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Nicola Cherry
Division of Preventive Medicine University of Alberta Edmonton Alberta Canada

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Published: 09 June 2021 in Journal of Occupational & Environmental Medicine
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Objective: Determine effects on respiratory health of firefighters attending a catastrophic wildfire. Methods: Within the Alberta Administrative Health Data-base we identified 5 community-based controls for each firefighter in a cohort of 1234 deployed to the 2016 Fort McMurray fire. Spirometry records were identified and a stratified sample assessed clinically. We estimated PM2.5 particles exposure. Results: Firefighters had an increased risk of asthma consultation post-fire (OR new onset asthma = 2.56 95%CI 1.75–3.74). Spirometry showed decreased FEV1 and FVC with increasing exposure. In the clinical assessment, 20% had a positive methacholine challenge test (MCT) and 21% bronchial wall thickening (BWT). Those with ongoing fire-related symptoms had a higher concurrence of positive MCT and BWT (OR = 4.35 95%CI 1.11–17.12). Lower diffusion capacity related to higher exposure. Conclusions: Massive exposures during a wildfire are associated with non-resolving airways damage.

ACS Style

Nicola Cherry; James R. Barrie; Jeremy Beach; Jean-Michel Galarneau; Trish Mhonde; Eric Wong. Respiratory Outcomes of Firefighter Exposures in the Fort McMurray fire. Journal of Occupational & Environmental Medicine 2021, Publish Ah, 1 .

AMA Style

Nicola Cherry, James R. Barrie, Jeremy Beach, Jean-Michel Galarneau, Trish Mhonde, Eric Wong. Respiratory Outcomes of Firefighter Exposures in the Fort McMurray fire. Journal of Occupational & Environmental Medicine. 2021; Publish Ah ():1.

Chicago/Turabian Style

Nicola Cherry; James R. Barrie; Jeremy Beach; Jean-Michel Galarneau; Trish Mhonde; Eric Wong. 2021. "Respiratory Outcomes of Firefighter Exposures in the Fort McMurray fire." Journal of Occupational & Environmental Medicine Publish Ah, no. : 1.

Research article
Published: 04 May 2021 in American Journal of Industrial Medicine
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Introduction Little is known about the effectiveness of ongoing mental health support in reducing the mental health impacts of a traumatic deployment. Methods A cohort of firefighters was established among those deployed to a devastating wildfire in Alberta, Canada in May 2016. Firefighters completed three questionnaires: at recruitment giving details of exposures, a first follow‐up reporting mental health supports before, during, and after the fire and a second follow‐up, at least 30 months after the fire, with screening questionnaires for anxiety, depression, and posttraumatic stress disorder (PTSD). Fire chiefs were interviewed about mental health provisions. The impact of supports on mental ill health was estimated, adjusting for clustering within fire service and potential confounders. Results Of 1234 firefighters in the cohort, 840 completed the questionnaire on mental health supports. In total, 78 of 82 fire chiefs were interviewed. Analysis of the impact of supports on mental ill health included 745 firefighters from 67 fire services. Only 45.8% of reports of peer support were concordant between firefighters and fire chiefs. After adjusting for confounding, the odds ratios (OR) for peer support reported by both fire chief and firefighter were depressive disorder: OR = 0.22, 95% confidence interval (CI), 0.08–0.61; anxiety disorder: OR = 0.45, 95% CI, 0.24–0.82; PTSD: OR = 0.62, 95% CI, 0.37–1.02. Symptoms of anxiety and depression but not PTSD were reduced by resiliency training before the fire and by support offered within 48 h of return from deployment. Conclusion The results suggest peer support in firefighters is protective but its availability is poorly recognized. PTSD was somewhat less responsive, perhaps reflecting the cumulative effects of previous exposures.

ACS Style

Nicola Cherry; Jean‐Michel Galarneau Ma; Whitney Haynes; Bryan Sluggett Ma. The role of organizational supports in mitigating mental ill health in firefighters: A cohort study in Alberta, Canada. American Journal of Industrial Medicine 2021, 64, 593 -601.

AMA Style

Nicola Cherry, Jean‐Michel Galarneau Ma, Whitney Haynes, Bryan Sluggett Ma. The role of organizational supports in mitigating mental ill health in firefighters: A cohort study in Alberta, Canada. American Journal of Industrial Medicine. 2021; 64 (7):593-601.

Chicago/Turabian Style

Nicola Cherry; Jean‐Michel Galarneau Ma; Whitney Haynes; Bryan Sluggett Ma. 2021. "The role of organizational supports in mitigating mental ill health in firefighters: A cohort study in Alberta, Canada." American Journal of Industrial Medicine 64, no. 7: 593-601.

Journal article
Published: 23 February 2021 in Annals of Work Exposures and Health
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Objectives The Fort McMurray fire in Alberta, Canada, devastated the townsite in May 2016. First responders were heavily exposed to smoke particles. Blood samples taken from firefighters in May and August/September 2016 were used to measure concentrations of inflammatory markers in plasma and the relation of these markers to exposures and respiratory ill-health. Methods Blood samples were drawn from firefighters from two fire services, who also completed questionnaires about tasks and exposures during their deployment to the fire and about respiratory symptoms. Plasma was analysed for 42 inflammatory markers in a multiplex assay. At Service A, samples were collected twice, within 19 days of the start of the fire (early sample) and again 14–18 weeks later (late sample). At Service B, only late samples were collected, at 16–20 weeks. Principal component (PC) scores were extracted from markers in plasma from the early and late samples and, at both time periods, the first two components retained. PC scores were examined against estimated cumulative exposures to PM2.5 particles, self-rated physical stressors during the fire, and time since the last deployment to an active fire. The relation of component scores and exposure estimates to respiratory health were examined, using self-ratings at the time of the blood draw, a validated respiratory screening questionnaire (the European Community Respiratory Health Survey [ECRHS]) some 30 months after the fire, and clinical assessments in 2019–2020. Results Repeat blood samples were available for 68 non-smoking first responders from Service A and late samples from 160 non-smokers from both services. In the 68 with two samples, marker concentrations decreased from early to late samples for all but 3 of the 42 markers, significantly so (P < 0.05) for 25. The first component extracted from the early samples (C1E) was unrelated to respiratory symptoms but the second (C2E) was weakly related to increased cough (P = 0.079) and breathlessness (P = 0.068) and a lower forced expiratory volume in one second/forced expiratory capacity (FEV1/FVC)(β = –1.63, 95% CI –3.11 to –0.14) P = 0.032. The first PC at 14–20 weeks (C1L) was unrelated to exposure or respiratory health but the second PC (C2L) from these late samples, drawn from both fire services, related to cumulative PM2.5 exposure. In a multivariate model, clustered within fire service, cumulative exposure (β = 0.19, 95% CI 0.09–0.30), dehydration (β = 0.65, 95% CI 0.04–1.27) and time since last deployed to a fire (β = –0.04, 95% CI –0.06 to –0.01) were all related to the C2L score. This score was also associated with respiratory symptoms of wheezing, chest tightness, and breathlessness at the time of the blood draw but not to symptoms at later follow-up. However, apart from the lower FEV1/FVC at 15–19 days, the marker scores did not add to regression models that also included estimated cumulative PM2.5 exposure. Conclusions Concentrations of persisting inflammatory markers in the plasma of firefighters deployed to a devastating fire decreased with time and were related to estimates of exposure. Although not a powerful independent predictor of later respiratory ill-health, they may serve as an indicator of previous high exposure in the absence of contemporary exposure estimates.

