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Chartier MJ, Brownell M, Star L, Murdock N, Campbell R, Phillips-Beck W, Horton M, Meade C, Au W, Schultz J, Bowes JM, Cochrane B. The Mental Health of First Nations Children in Manitoba: A Population-Based Retrospective Cohort Study Using Linked Administrative Data: La santé mentale des enfants des Premières Nations au Manitoba : une étude de cohorte rétrospective dans la population, à l'aide de données administratives liées. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:404-414. [PMID: 38343025 PMCID: PMC11107444 DOI: 10.1177/07067437241226998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2024]
Abstract
OBJECTIVE First Nations children face a greater risk of experiencing mental disorders than other children from the general population because of family and societal factors, yet there is little research examining their mental health. This study compares diagnosed mental disorders and suicidal behaviours of First Nations children living on-reserve and off-reserve to all other children living in Manitoba. METHOD The research team, which included First Nations and non-First Nations researchers, utilized population-based administrative data that linked de-identified individual-level records from the 2016 First Nations Research File to health and social information for children living in Manitoba. Adjusted rates and rate ratios of mental disorders and suicide behaviours were calculated using a generalized linear modelling approach to compare First Nations children (n = 40,574) and all other children (n = 197,109) and comparing First Nations children living on- and off-reserve. RESULTS Compared with all other children, First Nations children had a higher prevalence of schizophrenia (adjusted rate ratio (aRR): 4.42, 95% confidence interval (CI), 3.36 to 5.82), attention-deficit hyperactivity disorder (ADHD; aRR: 1.21, 95% CI, 1.09 to 1.33), substance use disorders (aRR: 5.19; 95% CI, 4.25 to 6.33), hospitalizations for suicide attempts (aRR: 6.96; 95% CI, 4.36 to 11.13) and suicide deaths (aRR: 10.63; 95% CI, 7.08 to 15.95). The prevalence of ADHD and mood/anxiety disorders was significantly higher for First Nations children living off-reserve compared with on-reserve; in contrast, hospitalization rates for suicide attempts were twice as high on-reserve than off-reserve. When the comparison cohort was restricted to only other children in low-income areas, a higher prevalence of almost all disorders remained for First Nations children. CONCLUSION Large disparities were found in mental health indicators between First Nations children and other children in Manitoba, demonstrating that considerable work is required to improve the mental well-being of First Nations children. Equitable access to culturally safe services is urgently needed and these services should be self-determined, planned, and implemented by First Nations people.
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Affiliation(s)
- Mariette J Chartier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Leona Star
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Nora Murdock
- Manitoba First Nations Education Resource Centre, Winnipeg, Canada
| | - Rhonda Campbell
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Mabel Horton
- Advisory Working Group, First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Chelsey Meade
- Manitoba First Nations Education Resource Centre, Winnipeg, Canada
| | - Wendy Au
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Jennifer Schultz
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - John-Michael Bowes
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Brooke Cochrane
- College of Medicine, Rady Faculty of Health Sciences, University of Manitoba. Winnipeg, Canada
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Kraut A, Rydz E, Walld R, Demers PA, Peters CE. Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System. Am J Ind Med 2024; 67:243-260. [PMID: 38265110 DOI: 10.1002/ajim.23566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. METHODS We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. RESULTS A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. CONCLUSIONS The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.
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Affiliation(s)
- Allen Kraut
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Rydz
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl E Peters
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
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Levy AR, Stock D, Paterson JM, Tamim H, Chateau D, Quail J, Ronksley PE, Carney G, Reynier P, Targownik L. Prescription ranitidine use and population exposure in 6 Canadian provinces, 1996 to 2019: a serial cross-sectional analysis. CMAJ Open 2023; 11:E1033-E1040. [PMID: 37935487 PMCID: PMC10635705 DOI: 10.9778/cmajo.20220131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Ranitidine was the most prescribed histamine-2 receptor antagonist (H2RA) in Canada when recalled in 2019 because of potential carcinogenicity. We sought to compare geographic and temporal patterns in use of prescription ranitidine and 3 other HRAs and estimated population exposure to ranitidine in 6 provinces between 1996 and 2019. METHODS This population-based serial cross-sectional study used prescription claims for H2RAs dispensed from community pharmacies in Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia. We estimated the period prevalence of ranitidine use per 100 population by province, age category and sex. We estimated exposure to ranitidine between 2015 and 2019 using defined daily doses (DDDs). RESULTS Overall, 2.4 million ranitidine prescriptions were dispensed to patients aged 65 years and older, and 1.7 million were dispensed to younger adults. Among older adults, the median period prevalence of ranitidine use among females was 16% (interquartile range [IQR] 13%-27%) higher than among males. Among younger adults, the median prevalence was 50% (IQR 37%-70%) higher among females. Among older adults, between 1996 and 1999, use was highest in Nova Scotia (33%) and Ontario (30%), lower in the prairies (Manitoba [18%], Saskatchewan [26%], Alberta [17%]) and lowest in BC (11%). By 2015-2019, use of ranitidine among older adults dropped by at least 50% in all provinces except BC. We estimate that at least 142 million DDDs of prescribed ranitidine were consumed annually in 6 provinces (2015-2019). INTERPRETATION Over the 24-year period in 6 provinces, patients aged 65 years and older were dispensed 2.4 million prescriptions of ranitidine and younger adults were dispensed 1.7 million prescriptions of ranitidine. These estimates of ranitidine exposure can be used for planning studies of cancer risk and identifying target populations for cancer surveillance.
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Affiliation(s)
- Adrian R Levy
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont.
| | - David Stock
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - J Michael Paterson
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - Hala Tamim
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - Dan Chateau
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - Jacqueline Quail
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - Paul E Ronksley
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - Greg Carney
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - Pauline Reynier
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
| | - Laura Targownik
- Department of Community Health and Epidemiology (Levy, Stock), Dalhousie University, Halifax, NS; ICES (Paterson); York University (Tamim), Toronto, Ont.; National Centre for Epidemiology and Population Health (Chateau), College of Health & Medicine, Australian National University, Canberra, AU; Health Quality Council (Quail), Saskatoon, Sask.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Therapeutics Initiative (Carney), University of British Columbia, Vancouver, BC; Lady Davis Institute (Reynier), Jewish General Hospital, Montréal, Que.; Department of Medicine (Targownik), University of Toronto, Toronto, Ont
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Antonova L, Somayaji C, Cameron J, Sirski M, Sundaram ME, McDonald JT, Mishra S, Kwong JC, Katz A, Baral S, Caulley L, Calzavara A, Corsten M, Johnson-Obaseki S. Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis. PLoS One 2023; 18:e0289292. [PMID: 37611032 PMCID: PMC10446177 DOI: 10.1371/journal.pone.0289292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The effects of the COVID-19 pandemic have been more pronounced for socially disadvantaged populations. We sought to determine how access to SARS-CoV-2 testing and the likelihood of testing positive for COVID-19 were associated with demographic factors, socioeconomic status (SES) and social determinants of health (SDH) in three Canadian provinces. METHODS An observational population-based cross-sectional study was conducted for the provinces of Ontario, Manitoba and New Brunswick between March 1, 2020 and April 27, 2021, using provincial health administrative data. After excluding residents of long-term care homes, those without current provincial health insurance and those who were tested for COVID-19 out of province, records from provincial healthcare administrative databases were reviewed for 16,900,661 healthcare users. Data was modelled separately for each province in accordance to a prespecified protocol and follow-up consultations among provincial statisticians and collaborators. We employed univariate and multivariate regression models to examine determinants of testing and test results. RESULTS After adjustment for other variables, female sex and urban residency were positively associated with testing, while female sex was negatively associated with test positivity. In New Brunswick and Ontario, individuals living in higher income areas were more likely to be tested, whereas in Manitoba higher income was negatively associated with both testing and positivity. High ethnocultural composition was associated with lower testing rates. Both high ethnocultural composition and high situational vulnerability increased the odds of testing positive for SARS-CoV-2. DISCUSSION We observed that multiple demographic, income and SDH factors were associated with SARS-CoV-2 testing and test positivity. Barriers to healthcare access identified in this study specifically relate to COVID-19 testing but may reflect broader inequities for certain at-risk groups.
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Affiliation(s)
- Lilia Antonova
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Chandy Somayaji
- New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB, Canada
| | - Jillian Cameron
- New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB, Canada
| | - Monica Sirski
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Maria E. Sundaram
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, United States of America
- ICES, Toronto, ON, Canada
| | - James Ted McDonald
- Department of Political Science, University of New Brunswick, Fredericton, NB, Canada
| | - Sharmistha Mishra
- ICES, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- MAP Center for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jeffrey C. Kwong
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, United States of America
| | - Lisa Caulley
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Martin Corsten
- Division of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Russell K, Walld R, Bolton JM, Chateau D, Ellis MJ. Incidence of Subsequent Mental Health Disorders and Social Adversity Following Pediatric Concussion: A Longitudinal, Population-Based Study. J Pediatr 2023; 259:113436. [PMID: 37088182 DOI: 10.1016/j.jpeds.2023.113436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To determine the long-term risk of new adverse psychosocial outcomes among adolescents diagnosed with a concussion compared with those not diagnosed. STUDY DESIGN A retrospective, population-based cohort study was conducted. Adolescents (10-18 years) with a physician-diagnosed concussion between 2000 and 2005 were matched on neighborhood and age with 5 controls without concussion from the general population. New-onset mental health disorders, medication use, social, and justice outcomes were extracted using datasets linked to the population data repository. Adolescents were followed for 11-16 years. Adjusted hazard ratios (95% CIs) were estimated. RESULTS In total, 2082 adolescents with a concussion were matched to 10 510 without. Adolescents with a concussion had an increased risk of any mental health disorder (HR 1.34; 95% CI 1.25-1.45), mood disorder (HR 1.30; 95% 1.18-1.43), psychosis (HR 1.43; 95% CI 1.18-1.74), substance abuse disorder (HR 1.67; 95% 1.31-2.14), and receiving a psychotropic prescription (HR 1.31; 95% CI 1.20-1.42). Female adolescents had an increased risk of ADHD following concussion (HR 1.89; 95% CI 1.17-3.05). Adolescents with a concussion had an increased risk of being accused (HR 1.22; 95% CI 1.11-1.34), victim (HR 1.29; 95% CI 1.11-1.48), or witness (HR 1.16; 95% CI 1.01-1.32) of a crime, or contact with Child and Family Services (HR 1.33; 95% CI 1.10-1.62). There was no association between concussion and attempting or completing suicide, receiving housing support, or collecting income support. CONCLUSIONS Concussion was associated with an increased risk for multiple adverse psychosocial outcomes. Future work should focus on early identification of those at risk of these outcomes to help optimize longitudinal medical care and support.
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Affiliation(s)
- Kelly Russell
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Excellence in Neurodevelopment and Rehabilitation Research in Child Health Research Theme - Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
| | - Randy Walld
- Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel Chateau
- Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Michael J Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada; Pan Am Concussion Program, Winnipeg, Manitoba, Canada
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Kraut A, Peters CE, Rydz E, Walld R. Acute myocardial infarctions identified in the Manitoba Occupational Disease Surveillance System: A linkage of worker's compensation and provincial health data. Am J Ind Med 2023; 66:679-686. [PMID: 37249122 DOI: 10.1002/ajim.23505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The purpose of this study was to identify jobs and industries that may be associated with increased or decreased risk of myocardial infarction. METHODS We linked provincial health care data with Workers Compensation Board (WCB) of Manitoba claims data to create the Manitoba Occupational Disease Surveillance System (MODSS). Workers were eligible for inclusion in this study if their WCB claim listed an occupation, their claim could be linked to health data, they had an accepted non-acute myocardial infarction (AMI) compensation time loss claim and were free of a recent (<1 year) AMI diagnosis at the start of disease follow-up. AMI cases were identified as the most-responsible diagnosis in the hospitalization file (ICD-9 410 or ICD-10 I20). Cases were included if they occurred after the WCB record injury date until end of coverage, either through moving out of province, reaching age 65, death, or the end of the study period (March 1, 2020). RESULTS We identified 1880 incident AMIs amongst 150,022 claims recorded in the MODSS (1.25%). A number of industries and occupations were found to have higher and lower AMI rates. Care providers and educational, legal, and public protection support occupations had a lower hazard ratio (HR; 0.64; 95% confidence interval [CI]: 0.44-0.92) compared to the overall cohort. Female chefs and cooks, and male butchers and bakers had elevated AMI HRs. Both male and female transport and heavy equipment operators and related maintenance occupations had increased HRs (1.48; 95% CI: 1.30-1.67). Often male and female workers employed in the same occupations had congruent AMI risks, but this was not always the case. CONCLUSIONS The linkage of a WCB data set with provincial health claims data led to the identification of a number of occupations with elevated risks of AMI in Manitoba. This was most notable in the transportation industry. Identifying work areas with increased risk of AMIs could lead to targeted educational efforts and potential workplace modifications to lower this risk.
