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Sleep is crucial for maintaining the recovery and restoration of the body and brain. Less sleep is associated with poor mental and physical performance. Seasonal changes in sleep patterns can be observed. This paper examines seasonal effects on sleep timing, duration, and problems in two Cree First Nation communities in Saskatchewan, Canada. Data were available from a community survey of 588 adults aged 18 years and older (range: 18–78 years) with 44.2% males and 55.8% females. Results are presented using descriptive statistics and a binary logistic-regression model to identify the association between seasonal changes in sleep patterns, and demographic, social, and environmental factors. The participants reported sleeping the least during the spring and summer months and sleeping the most during the fall and winter months. This was further confirmed by sleep hours and the lower proportion of recommended hours of sleep during the spring and summer, and a higher proportion of longer sleep duration during the fall and winter months. There was no significant variation in sleeping onset and wake-up times by season. Overall, there were no significant differences in the prevalence of sleep deprivation, insomnia, and excessive daytime sleepiness by season. When stratified by age group and sex, some differences existed in the prevalence of sleep problems by season. More than two-thirds (68.6%) of the participants reported that there was a change in sleep patterns across seasons, and about 26.0% reported a very or extremely marked change in sleep patterns across seasons. Changes in sleep patterns by season were related to money left at the end of the month and damage caused by dampness in the house.

BACKGROUND: Elevated levels of the enzymes gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP) have been shown to be associated with increased risk of cardiovascular disease (CVD). Objective: To assess cross-sectional relationships between biomarkers GGT, ALT, AST, ALP and CVD in adult Canadian population. METHODS: The Canadian Health Measures Surveys (CHMSs) are a series of cross-sectional national surveys and collect information on indicators of general health and wellness of Canadians. The CHMS has four components. We used data from the first three components (for Study participants ≥ 20 years) from CHMS cycles 1 through 5. RESULTS: Multivariable logistic regression revealed: immigration status [Odds ratio (OR)(95% Confidence Interval (95% CI)) = 0.67 (0.53–0.85), reference category (RC)-no-immigrant] education [1.38(1.10–1.75), RC- > secondary education]; smoking status [ex-smokers: 1.16(0.89–1.51); current smokers: 1.41(0.98–2.05), RC-non-smoker]; and income [middle income: 0.69(0.43–1.10); high income: 0.49(0.29–0.83); RC-lower income] were significantly associated with CVD prevalence. CONCLUSION: The relationship of GGT with CVD prevalence changed among age groups and body mass index categories; was different for males and females; and diabetes was an effect modifier in the relationship between AST and CVD prevalence. Socio-economic factors were significantly associated with CVD prevalence.

The relationship between liver enzymes and Metabolic Syndrome (MetS) in different populations, including Canadians, is not consistent and well understood. We used the Canadian Health Measures Survey data (Cycles 3 and 4) to examine the cross-sectional relationships between select liver biomarkers and MetS in the adult Canadian population. The biomarkers selected were gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alkaline phosphatase (ALKP).Fasting blood samples (FBS) were collected from adults above the age of 20 years for Cycle 3 and Cycle 4 (MetS was prevalent in 32.3% of subjects. BMI was an effect modifier in the relationship between GGT and MetS prevalence, while sex was an effect modifier in the relationship between ALKP and MetS prevalence; and age was an effect modifier in the relationship between AST and MetS prevalence.Since the mechanisms to underpin the associations between the liver enzymes activity and MetS are unknown, further epidemiologic investigations using longitudinal designs are necessary to understand these associations.

Objectives: To evaluate a mouth rinse containing tetrapotassium pyrophosphate and sodium tripolyphosphate on supragingival calculus formation in a group consisting initially of forty adults seeking periodontal treatment at a Canadian dental school. Methods: The extent of supragingival calculus in relation to the lingual surfaces of the lower anterior teeth was measured using the Volpe-Manhold Calculus Index (VMI). In addition, The Plaque Index (PI) was used to evaluate plaque scores while the presence or absence of gingival bleeding index (GBI) was used to determine gingival health. At the completion of the hygiene appointment (baseline), the PI, GBI and VMI was assumed to be zero and the subjects were randomly assigned to test (rinsed twice a day with the anticalculus mouthwash) or control groups (only used regular dentifrice) and appropriate instructions provided. After a 60-day trial period, the test and control subjects were recalled, and the clinical measurements were conducted using the indices indicated above. Results: There were no statistically significant differences in the overall reduction in the mean VMI scores between the test and control groups. Conclusion: Within the limitations of the study, rinsing with tetrapotassium pyrophosphate and sodium tripolyphosphate for sixty days did not affect the formation of supragingival calculus in the present cohort of adults.

