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Slater J, Katz A, Pilli B, Hinds A, Urquia ML, Sanguins J, Green C, Cidro J, Chateau D, Nickel N. Geographic Comparison of Dietary Intake and Quality in Manitoba Adolescents. CAN J DIET PRACT RES 2024:1-9. [PMID: 38456655 DOI: 10.3148/cjdpr-2024-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Purpose: The Food and Nutrition for Manitoba Youth (FANS) study examined dietary intakes, food behaviours, food security status, health indicators, and body mass index of a cohort of grade 9 students. This paper describes regional differences and similarities in dietary intake (food and nutrients) and quality of youth participants in the FANS study.Methods: Grade 9 students completed a web-based survey on dietary intakes (24-hour recall), food behaviours, self-reported health indicators, and sociodemographic variables. Nutrient intakes were compared with national guidelines and diet quality was assessed using a modified Healthy Eating Index.Results: A total of 1587 students participated from northern, rural, and urban regions in Manitoba. Northern and rural students had higher intakes of sugar, sodium, and saturated fat compared with urban. Northern students consumed fewer grain products compared to urban, and more servings of "other" foods compared with rural and urban. While most participants were classified into the "needs improvement" or "poor" Healthy Eating Index categories, significantly more northern participants were in the "poor" category.Conclusions: Most adolescents in the study are at nutritional risk; however, there are additional vulnerabilities for those in rural and northern communities. Dietitians can use results to advocate for and plan interventions to improve adolescent nutrition.
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Affiliation(s)
- Joyce Slater
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Bhanu Pilli
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB
| | - Aynslie Hinds
- Department of Psychology, University of Winnipeg, Winnipeg, MB
| | - Marcelo L Urquia
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | | | - Chris Green
- Winnipeg Regional Health Authority, Winnipeg, MB
| | - Jaime Cidro
- Department of Anthropology, University of Winnipeg, Winnipeg, MB
| | - Dan Chateau
- Research School of Population Health, Australian National University, Canberra ACT
| | - Nathan Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
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Nickel NC, Phillips-Beck W, Enns JE, Ekuma O, Taylor C, Fileatreault S, Eze N, Star L, Lavoie J, Katz A, Brownell M, Mahar A, Urquia M, Chateau D, Lix L, Chartier M, Brownell E, Tso Deh M, Durksen A, Romanescu R. COVID-19 diagnostic testing and vaccinations among First Nations in Manitoba: A nations-based retrospective cohort study using linked administrative data, 2020-2021. PLoS Med 2024; 21:e1004348. [PMID: 38363739 PMCID: PMC10871479 DOI: 10.1371/journal.pmed.1004348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/15/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM). METHODS AND FINDINGS In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms. CONCLUSION In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada.
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Affiliation(s)
- Nathan C. Nickel
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Jennifer E. Enns
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarah Fileatreault
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nkiru Eze
- Manitoba Centre for Health Policy, Dept 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
| | - Josée Lavoie
- Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dept of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- School of Nursing, Faculty of Health Sciences, Queen’s University, Kingston, Canada
| | - Marcelo Urquia
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australia National University, Canberra, Australia
| | - Lisa Lix
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emily Brownell
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Miyosha Tso Deh
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Anita Durksen
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Razvan Romanescu
- Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
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Quilty S, Lal A, Honan B, Chateau D, O’Donnell E, Mills J. The Impact of Climate Change on Aeromedical Retrieval Services in Remote Northern Australia: Planning for a Hotter Future. Int J Environ Res Public Health 2024; 21:114. [PMID: 38276808 PMCID: PMC10815201 DOI: 10.3390/ijerph21010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
It is known that environmental heat is associated with increased morbidity manifesting as increasing demand on acute care health services including pre-hospital transport and emergency departments. These services play a vital role in emergency care, and in rural and remote locations, where resource capacity is limited, aeromedical and other retrieval services are a vital part of healthcare delivery. There is no research examining how heat impacts remote retrieval service delivery. The Northern Territory (NT) of Australia is characterised by very remote communities with limited acute healthcare capacities and is a region subject to regular extreme tropical heat. In this study, we examine the relationship between aeromedical retrievals and hot weather for all NT retrievals between February 2018 and December 2019. A regression analysis was performed on the number of retrievals by clinical reason for retrieval matched to the temperature on the day of retrieval. There was a statistically significant exposure response relationship with increasing retrievals of obstetric emergencies in hotter weather in the humid climate zone and surgical retrievals in the arid zone. Retrieval services appeared to be at capacity at all times of the year. Given that there are no obstetric services in remote communities and that obstetric emergencies are a higher triage category than other emergencies (i.e., more urgent), such an increase will impede overall retrieval service delivery in hot weather. Increasing surgical retrievals in the arid zone may reflect an increase in soft tissue infections occurring in overcrowded houses in the hotter months of the year. Given that retrieval services are at capacity throughout the year, any increase in demand caused by increasing environmental heat will have broad implications for service delivery as the climate warms. Planning for a hotter future must include building resilient communities by optimising local healthcare capacity and addressing housing and other socioeconomic inequities that amplify heat-related illness.