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Affiliation(s)
- Allen Kraut
- Departments of Internal Medicine and Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cheryl E Peters
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ela Rydz
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Randy Walld
- Manitoba Center for Health Policy, Winnipeg, Manitoba, Canada
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Wall-Wieler E, Bolton JM, Detillieux G, Roos LL. Use of Medication to Treat Attention-Deficit/Hyperactivity Disorder in Young Children: The Role of Maternal History of Psychotropic Medication Use. Child Psychiatry Hum Dev 2023; 54:283-289. [PMID: 34524582 DOI: 10.1007/s10578-021-01247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
We examine whether, among children diagnosed with ADHD, are those whose mothers have a history of psychotropic medication use more likely to treat their ADHD with medication? Children born in Manitoba, Canada from 2000 to 2010 diagnosed with ADHD between their 4th and 8th birthday. Maternal psychotropic medication use was assessed from one year before the child's birth to the child's fourth birthday. Logistic regression models examine the relationship between maternal history of psychotropic medication use and the use of medication to treat ADHD in children. Among the 2384 children diagnosed with ADHD, the rate of ADHD medication use was higher for those whose mother had a history of psychotropic medication use (76.6%) than for those whose mothers did not (72.5%) (OR 1.24, 95% CI 1.03, 1.49). Children whose mothers have a history of psychotropic medication use are more likely to have their ADHD treated with medication.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada.
| | - James M Bolton
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Gilles Detillieux
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
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Jakubowski A, Roos LL, Wall-Wieler E. Unwinding the tangle of adolescent pregnancy and socio-economic functioning: leveraging administrative data from Manitoba, Canada. BMC Pregnancy Childbirth 2023; 23:140. [PMID: 36870979 PMCID: PMC9985199 DOI: 10.1186/s12884-023-05443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Understanding the relationship between adolescent pregnancy and adult education and employment outcomes is complicated due to the endogeneity of fertility behaviors and socio-economic functioning. Studies exploring adolescent pregnancy have often relied on limited data to measure adolescent pregnancy (i.e. birth during adolescence or self-reports) and lack access to objective measures of school performance during childhood. METHODS We use rich administrative data from Manitoba, Canada, to assess women's functioning during childhood (including pre-pregnancy academic performance), fertility behaviors during adolescence (live birth, abortion, pregnancy loss, or no history of pregnancy), and adult outcomes of high school completion and receipt of income assistance. This rich set of covariates allows calculating propensity score weights to help adjust for characteristics possibly predictive of adolescent pregnancy. We also explore which risk factors are associated with the study outcomes. RESULTS We assessed a cohort of 65,732 women, of whom 93.5% had no teen pregnancy, 3.8% had a live birth, 2.6% had abortion, and < 1% had a pregnancy loss. Women with a history of adolescent pregnancy were less likely to complete high school regardless of the outcome of that pregnancy. The probability of dropping out of high school was 7.5% for women with no history of adolescent pregnancy; after adjusting for individual, household, and neighborhood characteristics, the probability of dropping out of high school was 14.2 percentage points (pp) higher (95% CI 12.0-16.5) for women with live birth, 7.6 pp. higher (95% CI 1.5-13.7) for women with a pregnancy loss, and 6.9 pp. higher (95% CI 5.2-8.6) for women who had abortion. They key risk factors for never completing high school are poor or average school performance in 9th grade. Women who had a live births during adolescence were much more likely to receive income assistance than any other group in the sample. Aside from poor school performance, growing up in poor households and in poor neighborhoods were also highly predictive of receiving income assistance during adulthood. DISCUSSION The administrative data used in this study enabled us to assess the relationship between adolescent pregnancy and adult outcomes after controlling for a rich set of individual-, household-, and neighborhood-level characteristics. Adolescent pregnancy was associated with higher risk of never completing high school regardless of the pregnancy outcome. Receipt of income assistance was significantly higher for women having a live birth, but only marginally higher for those who had a pregnancy that ended in loss or termination, underlining the harsh economic consequences of caring for a child as a young mother. Our data suggest that interventions targeting young women with poor or average school marks may be especially effective public policy priorities.
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Affiliation(s)
- Aleksandra Jakubowski
- Department of Health Sciences, Department of Economics, Northeastern University, Boston, MA, USA
| | - Leslie L Roos
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
| | - Elizabeth Wall-Wieler
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.
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9
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Bell MF, Glauert R, Roos LL, Wall-Wieler E. Examining the relationship between maternal mental health-related hospital admissions and childhood developmental vulnerability at school entry in Canada and Australia. BJPsych Open 2023; 9:e29. [PMID: 36715086 PMCID: PMC9970171 DOI: 10.1192/bjo.2022.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND It is well established that maternal mental illness is associated with an increased risk of poor development for children. However, inconsistencies in findings regarding the nature of the difficulties children experience may be explained by methodological or geographical differences. AIMS We used a common methodological approach to compare developmental vulnerability for children whose mothers did and did not have a psychiatric hospital admission between conception and school entry in Manitoba, Canada, and Western Australia, Australia. We aimed to determine if there are common patterns to the type and timing of developmental difficulties across the two settings. METHOD Participants included children who were assessed with the Early Development Instrument in Manitoba, Canada (n = 69 785), and Western Australia, Australia (n = 19 529). We examined any maternal psychiatric hospital admission (obtained from administrative data) between conception and child's school entry, as well as at specific time points (pregnancy and each year until school entry). RESULTS Log-binomial regressions modelled the risk of children of mothers with psychiatric hospital admissions being developmentally vulnerable. In both Manitoba and Western Australia, an increased risk of developmental vulnerability on all domains was found. Children had an increased risk of developmental vulnerability regardless of their age at the time their mother was admitted to hospital. CONCLUSIONS This cross-national comparison provides further evidence of an increased risk of developmental vulnerability for children whose mothers experience severe mental health difficulties. Provision of preventative services during early childhood to children whose mothers experience mental ill health may help to mitigate developmental difficulties at school entry.
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Affiliation(s)
- Megan F Bell
- School of Population and Global Health, University of Western Australia, Western Australia; School of Psychological Science, University of Western Australia, Western Australia; and Telethon Kids Institute, University of Western Australia, Western Australia
| | - Rebecca Glauert
- School of Population and Global Health, University of Western Australia, Western Australia; and Telethon Kids Institute, University of Western Australia, Western Australia
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Canada
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10
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Nickel NC, Enns JE, Freier A, McCulloch SC, Chartier M, Casidsid HJM, Balogun OD, Mulhall D, Dragan R, Sarkar J, Bolton J, Konrad G, Phillips-Beck W, Sanguins J, Shimmin C, McDonald N, Mignone J, Hinds A. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open 2022; 12:e062127. [PMID: 36261234 PMCID: PMC9582321 DOI: 10.1136/bmjopen-2022-062127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological complications such as psychosis. National survey data point to increasing rates of methamphetamine use, as well as increasing ease of access and serious methamphetamine-related harms. There is an urgent need for evidence to address knowledge gaps, provide direction to harm reduction and treatment efforts and inform health and social policies for people using methamphetamine. This protocol describes a study that aims to address this need for evidence. METHODS The study will use linked, whole population, de-identified administrative data from the Manitoba Population Research Data Repository. The cohort will include individuals in the city of Winnipeg, Manitoba, who came into contact with the health system for reasons related to methamphetamine use from 2013 to 2021 and a comparison group matched on age, sex and geography. We will describe the cohort's sociodemographic characteristics, calculate incidence and prevalence of mental disorders associated with methamphetamine use and examine rates of health and social service use. We will evaluate the use of olanzapine pharmacotherapy in reducing adverse emergency department outcomes. In partnership with Indigenous co-investigators, outcomes will be stratified by First Nations and Métis identity. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board, and access datasets have been granted by all data providers. We also received approval from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Métis Federation. Dissemination will be guided by an 'Evidence 2 Action' group of public rightsholders, service providers and knowledge users who will ensure that the analyses address the critical issues.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Freier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott C McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hera J M Casidsid
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Drew Mulhall
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Javier Mignone
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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11
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Shafer LA, Shaffer S, Witt J, Nugent Z, Bernstein CN. IBD Disability Index Is Associated With Both Direct and Indirect Costs of Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1189-1197. [PMID: 34636400 DOI: 10.1093/ibd/izab248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We aimed to determine both direct (medical) and indirect (lost wages) costs of IBD and the association between the degree of IBD-related disability and extent of IBD-related costs. METHODS Persons age 18-65 from the population-based University of Manitoba IBD Research Registry completed a survey including the IBD Disability Index (IBDDI) and questions related to employment, missed work (absenteeism), and reduced productivity at work (presenteeism). Administrative health data including surgeries, hospitalizations, physician claims, and prescriptions were linked to the survey and assessed. To calculate annual wage loss, number of days of missed work was multiplied by the average wage in Manitoba for the given occupation per Statistics Canada. Costs were adjusted to 2016-17 Canadian dollars. Using descriptive and regression analysis, we explored the association between IBDDI and annual direct and indirect costs associated with IBD. RESULTS Average annual medical costs rose from $1918 among those with IBDDI 0-4 to $9,993 among those with IBDDI 80-86. Average annual cost of lost work rose from $0 among those with IBDDI 0-4 to $30,101 among those with IBDDI 80-86. Using linear regression, each additional unit of IBDDI was associated with an increase of $77 in annual medical cost (95% CI, $52-102; P < .001) and an increase of $341 in annual cost of lost wages (95% CI, $288-395; P < .001). CONCLUSIONS Costs related to IBD are significantly associated with the degree of IBD-related disability. Among the approximate 30% of the IBD population with IBDDI scores ≥40, the indirect costs of absenteeism and presenteeism accounts for ~75% of the total IBD-related costs.
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Affiliation(s)
- Leigh Anne Shafer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada
| | - Seth Shaffer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada
| | - Julia Witt
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada.,Department of Economics, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zoann Nugent
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada.,Cancercare Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada
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12
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Garland A, Marrie RA, Wunsch H, Yogendran M, Chateau D. Administrative Data Is Insufficient to Identify Near-Future Critical Illness: A Population-Based Retrospective Cohort Study. FRONTIERS IN EPIDEMIOLOGY 2022; 2:944216. [PMID: 38455278 PMCID: PMC10910992 DOI: 10.3389/fepid.2022.944216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/13/2022] [Indexed: 03/09/2024]
Abstract
Background Prediction of future critical illness could render it practical to test interventions seeking to avoid or delay the coming event. Objective Identify adults having >33% probability of near-future critical illness. Research Design Retrospective cohort study, 2013-2015. Subjects Community-dwelling residents of Manitoba, Canada, aged 40-89 years. Measures The outcome was a near-future critical illness, defined as intensive care unit admission with invasive mechanical ventilation, or non-palliative death occurring 30-180 days after 1 April each year. By dividing the data into training and test cohorts, a Classification and Regression Tree analysis was used to identify subgroups with ≥33% probability of the outcome. We considered 72 predictors including sociodemographics, chronic conditions, frailty, and health care utilization. Sensitivity analysis used logistic regression methods. Results Approximately 0.38% of each yearly cohort experienced near-future critical illness. The optimal Tree identified 2,644 mutually exclusive subgroups. Socioeconomic status was the most influential variable, followed by nursing home residency and frailty; age was sixth. In the training data, the model performed well; 41 subgroups containing 493 subjects had ≥33% members who developed the outcome. However, in the test data, those subgroups contained 429 individuals, with 20 (4.7%) experiencing the outcome, which comprised 0.98% of all subjects with the outcome. While logistic regression showed less model overfitting, it likewise failed to achieve the stated objective. Conclusions High-fidelity prediction of near-future critical illness among community-dwelling adults was not successful using population-based administrative data. Additional research is needed to ascertain whether the inclusion of additional types of data can achieve this goal.
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Affiliation(s)
- Allan Garland
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Hannah Wunsch
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Marina Yogendran
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Daniel Chateau
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
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13
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Chartier MJ, Bolton JM, Ekuma O, Mota N, Hensel JM, Nie Y, McDougall C. Suicidal Risk and Adverse Social Outcomes in Adulthood Associated with Child and Adolescent Mental Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:512-523. [PMID: 34796744 PMCID: PMC9234896 DOI: 10.1177/07067437211055417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The life course of children and adolescents with mental disorders is an important area of investigation, yet it remains understudied. This study provides a first-ever comprehensive examination of the relationship between child and adolescent mental disorders and subsequent suicidal and adverse social outcomes in early adulthood using population-based data. METHODS De-identified administrative databases were used to create a birth cohort of 60,838 residents of Manitoba born between April 1980 to March 1985 who were followed until March 2015. Unadjusted and adjusted hazard ratios (aHRs) and odds ratios (aORs) were calculated to determine associations between physician-diagnosed mental disorders in childhood or adolescence and a range of adverse early adulthood (ages 18 to 35) outcomes. RESULTS Diagnoses of mood/anxiety disorders, attention-deficit hyperactivity disorder, substance use disorder, conduct disorder, psychotic disorder, personality disorders in childhood or adolescence were associated with having the same diagnoses in adulthood. These mental disorder diagnoses in childhood/adolescence were strongly associated with an increased risk of suicidal behaviors and adverse adult social outcomes in adulthood. Similarly, suicide attempts in adolescence conferred an increased risk in adulthood of suicide death (aHR: 3.6; 95% confidence interval [CI]: 1.9-6.9), suicide attempts (aHR: 6.2; CI: 5.0-7.6), social housing use (aHR: 1.7; CI 1.4-2.1), income assistance (aHR: 1.8; CI 1.6-2.1), criminal accusation (aHR: 2.2; CI 2.0-2.5), criminal victimization (aHR:2.5; CI 2.2-2.7), and not completing high school (aOR: 3.1; CI: 2.5-3.9). CONCLUSION Mental disorders diagnosed in childhood and adolescence are important risk factors not only for mental disorders in adulthood but also for a range of early adult adversity. These findings provide an evidence-based prognosis of children's long-term well-being and a rationale for ensuring timely access to mental health services. Better population-level mental health promotion and early intervention for children and adolescents with mental disorders are promising for improving future adult outcomes.