Objectives Because of the immediate and long-term consequences of diabetes in pregnancy (DIP) for mother and child, we compared frequencies of gestational diabetes (GDM) and pre-GDM between First Nations (FN) and non-FN people in Saskatchewan from 1980 to 2009. Methods Using Ministry of Health administrative databases, we conducted a retrospective cohort study of GDM and pre-GDM rates within all FN and non-FN pregnancies in Saskatchewan. Annual crude and 10-year age-adjusted incidence of GDM and pre-GDM were determined as were maternal age-specific rates of DIP. Results De-identified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. The crude annual incidence of GDM rose from 1.0% to 6.6% among FN and from 0.4% to 3.6% among non-FN between 1980 and 2009. The crude annual incidence of pre-GDM rose from 0.7% to 2.0% among FN and from 0.4% to 0.9% among non-FN over the same period. The 10-year age-standardized incidence of GDM increased from 3.53% in 1980–1989 to 8.37% in 2000–2009 for FN, and from 1.55% to 3.13% for non-FN. For pre-GDM, the corresponding increases were from 1.65% to 3.26% for FN and from 0.5% to 0.91% for non-FN. Both GDM and pre-GDM rates increased with increasing maternal age, reaching 10.9% and 8.0% of FN pregnancies, and 7.7% and 1.1% of non-FN pregnancies, respectively, for mothers >40 years old. Conclusions The proportion of pregnancies complicated by DIP increased steadily among FN and non-FN women in Saskatchewan in 1980‒2009, but the incidence of GDM and pre-GDM is 2- to 3-fold higher among FN.

Objectives Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the two populations from 1980-2013. Methods Using Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using Chi square analysis. Results De-identified data was obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age; a previous high birth weight (HBW) or stillborn infant; and most importantly previous maternal GDM. Both GDM and pre-GDM were over 2.3 times as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM experienced higher rates of prematurity, shoulder dystocia, Caesarian section, HBW, and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW, and shoulder dystocia. Conclusions Along with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early maternal/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in pre-conception, prenatal and perinatal care are required to remove ethnicity-based disparities in DIP rates and outcomes.

OBJECTIVE This study aims to assess the annual changes in lung function among farm and nonfarm adult residences in rural Saskatchewan, Canada. METHODS Data from the Saskatchewan Rural Health Study survey (2010 to 2014) among 724 adults were used. RESULTS For forced expiratory volume in 1 second (FEV1) measurements, estimates of annual decline (in milliliters) were highest in older age male (65+ years) (Mean, SD) (-42.63, 21.16); and among old heavy smokers (-57.79, 24.30). Estimates of annual decline in forced vital capacity (FVC) were highest in current smokers without the use of natural gas (-25.78, 14.78) and among old heavy smokers (-33.88, 20.28). Living on a farm is associated with decreased FEV1 and FVC, but not statistically significant by sex and age. CONCLUSIONS A complex mix of personal and contextual factors may affect these estimates.

Background:Young-onset dementia (YOD) is defined as the onset of dementia symptoms before the age of 65 years and accounts for 2–8% of dementia. YOD patients and their caregivers face unique challenges in diagnosis and management. We aimed to compare the characteristics of rural YOD and late-onset dementia (LOD) patients at a rural and remote memory clinic in Western Canada.Methods:A total of 333 consecutive patients (YOD = 61, LOD = 272) at a rural and remote memory clinic between March 2004 and July 2016 were included in this study. Each patient had neuropsychological assessment. Health, mood, function, behaviour and social factors were also measured. Both groups were compared using χ2 tests and independent sample tests.Results:YOD patients were more likely to be married, employed, current smokers and highly educated. They reported fewer cognitive symptoms, but had more depressive symptoms. YOD patients were less likely to live alone and use homecare services. YOD caregivers were also more likely to be a spouse and had higher levels of distress than LOD caregivers. Both YOD and LOD patient groups were equally likely to have a driver’s licence.Conclusions:Our findings indicate YOD and LOD patients have distinct characteristics and services must be modified to better meet YOD patient needs. In particular, the use of homecare services and caregiver support may alleviate the higher levels of distress found in YOD patients and their caregivers. Additional research should be directed to addressing YOD patient depression, caregiver distress and barriers to services.

Objectives Sleep deprivation is a common problem in Canada and is associated with many health problems. More than a quarter of Canadians get fewer than the recommended sleep hours (, Highlights • The prevalence sleep deprivation was about 25% in these two First Nation communities. • Association between sleep deprivation and males with nighttime insomnia observed. • Another important finding was association between visible mold and sleep deprivation.

