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Purpose: The aim of the study was to estimate the prevalence of allergic diseases and symptoms in children of the Ternopil Region (Ukraine) and to explore their familial and environmental correlates. Material/Methods: A cross-sectional study based on parental answers to a respiratory questionnaire based on ISAAC that included 4871 urban and rural children aged 6-14 years. Association of physician-made diagnoses and symptoms with environmental factors was examined by means of multivariate logistic regression. Results: Increased risk of asthma (1.7%) was associated with urban residence (OR=1.8; p=0.04) and high parental education (OR=1.8; p=0.02); Spastic bronchitis (6.2%) with parental allergy (OR=1.3; p=0.03); atopic eczema (6.2%) with younger age (OR=1.3; p=0.03), high parental education (OR=1.3; p=0.03), parental allergy (OR=1.4; p=0.02), tobacco smoke at home (OR=0.7; p=0.01) and household density (OR=0.6; p=0.001); diagnosis of unspecified allergic sensitization (11.8%) was related to high parental education (OR=1.2; p=0.03), parental employment (OR=0.8; p=0.02) and pets at home (OR=1.2; p=0.06). Symptoms of chest wheezing (11.5%) were related to tobacco smoke at home (OR=0.8; p=0.06). Attacks of dyspnea (7.3%) were related to parental allergy (OR=1.4; p=0.007), and type of heating (OR=1.7; p=0.04). Hay fever symptoms (5.7%) were related to younger age (OR=1.3; p=0,01) and urban residence (OR=2.0; p<0.0001). Conclusions: Except for asthma the prevalence of allergic diseases and symptoms as well as their correlates in children of Ternopil are similar to other estimates obtained in Eastern Europe. Low prevalence of asthma and relatively frequent occurrence of spastic bronchitis may suggest substantial underdiagnosis of childhood asthma. [ABSTRACT FROM AUTHOR]

Introduction: The present and future health of children is significantly threatened by physical inactivity, poor diet, and the obesity epidemic. Limited studies on the health of children living in rural settings suggest that rural children have a higher prevalence of overweight and may not be as active as their urban counterparts. The purpose of this study was to examine the health behaviors and weight status of children aged 8 to 13 years living in rural Saskatchewan, Canada. Methods: A cross-sectional health questionnaire assessed the health behaviors (eg physical activity, sedentary behaviors, dietary patterns) and perception of health status (eg very healthy, quite healthy, not very healthy) of 99 children attending a rural school. Heights and weights were measured and used to calculate BMI's (kg/m2). The BMIs were used to categorize children as healthy weight, overweight, or obese. Results: Thirty-four percent of children were overweight (23.7%) or obese (10.3%) with a significantly higher prevalence of overweight/obesity in boys aged 6 to 8 years (p <0.05). A significantly higher proportion of children living in town (vs living on a farm) watched two or more hours of television a day (p <0.05). Many children (65%) used active transport (bus or car) to school or after-school activities. The majority of children reported they were very healthy. Most children reported eating fruit and vegetables more frequently, and sugared drinks and French fries less frequently. Conclusion: Prevalence of overweight/obesity in these rural children was high with gender differences evident at a very young age. Most children reported eating healthy diets but many participated in several hours of daily 'screen time' (eg watching television or using a computer). Despite their weight status or patterns of physical inactivity, children perceived themselves as being very healthy. Understanding the health behaviors and weight status of rural children may assist in the development of effective health promotion programs for rural children. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory illness is a leading cause of death worldwide, with rates that will continue to escalate into the foreseeable future. Rural residents have an increased risk of dying from some forms of respiratory disease, although little is known about the healthcare utilization or location of death for persons with advanced respiratory illness in rural settings. The purpose of this study was to examine rural--urban differences in healthcare utilization and location of death for residents of Saskatchewan, Canada, with chronic obstructive pulmonary disease (COPD) or lung cancer in the last 12 months of life. Methods: A retrospective cohort study was undertaken of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer in administrative health data from Saskatchewan Health. Decedents were classified as residents of rural/remote (≤9,999 population size), small urban or urban (≥100 000) locations and analysis conducted using this primary variable of interest. Comparisons were made between the three groups in terms of demographic characteristics, healthcare utilization (physician visits, length of stay, hospitalizations, institutional care, home care, transitions between care settings) and location of death (hospital, long-term care [LTC] or home). Results: The study population was 57% male with a mean age of 77 years (SD=11). Demographic characteristics, underlying cause of death and number of comorbid conditions were similar between urban, small urban and rural/remote groups. After adjustment for area of residence, underlying cause of death (UCOD), age group, sex, marital status, and comorbidity, urban, small urban and rural/remote residents were comparable in terms of the likelihood of: any hospitalizations, having had 5 or more transfers between settings, and dying in hospital. The proportion of home deaths in rural settings was 15.4%, and was comparable to the rate in urban settings (16.3%). Urban residents were more likely to have had 24 or more physician visits in the last year of life compared with small urban (OR=0.52, 95% CI=.37-.74) or rural/remote residents (OR=0.52, 95% CI=.40-.69), while rural/remote residents were more likely to have received any institutional LTC (OR=1.40, 95% CI=1.03-1.90) than the other groups. Hospital as a location of death was more likely for those with a UCOD of cardiovascular disease (OR=1.84, 95% CI=1.24- 2.71), but was less likely for those aged 80-85 years (OR=0.46, 95% CI=.31-.69), those aged more than 85 years (OR=0.28, 95% CI=.19-.42) and those who had never married (OR=0.48, 95% CI=.29-.78). Residents of rural/remote areas were significantly less likely than those in urban or small urban settings to receive any home care (OR=0.74, 95% CI=.56-.97), any home palliative care (OR=0.29, 95% CI=.19-.45) or home physiotherapy services (OR=0.09, 95% CI=.03-.25). Rural/remote residents were, however, much more likely to receive home supportive care (OR=1.60, 95% CI=1.17-2.19) and home meal preparation (OR=2.51, 95% CI=1.44-4.39). Conclusions: While the healthcare needs of persons with respiratory illness in the last year of life were likely to be similar between locations, rural-urban differences were apparent in the number of primary care physician visits and in access to and the nature of home care services provided. Significantly fewer physician visits were made by residents of small urban or rural remote locations compared with those in urban settings, although additional research is needed to determine the reasons for this discrepancy. The likelihood of receiving home care services and professional home care services such as palliative care and physiotherapy was significantly lower for persons in rural/remote locations. The challenges experienced by rural remote regions with supporting patients in the community may have led to the increased likelihood of admission to institutional LTC noted for this group compared with residents of urban and small urban settings. The low home death rates is both urban and rural settings may pose particular hardship for rural families who may need to travel extensively or temporarily relocate to be closer to the hospital where their loved one is dying. Further investigation of issues related to differences in quality of care and unmet health care needs between rural and non-rural settings will strengthen the evidence base to allow equitable care at the end of life [ABSTRACT FROM AUTHOR]