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Affiliation(s)
- Mariette J. Chartier
- Department of Community Health
Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Mariette J. Chartier PhD, Manitoba Centre
for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg,
Manitoba, R3E 3P5, Canada.
| | - James M. Bolton
- Department of Psychiatry and Community Health Sciences, Rady Faculty
of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Jennifer M. Hensel
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yao Nie
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Chelsey McDougall
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
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14
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Leong C, Kowalec K, Eltonsy S, Bolton JM, Enns MW, Tan Q, Yogendran M, Chateau D, Delaney JA, Sareen J, Falk J, Spiwak R, Logsetty S, Alessi-Severini S. Psychotropic Medication Use Before and During COVID-19: A Population-Wide Study. Front Pharmacol 2022; 13:886652. [PMID: 35571118 PMCID: PMC9092447 DOI: 10.3389/fphar.2022.886652] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic and public health measures that took place have led to concerns regarding mental health and receipt of psychotropic medications. We aimed to study the changes in psychotropic medication dispensation rates before and during the COVID-19 pandemic in the general population. Methods: Administrative health data from the Canadian province of Manitoba was used to describe the quarterly incidence and prevalence of antipsychotics, antidepressants, and anxiolytic/sedative-hypnotics from January 1, 2015 to December 31, 2020. Individuals who received at least one prescription within each quarter were considered exposed to the medication. The denominator was the total population within each quarter. Incidence was defined as no receipt of medication in the 3 years prior to the quarter of interest. Autoregression models for time series data plus indicator variables were used to compare each quarter of 2020 after public health measures were implemented in March 2020 in relation to the expected trend. Analyses were stratified by age and sex. Results: There were 1,394,885 individuals in the first quarter of 2020, with a mean (SD) age of 38.9 (23.4) years, 50.3% were female, and 36.1% had a psychiatric diagnosis in the previous 5 years. A significant decrease was observed for incident antidepressant use (p < 0.05 for both sexes and all age groups except for those 65 years and older) and anxiolytic use (p < 0.05 for both sexes and all age groups except 80 years and older) in the second quarter (April-June) of 2020 compared to the expected trend. Females and those aged 40 years and older had a significantly higher incidence of antidepressant and antipsychotic use in the final quarter of 2020 compared to the expected trend (p < 0.05). Conclusion: Our findings indicate a decrease in new prescriptions for antidepressants and anxiolytics in the 3 months after COVID-19 in-person restrictions were first implemented. We then observed an increase in the new use of antidepressants and antipsychotics at the end of 2020, in females and people aged 40 years and older, with the highest rates of use in the population 80 years and older.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kaarina Kowalec
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Murray W Enns
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Qier Tan
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marina Yogendran
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Joseph A Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Jamison Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Rae Spiwak
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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15
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Sanusi RA, Yan L, Hamad AF, Ayilara OF, Vasylkiv V, Jozani MJ, Banerji S, Delaney J, Hu P, Wall-Wieler E, Lix LM. Transitions between versions of the International Classification of Diseases and chronic disease prevalence estimates from administrative health data: a population-based study. BMC Public Health 2022; 22:701. [PMID: 35397596 PMCID: PMC8994899 DOI: 10.1186/s12889-022-13118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis codes in administrative health data are routinely used to monitor trends in disease prevalence and incidence. The International Classification of Diseases (ICD), which is used to record these diagnoses, have been updated multiple times to reflect advances in health and medical research. Our objective was to examine the impact of transitions between ICD versions on the prevalence of chronic health conditions estimated from administrative health data. Methods Study data (i.e., physician billing claims, hospital records) were from the province of Manitoba, Canada, which has a universal healthcare system. ICDA-8 (with adaptations), ICD-9-CM (clinical modification), and ICD-10-CA (Canadian adaptation; hospital records only) codes are captured in the data. Annual study cohorts included all individuals 18 + years of age for 45 years from 1974 to 2018. Negative binomial regression was used to estimate annual age- and sex-adjusted prevalence and model parameters (i.e., slopes and intercepts) for 16 chronic health conditions. Statistical control charts were used to assess the impact of changes in ICD version on model parameter estimates. Hotelling’s T2 statistic was used to combine the parameter estimates and provide an out-of-control signal when its value was above a pre-specified control limit. Results The annual cohort sizes ranged from 360,341 to 824,816. Hypertension and skin cancer were among the most and least diagnosed health conditions, respectively; their prevalence per 1,000 population increased from 40.5 to 223.6 and from 0.3 to 2.1, respectively, within the study period. The average annual rate of change in prevalence ranged from -1.6% (95% confidence interval [CI]: -1.8, -1.4) for acute myocardial infarction to 14.6% (95% CI: 13.9, 15.2) for hypertension. The control chart indicated out-of-control observations when transitioning from ICDA-8 to ICD-9-CM for 75% of the investigated chronic health conditions but no out-of-control observations when transitioning from ICD-9-CM to ICD-10-CA. Conclusions The prevalence of most of the investigated chronic health conditions changed significantly in the transition from ICDA-8 to ICD-9-CM. These results point to the importance of considering changes in ICD coding as a factor that may influence the interpretation of trend estimates for chronic health conditions derived from administrative health data. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13118-8.
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16
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Leong C, Bolton JM, Ekuma O, Prior HJ, Singal D, Nepon J, Konrad G, Paillé M, Finlayson G, Nickel N. Association of alcohol use disorder on alcohol-related cancers, diabetes, ischemic heart disease and death: a population-based, matched cohort study. Addiction 2022; 117:368-381. [PMID: 34286922 DOI: 10.1111/add.15646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/04/2020] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS High-risk alcohol consumption is associated with compromised health. This study aimed to compare the incidence of alcohol-related cancers, diabetes, ischemic heart disease (IHD) and mortality between those with and without an indication of alcohol use disorder (AUD). DESIGN Retrospective, population-based, matched cohort study using data from the Manitoba Population Research Data Repository. Rates were modeled using generalized linear models with either negative binomial distribution or Poisson distribution and a log offset of person-years to account for each person's time to follow-up. SETTING Manitoba, Canada. PARTICIPANTS Individuals aged ≥ 12 years with a first indication of AUD (index date) between 1 April 1990 and 31 March 2015 were matched to five controls based on age, sex and geographical region at index. This study included 53 410 individuals with AUD and 264 857 matched controls. MEASUREMENTS Adjusted rate ratios (aRR) and 95% confidence intervals (CI) were determined for each outcome from 5 years prior to and 20 years after AUD detection. FINDINGS Alcohol-related cancers (aRR = 4.85, 95% CI = 3.88-6.07 and aRR = 1.85, 95% CI = 1.35-2.53 for men and women, respectively), diabetes (aRR = 1.74, 95% CI = 1.50-2.02 and aRR = 2.43, 95% CI = 2.20-2.68) and IHD (aRR = 3.59, 95% CI = 3.31-3.90 and aRR = 2.92, 95% CI = 2.50-3.41) peaked in the 1 year prior to index for those with AUD compared with matched controls. All-cause mortality (aRR = 3.31, 95% CI = 3.09-3.55 and aRR =3.61, 95% CI = 3.21-4.04) was highest in the year of index and remained higher among cases compared with controls throughout the 20-year follow-up. CONCLUSION People with alcohol use disorder appear to have higher rates of adverse health outcomes in the year before alcohol use disorder recognition, and death at the time of alcohol use disorder recognition, compared with matched controls.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Josh Nepon
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Paillé
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Greg Finlayson
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Nathan Nickel
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Clair L, Anderson H, Anderson C, Ekuma O, Prior HJ. Cardiovascular disease and the risk of dementia: a survival analysis using administrative data from Manitoba. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:455-464. [PMID: 35025100 PMCID: PMC9043061 DOI: 10.17269/s41997-021-00589-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/15/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Recent research has shown that cardiovascular disease (CVD) raises the risk of dementia and other forms of cognitive decline. Generally, these studies are unable to model the time of diagnosis of CVD in their analyses and treat CVD as a time-fixed variable. Our objective was to assess the risk of being diagnosed with dementia for individuals diagnosed with CVD when CVD is time-dependent. METHODS We performed a retrospective cohort study using administrative health datasets from the Manitoba Population Research Data Repository in Canada. We constructed a longitudinal dataset to track individuals enrolled in the Manitoba Health Insurance Registry between April 1, 1997 and March 31, 2015. The study population consisted of 496,192 individuals 30 years of age or older who were not diagnosed with CVD or dementia prior to April 1, 1997. Diagnoses of CVD and dementia were based on diagnosis codes from medical claims and hospitalizations and the use of prescription medications. Hazard ratios were then computed using adjusted Cox-proportional hazards analyses. RESULTS Among the CVD subgroups considered, atrial fibrillation, ischemic heart disease, and stroke increased the risk of developing dementia, with stroke doubling one's risk of being diagnosed with the disease (hazard ratio: 1.95; 95% confidence interval: 1.9, 2.01). Age, lower socioeconomic status, and worsening comorbidities also increased the risk of being diagnosed with dementia. CONCLUSION A diagnosis of CVD is associated with an increased risk of a future diagnosis of dementia. Promoting good cardiovascular health may serve as an effective measure for preventing dementia.
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Affiliation(s)
- Luc Clair
- Department of Economics, University of Winnipeg, 515 Portage, Avenue, Winnipeg, MB R3B 2E9 Canada ,Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB Canada
| | - Hope Anderson
- Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB Canada ,College of Pharmacy, University of Manitoba, Winnipeg, MB Canada
| | - Christopher Anderson
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, MB Canada ,Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre, Winnipeg, MB Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB Canada
| | - Heather J. Prior
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB Canada
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Katz A, Urquia ML, Star L, Lavoie JG, Taylor C, Chateau D, Enns JE, Tait MJ, Burchill C. Changes in health indicator gaps between First Nations and other residents of Manitoba. CMAJ 2021; 193:E1830-E1835. [PMID: 34872954 PMCID: PMC8648361 DOI: 10.1503/cmaj.210201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/06/2022] Open
Abstract
Background: The Truth and Reconciliation Commission of Canada has called for better reporting of health disparities between First Nations people and other Canadians to close gaps in health outcomes. We sought to evaluate changes in these disparities using indicators of health and health care use over the last 2 decades. Methods: We used linked, whole-population, administrative claims data from the Manitoba Centre for Health Policy for fiscal years 1994/95 to 1998/99 and 2012/13 to 2016/17. We measured indicators of health and health care use among registered First Nations and all other Manitobans, and compared differences between these groups over the 2 time periods. Results: Over time, the relative gap between First Nations and all other Manitobans widened by 51% (95% confidence interval [CI] 42% to 60%) for premature mortality rate. For potential years of life lost, the gap widened by 54% (95% CI 51% to 57%) among women and by 32% (95% CI 30% to 35%) among men. The absolute gap in life expectancy widened by 3.14 years (95% CI 2.92 to 3.36) among men and 3.61 years (95% CI 3.38 to 3.84) among women. Relative gaps widened by 20% (95% CI 12% to 27%) for ambulatory specialist visits, by 14% (95% CI 12% to 16%) for hospital separations and by 50% (95% CI 39% to 62%) for days spent in hospital, but narrowed by 33% (95% CI −36% to −30%) for ambulatory primary care visits, by 22% (95% CI −27% to −16%) for mammography and by 27% (95% CI −40% to −23%) for injury hospitalizations. Interpretation: Disparities between First Nations and all other Manitobans in many key indicators of health and health care use have grown larger over time. New approaches are needed to address these disparities and promote better health with and for First Nations.
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Affiliation(s)
- Alan Katz
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta.
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Leona Star
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Josée G Lavoie
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Carole Taylor
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Dan Chateau
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Jennifer E Enns
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Myra J Tait
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Charles Burchill
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
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Incidence of Total Knee Replacement in Patients With Previous Anterior Cruciate Ligament Reconstruction. Clin J Sport Med 2021; 31:e442-e446. [PMID: 33914491 DOI: 10.1097/jsm.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the rate of total knee replacement (TKR) after anterior cruciate ligament reconstruction (ACL-R) compared to the general population. DESIGN Retrospective review. SETTING All hospitals that performed TKR and ACL-R in Manitoba between 1980 and 2015. PARTICIPANT All patients that underwent TKR and ACL-R in Manitoba between 1980 and 2015. INTERVENTION Patient factors gathered at time of surgery included: age, sex, urban or rural residence, neighborhood income quintile, and resource utilization band (RUB). Each person was matched with up to 5 people from the general population who had never had ACL-R and had not had a TKR at the time of the case ACL-R. MAIN OUTCOME MEASURES The rate of TKR after ACL-R. RESULTS Overall from 1980 to 2015, 8500 ACL-R were identified within the 16 to 60 years age group with a resultant 42 497 population matches. Sex was predominantly male. The mean age of the ACL-R group at the time of TKR was 53.7 years, whereas the mean age for the matched cohort was 58.2 years, P < 0.001. Those with ACL-R were 4.85 times more likely to go on to have TKR. Apart from age, no other risk factors examined (location, year of surgery, place of residence, income quintile, and RUB) seemed to increase risk of TKR after ACL-R. CONCLUSION Patients who underwent ACL-R were 5 times more likely to undergo TKR.