Objective: This study examined accessibility of communication tools in the workplace, use of education to update nursing knowledge, and use of information to make specific decisions in practice among registered nurses (RNs) and licensed practical nurses (LPNs) in rural and remote communities in Canada.Methods: Data were analyzed from the cross-sectional survey, “Nursing Practice in Rural and Remote Canada II,” of regulated nurses practicing in all provinces and territories of Canada. Data were collected from April 2014 to August 2015.Results: The survey was completed by 3,822 of 9,622 nurses (40% response), and the present analysis was conducted with a subsample of 2,827 nurses. High-speed Internet was the most accessible communication tool, and nurses used “online/electronic education” more often than “in-person education” to update their nursing knowledge. Internet searches were used more often than several other online/electronic sources to inform decision making. Compared to LPNs, RNs reported greater workplace access to most communication tools and greater use of online/electronic education as well as information sources in online/electronic and print formats. Compared to nurses in community-based health care and hospital settings, nurses in long-term care settings reported lower access to most communication tools, lower use of online/electronic and in-person education, and lower use of online/electronic information.Conclusions: Access to continuing education and up-to-date information is important for effective patient care. This study points to a need for further research on the continuing education and information needs of rural and remote RNs and LPNs, and on their capacity to incorporate and apply new knowledge in practice.

Objective To assess the predictors associated with incidence and longitudinal changes in the prevalence of chronic bronchitis (CB) among farm and non-farm residents of rural Saskatchewan, Canada. Methods The Saskatchewan Rural Health Study was a prospective study of the lung health of rural dwellers. We obtained information on 4624 households, 8261 individuals (2797 households, 4867 individuals) at baseline (follow-up). Results Incidence of CB was 4.3% over 4 years. The prevalence was 6.4% and 5.3% (baseline) and 12.1% and 9.2% (follow-up) in non-farm and farm residents, respectively. The prevalence of CB was associated with current smokers; father ever had lung trouble; obesity; mother smoked during pregnancy; allergic reaction to cats and to pollen; household income inadequacy and age. Conclusion Prevalence and incidence of CB in rural people appear to be a complex mix of personal and contextual factors.

Registered nurses (RNs) enact their scope of practice in everyday practice through the influences of client needs, the practice setting, employer requirements and policies and the nurse's own level of competence (Canadian Nurses Association 2015). A scope of practice is "dynamic and responsive to changing health needs, knowledge development and technological advances" (International Council of Nurses 2013). In Canada, RNs' scope of practice is set out through provincial and territorial legislation and provincial regulatory frameworks, which are broadly consistent, but vary across provinces (Schiller 2015). Provincial and territorial regulatory bodies articulate the RN scope through frameworks that include expected standards as well as, in some jurisdictions, limits and conditions upon practice (British Columbia College of Nursing Professionals 2018), and which are commonly referred to as a licensed or registered scope of practice. Rural and remote practice is starting to be explicitly acknowledged within nurses' legislated scopes of practice through the identification of certified practices for RNs in specific rural and remote practice settings, following approved education (British Columbia College of Nursing Professionals 2018).

Over the past two decades in Canada, licensed or registered practical nurses (LPNs) have experienced an extension of their educational preparation and scope of practice. Simultaneously, there has been an increase in the number of LPNs employed in rural and remote communities. These changes have influenced the practice environment and LPNs' perceptions of their work. The aim of this article is to examine what factors predict rural and remote LPNs' perceptions of working below their legislated scope of practice and to explore their perceptions of working below scope. The findings arise from a national survey of rural and remote regulated nurses, in which 77.3% and 17.6% of the LPNs reported their practice as within and as below their legislated scope of practice, respectively. Three factors, age, stage of career and job-resources related to autonomy and control, predicted that LPNs would perceive themselves to be working below their scope of practice. These results suggest that new ways to communicate nurses' scope of practice are needed, along with supports to help rural and remote LPNs more consistently practice to their legislated scope of practice. Without such changes, the LPN role cannot be optimized and disharmony within rural and remote settings may be exacerbated.

Objective: The objective of the study was to determine the prevalence and associated risk factors of asthma in Aboriginal adolescents in Canada based on the Canadian Aboriginal Peoples Surv...

Objective This study aimed to determine the prevalence of hormone-related cancers (HRCs) among Saskatchewan rural dwellers and explore associated risk factors. Methods Data were analyzed from the Saskatchewan Rural Health Study (SRHS), which was a prospective cohort (2010 to 2014). Completed questionnaires were obtained from 4624 (2797) households, with information about 8261 (4867) individuals more than or equal to 18 years at baseline (follow-up). The crude prevalence of HRCs was calculated using appropriate formulae. Adjusted prevalence was calculated using logistic regression based on the generalized estimating equation (GEE). Results Crude prevalence of HRCs was 3.0% at the baseline. Variables significantly associated with HRCs were: exposure to radiation comprising ultraviolet radiation from sunlight as well as ionizing radiation (odds ratio [OR] 3.39; 95% confidence interval [CI]: 2.23, 4.84), previous history of cancer in sibling (OR = 1.51, 95% CI: 1.11, 2.07) and in father (OR = 1.37; 95% CI = 1.01, 1.86). Conclusions The study informs the Saskatchewan Health Region for health care resource allocation.

