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Background: Previous research suggests that children living on farms have a lower prevalence of asthma compared to their more urban counterparts. Four potential explanations may underlie this association: personal factors, health care access, health risk behaviours, and the environmental explanation. Objectives: The objective of this thesis was to first compare the prevalence of asthma between children living on farms and those living in small towns. The second objective was to identify and compare potential risk and protective factors for childhood asthma in rural and farm environments. Finally, we interpreted the findings in light of the above explanations in terms of which is most likely to explain previously observed differences in pediatric asthma prevalence. Methods: We used cross-sectional data (n=834) from a 2003 study conducted in Estevan, Saskatchewan as well as cross-sectional data (n=2,259) collected as part of the Saskatchewan Rural Health Study in 2011. We determined differences in asthma prevalence and examined the distribution of potential risk and protective factors between farm and small town children. Using multiple logistic regression, we identified a number of potential risk and protective factors for both pediatric asthma and wheeze among these populations. Results: No differences in prevalence of asthma or wheeze were identified by farm and small town status in both analyses. Risk factors that were identified included: male sex, parental history of asthma, personal history of allergy, home dampness, being overweight or obese, premature birth, living in a single parent home, difficulty accessing routine healthcare, previous daycare attendance, having a mother that previously smoked, having mice in the home, having an air filter in the home and feeding livestock. Protective factors included: previous daycare attendance, having pets in the home and having a dehumidifier present in the home. Farm-specific protective factors included: filling or emptying grain bins, cleaning or playing in pens, and living on a grain farm. Conclusions: No differences in asthma or wheeze prevalence were identified between small town and farm children in these study populations. Findings primarily supported the environmental explanation for geographic differences in asthma prevalence identified historically, with modest support for the health care access explanation. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-09-20 16:44:44.525

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Respiratory viral testing in hospitalized patients is thought to improve quality of care by reducing the use of diagnostic tests, guiding infection control precautions, and rationalizing antimicrobial therapies. Few small published studies have tested these assumptions, and have demonstrated conflicting results. We conducted a retrospective cohort study of 24,567 hospitalizations using administrative data to determine the associations between viral testing, patient outcomes, and process of care. Viral testing was not associated with improved mortality or length of stay in hospital, and resulted in more resource utilization. The test result did not influence the duration of isolation precautions. This implies that health care providers may not use the results of testing in making management decisions, or in guiding the use of isolation precautions. This study provides the foundation for further scientific evaluation and reform of our current respiratory infection control policy.

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