RATIONALE FOR THE STUDY: Improving the quality of end-of-life (EOL) care in critical care settings is a high priority. Patients with advanced chronic obstructive pulmonary disease (COPD) are frequently admitted to and die in critical care units. To date, there has been little research examining the quality of EOL care for this unique subpopulation of critical care patients. AIMS: The aims of this study were (a) to examine critical care clinician perspectives on the quality of dying of patients with COPD and (b) to compare nurse ratings of the quality of dying and death between patients with COPD with those who died from other illnesses in critical care settings. DESIGN AND SAMPLE: A sequential mixed method design was used. Three focus groups provided data describing the EOL care provided to patients with COPD dying in the intensive care unit (ICU). Nurses caring for patients who died in the ICU completed a previously validated, cross-sectional survey (Quality of Dying and Death) rating the quality of dying for 103 patients. DATA ANALYSIS: Thematic analysis was used to analyse the focus group data. Total and item scores for 34 patients who had died in the ICU with COPD were compared with those for 69 patients who died from other causes. RESULTS: Three primary themes emerged from the qualitative data are as follows: managing difficult symptoms, questioning the appropriateness of care and establishing care priorities. Ratings for the quality of dying were significantly lower for patients with COPD than for those who died from other causes on several survey items, including dyspnoea, anxiety and the belief that the patient had been kept alive too long. The qualitative data allowed for in-depth explication of the survey results. CONCLUSIONS: Attention to the management of dyspnoea, anxiety and treatment decision-making are priority concerns when providing EOL care in the ICU to patients with COPD. [ABSTRACT FROM AUTHOR]

Objective: To determine the changes in the prevalence of obesity in a rural community between 1977 and 2003. Study design: A multiple cross-sectional study. Methods: The analysis was based on data from four cross-sectional surveys of adults aged 25-59 years, conducted in the town of Humboldt, Saskatchewan in 1977. 1983, 1993 and 2003. People with a body mass index (BMI) ≥30 kg/m² were considered to be obese. Results: Average body weight increased by 8 kg for both men and women during the study period. The increase in BMI was greater in adults aged 25-39 years compared with older age groups. The prevalence of obesity increased from 24% in 1977 to 38% in 2003 for men, and from 16% to 32% for women. The change was more pronounced from 1993 to 2003 than from 1977 to 1993, especially among younger adults. Standardized to the 2003 study population by sex, age and smoking status, the prevalence of obesity was 16.8% in 1977. 22.7% in 1983, 24.7% in 1993 and 34.5% in 2003, and was much higher than the Canadian national average (16% in 2003). Conclusion: There was a dramatic increase in the prevalence of obesity in rural adults, and this was greater in younger adults. Changes in cigarette smoking did not explain the increase. There is an urgent need to identify and implement effective interventions to slow if not reverse the trend, particularly in rural populations. [ABSTRACT FROM AUTHOR]

Recently there has been interest in the air quality in and around intensive livestock production facilities, such as modern swine production barns, where agricultural workers and surrounding residents may be exposed to elevated levels of organic dusts. The health effects of these exposures are not completely understood. The study that is reported here is a component of a larger investigation of the relationships among the acute effects of high-concentration endotoxin exposure (swine barn dust), polymorphisms in the TLR4 gene, and respiratory outcomes following exposure to swine confinement buildings. The relationships among a mediator of acute lung inflammation, tumor necrosis factor alpha (TNF-α), and clinical responses to acute swine barn exposure were characterized. Analysis of the results showed that in vitro stimulation of human monocytes with as little as 1 ng/ml of lipopolysaccharide (LPS) produced a significant increase in the monocytes that produced TNF-α. Although the proportion of TNF-α-positive monocytes after in vitro stimulation with 1 ng/ml of LPS was not associated with gender or TLR4 genotype, it was positively associated with the concentration of monocytes in blood after barn exposure. Thus, these two responses to different forms of LPS exposure are significantly correlated, and more responsive monocytes in vitro indicate a forthcoming relative monocytosis, post barn exposure, which may initiate a cascade of chronic inflammation. [ABSTRACT FROM AUTHOR]