Study objectives Estimates of sleep duration and quality are lacking for Canadian First Nations peoples. This study examines the prevalence of and risk factors for short/normal/long sleep duration and sleep quality. Methods Five hundred eighty-eight adults participated in the baseline survey of the First Nations Sleep Health Project conducted in 2018-2019 in Saskatchewan, Canada. Sleep duration and quality were self-reported. Results Mean sleep duration was 8.18 hours per night. About 45.5% slept the recommended 7 hours per night. However, short sleep duration and poor sleep quality were relatively common: about one-quarter of the participants slept fewer hours than recommended. Sleep duration was significantly less for men than women. Women were significantly more likely to report poor sleep quality than males. Multiple regression models revealed that age was significantly related with shorter sleep duration; sex and employment status were significantly related with sleep duration; and sex and income indicators were significantly associated with sleep quality. Nearly half of participants reported having had the recommended hours of sleep, but nearly two-thirds reported poor sleep quality. Conclusions Information about the proportion of First Nations adults who sleep the recommended duration and the quality of sleep is important in informing health care and health policy.

To determine predictors associated with longitudinal changes in colorectal cancer (CRC) prevalence in farm and non-farm rural residents in Saskatchewan, Canada.Data from the Saskatchewan Rural Health Study were collected from 8261 individuals nested within 4624 households at baseline survey in 2010 and 4867 individuals (2797 households) at follow-up survey in 2014. The study sample consists of 5599 individuals (baseline) and 3933 at (follow-up) (more than or equal to 50 years).The prevalence of CRC increased over time among rural farm (baseline: 0.8%; follow-up: 1.3%, P 0.05) and non-farm (baseline: 1.4%; follow-up: 2.0%, P 0.05) residents. Longitudinal predictors of CRC prevalence were: quadrant, location of home, mother ever had cancer, age, body mass index (BMI), sex, radiation, natural gas.Longitudinal changes in prevalence of CRC among farm and non-farm residents appear to depend on a complex combination of individual and contextual factors.

PURPOSE: Saskatchewan has a high prevalence of diabetes. It is the largest, rurally populated, predominantly agricultural province in Canada. This research aims to determine the risk factors associated with the incidence and longitudinal changes in the prevalence of diabetes among Saskatchewan’s adult rural farm and non-farm residents. METHODS: The Saskatchewan Rural Health Study (SRHS) is a prospective cohort study conducted in two phases: a baseline survey (2010, 8261 participants) and a follow-up survey (2014, 4867 participants). Generalized estimation equations and survival analysis techniques were used to determine diabetes prevalence and incidence risk factors, respectively. RESULTS: Incidence of diabetes among rural residents was 2.75%. Positive family history, high BMI, sleep apnea and an abnormal Epworth Sleepiness Score (ESS) were significant predictors for diabetes incidence. A substantial increase (1.98%) of diabetes prevalence was observed after four years of follow-up. Risk factors of diabetes prevalence were increasing age, male, low income, positive family history, high BMI, hypertension and heart attack. CONCLUSION: A mix of individual and contextual factors interacting in complex pathways were responsible for the high incidence and prevalence of diabetes among rural residents. The most original finding of that study was a positive association of sleep apnea, and ESS with incident diabetes warrants further research to identify a causal linkage. Increased diabetes risk among rural male insecticide users indicates an adverse consequence of unprotected chemical exposures in the agricultural field. Urgent population-based preventive measures should initiate to slow the increasing trend of diabetes prevalence among rural residents.

Background and objective: Nurses provide essential primary care (PC) in rural and remote Canada. We examined the practice context and responsibilities of this little-known understudied workforce. Method: Data from Nursing Practice in Rural and Remote Canada II, a 2014 to 2015 pan-Canadian survey, were analyzed. Results: Of 3,822 respondents, 192 identified that PC was their only practice focus (PC-Only), and for 111, it was one focus among others (PC-Plus). Proportionally more PC-Only than PC-Plus nurses had graduate education, were employed in larger communities and had experienced higher job resources and lower job demands. Proportionally fewer PC-Only than PC-Plus nurses followed protocols/decision support tools, dispensed medications and provided emergency services. Proportionally more PC-Only than PC-Plus nurses ordered advanced diagnostic tests/imaging, and fewer PC-Only than PC-Plus nurses performed and interpreted laboratory tests and diagnostic imaging on site. Conclusion: Contributions of the rural and remote nursing workforce to PC are rendered invisible by contemporary characterizations of the PC workplace, limiting evaluation and improvement efforts.