ACS Style

Nicola Cherry; Jeremy Beach; Jean-Michel Galarneau. Are Inflammatory Markers an Indicator of Exposure or Effect in Firefighters Fighting a Devastating Wildfire? Follow-up of a Cohort in Alberta, Canada. Annals of Work Exposures and Health 2021, 65, 635 -648.

AMA Style

Nicola Cherry, Jeremy Beach, Jean-Michel Galarneau. Are Inflammatory Markers an Indicator of Exposure or Effect in Firefighters Fighting a Devastating Wildfire? Follow-up of a Cohort in Alberta, Canada. Annals of Work Exposures and Health. 2021; 65 (6):635-648.

Chicago/Turabian Style

Nicola Cherry; Jeremy Beach; Jean-Michel Galarneau. 2021. "Are Inflammatory Markers an Indicator of Exposure or Effect in Firefighters Fighting a Devastating Wildfire? Follow-up of a Cohort in Alberta, Canada." Annals of Work Exposures and Health 65, no. 6: 635-648.

Journal article
Published: 16 January 2021 in Journal of Affective Disorders Reports
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We aimed to determine the relationship between childhood abuse and mental ill-health in firefighters deployed to a devastating fire that engulfed Fort McMurray A stratified sample of 282 firefighters was selected from a cohort of 1234 for assessment by Structured Clinical Interview (SCID) for DSM-5 diagnostic criteria and the Childhood Experience of Care and Abuse questionnaire (CECA-Q). Diagnoses were grouped as post-traumatic stress disorder (PTSD), anxiety disorders, depressive disorders and substance use disorders. Scales extracted from the CECA-Q included parental loss, antipathy, neglect, physical punishment, sexual abuse and support from a same-age confidant. The relation to diagnostic group was examined by multivariable logistic regression 192 SCID interviews and 188 CECA-Qs were completed: 124 met DSM-5 criteria for diagnoses including anxiety disorder (56), depressive disorder (54), PTSD (77) and substance use disorder (43). Childhood sexual abuse was reported by 24 firefighters all of whom met DSM-5 diagnostic criteria. Sexual abuse and a childhood confidant differentiated diagnoses in an initial multivariable model of those with psychiatric disorders. Compared to those without a psychiatric diagnosis, father's antipathy was related to anxiety and substance use, physical punishment to PTSD and substance use. A childhood same-age confidant protected against anxiety, depression and PTSD. Fire exposures related only to PTSD. The comparison group without mental disorders was small. Childhood abuse information was collected retrospectively and may be biased by current state. Firefighters’ mental health is a function of both work-role traumas and childhood events. Occupational health provision must address this complexity.

ACS Style

Nicola Cherry; Jean-Michel Galarneau; Andrea Melnyk; Scott Patten. Childhood care and abuse in firefighters assessed for mental ill-health following the Fort McMurray fire of May 2016. Journal of Affective Disorders Reports 2021, 4, 100090 .

AMA Style

Nicola Cherry, Jean-Michel Galarneau, Andrea Melnyk, Scott Patten. Childhood care and abuse in firefighters assessed for mental ill-health following the Fort McMurray fire of May 2016. Journal of Affective Disorders Reports. 2021; 4 ():100090.

Chicago/Turabian Style

Nicola Cherry; Jean-Michel Galarneau; Andrea Melnyk; Scott Patten. 2021. "Childhood care and abuse in firefighters assessed for mental ill-health following the Fort McMurray fire of May 2016." Journal of Affective Disorders Reports 4, no. : 100090.

Research article
Published: 26 November 2020 in The Canadian Journal of Psychiatry
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Objectives: The study was designed to estimate the prevalence of mental disorders in a cohort of firefighters who had been deployed to a devastating fire in Fort McMurray, Alberta, in 2016. Methods: A cohort of firefighters was established and followed up by online questionnaires. The contact in October 2018 to March 2019 included the PCL-5 questionnaire screening for post-traumatic stress disorder (PTSD) and the Hospital Anxiety and Depression Scale (HADS) screening for anxiety and depression. A sample was selected comprising all scoring ≥31 on the PCL-5 or ≥12 on either scale of the HADS, 30% of those scoring 8 to 11 on the HADS, and 10% of those with lower scores on all scales. This sample was assessed through a structured clinical interview to categorize disorders as defined in Diagnostic and Statistical Manual for Mental Disorders, fifth edition ( DSM-5). Interviews were carried out face-to-face or by telephone between August 2019 and February 2020. Diagnoses in the interview sample were reweighted to obtain prevalence estimates for the whole cohort. In an analysis of receiver operating characteristics (ROC), possible cut points for scores from each screening questionnaire were examined. Results: In 2018 to 2019, 1,000 of the cohort of 1,234 firefighters completed the HADS and 998 completed the PCL-5. Of these, 282 were identified for structured clinical interviews for DSM-5 (SCID) assessment. Interviews were carried out with 192. Among those assessed, 40.6% met the criteria for PTSD, 30.7% for an anxiety disorder, and 28.5% for a depressive disorder. When reweighted to allow for sampling and losses to assessment, cohort prevalence estimates were as follows: PTSD 21.4% (15.7% to 29.1%), anxiety disorders 15.8% (11.0% to 22.5%), and depressive disorders 14.3% (9.9% to 20.8%). Lower prevalence estimates were obtained when using the cut point with least misclassification in the ROC analysis. Conclusion: Using the gold-standard SCID assessment, high rates of mental disorders were found in this cohort of firefighters who had experienced a devastating fire. Fewer cases would have been identified by screening questionnaire alone.

