Bayesian Hierarchical Models as Tools to Evaluate the Association Between Groundwater Quality and the Occurrence of Type 2 Diabetes in Rural Saskatchewan, Canada.

There is growing interest in the role of environmental exposures in the development of diabetes. Previous studies in rural Saskatchewan have raised concerns over drinking water contaminants, including arsenic, which has been identified as a possible risk factor for diabetes. Using administrative health and water-quality surveillance data from rural Saskatchewan, an ecological study design was used to investigate associations between concentrations of arsenic, water health standards and aesthetic objectives, and the incidence and prevalence of diabetes. Mixtures of contaminants measured as health standards or as aesthetic objectives were summarized using principal component (PC) analysis. Associations were modeled using Bayesian hierarchical models incorporating both spatial and unstructured random effects, standardized for age and sex, and adjusted for socioeconomic factors and a surrogate measure for smoking rates. Arsenic was not associated with an increased risk of diabetes. For private wells, having groundwater arsenic concentrations in the highest quintile was associated with decreased cumulative diabetes incidence for 2010-2012 (risk ratio [RR] = 0.854, 95% credible interval [CrI] 0.761-0.958) compared with the lowest quintile, a result inconsistent with other studies. For public water supplies, having a first PC score for health standards (primarily summarized selenium, nitrate, and lead) in the third quintile (RR = 1.101, 95% CrI 1.019-1.188), fourth quintile (RR = 1.088, 95% CrI 1.003-1.180), or fifth quintile (RR = 1.115, 95% CrI 1.026-1.213) was associated with an increase in 2010 diabetes prevalence compared with the first quintile. An increase in the PC scores for the third aesthetic objective in private wells (characterized primarily by iron and manganese) was associated with decreased diabetes incidence, although a meaningful dose-response relationship was not evident. No other associations between PC scores for health standards or aesthetic objectives from public or private water supplies and diabetes were identified.

Ecological analysis of associations between groundwater quality and hypertension and cardiovascular disease in rural Saskatchewan, Canada using Bayesian hierarchical models and administrative health data.

Associations between groundwater quality and the prevalence of hypertension and ischemic heart disease were investigated in rural areas of the Canadian province of Saskatchewan. The partially ecological study was analyzed using Bayesian hierarchical models to account for spatial variability in risk. Exposure measures and health outcomes were estimated based on previously collected water quality surveillance data from public water supplies and private wells and administrative health data. Water quality exposures for each study region were estimated by applying geostatistical techniques to arsenic concentrations and principal component (PC) scores. The PC scores summarized groups of parameters measuring either health standards or aesthetic objectives described by the province. Generalized linear mixed models with a log link assessed associations between water quality and observed count of health outcomes relative to the expected value. The Bayesian models contained uncorrelated and spatially correlated random effects for each geographic region. Effect estimates were controlled for sex and age by stratification of case and expected case counts, for smoking by inclusion of sex- and age-specific prevalence of chronic obstructive pulmonary disease as a surrogate covariate, and for education and income by use of census data. There was no evidence for associations between groundwater arsenic concentrations in public or private water supplies and increased risk of hypertension or cardiovascular disease. An increase in the second aesthetic objectives PC score from public supplies was associated with a protective effect against ischemic heart disease. This PC value summarized hardness and magnesium Similarly, an increase in the second aesthetic objectives PC in private supplies was associated with decreased prevalence of hypertension. The results of this study are consistent with others demonstrating a relationship between elevated hardness and magnesium concentrations in drinking water and reduced risk of hypertension and cardiovascular disease. Further investigation is warranted with individual exposure history, particularly with respect to the potential beneficial effect of hard water on the prevalence of hypertension and cardiovascular disease.

Does antimicrobial therapy improve outcomes in horses with severe equine asthma and a positive tracheal wash bacterial culture?

The objective of this study was to observe the outcomes of adding an antimicrobial treatment to a conventional treatment regime in horses with severe equine asthma in a clinical setting. Eleven client-owned horses with a history consistent with severe equine asthma, increased respiratory effort and nostril flaring, ≥ 20% neutrophils on bronchoalveolar lavage (BAL), and a positive tracheal wash (TW) bacterial culture were treated with environmental management, corticosteroids, and bronchodilators. Six horses were also treated with an antimicrobial (principal group), while the other 5 were administered saline as a placebo (control group). Treatment with antimicrobials significantly improved the post-treatment clinical score of the principal group compared with the pre-treatment score, whereas no significant difference occurred in the control group. The principal group also had significantly less neutrophil myeloperoxidase (MPO) activity post-treatment than pre-treatment, with a median difference of -0.39 units/[protein] in the principal group and a median difference of -0.21 units/[protein] in the controls. There was no difference in MPO activity pre- versus post-treatment in the control group. No differences were noted in the intra-group comparisons of pre- versus post-treatment BAL neutrophil counts, mucus scores, and concentrations of interleukin-8 (IL-8) or tumor necrosis factor-alpha (TNF-α) in bronchoalveolar lavage fluid (BALF) in either group. There were no differences found in the inter-group comparisons of the principal versus controls for each of the pre- and post-treatment time periods for BAL neutrophil count, mucus score, clinical scores, MPO activity, and IL-8 or TNF-α concentrations. The role of airway bacteria in horses with severe equine asthma requires further investigation as antimicrobial therapy improved post-treatment clinical scores and decreased MPO activity in the group of horses studied, but did not affect other measures of airway inflammation.

