of repeated episodes of depression. Future studies are needed to confirm the predictive value of these variables and to evaluate their accuracy for diagnosis and as a guide to treatment.
Canadian Medical Association Journal 11/2011; 183(17):1969-76. · 8.22 Impact Factor
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ABSTRACT: To date, only a few studies have assessed determinants of health trajectories using longitudinal health survey data. Multilevel models were used to estimate health-related quality of life trajectories and assess factors associated with variations among trajectories, controlling for mortality effects and cohort membership. Four biennial cycles (1996/97-2004/05) of the Canadian National Population Health Survey were used. Information for 13,665 respondents, including those who were subsequently institutionalized and/or died, was used. A typical life-course trajectory was concave with a slow decline until the age of 60, followed by a more rapid decline. Receiving social assistance, lower education and not being married had significant negative impacts on trajectories for young (age 18-39) and middle-aged (40-64). Chronic conditions and health behaviours such as smoking were important for seniors (65+). It is important to focus on the most relevant and important determinants of health in each phase of life.
Journal of Health Economics 11/2011; 31(1):207-18. · 2.34 Impact Factor
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ABSTRACT: BACKGROUND⁄
Knowledge of the effects of domestic endotoxin on children's lung function is limited. The association between domestic endotoxin and asthma or wheeze and lung function among school-age children (six to 18 years of age) was examined. The interaction between endotoxin and other personal and environmental characteristics and lung function was also assessed.
A case-control study was conducted in and around the rural community of Humboldt, Saskatchewan, between 2005 and 2007. Parents of cases reported either doctor-diagnosed asthma or wheeze in the previous year. Controls were randomly selected from those not reporting these conditions. Data were collected by questionnaire to ascertain symptoms and conditions, while spirometry was used to measure lung function including forced vital capacity and forced expiratory volume in 1 s. Dust collected from the child's play area floor and the child's mattress was used to quantify endotoxin, and saliva was collected to quantify cotinine levels and assess tobacco smoke exposure.
There were 102 cases and 207 controls included in the present study. Lower forced expiratory volume in 1 s was associated with higher mattress endotoxin load among female cases (beta=-0.25, SE=0.07 [P<0.01]). There was a trend toward lower forced vital capacity, which was associated with higher play area endotoxin load among cases with high tobacco smoke exposure (beta=-0.17, SE=0.09 [P<0.10]).
Findings indicated that high endotoxin levels present in common household areas of rural children with asthma or wheeze may also affect their lung function. These associations may be potentiated by tobacco smoke exposure and female sex.
Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2011; 18(6):e89-94. · 1.56 Impact Factor
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ABSTRACT: Vesicoureteral reflux (VUR) is commonly diagnosed in children presenting with urinary tract infections. Antibiotic prophylaxis and ureteric surgery are standard treatments for these children. Our aim was to investigate whether health-related quality of life (HRQOL) was altered in children treated for VUR. Children aged 1-5 years with grade III or higher VUR were identified through electronic records at the Stollery Children's Hospital. Parents of these children were mailed the TNO-AZL Netherlands Organisation for Applied Scientific Research Academic Medical Centre Quality of Life (TAPQOL) questionnaire. QOL scores for this group were compared with normative controls from the instrument's creators using the Mann-Whitney U test. Thirty-two of the 96 (33%) mailed surveys were returned. Eight children had surgery, and 19 were treated with antibiotic prophylaxis. When comparing the VUR group with the control group, we found that anxiety and social functioning scores were significantly better in patients with VUR (p < 0.01). The VUR group had worse scores in problem behavior, stomach complaints ,and communication (p < 0.01). This study reveals that children with VUR have a reasonable QOL when compared with controls. However, the diagnosis of VUR and its management does have an impact on gastrointestinal complaints, behavior, and communication, which may occur as a result of chronic medical intervention.
Pediatric Nephrology 09/2011; 27(3):423-8. · 2.52 Impact Factor
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ABSTRACT: Croup is a common pediatric respiratory illness presenting to the emergency department (ED) in the fall and winter months. Most cases are caused by parainfluenza viruses. We examine the monthly patterns of young children who made croup-related visits to EDs in Alberta, Canada.
Emergency department visits were identified in provincial administrative databases to obtain all ED encounters for croup made by young children (aged ≤2 years) during 6 years (April 1, 1999, to March 30, 2005). Time series models (seasonal autoregressive integrated moving average) were developed to capture temporal and seasonal trends and predict future presentations.
Overall, 27,355 croup-related ED visits were made during the study period. More males (62%) than females presented, and most (43%) were younger than 1 year. Differences were observed in the number of visits made in odd and even years. Peak visits occurred in November for odd years and in February for other years. Strong seasonal patterns at 12 months were detected and included in the modeling.
We observed the presence of a clear biennial pattern of croup ED visits. The seasonal autoregressive moving average models and predictions offer insights into the epidemiology of croup-related visits to EDs and may be helpful in planning both research and resource needs.
Pediatric emergency care 04/2011; 27(4):256-60. · 0.92 Impact Factor
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ABSTRACT: Investigations of the effects of antidepressant treatment for individuals with major depression have focused on short-term outcomes in individuals that meet very specific criteria; however, there is limited knowledge about long-term outcomes associated with antidepressant use in general population samples. This study aimed to investigate the long-term outcomes associated with antidepressant use by focusing on 486 depressed adults in a prospective observational Canadian cohort in 1998/99. We used logistic regression to investigate the association between antidepressant use and depression status 8 years later. Non-random allocation to treatment was accounted for by a propensity-for-treatment model which included thirteen predictors of antidepressant use, including: severity of depressive symptoms, previous episodes of depression (from 1994 to 1997), physical health condition, social support and socio-demographic characteristics. 29% of individuals with major depression reported antidepressant use. After adjusting for propensity for treatment in 1998/99, and antidepressant use from 2000 to 2007, depressed individuals who reported antidepressant use in 1998/99 were less likely to be depressed in 2006/07 compared to those who did not report antidepressant use (OR = 0.36, 95% CI: 0.15-0.88). Amongst individuals with symptoms of major depression, those reporting use of anti-depressants at baseline exhibited improved long-term outcomes in comparison to those who did not report treatment.
Journal of psychiatric research 03/2011; 45(8):1012-8. · 3.72 Impact Factor
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ABSTRACT: 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.
Respirology 02/2011; 16(2):332-9. · 2.42 Impact Factor