ACS Style

Nicola Cherry; Jean-Michel Galarneau; Andrea Melnyk; Scott Patten. Prevalence of Mental Ill-Health in a Cohort of First Responders Attending the Fort McMurray Fire. The Canadian Journal of Psychiatry 2020, 66, 719 -725.

AMA Style

Nicola Cherry, Jean-Michel Galarneau, Andrea Melnyk, Scott Patten. Prevalence of Mental Ill-Health in a Cohort of First Responders Attending the Fort McMurray Fire. The Canadian Journal of Psychiatry. 2020; 66 (8):719-725.

Chicago/Turabian Style

Nicola Cherry; Jean-Michel Galarneau; Andrea Melnyk; Scott Patten. 2020. "Prevalence of Mental Ill-Health in a Cohort of First Responders Attending the Fort McMurray Fire." The Canadian Journal of Psychiatry 66, no. 8: 719-725.

Journal article
Published: 23 June 2020 in Annals of Work Exposures and Health
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Objectives There is limited knowledge of exposure to polycyclic aromatic hydrocarbons (PAHs) in wildland firefighters, or of the effectiveness of interventions to reduce this. This study of wildland firefighters assessed whether PAHs were present and considered respiratory protection and enhanced skin hygiene as possible interventions. Methods 1-Hydroxypyrene (1-HP) was measured in urine samples collected pre-shift, post-shift, and next morning from wildland firefighters in Alberta and British Columbia. Skin wipes, collected pre- and post-shift, were analysed for eight PAHs. Breathing zone air samples were analysed for 11 PAHs. As pilot interventions, participants were randomized to either normal or enhanced skin hygiene. A sample of volunteers was assigned to a disposable N95 mask or a half facepiece mask with P100 organic vapour cartridge. Participants completed a brief questionnaire on activities post-shift and respiratory symptoms. Results Non-smoking firefighters (66 male and 20 female) were recruited from 11 fire crews. Air sampling pumps were carried for the full shift by 28 firefighters, 25 firefighters wore masks (14 N95 and 11 P100); 42 were assigned to the enhanced skin hygiene intervention. Sixty had hot spotting as their main task. Air monitoring identified PAHs (benzo(b,j,k)fluoranthene in particulates, phenanthrene in the gaseous phase) for 6 of the 11 crews. PAHs (largely naphthalene) were found post-shift on 40/84 skin wipes from the hand and 38/84 from jaw/throat. The mean increase in 1-HP in urine samples collected after the shift (compared with samples collected before the shift) was 66 ng g−1 creatinine (P < 0.001) with an increase over the shift found for 76% of participants. 1-HP in next morning urine samples was significantly lower than at the end of shift (a reduction of 39.3 ng g−1: P < 0.001). The amount of naphthalene on skin wipes was greater at the end of the shift (post) than at the start (pre). The mean post–pre weight difference of naphthalene on skin wipes taken from the hand was 0.96 ng wipe−1 (P = 0.01) and from the jaw/throat 1.28 ng wipe−1 (P = 0.002). The enhanced skin hygiene intervention lead to a larger reduction in 1-HP between end of shift and next morning urine samples but only for those with naphthalene on skin wipes at the end of shift. The difference in 1-HP concentration in urine samples collected before and after the shift was reduced for those wearing a mask (linear tend P = 0.063, one-sided). In multivariable models, 1-HP at end of shift was related to gaseous phase phenanthrene, estimated from air sampling [β = 318.2, 95% confidence interval (CI) 67.1–569.2]. Naphthalene on hand skin wipes reflected work in hot spotting during the shift (β = 0.53, 95% CI 0.22–0.86). Conclusions This study provided evidence of PAHs in the air and on the skin of many, but not all, fire crew. Absorbed PAHs, reflected in 1-HP in urine, increased over the shift. Results from the pilot interventions suggest that enhanced skin hygiene would reduce absorption post fire where PAHs had been accumulated on the skin, and that masks could be effective in reducing PAH inhalation exposure. Interventions to reduce PAH absorption are supported by the pilot work reported here and warrant further evaluation across a full fire season.

ACS Style

Nicola Cherry; Jean-Michel Galarneau; David Kinniburgh; Bernadette Quemerais; Sylvia Tiu; Xu Zhang. Exposure and Absorption of PAHs in Wildland Firefighters: A Field Study with Pilot Interventions. Annals of Work Exposures and Health 2020, 65, 148 -161.

AMA Style

Nicola Cherry, Jean-Michel Galarneau, David Kinniburgh, Bernadette Quemerais, Sylvia Tiu, Xu Zhang. Exposure and Absorption of PAHs in Wildland Firefighters: A Field Study with Pilot Interventions. Annals of Work Exposures and Health. 2020; 65 (2):148-161.

Chicago/Turabian Style

Nicola Cherry; Jean-Michel Galarneau; David Kinniburgh; Bernadette Quemerais; Sylvia Tiu; Xu Zhang. 2020. "Exposure and Absorption of PAHs in Wildland Firefighters: A Field Study with Pilot Interventions." Annals of Work Exposures and Health 65, no. 2: 148-161.

Journal article
Published: 20 May 2020 in Annals of Work Exposures and Health
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Objectives Women are reported to have higher rates of nickel sensitization than men, but there have been few studies of sex-related differences in dermatitis associated with occupational nickel exposure. This analysis examines dermatitis in a large cohort of women and men in welding and electrical occupations and considers how far differences in rates of dermatitis may be accounted for by nickel exposure. Methods Women and men were recruited to cohorts of workers who had entered welding and electrical apprenticeships (the WHAT-ME and WHAT-MEN studies). Participants completed questionnaires at baseline and every 6 months for up to 5 years. At each contact, cohort members were asked about current dermatitis and whether it was made worse by work. From the first follow-up after recruitment, those working in their trade completed detailed subroutines about tasks in their trade including, for welders, the process, base metal, and consumables. Exposures were considered by trade and, within welding, by stainless or high alloy steel (SOHAS) as the base metal. Urinary nickel concentration was also examined. Using only report of dermatitis that began after entry to the trade, new-onset dermatitis, all episodes of dermatitis, and dermatitis made worse by work were examined against exposure by multilevel, multivariable logistic regression, allowing for potential confounding. Results Among 1885 participants (welders; 447 women, 554 men: electrical trades; 438 women, 446 men), 200 reported dermatitis that started before they entered the trade, leaving 1685 for analysis. Women, but not men, who had entered the welding trades were more at risk of new onset [odds ratio (OR) = 1.54; 95% confidence interval (CI) 1.02–2.32] or dermatitis episodes (OR = 1.75; 95% CI 1.10–2.77) than those entering the electrical trades. Within welding, women were more at risk than men of new-onset dermatitis (OR = 1.85; 95% CI 1.15–2.96) and dermatitis episodes (2.14; 95% CI 1.24–3.68) but were not more likely to report these were made worse by work. Use of SOHAS as the base metal was associated with reports that dermatitis was made worse by work (3.54; 95% CI 1.04–12.03), but having adjusted for SOHAS use, women still remained at greater risk. A final analysis considered the effect on risk estimates of removing those welding SOHAS from the analysis. The risk for women of episodes of dermatitis was essentially unchanged, whether the comparison group was male welders or women in the electrical trades. Conclusions Welding is associated with risk of dermatitis in women. Although welding of SOHAS was associated with dermatitis that was made worse by work, it does not importantly explain the higher female rates in welding and other causes must be examined to support preventive measures.