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Kendell C, Levy AR, Porter G, Gibson E, Urquhart R. Factors affecting access to administrative health data for research in Canada: a study protocol. Int J Popul Data Sci 2021; 6:1653. [PMID: 34632104 PMCID: PMC8477899 DOI: 10.23889/ijpds.v6i1.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In Canada, most provinces have established administrative health data repositories to facilitate access to these data for research. Anecdotally, researchers have described delays and substantial inter-provincial variations in the timeliness of data access approvals and receipt of data. Currently, the reasons for these delays and variations in timeliness are not well understood. This paper provides a study protocol for (1) identifying the factors affecting access to administrative health data for research within select Canadian provinces, and (2) comparing factors across provinces to assess whether and how they contribute to inter-provincial variations in access to administrative health data for research. METHODS A qualitative, multiple-case study research design will be used. Three cases will be included, representing three different provinces. For each case, data will be collected from documents and interviews. Specifically, interviews will be carried out with (1) research stakeholders, and (2) regulatory stakeholders (10 individuals/group * 2 groups/province * 3 provinces = 60). During within-case analysis, interview data for each stakeholder group will be analyzed separately using constant comparative analysis. Document analysis will occur iteratively, and will inform interview guide adaptation, and supplement interview data. Cross-case analysis will involve systematic comparison of findings across cases. DISCUSSION This study represents the first in-depth examination of access to administrative health data in Canada. The main outcome will be an overarching mid-range theory explaining inter-provincial variations in access to administrative health data in Canada. This theory will be strengthened by the inclusion of the perspectives of both researchers and those involved in the regulation of data access. The findings from this study may be used to improve equitable and timely access to administrative health data across provinces, and may be transferable to other jurisdictions where barriers to access to administrative health data have been reported.
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Affiliation(s)
- Cynthia Kendell
- Interdisciplinary PhD Program, Dalhousie University, Halifax, Nova Scotia, B3H 4H6
- Department of Surgery, Nova Scotia Health, Halifax, Nova Scotia, B3H 2Y9
| | - Adrian R Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, B3H 1V7
| | - Geoff Porter
- Department of Surgery, Nova Scotia Health, Halifax, Nova Scotia, B3H 2Y9
| | - Elaine Gibson
- Schulich School of Law, Health Law Institute, Dalhousie University, Halifax, Nova Scotia, B3H 4R2
| | - Robin Urquhart
- Department of Surgery, Nova Scotia Health, Halifax, Nova Scotia, B3H 2Y9
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, B3H 1V7
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21
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Nickel NC, Clark W, Phillips-Beck W, Sanguins J, Enns JE, Lavoie JG, Romanescu R, Katz A, Mahar AL, Brownell M, Lix L, Urquia M, Tso Deh M, O'Conaill C, Durksen A, Brownell E. Diagnostic testing and vaccination for COVID-19 among First Nations, Metis and Inuit in Manitoba, Canada: protocol for a nations-based cohort study using linked administrative data. BMJ Open 2021; 11:e052936. [PMID: 34521679 PMCID: PMC8441222 DOI: 10.1136/bmjopen-2021-052936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Decades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by FN/M/I partners, will generate and distribute evidence on COVID-19 diagnostic testing and vaccination in high-priority FN/M/I populations in Manitoba, with the goal of identifying system-level and individual-level factors that act as barriers to equitable care and thereby informing Indigenous-led public health responses. METHODS AND ANALYSIS Our nations-based approach focuses on FN/M/I populations with separate study arms for each group. Linked administrative health data on COVID-19 diagnostic testing and vaccinations are available on a weekly basis. We will conduct surveillance to monitor trends in testing and vaccination among each FN/M/I population and all other Manitobans, map the geographic distribution of these outcomes by health region and tribal council, and identify barriers to testing and vaccination to inform public health strategies. We will follow the course of the pandemic starting from January 2020 and report findings quarterly. ETHICS AND DISSEMINATION Ethics approvals have been granted by the University of Manitoba Research Ethics Board and from each of our FN/M/I partners' organisations. Our team is committed to engaging in authentic relationship-based research that follows First Nations, Metis and Inuit research ethics principles. Our FN/M/I partners will direct the dissemination of new information to leadership in their communities (health directors, community health organisations) and to decision-makers in the provincial Ministry of Health. We will also publish in open-access journals. The study will create ongoing capacity to monitor Manitoba's pandemic response and ensure potential health inequities are minimised, with learnings applicable to other jurisdictions where detailed administrative data may not be available.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Wayne Clark
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jennifer Emily Enns
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Josée G Lavoie
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Razvan Romanescu
- Biostatistics, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
- Department of Family Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Marcelo Urquia
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Miyosha Tso Deh
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Carrie O'Conaill
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Anita Durksen
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Emily Brownell
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
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22
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Konrad G, Leong C, Bolton JM, Prior HJ, Paillé MT, Nepon J, Singal D, Ekuma O, Enns JE, Nickel NC. Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada: A whole-population cohort study. PLoS One 2021; 16:e0257025. [PMID: 34478448 PMCID: PMC8415582 DOI: 10.1371/journal.pone.0257025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Update the evidence on use of pharmacotherapy for alcohol use disorder in a Canadian population. METHODS Using whole-population administrative data from Manitoba, Canada, we identified all residents age 12+ who were first diagnosed with alcohol use disorder between April 1, 1996 and March 31, 2015, and compared characteristics of those who filled a prescription for naltrexone, acamprosate or disulfiram at least once during that period to those who did not fill a prescription for an alcohol use disorder medication. RESULTS Only 1.3% of individuals with alcohol use disorder received pharmacotherapy (62.3% of prescriptions were for naltrexone, 39.4% for acamprosate, 7.5% for disulfiram). Most prescriptions came from family physicians in urban alcohol use disorder (53.6%) and psychiatrists (22.3%). Individuals were more likely to fill a prescription for alcohol use disorder medication if they lived in an urban vs rural environment (OR 2.25; 95% CI 1.83-2.77) or had a mood/anxiety disorder diagnosis vs no diagnosis (OR 2.40, 95% CI 1.98-2.90) in the five years before being diagnosed with alcohol use disorder. CONCLUSION Despite established evidence for the effectiveness of pharmacotherapy for alcohol use disorder, these medications continue to be profoundly underutilized in Canada.
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Affiliation(s)
- Geoffrey Konrad
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Leong
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M. Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Heather J. Prior
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael T. Paillé
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josh Nepon
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E. Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C. Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dept. of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Leslie WD, Epp R, Morin SN, Lix LM. Assessment of site-specific X-ray procedure codes for fracture ascertainment: a registry-based cohort study. Arch Osteoporos 2021; 16:107. [PMID: 34231060 DOI: 10.1007/s11657-021-00980-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Site-specific X-ray procedure codes are a useful ancillary source of information for identifying fractures in healthcare administrative and claims data. INTRODUCTION Real-world evaluation of fracture epidemiology at the population level from electronic healthcare information, such as administrative data, requires comprehensive data sources and validated case definitions. Only hip fractures are routinely hospitalized, and the identification of most osteoporosis-related fractures which are non-hospitalized fractures remains challenging. Plain X-rays (radiographs) are first-line tests for fracture diagnosis and are frequently repeated to monitor fracture healing, and claims data related to radiologic procedures are available in many healthcare systems. We hypothesized that temporal clustering in plain X-ray procedure codes might be an ancillary source of fracture data. METHODS We identified individuals age 40 years and older in Manitoba Bone Mineral Density (BMD) Registry with a fracture diagnosis (hip, forearm, humerus, clinical vertebral) before or following a BMD test. A subset underwent detailed review of X-rays to verify an acute fracture. We examined the association between fracture diagnosis and numbers of site-specific X-ray procedures. RESULTS The registry cohort included 7793 individuals with a fracture in the previous 5 years and 8417 incident fractures. The X-ray review cohort included 167 radiologically-verified fractures. The number of site-specific X-ray codes was greater in those with vs without fracture (all P < 0.001). The number of days with site-specific X-rays was strongly associated with a fracture diagnosis (area under the curve 0.90 to 0.99 for all non-vertebral fractures, 0.66 to 0.75 for clinical vertebral fractures). There was good agreement between the date of fracture diagnosis and the first X-ray at all non-vertebral fracture sites (Spearman correlation range 0.65 to 0.99), but this was lower for clinical vertebral fractures (range 0.29 to 0.59). CONCLUSIONS Temporal clustering in site-specific X-ray procedures was associated with a corresponding fracture diagnosis in administrative medical records. Non-vertebral fracture sites were more strongly associated with X-ray procedures than clinical vertebral fractures.
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Affiliation(s)
- William D Leslie
- Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
| | - Riley Epp
- Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
| | | | - Lisa M Lix
- Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
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Wall-Wieler E, Bateman BT, Hanlon-Dearman A, Roos LL, Butwick AJ. Association of Epidural Labor Analgesia With Offspring Risk of Autism Spectrum Disorders. JAMA Pediatr 2021; 175:698-705. [PMID: 33871547 PMCID: PMC8056314 DOI: 10.1001/jamapediatrics.2021.0376] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Epidural labor analgesia (ELA) has been associated with an increased offspring risk of autism spectrum disorder (ASD). Whether this finding may be explained by residual confounding remains unclear. OBJECTIVE To assess the association between ELA and offspring risk of ASD. DESIGN, SETTING, AND PARTICIPANTS Longitudinal cohort study of vaginal deliveries of singleton live infants born from 2005 to 2016 from a population-based data set linking information from health care databases in Manitoba, Canada; offspring were followed from birth until 2019 or censored by death or emigration. Data were analyzed from October 19, 2020, to January 22, 2021. EXPOSURES Epidural labor analgesia. MAIN OUTCOMES AND MEASURES At least 1 inpatient or outpatient diagnosis of ASD in offspring aged at least 18 months. For the full population and a sibling cohort, inverse probability of treatment-weighted Cox proportional hazards regression analyses were used to control for potential confounders. RESULTS Of the 123 175 offspring included in this study (62 647 boys [50.9%]; mean [SD] age of mothers, 28.2 [5.8] years), 47 011 (38.2%) were exposed to ELA; 2.1% (985 of 47 011) of exposed vs 1.7% (1272 of 76 164) of unexposed offspring were diagnosed with ASD in the follow-up period (hazard ratio [HR], 1.25; 95% CI, 1.15-1.36). After adjusting for maternal sociodemographic, prepregnancy, pregnancy, and perinatal covariates, ELA was not associated with an offspring risk of ASD (inverse probability of treatment-weighted HR, 1.08; 95% CI, 0.97-1.20). In the within-siblings design adjusting for baseline covariates, ELA was not associated with ASD (inverse probability of treatment-weighted HR, 0.97; 95% CI, 0.78-1.22). Results from sensitivity analyses restricted to women without missing data who delivered at or after 37 weeks of gestation, firstborn infants only, and offspring with ASD classified with at least 2 diagnostic codes were consistent with findings from the main analyses. CONCLUSIONS AND RELEVANCE In a Canadian population-based birth cohort study, no association between ELA exposure and an increased offspring risk of ASD was found.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ana Hanlon-Dearman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L. Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexander J. Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Enns JE, Nickel NC, Chartier M, Chateau D, Campbell R, Phillips-Beck W, Sarkar J, Burland E, Katz A, Santos R, Brownell M. An unconditional prenatal income supplement is associated with improved birth and early childhood outcomes among First Nations children in Manitoba, Canada: a population-based cohort study. BMC Pregnancy Childbirth 2021; 21:312. [PMID: 33879074 PMCID: PMC8059008 DOI: 10.1186/s12884-021-03782-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Manitoba, Canada, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit, an unconditional income supplement of up to CAD $81/month, during their latter two trimesters. Our objective was to determine the impact of the Healthy Baby Prenatal Benefit on birth and early childhood outcomes among Manitoba First Nations women and their children. METHODS We used administrative data to identify low-income First Nations women who gave birth 2003-2011 (n = 8209), adjusting for differences between women who received (n = 6103) and did not receive the Healthy Baby Prenatal Benefit (n = 2106) with using propensity score weighting. Using multi-variable regressions, we compared rates of low birth weight, preterm, and small- and large-for-gestational-age births, 5-min Apgar scores, breastfeeding initiation, birth hospitalization length of stay, hospital readmissions, complete vaccination at age one and two, and developmental vulnerability in Kindergarten. RESULTS Women who received the benefit had lower risk of low birth weight (adjusted relative risk [aRR] 0.74; 95% CI 0.62-0.88) and preterm (aRR 0.77; 0.68-0.88) births, and were more likely to initiate breastfeeding (aRR 1.05; 1.01-1.09). Receipt of the Healthy Baby Prenatal Benefit was also associated with higher rates of child vaccination at age one (aRR 1.10; 1.06-1.14) and two (aRR 1.19; 1.13-1.25), and a lower risk that children would be vulnerable in the developmental domains of language and cognitive development (aRR 0.88; 0.79-0.98) and general knowledge/communication skills (aRR 0.87; 0.77-0.98) in Kindergarten. CONCLUSIONS A modest unconditional income supplement of CAD $81/month during pregnancy was associated with improved birth outcomes, increased vaccination rates, and better developmental health outcomes for First Nations children from low-income families.
