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Lee HJ, Cho S, Lee SH, Kim SJ, Kim KM, Chu MK. Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016. J Clin Sleep Med 2024; 20:39-47. [PMID: 38163942 PMCID: PMC10758546 DOI: 10.5664/jcsm.10790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 01/03/2024]
Abstract
STUDY OBJECTIVES We aimed to identify the relationship between duration of categorized catch-up sleep on free days (CUS) and measured body mass index (BMI) in adults using the data from the seventh Korean National Health and Nutrition Examination Survey (KNHANES VII), 2016. METHODS CUS duration was classified as ≤ 0, > 0-1, > 1-2, and > 2 hours. Being overweight or obese was defined as having a BMI ≥ 25.0 kg/m2 or ≥ 30.0 kg/m2, respectively. RESULTS Of 6,382 participants aged 19-80 years in the KNHANES VII survey of 2016, 201 and 583 participants were excluded because of shift-working and insufficient data, respectively. Of 5,598 participants, CUS was observed in 2,274 (44.9%) participants, of which 3,324 (55.1%), 1,043 (19.4%), 724 (14.7%), and 507 (10.8%) had CUS of ≤ 0, > 0-1, > 1-2, and > 2 hours, respectively; the prevalence of obesity was 5.6%, 5.6%, 4.8%, and 6.1%, respectively. The association between BMI and CUS duration showed a significant negative association in the CUS ≤ 0 hours group (beta [95% confidence interval], -0.394 [-0.646, -0.143], P = .002); however, other CUS groups did not show any significant association with BMI (CUS > 0-1 hours: -0.196 [-1.258, 0.865], P = .716; CUS > 1-2 hours, -0.542 [-1.625, 0.541], P = .325; CUS > 2 hours, -0.113 [-0.459, 0.233], P = .519). CONCLUSIONS Our findings provide an understanding of the relationship between CUS and BMI and can serve as an instructive basis for the management of BMI. CITATION Lee HJ, Cho S, Lee SH, Kim SJ, Kim KM, Chu MK. Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016. J Clin Sleep Med. 2024;20(1):39-47.
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Affiliation(s)
- Hye Jeong Lee
- Department of Neurology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Gyeonggi-do, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sue Hyun Lee
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Seung Jae Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Chin YL, Seng KB, Ye HY, En PR, Aslam MS, Kim YJ, Linchao Q, Peryen T, Qi KY, Jun LY, Cheah OY, Chi TN. Treating Narcolepsy With Traditional Chinese Medicine. MULTIDISCIPLINARY APPLICATIONS OF NATURAL SCIENCE FOR DRUG DISCOVERY AND INTEGRATIVE MEDICINE 2023:185-241. [DOI: 10.4018/978-1-6684-9463-9.ch006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Narcolepsy is an uncommon brain condition characterized by falling asleep suddenly without any proper reason or time. In this chapter, the authors include a brief history of narcolepsy, clinical symptoms, pathophysiology, and current treatments for the disease. The review explains narcolepsy according to the theory of TCM. The authors review the curative effect, pharmacological properties, and clinical results of herbs and prescriptions against narcolepsy. The study searched keywords such as ‘narcolepsy,' ‘Traditional Chinese medicine,' ‘sleep disorder,' ‘excessive sleepiness,' and ‘medicinal treatment' using databases such as CNKI, PubMed, and Google Scholar. Based on the analysis of data obtained from 110 articles, the authors have classified the herbs and prescriptions by their curative effects, following the theory of traditional Chinese medicine. Some herbs can be used alone, while others can use in conjunction with other prescriptions.
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Affiliation(s)
- Yap Lay Chin
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Kho Boon Seng
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - How Yng Ye
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Poo Rou En
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | | | - Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Qian Linchao
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Teoh Peryen
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Koh Yong Qi
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Lim Ye Jun
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Ooi Yin Cheah
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
| | - Tee Niam Chi
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Malaysia
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Sener ZE, Marakoglu K, Sener S. Evaluation of Excessive Daytime Sleepiness, Anxiety and Depression Symptomatologies in Obesity. EURASIAN JOURNAL OF FAMILY MEDICINE 2022. [DOI: 10.33880/ejfm.2022110403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aim: In this study, it was aimed to evaluate the excessive daytime sleepiness, anxiety and depression symptomatology in normal-weight, overweight and obese individuals.
Methods: In the study, 605 people who applied to the family medicine outpatient clinic between 2020 November 25 and 2021 March 5 were included. The questionnaire form evaluating the sociodemographic characteristics of the participants, the Hospital Anxiety and Depression Scale and the Epworth Sleepiness Scale were administered using a face-to-face interview technique.