To examine determinants of intention to leave a nursing position in rural and remote areas within the next year, for Registered Nurses or Nurse Practitioners (RNs/NPs) and Licensed Practical Nurses (LPNs).A pan-Canadian cross-sectional survey.The Nursing Practice in Rural and Remote Canada II survey (2014-2015) used stratified, systematic sampling and obtained two samples of questionnaire responses on intent to leave from 1,932 RNs/NPs and 1,133 LPNs. Separate logistic regression analyses were conducted for RNs/NPs and LPNs.For RNs/NPs, 19.8% of the variance on intent to leave was explained by 11 variables; and for LPNs, 16.9% of the variance was explained by seven variables. Organizational commitment was the only variable associated with intent to leave for both RNs/NPs and LPNs.Enhancement of organizational commitment is important in reducing intent to leave and turnover. Since most variables associated with intent to leave differ between RNs/NPs and LPNs, the distinction of nurse type is critical for the development of rural-specific turnover reduction strategies. Comparison of determinants of intent to leave in the current RNs/NPs analysis with the first pan-Canadian study of rural and remote nurses (2001-2002) showed similarity of issues for RNs/NPs over time, suggesting that some issues addressing turnover remain unresolved.The geographic maldistribution of nurses requires focused attention on nurses' intent to leave. This research shows that healthcare organizations would do well to develop policies targeting specific variables associated with intent to leave for each type of nurse in the rural and remote context. Practical strategies could include specific continuing education initiatives, tailored mentoring programs, and the creation of career pathways for nurses in rural and remote settings. They would also include place-based actions designed to enhance nurses' integration with their communities and which would be planned together with communities and nurses themselves.目的: 探讨注册护士或执业护士(RNs/NPs)和持证护士(LPNs)在未来一年内辞去农村和偏远地区护理职务的决定因素。 设计: 泛加拿大横断面调查。 方法: 加拿大农村和边远地区护理实践II调查(2014-2015)过程中,采用分层、系统抽样的方法,对1932名注册护士/执业护士和1133名持证护士进行问卷调查,调查样本显示,共两名有意离职。分别对注册护士/执业护士和持证护士进行逻辑回归分析。 结果: 19.8%注册护士或执业护士的离职意愿与11个变量相关,而16.9%持证护士的离职意愿与7个变量相关;组织承诺是唯一与注册护士/执业护士和持证护士离职意愿都相关的变量。 结论: 强化组织承诺可以降低离职意愿和离职率,这一点至关重要。由于注册护士/执业护士和持证护士的离职意愿相关变量大多不同,护士类型的区分对于农村地区离职率降低策略的制定至关重要。将当前注册护士/执业护士分析中的离职意愿决定因素与首次泛加拿大农村和远程护士研究(2001-2002年)进行比较,比较结果表明,随着时间的推移,注册护士/执业护士的问题趋同,表明部分离职相关问题仍未解决。 影响: 当前,护士地理分布不均,因此需要关注护士的离职意愿。研究表明,医疗单位应该针对与农村和偏远地区不同类型护士离职意愿相关的特定变量制定政策。实际策略包括制定具体的继续教育计划,因地制宜编制指导计划,以及为农村和偏远地区的护士确定职业发展道路。此外,包括地方行动,旨在加强护士与社区的融合,同时为社区和护士作出规划。.

Introduction: Despite some attention paid to farm stress in the popular press, recent Canadian research examining the mental wellbeing of farming populations relative to other rural dwellers is sparse. International research on the topic has shown inconsistent findings and has mainly focused on men. The objective of the present study was to examine the correlates of mental health among rural Saskatchewan women and men, positioning farm/non-farm residence as a main explanatory variable, and depression and binge drinking as measures of mental health. Methods: The cross-sectional sample consisted of 1701 women (47.8% farm) and 1700 men (53.3% farm) who participated in the 2014 phase of the Saskatchewan Rural Health Study, a prospective cohort study primarily examining the respiratory health of rural people in the southern part of the province of Saskatchewan, Canada. Data were collected using mailed self-report questionnaires and included measures of mental health assessing health professional diagnosed depression and binge drinking, in addition to a broad array of demographic characteristics, stressors and resources. Multiple logistic regression was the primary method of analysis; generalized estimating equations were utilized to account for household clustering. All analyses were conducted separately for women and men and by mental health indicator. Results: Farm/non-farm residence was related to depression but only under particular circumstances, which in turn differed by gender. In women, non-farm residents with two or more chronic conditions reported more depression than their farm counterparts (odds ratio (OR)=2.62; 95% confidence interval (CI) 1.28-5.36); non-farm men with secondary school education reported greater depression than farm-dwelling men (OR=2.93; 95%CI 1.31-6.59). The remaining correlates of depression were generally consistent with previous research in rural populations, including younger age, being non-partnered (men only), higher stress, greater financial strain (women only) and lower social support (women only). Binge drinking was significantly elevated in non-farm women (OR=1.68; 95%CI 1.21-2.33) and non-farm men (OR=1.70; 95%CI 1.33-2.17) compared to the farming population. Among women only, not having access to a regular family doctor/nurse practitioner was associated with an increased likelihood of binge drinking (OR=2.05; 95%CI 1.13-3.71) compared to women perceiving better access. Conclusion: The present study is one of very few recently published quantitative studies of the correlates of mental health among farm and non-farm adults in rural Canada. The findings suggest that non-farm dwellers in rural Saskatchewan may be more vulnerable to compromised mental health than their farming counterparts. Additional research employing a longitudinal design and enhanced measurement is required to confirm or refute these findings.