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Affiliation(s)
- Jennifer E Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Rhonda Campbell
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | | | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rob Santos
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada.
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Strumpf E, Lang A, Austin N, Derksen SA, Bolton JM, Brownell MD, Chateau D, Gregory P, Heaman MI. Prevalence and clinical, social, and health care predictors of miscarriage. BMC Pregnancy Childbirth 2021; 21:185. [PMID: 33673832 PMCID: PMC7936485 DOI: 10.1186/s12884-021-03682-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pregnancy loss is common and several factors (e.g. chromosomal anomalies, parental age) are known to increase the risk of occurrence. However, much existing research focuses on recurrent loss; comparatively little is known about the predictors of a first miscarriage. Our objective was to estimate the population-level prevalence of miscarriages and to assess the contributions of clinical, social, and health care use factors as predictors of the first detected occurrence of these losses. METHODS In this population-based cohort study, we used linked administrative health data to estimate annual rates of miscarriage in the Manitoba population from 2003 to 2014, as a share of identified pregnancies. We compared the unadjusted associations between clinical, social, and health care use factors and first detected miscarriage compared with a live birth. We estimated multivariable generalized linear models to assess whether risk factors were associated with first detected miscarriage controlling for other predictors. RESULTS We estimated an average annual miscarriage rate of 11.3%. In our final sample (n = 79,978 women), the fully-adjusted model indicated that use of infertility drugs was associated with a 4 percentage point higher risk of miscarriage (95% CI 0.02, 0.06) and a past suicide attempt with a 3 percentage point higher risk (95% CI -0.002, 0.07). Women with high morbidity were twice as likely to experience a miscarriage compared to women with low morbidity (RD = 0.12, 95% CI 0.09, 0.15). Women on income assistance had a 3 percentage point lower risk (95% CI -0.04, -0.02). CONCLUSIONS We estimate that 1 in 9 pregnant women in Manitoba experience and seek care for a miscarriage. After adjusting for clinical factors, past health care use and morbidity contribute important additional information about the risk of first detected miscarriage. Social factors may also be informative.
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Affiliation(s)
- Erin Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Leacock Building, Room 418, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada. .,Department of Economics, McGill University, Montreal, Canada.
| | - Ariella Lang
- School of Nursing, McGill University, Montreal, Canada
| | - Nichole Austin
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Leacock Building, Room 418, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada
| | - Shelley A Derksen
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni D Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | | | - Maureen I Heaman
- College of Nursing, University of Manitoba, Winnipeg, Canada.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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Kraut A, Shafer LA. Determining the influence of the Workers Compensation Board of Manitoba's opioid policy on prescription opioid use amongst WCB recipients. Am J Ind Med 2021; 64:170-177. [PMID: 33373046 PMCID: PMC7986794 DOI: 10.1002/ajim.23216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 01/31/2023]
Abstract
Background Opioid medications are commonly used by Workers Compensation Board (WCB) claimants following workplace injuries. The purpose of this study is to describe the impact of an opioid management policy on opioid prescriptions amongst a WCB‐covered population compared to changes in the use of these medications in the general population of a Canadian province. Methods We linked WCB claims data from 2006 to 2016 (13,155 claims, 11,905 individuals) to Manitoba provincial health records and compared opioid use amongst this group to 478,606 individuals aged 18–65. Linear regression was performed to examine the change over time in number of individuals being prescribed opioids for various durations and dosages of 50 or more, and 120 or more morphine equivalents (ME)/day for both the WCB and Manitoba population. Results WCB claimants totaled 2.5% of Manitoba residents aged 18–65 who were prescribed opioids for non‐cancer pain. After the introduction of the opioid use policy for the WCB population in November 2011, the number of people prescribed opioids declined 49.4% in the WCB group, while increasing 10.8% in the province as a whole. The number of individuals using 50 ME/day or more declined 43.1% in the WCB group and increased 5.8% in the province. Conclusions Opioid management programs organized by a compensation board can lead to a substantial reduction in the prescription of opioid medications to a WCB client population, including individuals who were prescribed higher doses of these medications when compared with general trends in the community.
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Affiliation(s)
- Allen Kraut
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Leigh Anne Shafer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada
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Leong C, Czaykowski P, Geirnaert M, Katz A, Dragan R, Yogendran M, Raymond C. Outpatient oral anticancer agent utilization and costs in Manitoba from 2003 to 2016: a population-based study. Canadian Journal of Public Health 2021; 112:530-540. [PMID: 33471346 DOI: 10.17269/s41997-020-00464-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022]
Abstract
INTERVENTION In April 2012, the Manitoba Home Cancer Drug Program (HCDP) was introduced to allow 100% coverage for eligible oral anticancer agents (OAA) and supportive medications for Manitobans with cancer requiring these therapies. RESEARCH QUESTIONS What is the extent of use and cost of OAAs among outpatients in Manitoba from 2003/04 to 2015/16? Did the HCDP change OAA user and prescription patterns? METHODS This was a retrospective, population-based study using administrative data to measure the prevalence of drug utilization over time and the impact of HCDP on OAA use and prescriptions using generalized linear models. Manitobans with cancer who filled an OAA or supportive medication covered by HCDP from 2003/04 to 2015/16 were included. RESULTS This study included 22,393 people with cancer who filled an OAA prescription. The prevalence of OAA use increased from 222 per 100,000 to 328 per 100,000 from 2003/04 to 2015/16. Hormone therapy for breast cancer was the most common class of OAA used (increased from 154 per 100,000 to 231 per 100,000). We observed a 2.6-fold decrease in the prevalence of oral alkylating agents and a 10.7-fold increase in the prevalence of protein kinase inhibitors during the study period. The total cost of targeted OAAs per year for all Manitobans with cancer increased from $1.8 million to $19 million. CONCLUSION We observed an increase in OAA prevalence and the cost of oral targeted chemotherapy is high. Our findings underline the need for addressing these high-cost medications in future developments of a national drug program.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, University of Manitoba, 219 Apotex Centre, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
| | - Piotr Czaykowski
- CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, Section of Haematology/Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Alan Katz
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | | | - Colette Raymond
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
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Llorian ER, Mason G. Healthcare utilization and telemedicine: An evaluation using linked administrative data from Manitoba. J Telemed Telecare 2021; 29:282-290. [PMID: 33459121 DOI: 10.1177/1357633x20981227] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This research examines utilization patterns for patients using telemedicine compared to those receiving treatment conventionally. Administrative data from 2007-2016 is linked to records from the Manitoba Telehealth programme to conduct a population-level study. METHODS Using a high dimensional propensity-weighted regression model, the study compares four utilization measures between telemedicine users and non-users. These include: ambulatory visits (number of visits to any physician), visits to primary care physicians, visits to specialists and the number of hospitalizations. RESULTS Compared to non-users, telemedicine patients showed a higher number of in-person visits. Specifically, using incidence-rate ratios, telemedicine users had 1.32 more ambulatory visits (p < 0.001; 95% confidence interval, 1.23-1.41), 1.26 more visits to primary care practitioners (p<0.001; 95% confidence interval, 1.17-1.35), 1.38 more visits to specialists (p < 0.001; 95% confidence interval, 1.19-1.61) and 1.14 more hospitalizations (p>0.1; 95% confidence interval, 0.91-1.43). These results were robust to restricted analyses for distance, regions, and chronic conditions. Those patients with frequent virtual encounters with a specialist showed a decrease of the frequency of in-person visits of the same type of care (incidence-rate ratio=0.48, p < 0.001; 95% confidence interval, 0.44-0.54). DISCUSSION Patterns in utilization vary between telemedicine users and non-users, with users showing a higher number of in-person visits than non-users, and only frequent users of telemedicine showing reduced in-person visits. Future investigation linking utilization patterns with patient care outcomes and costs will inform healthcare policy and clinical treatment plans.
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Affiliation(s)
- Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Gregory Mason
- Department of Economics, University of Manitoba, Canada
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Bolton JM, Leong C, Ekuma O, Prior HJ, Konrad G, Enns J, Singal D, Nepon J, Paillé MT, Finlayson G, Nickel NC. Health service use among Manitobans with alcohol use disorder: a population-based matched cohort study. CMAJ Open 2020; 8:E762-E771. [PMID: 33234583 PMCID: PMC7721253 DOI: 10.9778/cmajo.20200124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alcohol is the drug most commonly used by Canadians, with multiple impacts on health and health service use. We examined patterns of short- and long-term health service use among people with a diagnosis of alcohol use disorder. METHODS In this retrospective matched cohort study, we used population-based administrative data from the province of Manitoba, Canada, to identify individuals aged 12 years or older with a first indication of alcohol use disorder (index date) in the period 1990 to 2015. We matched cases (those with diagnosis of alcohol use disorder) to controls (those without this diagnosis), at a 1:5 ratio, on the basis of age, sex, geographic region and income quintile at the index date. The outcome measures were inpatient hospital admission, outpatient physician visits, emergency department visits and use of prescription medications. We modelled crude rates using generalized estimating equations with either a negative binomial or a Poisson distribution RESULTS: We identified 53 410 people with alcohol use disorder and 264 857 matched controls. All outcomes occurred at a higher rate among people with the disorder than among controls. For example, during the year of diagnosis, the rate ratio for hospital admission was 4.0 (95% confidence interval [CI] 3.9-4.2) for women and 4.5 (95% CI 4.4-4.7) for men. All rates of health service use peaked close to the index date, but remained significantly higher among people with alcohol use disorder than among controls for 20 years. Among people with alcohol use disorder, the most commonly filled prescriptions were for psycholeptics, whereas among controls, the most commonly filled prescriptions were for sex hormones (women) and antihypertensives (men). INTERPRETATION Compared with controls, people with alcohol use disorder used significantly more health services from the time of diagnosis and over the next 20 years. This finding highlights the need for better detection and early intervention to reduce the need for acute and emergency care, as well as the need for improved management of alcohol use disorder over the longer term.
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Affiliation(s)
- James M Bolton
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Christine Leong
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Okechukwu Ekuma
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Heather J Prior
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Geoffrey Konrad
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Jennifer Enns
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Deepa Singal
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Josh Nepon
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Michael T Paillé
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Greg Finlayson
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Nathan C Nickel
- Department of Psychiatry (Bolton, Leong, Konrad, Nepon), Manitoba Centre for Health Policy (Bolton, Ekuma, Prior, Enns, Singal, Paillé, Finlayson, Nickel), College of Pharmacy (Leong) and Department of Community Health Sciences (Nickel), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
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Wall-Wieler E, Roos LL, Gotlib IH. Maternal Depression in Early Childhood and Developmental Vulnerability at School Entry. Pediatrics 2020; 146:e20200794. [PMID: 32817440 PMCID: PMC7461243 DOI: 10.1542/peds.2020-0794] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the relation between exposure to maternal depression before age 5 and 5 domains of developmental vulnerability at school entry, overall, and by age at exposure. METHODS This cohort study included all children born in Manitoba, Canada, who completed the Early Development Instrument between 2005 and 2016 (N = 52 103). Maternal depression was defined by using physician visits, hospitalizations, and pharmaceutical data; developmental vulnerability was assessed by using the Early Development Instrument. Relative risk of developmental vulnerability was assessed by using log-binomial regression models adjusted for characteristics at birth. RESULTS Children exposed to maternal depression before age 5 had a 17% higher risk of having at least 1 developmental vulnerability at school entry than did children not exposed to maternal depression before age 5. Exposure to maternal depression was most strongly associated with difficulties in social competence (adjusted relative risk [aRR] = 1.28; 95% confidence interval [CI]: 1.20-1.38), physical health and well-being (aRR = 1.28; 95% CI: 1.20-1.36), and emotional maturity (aRR = 1.27; 95% CI: 1.18-1.37). For most developmental domains, exposure to maternal depression before age 1 and between ages 4 and 5 had the strongest association with developmental vulnerability. CONCLUSIONS Our finding that children exposed to maternal depression are at higher risk for developmental vulnerability at school entry is consistent with previous findings. We extended this literature by documenting that the adverse effects of exposure to maternal depression are specific to particular developmental domains and that these effects vary depending on the age at which the child is exposed to maternal depression.
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Affiliation(s)
| | - Leslie L Roos
- Psychology, Stanford University, Stanford, California; and
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Padalko A, Gawaziuk J, Chateau D, Sareen J, Logsetty S. Social Determinants Associated with Pediatric Burn Injury: A Population-Based, Case-Control Study. J Burn Care Res 2020; 41:743-750. [PMID: 32352522 DOI: 10.1093/jbcr/iraa045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Social determinants of health (SDoH) influence risk of injury. We conducted a population-based, case-control study to identify which social determinants influence burn injury in children. Children (≤16 years of age) admitted to a Canadian regional burn center between January 1, 1999 and March 30, 2017 were matched based on age, sex, and geographic location 1:5 with an uninjured control cohort from the general population. Population-level administrative data describing the SDoH at the Manitoba Center for Health Policy (MCHP) were compared between the cohorts. Specific SDoH were chosen based on a published systematic review conducted by the research team. In the final multivariable model, children from a low-income household odds ratio (OR) (95% confidence interval) 1.97 (1.46, 2.65), in care 1.57 (1.11, 2.21), from a family that received income assistance 1.71 (1.33, 2.19) and born to a teen mother 1.43 (1.13, 1.81) were significantly associated with an increased risk of pediatric burn injury. This study identified SDoH that are associated with an increased risk of burn injury. This case-control study supports the finding that children from a low-income household, children in care, from a family that received income assistance, and children born to a teen mother are at an elevated risk of burn injury. Identifying children at increased potential risk allows targeting of burn risk reduction and home safety programs.