ACS Style

Nicola Cherry; Jean-Michel Galarneau. Occupational Dermatitis in Welding: Does Nickel Exposure Account for Higher Rates in Women? Analysis of a Canadian Cohort. Annals of Work Exposures and Health 2020, 65, 183 -195.

AMA Style

Nicola Cherry, Jean-Michel Galarneau. Occupational Dermatitis in Welding: Does Nickel Exposure Account for Higher Rates in Women? Analysis of a Canadian Cohort. Annals of Work Exposures and Health. 2020; 65 (2):183-195.

Chicago/Turabian Style

Nicola Cherry; Jean-Michel Galarneau. 2020. "Occupational Dermatitis in Welding: Does Nickel Exposure Account for Higher Rates in Women? Analysis of a Canadian Cohort." Annals of Work Exposures and Health 65, no. 2: 183-195.

Original clinical article
Published: 12 March 2020 in Neurourology and Urodynamics
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Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors. Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions RESULTS: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors CONCLUSIONS: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention.

ACS Style

Rezaul Haque; Fardous Kabir; Kamrun Naher; Nicola Cherry; Dianna Macdonald; Adrian Wagg; Zafrullah Chowdhury. Promoting and maintaining urinary continence: Follow‐up from a cluster‐randomized trial of elderly village women in Bangladesh. Neurourology and Urodynamics 2020, 39, 1152 -1161.

AMA Style

Rezaul Haque, Fardous Kabir, Kamrun Naher, Nicola Cherry, Dianna Macdonald, Adrian Wagg, Zafrullah Chowdhury. Promoting and maintaining urinary continence: Follow‐up from a cluster‐randomized trial of elderly village women in Bangladesh. Neurourology and Urodynamics. 2020; 39 (4):1152-1161.

Chicago/Turabian Style

Rezaul Haque; Fardous Kabir; Kamrun Naher; Nicola Cherry; Dianna Macdonald; Adrian Wagg; Zafrullah Chowdhury. 2020. "Promoting and maintaining urinary continence: Follow‐up from a cluster‐randomized trial of elderly village women in Bangladesh." Neurourology and Urodynamics 39, no. 4: 1152-1161.

Research article
Published: 06 November 2019 in American Journal of Industrial Medicine
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Workers moving between states or provinces to find employment are reported to take longer to return to work after the injury. The Alberta Workers Compensation Board (WCB) identified all workers from four Canadian Atlantic provinces who sustained a work injury in Alberta resulting in greater than 5 total temporary disability days (TTDDays) from January 2015 to June 2017. Each was matched on sex, age, and injury date with an Alberta claimant also with greater than 5 TTDDays. WCB information extracted included employment, injury, cost and place of treatment, and modified work. Cox regression identified factors associated with TTDDays. Semi-structured interviews were also undertaken. Two-hundred forty pairs were identified and 60 interviews completed. Those from the Atlantic provinces had more TTDDays (median 63 days) than Alberta (median 22 days) with an unadjusted hazard ratio (HR) 0.50 (95% confidence interval [CI], 0.42-0.61). When adjusted for all factors, the HR moved closer to unity (HR = 0.62; 95% CI, 0.50-0.76). Total health care costs were the strongest predictor, with modified work, injury type, and claim status also explanatory factors. Among the Atlantic workers, leaving Alberta for treatment was strongly related to a lower likelihood of ending wage replacement (HR = 0.45; 95% CI, 0.32-0.62). Participants in the interview study emphasized the importance of returning to the family after injury and the financial difficulties of maintaining a second home with reduced income after the injury. The higher costs of wage replacement associated with extended time off work may be inherent to the practice of employing out-of-province workers for jobs for which there is a shortage of local labor.

ACS Style

Nicola Cherry; Jean-Michel Galarneau; Whitney Haynes. Total disability days in interprovincial and home-province workers injured in Alberta, Canada: A mixed-methods study with matched-pair analysis of compensation data and participant interviews. American Journal of Industrial Medicine 2019, 63, 146 -155.

AMA Style

Nicola Cherry, Jean-Michel Galarneau, Whitney Haynes. Total disability days in interprovincial and home-province workers injured in Alberta, Canada: A mixed-methods study with matched-pair analysis of compensation data and participant interviews. American Journal of Industrial Medicine. 2019; 63 (2):146-155.

Chicago/Turabian Style

Nicola Cherry; Jean-Michel Galarneau; Whitney Haynes. 2019. "Total disability days in interprovincial and home-province workers injured in Alberta, Canada: A mixed-methods study with matched-pair analysis of compensation data and participant interviews." American Journal of Industrial Medicine 63, no. 2: 146-155.

