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Objective: To determine if aerially spraying a biological pesticide was associated with an increase in the symptoms or change in the Peak Expiratory Flow Rate of children with asthma., Methods: A pre/post matched pairs cohort design was used. Children living in the spray zone were matched with children outside of the spray zone. Peak Expiratory Flow Rates, asthma symptoms and non-asthma symptoms were recorded in diaries., Results: There were no differences in asthma symptom scores between subjects and controls, neither before nor after the spray; nor were there significant changes in Peak Expiratory Flow Rates for subjects after the spray period., Conclusions: No evidence of adverse effects from the use of the biological pesticide was found. We believe that this is the first paper to address the issue of whether or not aerial spraying with Btk has a harmful effect on children with asthma.

Most wireless phones and their corresponding base stations operate at a very low power output and in the radiofrequency range of 800 to 2000 Megahertz. Current international guidelines protect against thermal biological effects in terms of the local or whole-body specific absorption rate (SAR). Potential non-thermal bio-effects resulting from the use of wireless phones are not established and laboratory (i.e., in vitro, in vivo) studies have shown conflicting results. Epidemiological studies of potential human health effects are few but are expected to emerge in the near future. Challenges to epidemiological research include difficult exposure assessment, selection of appropriate controls, potential confounding bias, and validation of outcome. Scientists, community advocacy groups, and public health professionals must be equipped to critically analyze the emerging evidence within a benefit/risk assessment framework.

Background: Wide variations in the prevalence of asthma, rhinitis and eczema have been reported between regions within Canada and between different countries. The International Study of Asthma and Allergies in Childhood (ISAAC) was developed to provide a standardized tool and methodology to ascertain the prevalence of asthma and allergies in different regions. Comparisons of prevalence rates across geographic regions and at different times may help to identify factors that contribute to the development of these conditions in individuals., Methods: Two Canadian centres, Hamilton and Saskatoon, participated in the ISAAC. A standard questionnaire was distributed through schools and completed by 13- and 14-year-old children and by the parents of 6- and 7-year-old children. Prevalence rates and 95% confidence intervals were calculated for asthma, wheezing, rhinitis and eczema., Results: The overall response rates were 75.1% among the children 6 and 7 years old and 68.6% among those 13 and 14 years old. Among the younger children, the lifetime prevalence of asthma was 17.2% in Hamilton and 11.2% in Saskatoon; the corresponding rates among the older children were 19.2% and 12.2% respectively. The prevalence of wheezing in the 12 months before the survey in the younger group was 20.1% in Hamilton and 14.1% in Saskatoon; in the older group it was 30.6% and 24.0% respectively. The prevalence of rhinitis in the 12 months before the survey was 28.6% in Hamilton and 22.6% in Saskatoon in the younger group and 45.8% and 33.8% respectively in the older group. The prevalence of eczema was slightly higher in Saskatoon in both age groups., Interpretation: High prevalence rates of asthma, rhinitis and eczema exist among school children in Hamilton and Saskatoon, similar to rates in other Western countries. Further studies are required to determine the factors associated with the high rates in the 2 regions and possible reasons for the higher rates in Hamilton.

We describe the hospital utilization of 194 Saskatchewan persons with Fetal Alcohol Syndrome (88% Aboriginal), born between 1973-92. Complete provincial hospitalization data were obtained for 128 patients; partial data for 29 patients. Proportionately more persons missing data were adopted, not living with biological family members or were deceased. The hospital separation rates for the children with FAS, pooled from 1987-91, compared to the 1989-90 Saskatchewan rates were significantly higher (95% level of confidence) for males and females < 1 year, 1-4 years and 5-14 years of age. Relative to Saskatchewan Registered Indians, significantly higher hospitalization rate ratios were observed for males with FAS in all age groups and for females only age 5-14 years. Rate ratios for younger females may not have achieved significance because of missing data. Higher hospitalization rates in children with FAS may not be explained solely by factors associated with ethnicity.

Despite major initiatives in public and professional education about foetal alcohol syndrome (FAS) in Saskatchewan in the last 20 years, its incidence rate has not fallen. The rate was 0.515 per 1,000 live births in 1973-1977 and 0.589 in 1988-1992. Two hundred and seven (207) cases were ascertained, the majority being patients of the Alvin Buckwold Child Development Program in Saskatoon. These individuals were severely handicapped: 72% had at least one malformation, the mean intelligence quotient was 67.8 (range 35-106) and 45.9% had a behaviour problem. Only 25.6% still lived with their biological parents when last seen, and only 27 of 108 cases were in a regular class at school without additional support being necessary. New approaches are needed to reduce the incidence of FAS. Emphasis should be placed on individual case-finding, counselling for high-risk women, and community development programs. We are currently attempting this through a provincial coordinating committee.