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Affiliation(s)
- Adam Padalko
- BSc Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Justin Gawaziuk
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada; From the
| | - Dan Chateau
- Manitoba Centre for Health Policy, Winnipeg, Canada.,Department of Community Health Sciences, Winnipeg, Canada
| | - Jitender Sareen
- Department of Community Health Sciences, Winnipeg, Canada.,Department of Psychiatry, Winnipeg, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, Winnipeg, Canada.,Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Casiano H, Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM. The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:492-501. [PMID: 32363932 PMCID: PMC7298584 DOI: 10.1177/0706743720919660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understand the relationship between criminal accusations, victimization, and mental disorders at a population level using administrative data from Manitoba, Canada. METHOD Residents aged 18 to 64 between April 1, 2007, and March 31, 2012 (N = 793,024) with hospital- and physician-diagnosed mental disorders were compared to those without. Overall and per-person rates of criminal accusations and reported victimization in the 2011/2012 fiscal year were examined. Relative risks were calculated, adjusting for age, sex, income, and presence of a substance use disorder. The overlap between diagnosed mental disorders, accusations, and victimization with a χ2 test of independence was studied. RESULTS Twenty-four percent (n = 188,693) of the population had a mental disorder over the 5-year time frame. Four to fifteen percent of those with a mental disorder had a criminal accusation, compared to 2.4% of the referent group. Individuals with mental disorders, especially psychotic or personality disorders, were often living in low-income, urban neighborhoods. The adjusted relative risk of accusations and victimization remained 2 to 5 times higher in those with mental disorders compared to the referent group. Criminal accusations and victimization were most prevalent among individuals with a history of attempted suicide (15.2% had an accusation and 8.1% were victims). The risk of victimization in the same year as a criminal accusation was significantly increased among those with mental disorders compared to those without (χ2 = 211.8, P < 0.001). CONCLUSIONS Individuals with mental disorders are at elevated risk of both criminal involvement and victimization. The identification of these multiply-stigmatized individuals may lead to better intervention and support.
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Affiliation(s)
- Hygiea Casiano
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Singal D, Chateau D, Struck S, Lee JB, Dahl M, Derksen S, Katz LY, Ruth C, Hanlon-Dearman A, Brownell M. In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners. Pediatrics 2020; 145:peds.2019-1157. [PMID: 32341177 DOI: 10.1542/peds.2019-1157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if in utero selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine inhibitor (SNRI) exposure is associated with developmental vulnerability in kindergarten among children whose mothers were diagnosed with prenatal mood or anxiety disorder. METHODS Linkable administrative data were used to create a population-based cohort of 266 479 mother-child dyads of children born in Manitoba, Canada, between 1996 and 2014, with follow-up through 2015. The sample was restricted to mothers who had a mood or anxiety disorder diagnosis between 90 days before conception (N = 13 818). Exposed women had ≥2 SSRI or SNRI dispensations during pregnancy (n = 2055); unexposed mothers did not have a dispensation of an SSRI or SNRI during pregnancy (n = 10 017). The Early Development Instrument (EDI) was used to assess developmental health in kindergarten children. The EDI is a 104-component kindergarten teacher-administered questionnaire, encompassing 5 developmental domains. RESULTS Of the 3048 children included in the study who met inclusion criteria and had an EDI, 21.43% of children in the exposed group were assessed as vulnerable on 2 or more domains versus 16.16% of children in the unexposed group (adjusted odds ratio = 1.43; 95% confidence interval 1.08-1.90). Children in the exposed group also had a significant risk of being vulnerable in language and/or cognition (adjusted odds ratio = 1.40; 95% confidence interval 1.03-1.90). CONCLUSIONS Exposure to SSRIs or SNRIs during pregnancy was associated with an increased risk of developmental vulnerability and an increased risk of deficits in language and/or cognition. Replication of results is necessary before clinical implications can be reached.
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Affiliation(s)
- Deepa Singal
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Dan Chateau
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Shannon Struck
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Janelle Boram Lee
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Matthew Dahl
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Shelly Derksen
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Laurence Y Katz
- Department of Psychiatry, Child and Adolescent Psychiatry Health Sciences Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Section of Neonatology, Department of Pediatrics and Child Health
| | - Ana Hanlon-Dearman
- Section of Developmental Pediatrics, Department of Pediatrics and Child Health Policy, and
| | - Marni Brownell
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
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Tanner JA, Hensel J, Davies PE, Brown LC, Dechairo BM, Mulsant BH. Economic Burden of Depression and Associated Resource Use in Manitoba, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:338-346. [PMID: 31835904 PMCID: PMC7265616 DOI: 10.1177/0706743719895342] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To characterize the health-care utilization and economic burden associated with depression in Manitoba, Canada. METHODS Patient-level data were retrieved from the Manitoba Centre for Health Policy administrative, clinical, and laboratory databases for the study period of January 1, 1996, through December 31, 2016. Patients were assigned to the depression cohort based on diagnoses recorded in hospitalizations and outpatient physician claims, as well as antidepressant prescription drug claims. A comparison cohort of nondepressed subjects, matched with replacement for age, gender, place of residence (urban vs. rural), and index date, was created. Demographics, comorbidities, intentional self-harm, mortality, health-care utilization, prescription drug utilization, and costs of health-care utilization and social services were compared between depressed patients and matched nondepressed patients, and incidence rate ratios and hazard ratios were reported. RESULTS There were 190,065 patients in the depression cohort and 378,177 patients in the nondepression cohort. Comorbidities were 43% more prevalent among depressed patients. Intentional self-harm, all-cause mortality, and suicide mortality were higher among patients with depression than the nondepression cohort. Health-care utilization-including hospitalizations, physician visits, physician-provided psychotherapy, and prescription drugs-was higher in the depression than the nondepression cohort. Mean health-care utilization costs were 3.5 times higher among depressed patients than nondepressed patients ($10,064 and $2,832, respectively). Similarly, mean social services costs were 3 times higher ($1,522 and $510, respectively). Overall, depression adds a total average cost of $8,244 (SD = $40,542) per person per year. CONCLUSIONS Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.
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Affiliation(s)
- Julie-Anne Tanner
- Tanenbaum Pharmacogenetics Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Assurex Health Ltd., Toronto, Ontario, Canada
| | - Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Lethbridge LN, Richardson CG, Dunbar MJ. Measuring Surgical Site Infection From Linked Administrative Data Following Hip and Knee Replacement. J Arthroplasty 2020; 35:528-533. [PMID: 31615704 DOI: 10.1016/j.arth.2019.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) in hip and knee arthroplasty are increasing internationally. Current trends in SSI monitoring use single source administrative databases with data collection points commonly at 30 or 90 days. We hypothesize that SSI rates are being under-reported due to methodological biases. METHODS Data from multiple administrative data sets were contrasted and compared to look at the 90-day SSI rates for hip and knee arthroplasty in a single province from 2001 to 2015. SSI rates were calculated over time by year, and the differences in infection rates between single and multiple administrative data sets were calculated as an estimate of under reporting rates of SSIs. Days until diagnosis was measured for those diagnosed with an infection within 1 year. RESULTS Combining administrative data sets indicates that hospital-based data underestimate SSI rates by 0.44 (P < .0001) of a percentage point over all years, a clinically significant result given the overall infection rate of 2.2% over the period. Less than 50% of hip and knee arthroplasty was recorded as infected by 30 days and approximately 75% of cases were recorded as infected by 90 days. CONCLUSION Single source administrative data sets and short follow-up periods underestimate SSI rates. Administrative data sets should be combined and a minimum follow-up period of 90 days should be used to more accurately track SSI rates in hip and knee arthroplasty.
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Affiliation(s)
- Lynn N Lethbridge
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - C Glen Richardson
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Wall-Wieler E, Kenny K, Lee J, Thiessen K, Morris M, Roos LL. Prenatal care among mothers involved with child protection services in Manitoba: a retrospective cohort study. CMAJ 2019; 191:E209-E215. [PMID: 30803951 DOI: 10.1503/cmaj.181002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prenatal care is one of the most widely used preventive health services; however, use varies substantially. Our objective was to examine prenatal care among women with a history of having a child placed in out-of-home care, and whether their care differed from care among women who did not. METHODS We used linkable administrative data to create a population-based cohort of women whose first 2 children were born in Manitoba, Canada, between Apr. 1, 1998, and Mar. 1, 2015. We measured the level of prenatal care using the Revised Graduated Prenatal Care Utilization Index, which categorizes care into 5 groups: intensive, adequate, intermediate, inadequate and no care. We compared level of prenatal care for women whose first child was placed in care with level of prenatal care for women who had no contact with care services, using 2 multinomial logistic regression models to calculate odds ratios (ORs). RESULTS In a cohort of 52 438 mothers, 1284 (2.4%) had their first child placed in out-of-home care before conception of their second child. Mothers whose first child was placed in care had much higher rates of inadequate prenatal care during the pregnancy with their second child than mothers whose first child was not placed in care (33.0% v. 13.4%). The odds of having inadequate rather than adequate prenatal care were more than 4 times higher (OR 4.29, 95% CI 3.68 to 5.01) for women who had their first child placed in care than for women who did not have their first child placed in care. INTERPRETATION Mothers with a history of having a child taken into care by the child protection services system are at higher risk of having inadequate or no prenatal care in a subsequent pregnancy compared with mothers with no history of involvement with child protection services.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Pediatrics (Wall-Wieler), Stanford Medicine, Stanford University, Palo Alto, Calif.; Departments of Community Health Sciences (Wall-Wieler, during the conduct of the study; Lee, Roos), and Obstetrics, Gynecology and Reproductive Sciences (Morris); College of Nursing (Thiessen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Maternal and Child Health (Kenny), The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kathleen Kenny
- Department of Pediatrics (Wall-Wieler), Stanford Medicine, Stanford University, Palo Alto, Calif.; Departments of Community Health Sciences (Wall-Wieler, during the conduct of the study; Lee, Roos), and Obstetrics, Gynecology and Reproductive Sciences (Morris); College of Nursing (Thiessen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Maternal and Child Health (Kenny), The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janelle Lee
- Department of Pediatrics (Wall-Wieler), Stanford Medicine, Stanford University, Palo Alto, Calif.; Departments of Community Health Sciences (Wall-Wieler, during the conduct of the study; Lee, Roos), and Obstetrics, Gynecology and Reproductive Sciences (Morris); College of Nursing (Thiessen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Maternal and Child Health (Kenny), The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kellie Thiessen
- Department of Pediatrics (Wall-Wieler), Stanford Medicine, Stanford University, Palo Alto, Calif.; Departments of Community Health Sciences (Wall-Wieler, during the conduct of the study; Lee, Roos), and Obstetrics, Gynecology and Reproductive Sciences (Morris); College of Nursing (Thiessen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Maternal and Child Health (Kenny), The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Margaret Morris
- Department of Pediatrics (Wall-Wieler), Stanford Medicine, Stanford University, Palo Alto, Calif.; Departments of Community Health Sciences (Wall-Wieler, during the conduct of the study; Lee, Roos), and Obstetrics, Gynecology and Reproductive Sciences (Morris); College of Nursing (Thiessen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Maternal and Child Health (Kenny), The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leslie L Roos
- Department of Pediatrics (Wall-Wieler), Stanford Medicine, Stanford University, Palo Alto, Calif.; Departments of Community Health Sciences (Wall-Wieler, during the conduct of the study; Lee, Roos), and Obstetrics, Gynecology and Reproductive Sciences (Morris); College of Nursing (Thiessen), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Maternal and Child Health (Kenny), The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Shafer LA, Walker JR, Chhibba T, Targownik LE, Singh H, Ivekovic M, Bernstein CN. Health Care Indicators of Moderate to Severe IBD and Subsequent IBD-Related Disability: A Longitudinal Study. Inflamm Bowel Dis 2019; 25:1996-2005. [PMID: 31087034 DOI: 10.1093/ibd/izz102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND We aimed to determine how health care utilization indicators in IBD that reflect moderate to severe disease relate to disability later in life. METHODS Persons in the population-based University of Manitoba IBD Research Registry completed a survey and gave permission to access their Manitoba Health records. Of 2478 people in the Registry aged 18 to 65 years, 854 participated between April 2015 and March 2016. The survey included the IBD Disability Index (IBDDI). The health data included surgeries and hospitalizations since 1984 and prescriptions since 1995. We explored the association between indicators of moderate to severe disease (ie, surgeries, hospitalization, and new corticosteroids and anti-tumor necrosis factor [anti-TNF] prescriptions) and high IBD-related disability (IBDDI ≥35). In addition, among those who had at least 1 IBD-related surgery, we determined predictors of low or no postsurgery disability (IBDDI <21). RESULTS Eighty-five percent required at least 1 IBD-related surgery since diagnosis or had >2 hospitalizations or were ever prescribed corticosteroids or anti-TNF. Surgery was more common in Crohn's disease (55%) than in UC (13%, P < 0.001). High disability was more prevalent among those ever prescribed anti-TNF (49%) vs never prescribed (28%, P < 0.001), those ever prescribed corticosteroids (35%) vs never prescribed (26%, P = 0.02), and those who had had 1 IBD-related surgery (36%) or >1 surgery (53%) vs those who had had none (28%, P < 0.001). CONCLUSIONS Health care utilization indicators of moderate to severe disease (ie, surgeries, hospitalizations, corticosteroid or anti-TNF use) were associated with subsequent higher IBD-related disability. Persons experiencing those indicators should be followed more closely for social, mental, and physical consequences of IBD-related disability. Previous health care utilization can serve as a proxy for IBD-related disability.