Journal article
Published: 01 July 2019 in The Lancet Global Health
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Summary Background Group exercise-based programmes for urinary incontinence appear to be promising low-cost interventions for women in developing countries, but no evidence exists to support whether they could be implemented or effective in such populations. We aimed to evaluate whether a group intervention that comprised pelvic floor muscle training, mobility exercises, and bladder education would be more effective than education alone, and report changes between villages (ie, clusters) rather than between individual participants. Methods In this cluster randomised trial, we recruited women from 16 pairs of villages in Bangladesh, with each pair comprising similar villages from the same sub-district. Women aged 60–75 years were interviewed to establish eligibility. Women were eligible if they had current urinary incontinence, and were excluded if they had a third degree or higher uterine prolapse, if they were unable to walk or stand without help, or if they had insufficient intellectual capacity to understand questions and follow instructions. The villages were randomly assigned within each pair to either exercise plus education or education-only intervention by use of a random number generator from a fixed seed. Women were excluded after consenting if they lived too far from the centre of the village. The exercise intervention was a physiotherapist-led group exercise class that was held twice weekly for 12 weeks, with home exercises between classes and to 24 weeks. Both groups received bladder-health education. Participants were followed up for 24 weeks. A 3-day continence record was collected at recruitment and every 4 weeks up until 24 weeks. This record involved the participant tying a knot in ribbons worn under the clothing each time they had an episode of urinary leakage. The primary outcome was change in number of knots (recorded leakage episodes) from recruitment to 24 weeks. Safety was assessed in all participants in the exercise intervention group. The trial is registered at ClinicalTrials.gov, number NCT02453100. Findings Between Aug 22, 2015, and July 2, 2018, of 3577 women aged 60–75 years identified, 1003 were eligible, of whom 625 consented to participate (n=335 exercise plus education villages, and n=290 in education-only villages). Of these consenting women, 46 were excluded (n=37 exercise plus education, n=9 education only) because they lived too far from the centre of the village. At week 24, 283 (95%) of 298 in the exercise plus education group and 274 (98%) of 281 in the education-only group completed a 3-day continence record. The estimate of change in number of leakage episodes between baseline and 24 weeks was −7·7 (95% CI −10·6 to −4·8) at the village level in an unadjusted model, and −6·64 (–7·95 to −5·33) in a random-effects model accounting for cluster randomisation. No adverse events were reported. Interpretation A structured group-exercise intervention has the potential to manage urinary incontinence in older women in communities largely outside the reach of pharmaceutical or surgical interventions. Funding Canadian Institutes for Health Research.

ACS Style

Adrian Wagg; Zafrullah Chowdhury; Jean-Michel Galarneau; Rezaul Haque; Fardous Kabir; Dianna MacDonald; Kamrun Naher; Yutaka Yasui; Nicola Cherry. Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial. The Lancet Global Health 2019, 7, e923 -e931.

AMA Style

Adrian Wagg, Zafrullah Chowdhury, Jean-Michel Galarneau, Rezaul Haque, Fardous Kabir, Dianna MacDonald, Kamrun Naher, Yutaka Yasui, Nicola Cherry. Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial. The Lancet Global Health. 2019; 7 (7):e923-e931.

Chicago/Turabian Style

Adrian Wagg; Zafrullah Chowdhury; Jean-Michel Galarneau; Rezaul Haque; Fardous Kabir; Dianna MacDonald; Kamrun Naher; Yutaka Yasui; Nicola Cherry. 2019. "Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial." The Lancet Global Health 7, no. 7: e923-e931.

Research article
Published: 29 April 2019 in American Journal of Industrial Medicine
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Introduction It is not known whether out‐of‐province Canadians, who travel to Alberta for work, are at increased risk of occupational injury. Methods Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under‐reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta. Results Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12‐0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out‐of‐province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00‐0.40). Conclusion Differential rates of under‐reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time‐loss 1 to 30 days.

ACS Style

Nicola Cherry; Jean‐Michel Galarneau; Michael Haan; Whitney Haynes; Katherine Lippel. Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk? American Journal of Industrial Medicine 2019, 62, 486 -495.

AMA Style

Nicola Cherry, Jean‐Michel Galarneau, Michael Haan, Whitney Haynes, Katherine Lippel. Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk? American Journal of Industrial Medicine. 2019; 62 (6):486-495.

Chicago/Turabian Style

Nicola Cherry; Jean‐Michel Galarneau; Michael Haan; Whitney Haynes; Katherine Lippel. 2019. "Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk?" American Journal of Industrial Medicine 62, no. 6: 486-495.

Journal article
Published: 08 February 2019 in Annals of Work Exposures and Health
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Background In May 2016, firefighters from the province of Alberta, Canada deployed to a fire that engulfed the urban area of Fort McMurray. During the first days of the fire, firefighters experienced heavy smoke exposures during greatly extended work shifts. Urinary samples were collected post-deployment from three fire services for estimation of 1-hydroxypyrene (1-HP) concentration, reflecting exposure to polycyclic aromatic hydrocarbons (PAHs), to determine the effects of respiratory protective equipment (RPE) and skin hygiene in reducing internal dose Methods Urine samples from one fire service (n = 62) were analyzed for 1-HP by two laboratories, using different assays (LC-MS/MS: GC-MS): remaining samples were analyzed just by LC-MS/MS. A Skin Exposure Mitigation Index (SEMI) was computed from questions on opportunities for changing clothing, showering, and washing during breaks. Regression analyses, using 1-HP ng/g creatinine as the dependent variable, assessed the effect of RPE and skin factors on PAH absorption, allowing for environmental exposure and potential confounders. Stratification identified key groups with equal delay in sample collection. Results 1-HP was detected in 71.0% of 62 samples by LC-MS/MS and 98.4% by GC-MS, with good mutual agreement between the methods. In 171 post-fire samples, 1-HP corrected for creatinine was related to current cigarette smoking and recent barbeque. Among those with samples collected within 48 h, urinary 1-HP was correlated with estimated exposure(r = 0.53, P < 0.001). In those with only one rotation before urine sample collection, no effect was seen of RPE use but I-HP was significantly lower (P = 0.003) in those with those with a high score on the SEMI scale, indicating better access to factors mitigating skin absorption. Conclusion Skin exposure to PAHs is an important route of absorption in firefighters, which can be mitigated by good skin hygiene.

ACS Style

Nicola Cherry; Yayne-Abeba Aklilu; Jeremy Beach; Philip Britz-McKibbin; Rebecca Elbourne; Jean-Michel Galarneau; Biban Gill; David Kinniburgh; Xu Zhang. Urinary 1-hydroxypyrene and Skin Contamination in Firefighters Deployed to the Fort McMurray Fire. Annals of Work Exposures and Health 2019, 63, 448 -458.

AMA Style

Nicola Cherry, Yayne-Abeba Aklilu, Jeremy Beach, Philip Britz-McKibbin, Rebecca Elbourne, Jean-Michel Galarneau, Biban Gill, David Kinniburgh, Xu Zhang. Urinary 1-hydroxypyrene and Skin Contamination in Firefighters Deployed to the Fort McMurray Fire. Annals of Work Exposures and Health. 2019; 63 (4):448-458.