Aim To develop and test the psychometric properties of the Job Resources in Nursing (JRIN) Scale and the Job Demands in Nursing (JDIN) Scale. Design Cross‐sectional survey. Methods A three‐phase process of instrument development and psychometric evaluation was employed: Phase 1: development of a 42‐item JRIN Scale and 60‐item JDIN Scale through extensive literature review, expert consultation and an iterative content evaluation; Phase 2: pilot survey of 89 nurses and use of item discrimination analysis to estimate the internal consistency reliability of each subscale and reduce the length of each scale; Phase 3: Modified scales were tested in a nationwide survey of 3,822 rural/remote nurses, including use of exploratory factor analysis. Results The 24 items related to job resources favoured a six‐factor structure, accounting for 63% of the variance, Cronbach's alpha 0.88. The 22 items related to job demands favoured a six‐factor structure, accounting for 59% of the variance, Cronbach's alpha 0.84.

Although low birth weight (LBW) increases the risk for type 2 diabetes (T2DM), the relationship between high birth weight (HBW) and T2DM is less definitive and largely confined to North American Indigenous populations. We re-examined the relationship between LBW (4000 g) and both T2DM and gestational diabetes (GDM) among First Nations and non-First Nations women in Saskatchewan. We analyzed new data for female subjects from a 2001 case-control study that led to our hefty fetal phenotype hypothesis. Using survival analysis techniques and a validated algorithm for identifying diabetes in health care administrative data, we followed a 1950–1984 birth cohort of 2003 women until March 31, 2013. Cox regression analysis determined the time to occurrence of first episode of GDM and diagnosis of T2DM by birth weight and ethnicity. First Nations women with HBW demonstrated a greater risk for developing both T2DM [hazard ratios (HR) 1.568; 95% confidence interval (CI) 1.188, 2.069] and GDM (HR 1.468; 95% CI 1.016, 2.121) than those with normal birth weight (NBW). Non-First Nations women with LBW had a greater risk of developing GDM than those with NBW (HR 1.585; 95% CI 1.001, 2.512). HBW is a risk factor for GDM and T2DM among First Nations women. This is likely due to exposure of these women to their own mothers’ diabetic pregnancies or gestational impaired glucose tolerance. This inter-generational amplification of T2DM risk mediated throughprenatalexposures appears to play a substantial role in the epidemic of T2DM among First Nations peoples.

Introduction: In an effort to better understand why cognitively normal patients were referred to a memory clinic, we sought to identify features of “worried well” patients to better identify those more likely to be cognitively normal. Methods: In total, 375 consecutive patients referred by primary care practitioners to a Rural and Remote Memory Clinic were categorized into two groups based on their neurologic diagnosis, “worried well” (cognitively normal, N=81) or “other” (patients with any neurologic diagnosis, N=294). Data collected included: age, sex, years of formal education, Mini-Mental Status Examination score from initial visit, Center for Epidemiologic Studies Depression Scale score, Self-Rating of Memory Scale, alcohol consumption, marital status, hours per week of work, past medical history, sleep concerns, and family history of memory concerns. The two groups were compared using t-tests and χ2 tests. The same comparison was done between the same set of “worried well” patients (cognitively normal, N=81) and the subgroup of patients with a diagnosis of Alzheimer’s disease (N=146) from the “other” group. Results: Significant differences included younger age, more formal education, more frequently having previous psychiatric diagnosis and more self-reported alcohol consumption in the “worried well” group. The “worried well” and “Alzheimer’s disease” comparison had the same significant differences as the “worried well” and “other” comparison. Conclusion: We observed a pattern of differences unfold between the “worried well” patients and those with cognitive disease. No one variable was pathognomonic of a “worried well” patient. However, taking all the above into account when evaluating a patient may help clinically.

Objectives Less is known about the respiratory health of general farming and non-framing populations. A longitudinal Saskatchewan Rural Health Study (SRHS) was conducted to explore the association between individual and contextual factors with respiratory health outcomes in these populations. Hence, the objectives are to: (i) describe the updated methodology of longitudinal SRHS—an extension of baseline survey methodology published earlier; (ii) compare baseline characteristics and the prevalences of respiratory health outcomes between drops-outs and completers; and (iii) summarize key findings based on baseline survey data. Results The SRHS was a prospective cohort study conducted in two phases: baseline survey in 2010 and a follow-up in 2014. Each survey consisted of two components, self-administered questionnaire and clinical assessments. At baseline, 8261 participants (≥ 18 years) (4624 households) and at follow-up, 4867 participants (2797 households) completed the questionnaires. Clinical assessments on lung functions and/or allergies were conducted among a sub-group of participants from both the surveys. To date, we published 15 peer-reviewed manuscripts and 40 abstracts in conference proceedings. Findings from the study will improve the knowledge of respiratory disease etiology and assist in the development and targeting of prevention programs for rural populations in Saskatchewan, Canada.