Results: Overweight status in primary school, high school/adolescence, and university/twenties were higher in obese than in overweight. Additionally, it was higher in overweight than in normal weight. The risk of being overweight was 2.19 times higher and the risk of being obese was 6.07 times higher than those with obesity in their family compared to those who did not. Excessive daytime sleepiness was 2.95 times higher in obese than in normal weight. Anxiety symptoms were 1.97 times higher in obese than in normal weight. Depression symptoms were 2.77 times more in overweight and 2.99 times more in obese compared to normal-weight individuals.
Conclusion: As a result of this study, it was revealed that excessive daytime sleepiness, anxiety and depression symptomatologies are more common in obese compared to normal weight.
Keywords: obesity, overweight, depression, anxiety, disorders of excessive somnolence
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Mirawati DK, Sari ND, Hutabarat EAJ, Hambarsari Y, Prabaningtyas HR, Budianto P, Hafizhan M, Putra SE. Correlating excessive daytime sleepiness with body mass index, waist circumference, and lipid profile in shift workers. Saudi Med J 2022; 43:1234-1239. [PMID: 36379541 PMCID: PMC10043919 DOI: 10.15537/smj.2022.43.11.20220529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To determine the correlation between excessive daytime sleepiness and body mass index, waist circumference, and lipid profile of shift workers at Dr. Moewardi General Hospital, Surakarta. METHODS This cross-sectional study was carried out at the Dr. Moewardi Hospital, Surakarta, Indonesia between October 2018 and July 2019. The participants were recruited using purposive sampling. Multiple linear regression with backward elimination was performed to identify the odds ratios between Epworth Sleepiness Scale scores, anthropometric measurements, and lipid profiles. A p-value of <0.05 indicated statistically significant correlations. RESULTS Of the 150 included participants, 127 (84.67%) were women. Statistical analyses revealed odds ratios of 2.38 (95% confidence interval [CI] 1.14-4.89, p=0.000) for daytime sleepiness severity and total cholesterol levels, and 2.45 (95% CI 1.36-4.98, p=0.020) for daytime sleepiness severity and high-density lipoprotein levels. CONCLUSION Increased total cholesterol and decreased high-density lipoprotein levels increase the risk of excessive daytime sleepiness in shift workers.
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Affiliation(s)
- Diah Kurnia Mirawati
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
| | - Naomi Ditya Sari
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
| | - Ervina Arta Jayanti Hutabarat
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
| | - Yetty Hambarsari
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
| | - Hanindia Riani Prabaningtyas
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
| | - Pepi Budianto
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
| | - Muhammad Hafizhan
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
| | - Stefanus Erdana Putra
- From the Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
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Leonel LDS, Tozetto WR, Delevatti RS, Del Duca GF. Effects of Combined Training With Linear Periodization and Non-Periodization on Sleep Quality of Adults With Obesity. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2022; 93:171-179. [PMID: 32960160 DOI: 10.1080/02701367.2020.1817294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Background: Combined exercise training has proven effective in preventing and treating sleep disorders among obese adults. However, structured progression of intensity in sleep parameters remains poorly investigated within this population. Purpose: To verify the effects of non-periodized and linear periodization combined training on the sleep quality of obese adults. Methods: This was a randomized controlled trial involving adults with body mass index ≥ 30 kg/m2, allocated to 3 groups: control (CG; n = 13), non-periodized training (NG; n = 9), and with linear periodization (PG; n = 13). Groups PG and NG trained for 16 weeks in 3 weekly sessions lasting of 60 minutes. The NG trained in 50-59% heart rate reserve (HRR) e 2 × 10-12 repetition maximum (RM) and the PG with progression in 3 mesocycles: 40-49%;50-59%; 60-69% HRR e 2x12-14; 2x10-12; 2 × 8-10 RM, with the total volume equated. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index. For statistics, we used Generalized Estimation Equations considering p ≤ 0.05. Results: Sleep latency was reduced in both training groups after intervention (NG-Δ = -25.56 minutes p = .028; PG-Δ = -22.23 minutes p = .035), while significant improvements in sleep efficiency were found only in the NG (Δ = 20.67%; p = .042). Conclusion: Despite the NG's apparent superiority, which model has the best sleep effects on obese adults cannot be stated. Hence, caution is needed while extrapolating the results.