Objective: To examine recent trends in the use of inhaled beta 2-adrenergic agonists and inhaled corticosteroids for the treatment of asthma among Saskatchewan residents and to determine whether these trends are in keeping with widely publicized guidelines recommending a reduction in the use of agents to treat symptoms (i.e., inhaled beta 2-adrenergic agonists) and increased use of prophylactic agents (i.e., inhaled corticosteroids)., Design: Descriptive pharmacoepidemiologic study conducted with the use of data from the computerized database of the Saskatchewan Prescription Drug Plan., Setting: Saskatchewan., Patients: Saskatchewan residents 5 to 54 years of age who received one or more outpatient prescriptions for drugs to treat asthma (inhaled drugs, ingested beta 2-adrenergic agonists and ingested methylxanthines) from 1989 to 1993., Outcome Measures: Epidemiologic trends, calculated for each year: number of prescriptions per 1,000 persons; number of patients who received prescriptions for inhaled corticosteroids, inhaled beta 2-adrenergic agonists and any type of drug to treat asthma; mean number of such prescriptions per patient; and weighted mean amount of salbutamol, fenoterol and beclomethasone dispensed per patient., Results: There has been an increase in the proportion of the population receiving prescriptions for drugs to treat asthma. The number of patients receiving these drugs per 1,000 people rose during the study period from 33.38 to 46.59 for any drug to treat asthma, from 24.70 to 33.77 for inhaled beta 2-adrenergic agonists and from 6.1 to 19.9 for inhaled corticosteroids. The mean number of prescriptions per patient decreased steadily for all drugs to treat asthma (from 5.34 in 1989 to 3.88 in 1993), for inhaled beta 2-adrenergic agonists (from 4.35 to 3.09) and for inhaled corticosteroids (from 2.98 to 2.25). The weighted mean amount of inhaled salbutamol dispensed per patient per year decreased by 40%, from 178.08 mg in 1989 to 109.14 mg in 1993. The weighted amount of fenoterol dispensed per patient per year declined even more, by 58%, from 387.91 mg in 1989 to 164.00 mg in 1993. Conversely, the weighted amount of inhaled beclomethasone dispensed per patient per year increased by 35% from 46.95 mg in 1989 to 63.50 mg in 1992, then dropped to 56.17 mg per year in 1993., Conclusion: These data demonstrate a substantial change in Saskatchewan in the prescribing of drugs to treat asthma; they suggest that many physicians responded to current guidelines advocating increased attention to prevention of airway inflammation in the treatment of asthma.

The hospitalization rates for gastrointestinal and respiratory illnesses in children under five years of age were examined on two Indian reserves in Northern Saskatchewan. The gastrointestinal illness rate was used as an index of waterborne disease, and the respiratory rate as an index of general health and of local customs affecting hospitalizations. The reserve rates were compared with those for other Saskatchewan status Indians and for other Saskatchewan residents. The risk ratios between the reserves and other Indians, and between the reserves and other Saskatchewan residents, were increased for both gastrointestinal and respiratory illnesses. The risk ratio of gastrointestinal rate divided by respiratory rate was greater for either reserve than for other Indians or other Saskatchewan residents. Waterborne illnesses were an even greater problem on the two study reserves than on other reserves. Comparing hospitalization rates for different illness groups is a useful method to compare the effect of different social factors.

Parents, community health nurses (CHNs) and physicians in Saskatoon were surveyed to determine if specific components of well-baby services provided by CHNs and physicians were duplicated. A response was obtained from 348 (81%) of the parents, 34 (89%) of the CHNs and 129 (87%) of the physicians. Results of the study indicate that there is extensive duplication of measurements taken by CHNs and physicians at the two, four, six, and twelve-month well-baby visits, especially that of height and weight. Content of well-baby care was also examined. The percentage of both physicians and CHNs who "usually or always" perform specific tasks at each well-baby visit was very high, particularly screening tests and inquiries about nutrition. Assessments and inquiries regarding development were performed less frequently, as were inquiries about safety issues.

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.

Fever, which is the regulation of body temperature at an elevated level, must be differentiated from hyperthermia. The pathogenesis of fever involves exogenous pyrogens acting on macrophages/monocytes to produce the endogenous pyrogen, interleukin-1, which acts on the thermoregulatory centre and also has important effects on the body's immune responses to infection. Fever by itself is rarely harmful, and there is no evidence that febrile seizures produce long-term sequelae. On the other hand, fever may be part of the body's innate protection against infection. The main reason for treating a fever in a child is to relieve discomfort. Acetaminophen should be the drug of first choice in treatment, and sponging, if used at all, should be employed only after acetaminophen has been given first. Education of parents about fever management can be helpful.

In order to manage diabetes mellitus in children, the physician must understand the principles of insulin action and dosage adjustment, meal planning, growth assessment, and the effects of exercise. The objectives of office supervision include ongoing education of the patient and family, excellent control of the diabetes, and the maintenance of normal growth and development, emotionally as well as physically.

We carried out a case-control study of the hospital charts of 91 infants with infantile hypertrophic pyloric stenosis (IHPS) to determine the feeding practices at the time of discharge from the neonatal nursery. We excluded infants whose feeding might have been influenced by confounding factors. The infants were matched with controls for gestational age. The mean birth weight of the IHPS group was 3501 g and of the control group 3543 g. The male:female ratio for the IHPS group was 5.5. The odds ratio of male predominance was 4. We found that bottle-feeding was 2.9 times more prevalent among the infants with IHPS than among the control subjects. We speculate that the recently observed decrease in the incidence of IHPS is due to the decline in bottle-feeding.

This paper describes nine babies who appeared contented yet failed to thrive while being exclusively breast-fed. In each case the mother felt that her child was satisfied with the feedings. Following appropriate management all the infants were above the 80th percentile for both weight and weight for length. Five infants had achieved 110% to 120% and three more than 120% of the expected weight for length. This tendency to become overweight might be explained by inactivity or a defect in appetite control.

We reviewed the incidence rates of infantile hypertrophic pyloric stenosis (IHPS) and pylorospasm in Saskatchewan from 1970 to 1985 and found a marked decrease in the rates after 1976. As expected, there was a preponderance of males among those with IHPS and among those with pylorospasm discharged from hospital between 1 and 3 months of age. No seasonal pattern was observed. We believe that the decrease in incidence rates was related to environmental influences, such as changes in the methods of feeding observed since 1977.

A problem-solving approach is used to illustrate principles of managing diabetes mellitus in children. Situations discussed include adjustments for hypo- and hyperglycemia and vigorous activity, and care of the diabetic child who has another illness. The usefulness of referral to a diabetes education centre is emphasized.