Chicago/Turabian Style

Nicola Cherry; Yayne-Abeba Aklilu; Jeremy Beach; Philip Britz-McKibbin; Rebecca Elbourne; Jean-Michel Galarneau; Biban Gill; David Kinniburgh; Xu Zhang. 2019. "Urinary 1-hydroxypyrene and Skin Contamination in Firefighters Deployed to the Fort McMurray Fire." Annals of Work Exposures and Health 63, no. 4: 448-458.

Journal article
Published: 05 December 2018 in International Journal of Environmental Research and Public Health
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Objective: Sarcoidosis is thought to be an aberrant immune response to environmental agents, with rural living as a risk factor. We aimed to determine if farm living, consumption of farm (untreated) milk, or untreated water increased the risk of sarcoidosis. Methods: In a case-referent design, patients aged 18–60 with pulmonary sarcoidosis together with referents with other chronic respiratory disease, diagnosed 1999–2005 in Alberta, Canada, were approached through their specialist physician. Participants completed a telephone questionnaire about farm living, use of untreated water and farm milk for each residence from birth to diagnosis. Exposures at birth, up to age five, and up to diagnosis were calculated. Results: The study included 615 cases and 1334 referents. The consumption of farm milk, but not of unpiped water or farm living overall, appeared to be consistently associated with sarcoidosis in a fully adjusted analysis. The association was present for farm milk used in the residence of birth (odds ratios (OR): 1.59, 95% confidence intervals (CI): 1.08–2.34) and persisted for those drinking farm milk to age five years (OR: 1.52, 95% CI: 1.04–2.21), and for those drinking farm milk for >16 years to diagnosis (OR: 1.50, 95% CI: 1.04–2.15). The association with sarcoidosis was stronger when the referent was in the subgroup diagnosed with asthma but was present also with referents with other chronic respiratory disease. Among those whose family used farm milk at birth and to age 5 years, continued use of farm milk into adulthood increased the risk of sarcoidosis. Conclusion: We observed evidence of positive association between consumption of farm milk and sarcoidosis.

ACS Style

Janine Schouten; Jeremy Beach; Igor Burstyn; Ambikaipakan Senthilselvan; Nicola Cherry. Is Farm Milk a Risk Factor for Sarcoidosis? The Role of Farm Residence, Unpiped Water and Untreated Milk in Sarcoidosis: A Case-Referent Study in Alberta, Canada. International Journal of Environmental Research and Public Health 2018, 15, 2755 .

AMA Style

Janine Schouten, Jeremy Beach, Igor Burstyn, Ambikaipakan Senthilselvan, Nicola Cherry. Is Farm Milk a Risk Factor for Sarcoidosis? The Role of Farm Residence, Unpiped Water and Untreated Milk in Sarcoidosis: A Case-Referent Study in Alberta, Canada. International Journal of Environmental Research and Public Health. 2018; 15 (12):2755.

Chicago/Turabian Style

Janine Schouten; Jeremy Beach; Igor Burstyn; Ambikaipakan Senthilselvan; Nicola Cherry. 2018. "Is Farm Milk a Risk Factor for Sarcoidosis? The Role of Farm Residence, Unpiped Water and Untreated Milk in Sarcoidosis: A Case-Referent Study in Alberta, Canada." International Journal of Environmental Research and Public Health 15, no. 12: 2755.

Journal article
Published: 03 September 2018 in Annals of Work Exposures and Health
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ACS Style

Henry Aidoo; Jeremy Beach; Rebecca Elbourne; Jean-Michel F Galarneau; Sebastian Straube; Nicola Cherry. Estimation and Validation of Flour Exposure in Bakeries in Alberta, Canada. Annals of Work Exposures and Health 2018, 62, 1096 -1108.

AMA Style

Henry Aidoo, Jeremy Beach, Rebecca Elbourne, Jean-Michel F Galarneau, Sebastian Straube, Nicola Cherry. Estimation and Validation of Flour Exposure in Bakeries in Alberta, Canada. Annals of Work Exposures and Health. 2018; 62 (9):1096-1108.

Chicago/Turabian Style

Henry Aidoo; Jeremy Beach; Rebecca Elbourne; Jean-Michel F Galarneau; Sebastian Straube; Nicola Cherry. 2018. "Estimation and Validation of Flour Exposure in Bakeries in Alberta, Canada." Annals of Work Exposures and Health 62, no. 9: 1096-1108.

Journal article
Published: 15 March 2018 in International Journal of Environmental Research and Public Health
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A study of the respiratory health of grain farmers in Alberta, Canada was carried out in March 2002. Two populations were identified: members, in 1983, of a province-wide farm organisation, and grain farmers registered with the provincial agriculture department. A telephone interview addressed pesticide use (using pre-circulated trade names), chronic disease and respiratory symptoms. Pesticide ingredients were identified from provincial crop protection guides. Total years of use were calculated for seven chemical groups. Consent for linkage to administrative health records was obtained in 2009. A likelihood score (Lscore) is computed, relating symptoms to asthma diagnosis. Self-reported asthma and the Lscore are examined against duration of pesticide exposures. Of the 10,767 farmers listed, 2426 were still living, had farmed grain and were interviewed; 1371 were re-contacted and matched to health records. After allowance for confounders, years of exposure to phenoxy compounds are related to self-reported asthma and Lscore. Compared to no exposure, the adjusted odds ratios (95% Confidence Intervals for self-reported asthma for short, medium and long exposure to phenoxy compounds are 1.29 (0.66–2.52), 2.52 (1.25–5.09), and 3.18 (1.54–6.58), and for Lscore are 1.19 (0.91–1.55), 1.50 (1.13–1.99), and 1.58 (1.18–2.12). We conclude that lifetime exposure to phenoxy herbicides is associated with an increased risk of asthma.

ACS Style

Nicola Cherry; Jeremy Beach; Ambikaipakan Senthilselvan; Igor Burstyn. Pesticide Use and Asthma in Alberta Grain Farmers. International Journal of Environmental Research and Public Health 2018, 15, 526 .

AMA Style

Nicola Cherry, Jeremy Beach, Ambikaipakan Senthilselvan, Igor Burstyn. Pesticide Use and Asthma in Alberta Grain Farmers. International Journal of Environmental Research and Public Health. 2018; 15 (3):526.

Chicago/Turabian Style

Nicola Cherry; Jeremy Beach; Ambikaipakan Senthilselvan; Igor Burstyn. 2018. "Pesticide Use and Asthma in Alberta Grain Farmers." International Journal of Environmental Research and Public Health 15, no. 3: 526.