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Pallangyo P, Mgopa LR, Mkojera Z, Komba M, Millinga J, Misidai N, Swai HJ, Mayala H, Bhalia S, Wibonela S, Janabi M. Obstructive sleep apnea and associated factors among hypertensive patients attending a tertiary cardiac center in Tanzania: a comparative cross-sectional study. SLEEP SCIENCE AND PRACTICE 2021. [DOI: 10.1186/s41606-021-00069-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
There is mounting evidence for a reciprocal yet bidirectional association between sleep-disordered breathing and hypertension. Obstructive sleep apnea (OSA), a common cause of systemic hypertension is an independent risk factor for hypertension-related cardiovascular morbidity and mortality. In this comparative hospital-based cross-sectional study, we sought to explore the burden of obstructive sleep apnea and its associated risk factors among hypertensive patients attending Jakaya Kikwete Cardiac Institute.
Methodology
A total of 1974 individuals (i.e. 1289 hypertensive and 685 normotensives) were consecutively enrolled in this study. The Berlin questionnaire and Epworth Sleepiness Scale were utilized in the assessment of OSA and excessive daytime sleepiness (EDS) respectively. Logistic regression analyses were employed in the determination of associated factors for OSA.
Results
The mean age was 53.4 years and females constituted the large majority (60.4%) of participants. About three quarters (74.1%) of participants had excess body weight, 11.6% had diabetes, 8.0% had asthma and 18.6% had history of recurrent nasal congestion. Positive family history of snoring was reported by 43.1% of participants and 36.9% had a personal history of snoring. Persons with hypertension displayed a higher frequency (42.1%) of OSA compared to their normotensive counterparts (11.8%), p < 0.001. Multivariate logistic regression analyses revealed hypertension (OR 5.1, 95% CI 3.2-8.2, p < 0.001), diabetes mellitus (OR 2.2, 95% CI 1.3-3.5, p < 0.01), chronic nasal congestion (OR 1.6, 95% CI 1.1-2.5, p = 0.01), obesity (OR 2.4, 95% CI 1.8-3.3, p < 0.001), increased neck circumference (OR 2.7, 95% CI 1.2-6.4, p = 0.02), family history of snoring (OR 5.5, 95% CI 4.0-7.5, p < 0.001), and working > 8 h/24 h (OR 0.6, 95% CI 0.4-1.0, p = 0.03) to have an independent association for OSA. Furthermore, participants with hypertension displayed superior odds for OSA compared to their normotensive counterparts across all subgroup analyses.
Conclusion
OSA is considerably common among patients with hypertension in a tertiary health care setting in Tanzania. Positive family history of snoring was the strongest associated factor; however, excess body weight proved to be the strongest modifiable risk factor. In view of its pervasiveness, OSA should be an integral part of the medical evaluation in hypertensive individuals.
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Conradt R, Redhardt F, Beutel B, Hildebrandt O, Cassel W, Kesper K, Koehler J, Hildebrandt W, Koehler U. Predisposing factors of daytime sleepiness in obese OSA patients. J Sleep Res 2021; 31:e13458. [PMID: 34363265 DOI: 10.1111/jsr.13458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022]
Abstract
Excessive daytime sleepiness is a common symptom in obese patients with obstructive sleep apnea. We investigated predisposing factors of excessive daytime sleepiness by comparing obese non-sleepy with sleepy patients with obstructive sleep apnea. Excessive daytime sleepiness was determined by the Epworth Sleepiness Scale in 43 patients (34 men and 9 women) with obstructive sleep apnea (apnea-hypopnea index ≥ 15 events per hr) and obesity (body mass index ≥ 30 kg m-2 ). Two subgroups were formed with (Epworth Sleepiness Scale ≥ 11) and without (Epworth Sleepiness Scale < 11) excessive daytime sleepiness. The concept of excessive daytime sleepiness was compared with other established daytime performance tests (Stanford Sleepiness Scale, Multiple Sleep Latency Test, Pupillographic Sleepiness Test, Marburger Vigilance test). Associations were calculated between excessive daytime sleepiness and demographic, metabolic and polysomnographic data. We included 19 sleepy patients (mean Epworth Sleepiness Scale score 15.2) and 24 non-sleepy patients (mean Epworth Sleepiness Scale score 5.8). Epworth Sleepiness Scale was negatively correlated with age and morning cortisol. Epworth Sleepiness Scale was positively correlated with body mass index, Stanford Sleepiness Scale, Beck's Depression Inventory and Marburger Vigilance test. Sleepy obese patients were significantly younger (mean 49.1 years), showed lower morning cortisol level (mean 9.41 μg L-1 ) and a trend to higher body mass index (mean 37.5 kg m- ²) compared with non-sleepy obese patients (mean: 59.3 years, 5.7 μg L-1 , 34.6 kg m- ², respectively). Many different excessive daytime sleepiness phenotypes are probably enclosed in obese patients with obstructive sleep apnea. Epworth Sleepiness Scale scores were best reflected by the objective Marburger Vigilance test results. The objective test can be particularly useful in cohorts where subjective reports are unreliable and operational readiness is paramount. Sleepy and non-sleepy obese patients with obstructive sleep apnea were similar in all polysomnographic parameters. Sleepy patients were younger, heavier and showed lower morning cortisol levels than non-sleepy patients.