L'objectif de la présente étude était d'observer dans un contexte clinique les résultats de l'ajout d'un traitement antimicrobien au traitement conventionnel de chevaux souffrant d'asthme sévère. Onze chevaux appartenant à des propriétaires et ayant une histoire correspondant avec de l'asthme sévère, un effort inspiratoire augmenté et un élargissement des narines, ≥ 20 % de neutrophiles dans le lavage bronchoalvéolaire (LBA), et une culture bactérienne positive à partir du lavage trachéal (LT) ont été traités par gestion de leur environnement, des corticostéroïdes, et des broncho-dilatateurs. Six chevaux ont également été traités avec un antimicrobien (groupe principal) alors que les cinq autres chevaux ont reçu de la saline à titre de placebo (groupe témoin). Le traitement avec les antimicrobiens améliora de manière significative le score clinique post-traitement du groupe principal comparativement au score pré-traitement, alors qu'aucune différence significative ne fut notée dans le groupe témoin. Dans le groupe principal on nota également qu'il y avait significativement moins d'activité myéloperoxydase (MPO) des neutrophiles post-traitement comparativement à pré-traitement, avec une différence médiane de −0,39 unités/[protéine] dans le groupe principal et une différence médiane de −0,21 unités/[protéine] dans le groupe témoin. Il n'y avait pas de différence de l'activité MPO pré- versus post-traitement dans le groupe témoin. Aucune différence ne fut notée dans les comparaisons intra-groupe pré- versus posttraitement du dénombrement de neutrophiles dans les LAB, du score de mucus, et des concentrations d'interleukine-8 (IL-8) ou du facteuralpha nécrosant des tumeurs (TNF-α) dans les liquides de lavage broncho-alvéolaire (LLBA) d'un groupe ou l'autre. Aucune différence ne fut trouvée dans les comparaisons inter-groupes du principal versus les témoins pour chacune des périodes de temps pré- et post-traitement pour le dénombrement des neutrophiles des LAB, le score de mucus, les scores cliniques, l'activité MPO, et les concentrations d'IL-8 ou de TNF-α. Le rôle des bactéries dans les voies respiratoires des chevaux souffrant d'asthme sévère nécessite des études supplémentaires étant donné que les thérapies antimicrobiennes ont améliorés les scores cliniques post-traitement et ont diminué l'activité MPO dans le groupe de chevaux étudiés, mais n'affecta pas d'autres mesures de l'inflammation des voies respiratoires.(Traduit par Docteur Serge Messier).

Effects of a standardized anesthetic protocol on hematologic variables in healthy cats.

This study evaluated the effects of an anesthetic protocol using intravenous ketamine and midazolam, and intramuscular buprenorphine on hematologic variables in cats. Twelve healthy adult cats had blood collected for a complete blood count before and after the induction of anesthesia. There were significant decreases in red blood cell counts, hemoglobin concentrations and hematocrits after the induction of anesthesia. On average, red blood cell counts and hematocrits decreased by 25%, and hemoglobin concentrations decreased by 24%. Based on hematocrit, 3/12 samples (25%) taken while the cats were anesthetized would have been interpreted as belonging to anemic patients while none of the cats would have been considered anemic before anesthesia. This study suggests that a complete blood count performed on blood taken under anesthesia with this anesthetic protocol should be interpreted cautiously in order to not make a false diagnosis of anemia.

Predictive risk mapping of West Nile virus (WNV) infection in Saskatchewan horses.

The objective of this study was to develop a model using equine data from geographically limited surveillance locations to predict risk categories for West Nile virus (WNV) infection in horses in all geographic locations across the province of Saskatchewan. The province was divided geographically into low-, medium-, or high-risk categories for WNV, based on available serology information from 923 horses obtained through 4 studies of WNV infection in horse populations in Saskatchewan. Discriminant analysis was used to build models using the observed risk of WNV in horses and geographic division-specific environmental data as well as to predict the risk category for all areas, including those beyond the surveillance zones. High-risk areas were indicated by relatively lower rainfall, higher temperatures, and a lower percentage of area covered in trees, water, and wetland. These conditions were most often identified in the southwest corner of the province. Environmental conditions can be used to identify those areas that are at highest risk for WNV. Public health managers could use prediction maps, which are based on animal or human information and developed from annual early season meteorological information, to guide ongoing decisions about when and where to focus intervention strategies for WNV.

Predicting geographical human risk of West Nile virus--Saskatchewan, 2003 and 2007.

OBJECTIVES: To detail the use of a model to predict areas of low, medium, and high risk of West Nile virus (WNV) in humans in both 2003 and 2007 in the province of Saskatchewan. To identify consistent high-risk areas from year to year as well as important environmental variables within those high-risk areas. METHODS: The number of laboratory-confirmed WNV individuals was obtained from Saskatchewan Health by rural municipality. The population at risk was obtained from Statistics Canada by rural municipality. Climate and habitat variables were incorporated into a discriminant analysis model with the production of risk maps as an end product. RESULTS: The discriminant analysis models had testing classification accuracies of 67% in 2003 and 44% in 2007. Climate and habitat variables remained important in all models while some habitat variables were less important in 2007. Risk maps from historically trained 2007 model revealed a southwest to northeast decreasing trend of risk. CONCLUSION: The models could be useful for indicating areas of high risk on a year-to-year basis or based on historical data. High-risk regions are characterized by less rainfall in June and July followed by higher temperatures in July and August with less vegetation and water coverage than low-risk regions.