Journal article
Published: 17 February 2018 in Annals of Work Exposures and Health
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ObjectivesThere is little information on how work tasks, demands, and exposures differ between women and men in nominally the same job. This is critical in setting workplace standards that will protect the health of both men and those women moving into less traditional work roles. Information used in setting standards is currently based almost entirely on male workers. This paper describes differences in work and health, and the relation between them, in women and men who have undergone the same trade training for the welding or electrical trades.MethodFour cohorts were established. Two were women across Canada in the welding and electrical trades who had been in an apprenticeship since 2005. Cohorts of men in the same trades during the same period were established in the province of Alberta, Canada. Participants completed a baseline questionnaire at recruitment and were followed up every 6 months to collect detailed information on work carried out and on their health and habits. At the end of the study (up to 5 years for women and up to 3 years for men), the cohort members completed a final questionnaire including questions on mental health, harassment, and gender.ResultsThe four cohorts comprised 1001 welders (447 female; 554 male) and 885 in the electrical trades (438 female; 447 male). Follow-up information was available for 89%. Women were more likely than men to have had some post-secondary education before starting their trade and were less likely to be living as married or to have a child. More welders smoked, and more men were heavy drinkers. At recruitment, more welders than those in the electrical trades reported rhinitis (sneezing and runny nose), depression, and anxiety. Female welders reported more depression (38%) than male welders (30%), compared to 24% in the electrical trades. At first follow-up, new-onset shoulder pain was more frequent in men and new-onset asthma or wheezing in welders. Within each trade, women reported less variety in tasks. Women welders were less likely to be employed in construction than men, and women were less likely to become industrial electricians. Overall, 54% of women and 46% of men reported never using respiratory protection when welding. In the end-of-study questionnaires received to date, 49% reported bullying or harassment during the apprenticeship, with higher proportions in welding than electrical trades and in women compared with men. Such harassment was reflected in higher anxiety and depression scores.ConclusionsThis is the first report on these four cohorts and demonstrates the capacity for detailed analysis of the differences in exposure and new-onset occupationally related ill-health. While women and men in the same trades appear to be doing broadly similar work, and to have similar patterns on health at the first follow-up, there are some significant differences in the types of employment and variety of tasks. The very detailed information collected will allow more precise estimates of exposures to be correlated with health outcomes at the end of the follow-up period.

ACS Style

Nicola Cherry; Victoria Arrandale; Jeremy Beach; Jean-Michel Galarneau; Antonia Mannette; Laura Rodgers. Health and Work in Women and Men in the Welding and Electrical Trades: How Do They Differ? Annals of Work Exposures and Health 2018, 62, 393 -403.

AMA Style

Nicola Cherry, Victoria Arrandale, Jeremy Beach, Jean-Michel Galarneau, Antonia Mannette, Laura Rodgers. Health and Work in Women and Men in the Welding and Electrical Trades: How Do They Differ? Annals of Work Exposures and Health. 2018; 62 (4):393-403.

Chicago/Turabian Style

Nicola Cherry; Victoria Arrandale; Jeremy Beach; Jean-Michel Galarneau; Antonia Mannette; Laura Rodgers. 2018. "Health and Work in Women and Men in the Welding and Electrical Trades: How Do They Differ?" Annals of Work Exposures and Health 62, no. 4: 393-403.

Multicenter study
Published: 01 February 2018 in Journal of Obstetrics and Gynaecology
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Little information exists about socio-economic, environmental or occupational determinants of low Apgar scores among Nigerian neonates. Mothers in lying-in wards of four hospitals in Ibadan were interviewed on socio-demographic characteristics, obstetric history and work activities during index pregnancy. Apgar scores and clinical data were extracted from case notes. Of the 1349 respondents, 20% had Apgar score <7 at one minute, 4% at five minutes. Lower education, cooking with kerosene, physical exertion at work, nulliparity, hypertension in pregnancy, prolonged rupture of membranes, breech presentation and caesarean section were predictors for low Apgar scores at one minute; nulliparity, male infant and breech presentation at five minutes. Occupations with lower socio-economic status or those requiring physical exertion; tailoring, catering and hairdressing recorded higher rates of low Apgar scores at one minute (p = .08). Physical exertion at work and cooking with kerosene may be predictive of low Apgar scores and require further study.

ACS Style

Folashade Olufunke Omokhodion; Olumuyiwa Adebola Roberts; Modupe Onayinka Onadeko; Jeremy Richard Beach; Nicola Cherry; Igor Burstyn. Social, obstetric and environmental determinants of low Apgar score among infants born in four selected hospitals in Ibadan, Nigeria. Journal of Obstetrics and Gynaecology 2018, 38, 454 -460.

AMA Style

Folashade Olufunke Omokhodion, Olumuyiwa Adebola Roberts, Modupe Onayinka Onadeko, Jeremy Richard Beach, Nicola Cherry, Igor Burstyn. Social, obstetric and environmental determinants of low Apgar score among infants born in four selected hospitals in Ibadan, Nigeria. Journal of Obstetrics and Gynaecology. 2018; 38 (4):454-460.

Chicago/Turabian Style

Folashade Olufunke Omokhodion; Olumuyiwa Adebola Roberts; Modupe Onayinka Onadeko; Jeremy Richard Beach; Nicola Cherry; Igor Burstyn. 2018. "Social, obstetric and environmental determinants of low Apgar score among infants born in four selected hospitals in Ibadan, Nigeria." Journal of Obstetrics and Gynaecology 38, no. 4: 454-460.

Journal article
Published: 06 October 2017 in International Journal of Environmental Research and Public Health
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Arsenic in drinking water is causally linked with cancer of the skin, lung, and urinary bladder, but there is very little data on a possible role for arsenic in the etiology of cervical cancer, a disease in which human papilloma virus is held to be a necessary but not sufficient cause. All histopathology results from cervical specimens from the National Institute of Cancer Research and Hospital (NICRH), Dhaka (1997–2015), and the Anowara Medical Services (2003–2015), both serving the whole of Bangladesh, were classified by cell type. Arsenic concentrations in well water in the thana of residence were estimated from systematic sampling carried out by the British Geological Survey. In a case-referent analysis arsenic estimates for cases of cervical cancer were compared with those found to have benign lesions. In this study, 3464 NICRH (CH) cervical specimens and 30,050 community medical service (CMS) specimens were available: 3329 (CH) and 899 (CMS) were recorded as malignant. Most were squamous cell carcinoma, of which 4.9% were poorly differentiated. Overall, there was no increase in cervical cancer with increasing arsenic concentration. Among those with squamous cell histology, a strong dose response was seen for poorly differentiated cancer with increasing arsenic exposure. The odds ratio increased monotonically, compared with exposure 200 μg/L (p < 0.001). Given the high proportion of Bangladeshis using drinking water containing >50 μg/L of arsenic, the evidence that arsenic is implicated in cancer grade suggests a need for further investigation and the introduction of cervical screening in high arsenic areas.