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Affiliation(s)
- Regina Conradt
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
| | - Felicitas Redhardt
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
| | - Björn Beutel
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
| | - Olaf Hildebrandt
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
| | - Werner Cassel
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
| | - Karl Kesper
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
| | - Julian Koehler
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
| | - Wulf Hildebrandt
- Department of Medical Cell Biology, Institute for Anatomy and Cell Biology, Philipps-University of Marburg, Marburg, Germany
| | - Ulrich Koehler
- Division of Pneumology, Department of Sleep Medicine, Internal Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany
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Abstract
Drowsiness and fatigue are major safety issues that cannot be measured directly. Their measurements are sustained on indirect parameters such as the effects on driving performance, changes in physiological states, and subjective measures. We divided this study into two distinct lines. First, we wanted to find if any driver’s physiological characteristic, habit, or recent event could interfere with the results. Second, we aimed to analyze the effects of subjective sleepiness on driving behavior. On driving simulator experiments, the driver information and driving performance were collected, and responses to the Karolinska Sleepiness Scale (KSS) were compared with these parameters. The results showed that drowsiness increases when the driver has suffered a recent stress situation, has taken medication, or has slept fewer hours. An increasing driving time is also a strong factor in drowsiness development. On the other hand, robustness, smoking habits, being older, and being a man were revealed to be factors that make the participant less prone to getting drowsy. From another point of view, the speed and lane departures increased with the sleepiness feeling. Subjective drowsiness has a great correlation to drivers’ personal aspects and the driving behavior. In addition, the KSS shows a great potential to be used as a predictor of drowsiness.
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van der Spuy I, Karunanayake CP, Dosman JA, McMullin K, Zhao G, Abonyi S, Rennie DC, Lawson J, Kirychuk S, MacDonald J, Jimmy L, Koehncke N, Ramsden VR, Fenton M, Marchildon GP, King M, Pahwa P. Determinants of excessive daytime sleepiness in two First Nation communities. BMC Pulm Med 2017; 17:192. [PMID: 29233159 PMCID: PMC5726026 DOI: 10.1186/s12890-017-0536-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/29/2017] [Indexed: 12/27/2022] Open
Abstract
Background Excessive daytime sleepiness may be determined by a number of factors including personal characteristics, co-morbidities and socio-economic conditions. In this study we identified factors associated with excessive daytime sleepiness in 2 First Nation communities in rural Saskatchewan. Methods Data for this study were from a 2012–13 baseline assessment of the First Nations Lung Health Project, in collaboration between two Cree First Nation reserve communities in Saskatchewan and researchers at the University of Saskatchewan. Community research assistants conducted the assessments in two stages. In the first stage, brochures describing the purpose and nature of the project were distributed on a house by house basis. In the second stage, all individuals age 17 years and older not attending school in the participating communities were invited to the local health care center to participate in interviewer-administered questionnaires and clinical assessments. Excessive daytime sleepiness was defined as Epworth Sleepiness Scale score > 10. Results Of 874 persons studied, 829 had valid Epworth Sleepiness Scale scores. Of these, 91(11.0%) had excessive daytime sleepiness; 12.4% in women and 9.6% in men. Multivariate logistic regression analysis indicated that respiratory comorbidities, environmental exposures and loud snoring were significantly associated with excessive daytime sleepiness. Conclusions Excessive daytime sleepiness in First Nations peoples living on reserves in rural Saskatchewan is associated with factors related to respiratory co-morbidities, conditions of poverty, and loud snoring.
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Affiliation(s)
- Ina van der Spuy
- School of Physical Therapy, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Chandima P Karunanayake
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - James A Dosman
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Kathleen McMullin
- First Nations University of Canada, Prince Albert Campus, 1301 Central Avenue, Prince Albert, SK, S6V 4W1, Canada
| | - Gaungming Zhao
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Sylvia Abonyi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Donna C Rennie
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Joshua Lawson
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Shelley Kirychuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | | | - Laurie Jimmy
- Community B, Montreal Lake, Saskatoon, SK, Canada
| | - Niels Koehncke
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, West Winds Primary Health Centre, 3311 Fairlight Drive, Saskatoon, SK, S7M 3Y5, Canada
| | - Mark Fenton
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Gregory P Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Suite 425, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Malcolm King
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Punam Pahwa
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada. .,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
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