Because congenital anomalies of the kidneys and urinary tract (CAKUT) represent a frequent cause of end stage renal disease (ESRD) in the young, we explored the epidemiology of CAKUT and the role of diabetes in pregnancy.This was a retrospective cohort study of CAKUT, by maternal diabetes status, from among all 1980‒2009 births in Saskatchewan First Nations (FN) and non-First Nations (non-FN) people. We determined frequencies, predictors and complications of CAKUT, as well as cumulative survival (to 2014) of affected persons until ESRD and death.Of the 411,055 babies (204,167 mothers) in the Saskatchewan maternal-infant database, 2,540 had CAKUT (391 FN and 2,149 non-FN). Overall annual CAKUT incidence was 0.63% for non-FN and 0.57% for FN (p=0.082), but 5-year CAKUT incidence only increased among FN (0.40% in 1980‒1984 and 0.76% in 2005‒2009, p0.0001) and was highest among offspring of FN mothers with pregestational diabetes (pre-G/DM) (0% before 1995, 2.51% in 2000‒2004 and 1.66% in 2005-2009). Pre-G/DM, but not gestational diabetes mellitus (GDM), was an independent predictor of CAKUT in non-FN (odds ratio, 1.79; 95% confidence interval, 1.20 to 2.69), and in FN interacting with maternal history of stillbirth (odds ratio, 7.90; 95% confidence interval, 1.14 to 54.6). ESRD was100-fold more likely among offspring with CAKUT compared with all other offspring and was responsible for 40% of ESRD cases in young FN and non-FN people.In Saskatchewan, pre-G/DM is an emerging cause of CAKUT, accounting for 40% of ESRD cases in FN/non-FN children and young adults. Because pre-G/DM‒related CAKUT is potentially preventable with optimal glycemic management, increased recognition of this serious complication is required.

OBJECTIVES: To determine among rural-dwelling on-reserve Saskatchewan First Nations people whether racial discrimination is associated with depression, and in turn, if this relationship is moderated by gender. METHODS: As a component of a community-based participatory research project, a cross-sectional, interviewer-administered survey of 874 adults living on 2 Cree First Nation reserves in rural north-central Saskatchewan was conducted during May–August in 2012 and 2013. Self-reported, health-provider diagnosis of depression was the dependent variable and experiences of interpersonal racial discrimination was the primary exposure. Chi-square and multiple logistic regression were the main analytic techniques. Generalized estimating equations were applied to account for clustering within households. RESULTS: Overall, 64% of participants reported being treated unfairly in 1 or more situations because of their ethnicity; 38% indicated discrimination occurring in 3 or more situations. Nineteen percent reported a diagnosis of depression. Adjusted analyses indicated that compared to those with no experience of racial discrimination, those reporting 1–2 and 3 or more situations were 1.77 times (95% CI: 1.06–2.95) and 1.91 times (95% CI: 1.19–3.04) more likely to have diagnosed depression respectively. The relationship between racial discrimination and depression was not modified by gender, although women were 1.85 times (95% CI: 1.24–2.76) more likely to report depression than men. CONCLUSION: Interpersonal racial discrimination was associated with depression among First Nations women and men in rural Saskatchewan. Research directed at identifying the most efficacious interventions, programs and policies to combat racism is required to advance the goal of health equity.

Assess, Redress, Re-assess: Addressing Disparities in Respiratory Health Among First Nations is an ongoing community-based participatory research initiative involving two First Nations communities in Saskatchewan. The initiative’s rationale is grounded in the ethos of transformative community-based participatory research and facilitated through integrated knowledge translation with the aim of building community capacity. The initiative’s goal was to engage community members to actively participate in all research phases, from the development of the research questions to dissemination of results and evaluation of community-chosen interventions that evolved from the results. After baseline assessment of predictors and indicators of respiratory health, a program of integrated knowledge translation was adopted. As part of this program, a community-researcher collaboration was put in place that produced two knowledge translation symposia. The two symposia have brought together First Nations community members, interdisciplinary researchers, federal and provincial policy makers, and multiple Aboriginal organizational stakeholders. The symposia provided a pathway for knowledge synthesis and sharing to ultimately integrate knowledge into practice and enable First Nations’ community capacity building in addressing and redressing critical respiratory health issues. This article delineates the processes involved in developing this model of integrated knowledge translation and highlights the continuing engagement with the participating communities supported by Knowledge Translation (KT) Symposia.