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Affiliation(s)
- Leigh Anne Shafer
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Tarun Chhibba
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melony Ivekovic
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Brownell M, Enns JE, Hanlon-Dearman A, Chateau D, Phillips-Beck W, Singal D, MacWilliam L, Longstaffe S, Chudley A, Elias B, Roos N. Health, Social, Education, and Justice Outcomes of Manitoba First Nations Children Diagnosed with Fetal Alcohol Spectrum Disorder: A Population-Based Cohort Study of Linked Administrative Data. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:611-620. [PMID: 30595040 PMCID: PMC6699031 DOI: 10.1177/0706743718816064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine health services, social services, education, and justice system outcomes among First Nations children and youth with fetal alcohol spectrum disorder (FASD). METHODS In this retrospective cohort study, health and social services, education, and justice data were linked with clinical records on First Nations (FN) individuals aged 1 to 25 and diagnosed with FASD between 1999 and 2010 (n = 743). We compared the FN FASD group to non-FN individuals with FASD (non-FN FASD; n = 315) and to First Nations individuals (matched on age, sex, and income) not diagnosed with FASD (FN non-FASD; n = 2229). Rates and relative risks (RRs) were calculated using generalized linear models. RESULTS FN FASD individuals had similar health services use to non-FN FASD individuals but had greater involvement with child welfare (RR, 1.20; 95% confidence interval [CI], 1.02 to 1.41) and the justice system (RR, 1.37; 95% CI, 1.07 to 1.74) and were more likely to be charged with a crime (RR, 1.40; 95% CI, 1.05 to 1.86). There were no suicides/suicide attempts among the non-FN FASD individuals during the study, but the crude rate/100 person-years of suicides among FN FASD individuals (0.22 for females; 1.06 for males) was substantially higher than for FN non-FASD individuals (0.08 for females; 0.32 for males). There were no significant differences between groups in the education outcomes we measured. CONCLUSIONS Young people with FASD are at risk for poor health, education, and social outcomes, but First Nations young people with FASD face comparably higher risks, particularly with child welfare and justice system involvement. The study emphasizes a critical need for appropriate resources for First Nations children with FASD.
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Affiliation(s)
- Marni Brownell
- 1 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Jennifer E Enns
- 1 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Ana Hanlon-Dearman
- 2 Manitoba FASD Centre, Winnipeg, Manitoba.,3 Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Dan Chateau
- 1 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Wanda Phillips-Beck
- 4 First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba.,5 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Deepa Singal
- 1 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Leonard MacWilliam
- 1 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Sally Longstaffe
- 2 Manitoba FASD Centre, Winnipeg, Manitoba.,3 Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Ab Chudley
- 2 Manitoba FASD Centre, Winnipeg, Manitoba.,3 Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Brenda Elias
- 5 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Noralou Roos
- 1 Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, Tachere RO, McDougall C, Bolton JM. Risk and associated factors for a future schizophrenia diagnosis after an index diagnosis of unspecified psychotic disorder: A population-based study. J Psychiatr Res 2019; 114:105-112. [PMID: 31059990 DOI: 10.1016/j.jpsychires.2019.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Abstract
A significant minority of unspecified psychosis presentations progress to schizophrenia. Clinical risk factors can inform targeted referral to specialized treatment programs, but few population studies have examined this. In this study, we used health administrative data for a population-based cohort from Manitoba, Canada to characterize the risk and identify vulnerable subgroups for a future diagnosis of schizophrenia after a diagnosis of unspecified psychotic disorder. Individuals aged 13-60 years with an inpatient or outpatient diagnosis of unspecified psychotic disorder between April 1, 2007 and March 31, 2012, and without any prior diagnosis of schizophrenia or related disorder, were identified (N = 3, 289). The primary outcome was a diagnosis of schizophrenia recorded after the index diagnosis of unspecified psychotic disorder and before March 31, 2015. Adjusted hazard ratios were computed controlling for age, sex, urbanicity, income, prior diagnosis of unspecified psychotic disorder, provider making the diagnosis, prior 12-month psychiatric hospitalization, and prior 12-month diagnoses of mood, anxiety, substance use, or personality disorders, and substance-induced psychosis. A classification tree identified vulnerable subgroups. The cumulative risk of a future diagnosis of schizophrenia was 26% during the follow-up period (mean 4.5 years), with a mean time to diagnosis of 2.0 years. The most vulnerable subgroup was diagnosed by a psychiatrist, younger than 27 years, without a mood or anxiety disorder, male, and residing in a low-income neighborhood; the rate of a subsequent schizophrenia diagnosis was 61.2%. These results support that identification of specific sociodemographic and clinical factors can help clinicians counsel and intervene with those at highest risk.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada.
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada
| | - Richard O Tachere
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada; Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada; Department of Community Health Sciences, University of Manitoba, S113, 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
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Enns JE, Chartier M, Nickel N, Chateau D, Campbell R, Phillips-Beck W, Sarkar J, Burland E, Lee JB, Katz A, Santos R, Brownell M. Association between participation in the Families First Home Visiting programme and First Nations families' public health outcomes in Manitoba, Canada: a retrospective cohort study using linked administrative data. BMJ Open 2019; 9:e030386. [PMID: 31256043 PMCID: PMC6609045 DOI: 10.1136/bmjopen-2019-030386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine whether the Families First Home Visiting (FFHV) programme, which provides home visiting services to families across Manitoba, is associated with improved public health outcomes among First Nations families facing multiple parenting challenges. DESIGN Retrospective cohort study using population-based administrative data. SETTING Manitoba, Canada. PARTICIPANTS First Nations children born in Manitoba in 2003-2009 (n=4010) and their parents enrolled in FFHV compared with non-enrolled families with a similar risk profile. INTERVENTION FFHV supports public health in Manitoba by providing home visiting services to First Nations and non-First Nations families with preschool children and connecting them with resources in their communities. OUTCOMES Predicted probability (PP) and relative risk (RR) of childhood vaccination, parental involvement in community support programmes and children's development at school entry. RESULTS FFHV participation was associated with higher rates of complete childhood vaccination at age 1 (PP: FFHV 0.715, no FFHV 0.661, RR 1.08, 95% CI 1.03 to 1.14) and age 2 (PP: FFHV 0.465, no FFHV 0.401, RR 1.16, 95% CI 1.08 to 1.25), and with parental involvement in community support groups (PP: FFHV 0.149, no FFHV 0.097, RR 1.54, 95% CI 1.27 to 1.86). However, there was no difference between FFHV participants and non-participants in rates of children being vulnerable in at least one developmental domain at age 5 (PP: FFHV 0.551, no FFHV 0.557, RR 1.00, 95% CI 0.91 to 1.11). CONCLUSIONS FFHV supports First Nations families in Manitoba by promoting childhood vaccination and connecting families to parenting resources in their communities, thus playing an important role in fulfilling the mandate of public health practice.
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Affiliation(s)
- Jennifer E Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nathan Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rhonda Campbell
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janelle Boram Lee
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rob Santos
- Healthy Child Manitoba, Government of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
BACKGROUND Children born into poverty face many challenges. Exposure to poverty comes in different forms, and children may also transition into or out of poverty. In this study, we examine the relationships among various outcomes and different levels of poverty (household and/or neighborhood poverty) at different points during a child's first 5 years. METHODS We used linkable administrative databases, following 46 589 children born in Manitoba, Canada, between 2000 and 2009 to age 7. Poverty is defined as those receiving welfare and those living in low-income neighborhoods. Four outcomes are measured in the first 5 years (placement in out-of-home care, externalizing mental health diagnosis, asthma diagnosis, and hospitalization for injury), with school readiness assessed between ages 5 and 7. RESULTS Children born into poverty had greater odds of not being ready for school than children not born into poverty (adjusted odds ratio = 1.54, 1.59, 1.26 for children born in household and neighborhood poverty, household poverty only, and neighborhood poverty only, respectively; all significant at P < .05). Similar patterns were seen across outcomes. For those born into neighborhood poverty, the odds of school readiness were higher only if children moved before age 2. CONCLUSIONS The level of poverty (household or neighborhood) and its duration modify the relationship between early poverty and childhood outcomes. Covariate adjustment generally weakens but does not eliminate these relationships.
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Affiliation(s)
- Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Manitoba, Canada; and
| | | | - Janelle Boram Lee
- Department of Community Health Sciences, University of Manitoba, Manitoba, Canada; and
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Wall-Wieler E, Roos LL, Brownell M, Nickel NC, Chateau D, Nixon K. Postpartum Depression and Anxiety Among Mothers Whose Child was Placed in Care of Child Protection Services at Birth: A Retrospective Cohort Study Using Linkable Administrative Data. Matern Child Health J 2019; 22:1393-1399. [PMID: 30006727 DOI: 10.1007/s10995-018-2607-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives This study examines whether mothers involved with child protection services (CPS) at the birth of their first child had higher rates of postpartum depression and anxiety. Methods A retrospective cohort of mothers whose first child was born in Manitoba, Canada between April 1, 1995 and March 31, 2015 is used. Postpartum depression and anxiety among mothers whose first child was placed in care at birth (n = 776) was compared with mothers who received services from CPS (but whose children were not placed in care) (n = 4,270), and a 3:1 matched group of mothers who had no involvement with CPS in the first year of their firstborn's life (n = 2,328). Adjusted odds ratios (AOR) of depression and anxiety diagnoses in the first year postpartum were obtained from logistic regression models. Adjusted rate ratios (ARR) of antidepressant use obtained using Poisson models. Results Mothers whose children were taken into care have greater odds of having a postpartum depression or anxiety diagnosis than mothers receiving services (AOR = 1.31; 95% CI 1.08-1.59) and those not involved with CPS (AOR = 2.13; 95% CI 1.67-2.73). Among mothers who had a postpartum depression or anxiety diagnosis, mothers whose children were placed in care had significantly higher rates of antidepressant use than mothers receiving services only (ARR = 2.00; 1.82, 2.19) and mothers who were not involved with CPS (ARR = 2.42; 95% CI 1.94-3.51). Conclusions for Practice Targeted programs should be implemented to address postpartum mental illness among mothers who are involved with CPS at the birth of their child.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Kendra Nixon
- Department of Social Work, University of Manitoba, 500C Tier Building, Winnipeg, MB, Canada
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Kehler DS, Stammers AN, Horne D, Hiebert B, Kaoukis G, Duhamel TA, Arora RC. Impact of preoperative physical activity and depressive symptoms on post-cardiac surgical outcomes. PLoS One 2019; 14:e0213324. [PMID: 30818383 PMCID: PMC6394976 DOI: 10.1371/journal.pone.0213324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/19/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To determine the independent and combined impact of preoperative physical activity and depressive symptoms with hospital length of stay (HLOS), and postoperative re-hospitalization and mortality in cardiac surgery patients. Methods A cohort study including 405 elective and in-house urgent cardiac surgery patients were analyzed preoperatively. Physical activity was assessed with the International Physical Activity Questionnaire to categorize patients as active and inactive. The Patient Health Questionnaire-9 was used to evaluate preoperative depressive symptoms and categorize patients as depressed and not depressed. Patients were separated into four groups: 1) Not depressed/active (n = 209), 2) Depressed/active (n = 48), 3) Not depressed/inactive (n = 101), and 4) Depressed/inactive (n = 47). Administrative data captured re-hospitalization and mortality data, and were combined into a composite endpoint. Models adjusted for demographics, comorbidities, and cardiac surgery type. Multiple imputation was used to impute missing values. Results Preoperative physical activity behavior and depression were not associated with HLOS examined in isolation or when analyzed by the physical activity/depressive symptom groups. Physical inactivity (HR: 1.60, 95% CI 1.05 to 2.42; p = 0.03), but not depressive symptoms, was independently associated with the composite outcome. Freedom from the composite outcome were 76.1%, 87.5%, 68.0%, and 61.7% in the Not depressed/active, Depressed/active, Not depressed/inactive, and Depressed/inactive groups, respectively (P = 0.02). The Active/Depressed group had a lower risk of the composite outcome (HR: 0.35 95% CI 0.14 to 0.89; p = 0.03) compared to the other physical activity/depression groups. Conclusion Preoperative physical activity appears to be more important than depressive symptoms on short-term postoperative re-hospitalization and mortality.