ACS Style

Mohammad Golam Mostafa; Zarat Jahin Queen; Nicola Cherry. Histopathology of Cervical Cancer and Arsenic Concentration in Well Water: An Ecological Analysis. International Journal of Environmental Research and Public Health 2017, 14, 1185 .

AMA Style

Mohammad Golam Mostafa, Zarat Jahin Queen, Nicola Cherry. Histopathology of Cervical Cancer and Arsenic Concentration in Well Water: An Ecological Analysis. International Journal of Environmental Research and Public Health. 2017; 14 (10):1185.

Chicago/Turabian Style

Mohammad Golam Mostafa; Zarat Jahin Queen; Nicola Cherry. 2017. "Histopathology of Cervical Cancer and Arsenic Concentration in Well Water: An Ecological Analysis." International Journal of Environmental Research and Public Health 14, no. 10: 1185.

Journal article
Published: 15 August 2017 in CMAJ Open
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Background: Wildfire engulfed Fort McMurray, Alberta on May 3, 2016, leading to a total evacuation. Access to 2 active cohorts allowed us to rapidly assess health effects in those evacuated. Methods: People working in Fort McMurray who had been recruited before the fire for 2 occupational health cohort studies completed a questionnaire (online or via telephone) 3-26 weeks after evacuation. The questionnaire asked about respiratory and mental health and experiences since the fire. Results: Of the 129 participants, 109 were in the Fort McMurray area on May 3. Thirty-seven (33.9%) of the participants who were in Fort McMurray on May 3 reported a health condition, including respiratory symptoms (n = 17) and mental ill health (n = 17), immediately after the fire. At follow-up, a mean of 102 days after the fire, 11 participants (10.1%) reported a fire-related health condition, including mental ill health (n = 8) and respiratory symptoms (n = 2). There was no difference before and after the fire in use of alcohol, cigarettes, recreational drugs or medication. One in 4 participants (32 [24.6%]) had not worked since the fire, and fewer than half (58 [44.6%]) had returned to Fort McMurray. Of the 90 participants evacuated, 15 (16.7%) had scores indicative of moderate or severe anxiety or depression on the Hospital Anxiety and Depression Scale. Those evacuated had significantly higher mean anxiety (p = 0.01) and depression (p = 0.04) scores than those not evacuated. Regression modelling showed that anxiety scores were higher for women, with longer time since the fire and with evacuation to a motel. Depression scores were higher for women and with financial loss because of lack of work. Interpretation: Although evacuation was associated with higher anxiety and depression scores, persisting ill health was not widespread at early follow-up after the fire. Although these results are encouraging, these "healthy worker" results cannot be generalized to all evacuees.

ACS Style

Nicola Cherry; Whitney Haynes. Effects of the Fort McMurray wildfires on the health of evacuated workers: follow-up of 2 cohorts. CMAJ Open 2017, 5, E638 -E645.

AMA Style

Nicola Cherry, Whitney Haynes. Effects of the Fort McMurray wildfires on the health of evacuated workers: follow-up of 2 cohorts. CMAJ Open. 2017; 5 (3):E638-E645.

Chicago/Turabian Style

Nicola Cherry; Whitney Haynes. 2017. "Effects of the Fort McMurray wildfires on the health of evacuated workers: follow-up of 2 cohorts." CMAJ Open 5, no. 3: E638-E645.

Evaluation study
Published: 15 September 2016 in BMC Public Health
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Although many studies have investigated the relationship between the introduction of the New Cooperative Medical Scheme (NCMS) in rural China in 2003 and increased use of medical services, the effect on health status, objectively measured, is seldom reported. In Anhui Province a chronic disease scheme (CDS) for reimbursing part of the cost of outpatient care is designed to improve management of those with chronic conditions, including diabetes. A follow-up study was designed in which patients with diabetes aged 40-70 years who had recently (in 2010) been granted a chronic disease card were individually matched on age, sex and village with a patient with diabetes not yet in the scheme. Each subject gave a fingertip sample of blood to give the concentration of glycosylated hemoglobin (HbA1c), a measure indicating blood glucose control during the previous 3 months. This measure was made on recruitment and at 12 month follow-up: information on use of health services, quality of life and financial burden was also collected at the two contacts. Of 602 pairs initially recruited, 528 pairs were contacted at follow-up and are the subject of this report. To distinguish between outcomes associated with application and those of membership of the scheme, the primary analysis was of 256 pairs in which one had been a member of the CDS throughout and the other never applied. No difference between pairs on HbA1c was found either at recruitment or follow-up but those in the CDS reported more hospital visits, more tests and more use of high level hospitals. However they had poorer scores on quality of life scales (SF-12, EQ-5D) and were more likely to report that the financial costs were very burdensome. Those recently applying for the scheme, or being accepted since recruitment, had lower HbA1c scores. On-going membership of the CDS was associated with increased use of services but this did not appear to result in better management of blood glucose or improved quality of life. Those who had recently joined the scheme had signs of improvement, suggesting a need for active follow-up to maintain and reinforce early gains.

ACS Style

Qicheng Jiang; Zhen Jiang; Zhang Xin; Nicola Cherry. Evaluation of the impact of a chronic disease scheme reimbursing medical costs of patients with diabetes in Anhui province, China: a follow-up study. BMC Public Health 2016, 16, 980 .

AMA Style

Qicheng Jiang, Zhen Jiang, Zhang Xin, Nicola Cherry. Evaluation of the impact of a chronic disease scheme reimbursing medical costs of patients with diabetes in Anhui province, China: a follow-up study. BMC Public Health. 2016; 16 (1):980.

Chicago/Turabian Style

Qicheng Jiang; Zhen Jiang; Zhang Xin; Nicola Cherry. 2016. "Evaluation of the impact of a chronic disease scheme reimbursing medical costs of patients with diabetes in Anhui province, China: a follow-up study." BMC Public Health 16, no. 1: 980.