Background and objective The relationship between farming exposures and pulmonary function in a rural paediatric population was evaluated. Methods Baseline data collection records of the Saskatchewan Rural Health Study (SRHS), a population-based study, were used. A subset of children (6–14 years old) participated in clinical testing, including anthropometric measures and pulmonary function testing (PFT), using spirometry (n = 584). PFTs followed ATS criteria and all statistical analyses were controlled for age, sex and height. Results Among clinical testing participants, 47.5% were females and 54.5% were farm dwelling. Of those living on farms, 77.5% were livestock farms. Mean percent predicted value (PPV) for forced expiratory volume in 1 s (FEV1 ) and forced vital capacity (FVC) among children living on a farm were 104.8% and 105.4%, respectively. Mean PPV for FEV1 and FVC among children not living on a farm were 102.7% and 101.4%, respectively. After adjustment, higher FEV1 (=0.079, SE = 0.033, P = 0.03) and FVC (=0.110, SE = 0.039, P = 0.006) were seen among children living on a farm. A trend towards lower FEV1 /FVC ratio (−0.013, SE = 0.008, P = 0.09) among children living on a farm was seen compared with children not living on a farm. Higher FVC and lower FEV1 /FVC ratio were seen in children who regularly emptied grain bins (P

Background Globally, disasters are on the rise. Nurses play a significant role in responding to such events but little is known about rural and remote nurses' experiences. Methods A national cross-sectional survey of regulated nurses (registered nurses, registered psychiatric nurses, licensed practical nurses and nurse practitioners) in rural and remote Canada provided the data (n=2465) for the logistic regression of predictors of assisting with a disaster event within the last five years. The types of disaster events were also examined and open-ended responses were explored to reveal nurses' perspectives. Results Nurse type, age, region of employment, employment status, number of rural communities worked, distance to advanced referral centre, remote community, personal-professional boundaries, burnout and work engagement were significant factors related to assisting with a disaster event. Open-ended data alluded to the importance of pre-disaster preparation, and the difficulties experienced when personal-professional relationships are impacted during a disaster. Conclusions Nursing education curricula needs to include information about disasters and the nurse's role. Continuing education opportunities and preparation for nurses should be offered in the workplace. Psychosocial supports to assist rural nurses who attend to disasters in their workplace will help them deal with issues such as the blurring of personal-professional relationships.

Because of time and cost constraints, objective classification of atopic and nonatopic asthma has been limited in large epidemiologic studies. However, as we try to better understand exposure-outcome associations and ensure appropriate treatment of asthma, it is important to focus on phenotype-defined asthma classification.To compare atopic and nonatopic asthma in rural children with regard to risk factors and clinical outcomes.We conducted a cross-sectional study in rural Saskatchewan, Canada, in 2011. Parents of 6- to 14-year-old children completed a health and exposure survey. Skin prick tests were completed in a subsample of 529 children. Asthma was based physician diagnosis. Asthma status was defined as no asthma, nonatopic asthma, and atopic asthma.Asthma prevalence was 14.7% of which 32.1% of cases were atopic. After adjustment, early respiratory illness and a family history of asthma were predictors of childhood asthma, regardless of atopic status (P.05). Being overweight and having a dog in the home were associated with an increased risk of nonatopic asthma (P.05). A mother with a history of smoking increased the risk of atopic asthma (P = .01). Compared with those with nonatopic asthma, in the past 12 months, children with atopic asthma were more likely to report a sneezy, runny, or blocked nose or have shortness of breath (odds ratio2), whereas those with nonatopic asthma were more likely to have parents who missed work (odd ratio3). Those with nonatopic asthma had significantly lower forced expiratory volume in 1 second compared w2ith those with atopic asthma.Exposures may contribute differentially to atopic and nonatopic asthma and result in differential clinical presentation or burden. The study of these characteristics is important for etiologic understanding and management decisions.

While damp housing is a recognized risk factor for asthma and atopy in children, its importance for adult health is inconclusive. We investigated the relationship between damp housing and adult atopic and non-atopic asthma in two Canadian First Nations communities. Methods: As part of the First Nations Longitudinal Respiratory Health Study, initiated in 2012, participating adults completed a health and environmental questionnaire followed by clinical assessment of atopy. Asthma was defined as any doctor diagnosed asthma. Atopic asthma included asthma and a positive skin prick test (SPT) ≥ 3mm to any of 6 allergens including house dust mite, three mold species, cat, and local grasses. Major household factors assessed included recent household damage caused by dampness; presence of mold and mildew; pets; and smoking. Multinomial logistic regression models with 3 outcomes [non-atopic asthma, atopic asthma and no asthma (referent)] were used to assess associations between asthma phenotypes and damp housing factors adjusting for covariates. Results: Of the 874 participants, 669 had allergy testing. The prevalence of asthma and atopy was 14.9 % and 21.1%, respectively. The most prevalent SPT responses were to cat (11.1%) and Cladosporium (7.9%). Of those with asthma, 28.0% were atopic. While mold or mildew in the home was not associated with asthma phenotypes, adults with atopic asthma were more likely to live in houses with home dampness (adjusted odds ratio: 3.4, 95% confidence interval: 1.41–8.17). No such associations were found for non-atopic asthma. Conclusion: This study supports the evidence that home dampness is an important domestic risk factor for adults with an atopic asthma history.