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Affiliation(s)
- D. Scott Kehler
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
- * E-mail:
| | - Andrew N. Stammers
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
| | - David Horne
- Section of Cardiac Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brett Hiebert
- Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Kaoukis
- St. Boniface General Hospital, Cardiac Psychology Service, Winnipeg, Manitoba, Canada
| | - Todd A. Duhamel
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
- Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C. Arora
- Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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The multigenerational effects of adolescent motherhood on school readiness: A population-based retrospective cohort study. PLoS One 2019; 14:e0211284. [PMID: 30726256 PMCID: PMC6364914 DOI: 10.1371/journal.pone.0211284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022] Open
Abstract
Background Children born to adolescent mothers generally perform more poorly on school readiness assessments than their peers born to adult mothers. It is unknown, however, whether this relationship extends to the grandchildren of these adolescent mothers. This paper examines the multi-generational outcomes associated with adolescent motherhood by testing whether the grandchildren of adolescent mothers also have lower school readiness scores than their peers; we further assessed if this relationship was moderated by whether the child’s mother was an adolescent mother. Methods We used population-based data to conduct the retrospective cohort study of children born in Manitoba, Canada, 2000–2009, whose mothers were born 1979–1997 (n = 11,326). Overall school readiness and readiness on five domains of development were analyzed using logistic regression models. Results Compared with children whose mothers and grandmothers were both ≥ 20 at the birth of their first child, those born to grandmothers who were < 20 and mothers who were ≥ 20 years old at the birth of their first child had 39% greater odds of being not ready for school (95% CI: 1.22–1.60). Children whose grandmothers were ≥ 20 and mothers were < 20 at the birth of their first child had 25% greater odds of being not ready for school (95% CI: 1.11–1.41), and children born to grandmothers and mothers who were both <20 at the birth of their first child had 35% greater odds of being not ready for school (95% CI: 1.18–1.54). Conclusions These findings suggest a multigenerational effect of adolescent motherhood on school readiness.
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Wall-Wieler E, Roos LL, Lee JB, Urquia ML, Roos NP, Bruce S, Brownell M. Placement in Care in Early Childhood and School Readiness: A Retrospective Cohort Study. CHILD MALTREATMENT 2019; 24:66-75. [PMID: 30176734 DOI: 10.1177/1077559518796658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The current study examined school readiness for children placed in care of child protection services before age 5. This association was assessed using a population-based cohort of children born in Manitoba, Canada, between 2000 and 2009 ( n = 53,477) and subcohorts of discordant siblings (one sibling taken into care, one sibling not taken into care; n = 809) and discordant cousins ( n = 517). In the population analysis, children placed in care were significantly less likely to be ready for school; this difference was not seen in the discordant sibling or cousin analysis. The findings suggested that differences in school readiness for children placed in care are a result of broader social factors affecting families, not placement into care.
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Affiliation(s)
| | - Leslie L Roos
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Janelle Boram Lee
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcelo L Urquia
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Noralou P Roos
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Sharon Bruce
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
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Thomson KC, Richardson CG, Gadermann AM, Emerson SD, Shoveller J, Guhn M. Association of Childhood Social-Emotional Functioning Profiles at School Entry With Early-Onset Mental Health Conditions. JAMA Netw Open 2019; 2:e186694. [PMID: 30646194 PMCID: PMC6324314 DOI: 10.1001/jamanetworkopen.2018.6694] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE More than 50% of lifetime mental health disorders develop by early adolescence, and yet it is not well understood how early childhood social-emotional functioning varies in populations or how differences in functioning may be associated with emerging mental health conditions. OBJECTIVES To identify profiles of social-emotional functioning at kindergarten school entry (age 5 years) and to examine to what extent profiles are related to early-onset mental health conditions (ages 6-14 years). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study followed up a population cohort of 34 552 children in British Columbia, Canada, from birth (born 1996-1998) to age 14 years (last follow-up, December 31, 2011). Data were analyzed from the Developmental Trajectories cohort that links British Columbia child development data from the Early Development Instrument (EDI) to British Columbia Ministry of Health and Ministry of Education records. Data were analyzed between May and September 2017. EXPOSURES Early childhood social-emotional functioning (defined as social competence, internalizing, and externalizing symptoms) rated by the children's kindergarten teachers. MAIN OUTCOMES AND MEASURES Occurrences of physician-assessed mental health conditions throughout childhood and early adolescence, including depression, anxiety, conduct disorder, and attention-deficit/hyperactivity disorder (ADHD), calculated from billing codes from the International Classification of Diseases, Ninth Revision recorded in provincial health insurance data. RESULTS Data from 34 323 children (mean [SD] age, 5.7 [0.3] years; 17 538 [51.1%] were boys) were analyzed at kindergarten and followed up to age 14 years (15 204 completed follow-up). Latent profile analysis identified 6 unique social-emotional functioning profiles at school entry, with 41.6% of children (n = 14 262) exhibiting comparative vulnerabilities in internalizing or externalizing behaviors. Prevalence of mental health conditions from ages 6 to 14 years was 4.0% for depression, 7.0% for anxiety, 5.5% for conduct disorder, 7.1% for ADHD, and 5.4% for multiple conditions. Zero-inflated Poisson analyses showed an association between social-emotional functioning profiles at kindergarten school entry and physician-assessed mental health conditions by age 14 years (range of adjusted odds ratios: depression, 1.10 [95% CI, 0.76-1.60] to 2.93 [95% CI, 1.93-4.44]; anxiety, 1.00 [95% CI, 0.74-1.36] to 1.73 [95% CI, 1.11-2.70]; conduct disorder, 2.17 [95% CI, 1.41-3.34] to 6.91 [95% CI, 4.90-9.74]; ADHD, 1.46 [95% CI, 1.11-1.93] to 8.72 [95% CI, 6.46-11.78]; and multiple conditions, 1.20 [95% CI, 0.88-1.63] to 6.81 [95% CI, 4.91-9.44]). Children with higher teacher ratings of aggression and hyperactivity had more frequent consultations for conduct disorder, ADHD, and multiple conditions. CONCLUSIONS AND RELEVANCE This study's findings suggest that more than 40% of children enter the school system with relative vulnerabilities in social-emotional functioning that are associated with early-onset mental health conditions. The results raise important questions for using population-level early childhood development monitoring in the context of universal and proactive mental health strategies.
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Affiliation(s)
- Kimberly C. Thomson
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris G. Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Anne M. Gadermann
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Scott D. Emerson
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Singal D, Brownell M, Wall-Wieler E, Chateau D, Hanlon-Dearman A, Longstaffe S, Roos LL. Prenatal care of women who give birth to children with fetal alcohol spectrum disorder in a universal health care system: a case-control study using linked administrative data. CMAJ Open 2019; 7:E63-E72. [PMID: 30755413 PMCID: PMC6404961 DOI: 10.9778/cmajo.20180027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few studies have investigated prenatal care use among women who use alcohol during pregnancy. The objective of this study was to investigate rates of prenatal care usage of women who have given birth to children with fetal alcohol spectrum disorder (FASD). METHODS We conducted a case-control study of women with children born in Manitoba between Apr. 1, 1984, and Mar. 31, 2012, with follow-up until 2013, using linkable administrative data. The study group included women whose child(ren) was (were) diagnosed with FASD (n = 702) between Apr. 1, 1999, and Mar. 31, 2012, at a centralized diagnostic clinic. The comparison group included women whose child(ren) did not have an FASD diagnosis (n = 2097), exact matched on the index child's birthdate, postal code and socioeconomic status. Adequacy of prenatal care was defined using the Revised Graduated Prenatal Care Utilization Index. RESULTS Women in the study group had lower socioeconomic status than women in the comparison group and were more likely to have mental disorders and involvement with the child welfare system. Rates of inadequate prenatal care were higher among women in the study group (adjusted relative risk 2.47, 95% confidence interval [CI] 2.08-2.94), as were rates of no prenatal care (adjusted relative risk 3.55, 95% CI 2.42-5.22). In the study group, 41% of women accessed inadequate or no prenatal care, and 59% received intermediate, adequate or intensive prenatal care. INTERPRETATION Women who give birth to children with FASD have higher rates of inadequate prenatal care and significant social complexities. Socioeconomic disparities in the use of prenatal care should be addressed; multisector interventions are needed that facilitate the uptake of prenatal care by high-risk women who use alcohol.
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Affiliation(s)
- Deepa Singal
- Department of Community Health Sciences (Singal, Brownell, Chateau, Roos), Department of Paediatrics and Child Health (Hanlon-Dearman, Longstaffe) and Manitoba Centre for Health Policy (Brownell, Chateau), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Wall-Wieler), Stanford University, Stanford, Calif.
| | - Marni Brownell
- Department of Community Health Sciences (Singal, Brownell, Chateau, Roos), Department of Paediatrics and Child Health (Hanlon-Dearman, Longstaffe) and Manitoba Centre for Health Policy (Brownell, Chateau), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Wall-Wieler), Stanford University, Stanford, Calif
| | - Elizabeth Wall-Wieler
- Department of Community Health Sciences (Singal, Brownell, Chateau, Roos), Department of Paediatrics and Child Health (Hanlon-Dearman, Longstaffe) and Manitoba Centre for Health Policy (Brownell, Chateau), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Wall-Wieler), Stanford University, Stanford, Calif
| | - Dan Chateau
- Department of Community Health Sciences (Singal, Brownell, Chateau, Roos), Department of Paediatrics and Child Health (Hanlon-Dearman, Longstaffe) and Manitoba Centre for Health Policy (Brownell, Chateau), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Wall-Wieler), Stanford University, Stanford, Calif
| | - Ana Hanlon-Dearman
- Department of Community Health Sciences (Singal, Brownell, Chateau, Roos), Department of Paediatrics and Child Health (Hanlon-Dearman, Longstaffe) and Manitoba Centre for Health Policy (Brownell, Chateau), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Wall-Wieler), Stanford University, Stanford, Calif
| | - Sally Longstaffe
- Department of Community Health Sciences (Singal, Brownell, Chateau, Roos), Department of Paediatrics and Child Health (Hanlon-Dearman, Longstaffe) and Manitoba Centre for Health Policy (Brownell, Chateau), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Wall-Wieler), Stanford University, Stanford, Calif
| | - Leslie L Roos
- Department of Community Health Sciences (Singal, Brownell, Chateau, Roos), Department of Paediatrics and Child Health (Hanlon-Dearman, Longstaffe) and Manitoba Centre for Health Policy (Brownell, Chateau), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Wall-Wieler), Stanford University, Stanford, Calif
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Chartier MJ, Tangri N, Komenda P, Walld R, Koseva I, Burchill C, McGowan KL, Dart A. Prevalence, socio-demographic characteristics, and comorbid health conditions in pre-dialysis chronic kidney disease: results from the Manitoba chronic kidney disease cohort. BMC Nephrol 2018; 19:255. [PMID: 30305038 PMCID: PMC6180583 DOI: 10.1186/s12882-018-1058-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
Background Chronic Kidney Disease (CKD) is common and its prevalence has increased steadily over several decades. Monitoring of rates and severity of CKD across populations is critical for policy development and resource planning. Administrative health data alone has insufficient sensitivity for this purpose, therefore utilizing population level laboratory data and novel methodology is required for population-based surveillance. The aims of this study include a) develop the Manitoba CKD Cohort, b) estimate CKD prevalence, c) identify individuals at high risk of progression to kidney failure and d) determine rates of comorbid health conditions. Methods Administrative health and laboratory data from April 1996 to March 2012 were linked from the data repository at the Manitoba Centre for Health Policy. Prevalence was estimated using three methods: a) all CKD cases in administrative and laboratory databases; b) all CKD cases captured only through the laboratory data; c) and the capture-recapture method. Patients were stratified by risk by estimated Glomerular Filtration Rate (eGFR) and albuminuria based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. For comorbid health conditions, the counts were modelled using a Generalized Linear Model (GLM). Results The Manitoba CKD Cohort consisted of 55,876 people with CKD. Of these, 18,342 were identified using administrative health data, 27,393 with laboratory data, and 10,141 people were identified in both databases. The CKD prevalence was 5.6% using the standard definition, 10.6% using only people captured by the laboratory data and 10.6% using the capture-recapture method. Of the identified cases, 46% were at high risk of progression to end-stage kidney disease (ESKD), 41% were at low risk and 13% were not classified, due to unavailable laboratory data. High risk cases had a higher burden of comorbid conditions. Conclusion This study reports a novel methodology for population based CKD surveillance utilizing a combination of administrative health and laboratory data. High rates of CKD at risk of progression to ESKD have been identified with this approach. Given the high rates of comorbidity and associated healthcare costs, these data can be used to develop a targeted and comprehensive public health surveillance strategy that encompass a range of interrelated chronic diseases. Electronic supplementary material The online version of this article (10.1186/s12882-018-1058-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Department of Medicine and Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Paul Komenda
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Department of Medicine and Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ina Koseva
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charles Burchill
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kari-Lynne McGowan
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Section of Nephrology, University of Manitoba, Winnipeg, Canada
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Doupe MB, Chateau D, Chochinov A, Weber E, Enns JE, Derksen S, Sarkar J, Schull M, Lobato de Faria R, Katz A, Soodeen RA. Comparing the Effect of Throughput and Output Factors on Emergency Department Crowding: A Retrospective Observational Cohort Study. Ann Emerg Med 2018; 72:410-419. [DOI: 10.1016/j.annemergmed.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/18/2018] [Accepted: 04/02/2018] [Indexed: 11/15/2022]
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