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Affiliation(s)
- Simon Quilty
- National Centre of Epidemiology and Population Health, Australian National University, Canberra 2600, ACT, Australia; (A.L.); (D.C.)
| | - Aparna Lal
- National Centre of Epidemiology and Population Health, Australian National University, Canberra 2600, ACT, Australia; (A.L.); (D.C.)
| | - Bridget Honan
- Medical Retrieval and Consultation Centre, Alice Springs Hospital, Alice Springs 0870, NT, Australia; (B.H.); (E.O.)
| | - Dan Chateau
- National Centre of Epidemiology and Population Health, Australian National University, Canberra 2600, ACT, Australia; (A.L.); (D.C.)
| | - Elen O’Donnell
- Medical Retrieval and Consultation Centre, Alice Springs Hospital, Alice Springs 0870, NT, Australia; (B.H.); (E.O.)
| | - Jodie Mills
- Careflight Northern Territory, Eaton 0820, NT, Australia;
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Ayilara OF, Platt RW, Dahl M, Coulombe J, Ginestet PG, Chateau D, Lix LM. Generating synthetic data from administrative health records for drug safety and effectiveness studies. Int J Popul Data Sci 2023; 8:2176. [PMID: 38414538 PMCID: PMC10898503 DOI: 10.23889/ijpds.v8i1.2176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Introduction Administrative health records (AHRs) are used to conduct population-based post-market drug safety and comparative effectiveness studies to inform healthcare decision making. However, the cost of data extraction, and the challenges associated with privacy and securing approvals can make it challenging for researchers to conduct methodological research in a timely manner using real data. Generating synthetic AHRs that reasonably represent the real-world data are beneficial for developing analytic methods and training analysts to rapidly implement study protocols. We generated synthetic AHRs using two methods and compared these synthetic AHRs to real-world AHRs. We described the challenges associated with using synthetic AHRs for real-world study. Methods The real-world AHRs comprised prescription drug records for individuals with healthcare insurance coverage in the Population Research Data Repository (PRDR) from Manitoba, Canada for the 10-year period from 2008 to 2017. Synthetic data were generated using the Observational Medical Dataset Simulator II (OSIM2) and a modification (ModOSIM). Synthetic and real-world data were described using frequencies and percentages. Agreement of prescription drug use measures in PRDR, OSIM2 and ModOSIM was estimated with the concordance coefficient. Results The PRDR cohort included 169,586,633 drug records and 1,395 drug types for 1,604,734 individuals. Synthetic data for 1,000,000 individuals were generated using OSIM2 and ModOSIM. Sex and age group distributions were similar in the real-world and synthetic AHRs. However, there were significant differences in the number of drug records and number of unique drugs per person for OSIM2 and ModOSIM when compared with PRDR. For the average number of days of drug use, concordance with the PRDR was 16% (95% confidence interval [CI]: 12%-19%) for OSIM2 and 88% (95% CI: 87%-90%) for ModOSIM. Conclusions ModOSIM data were more similar to PRDR than OSIM2 data on many measures. Synthetic AHRs consistent with those found in real-world settings can be generated using ModOSIM. Synthetic data will benefit rapid implementation of methodological studies and data analyst training.
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Affiliation(s)
- Olawale F Ayilara
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Matt Dahl
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Janie Coulombe
- Department of Mathematics and Statistics, Université de Montréal, Montreal, Canada
| | - Pablo Gonzalez Ginestet
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Dan Chateau
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Froese B, Aquino G, Valencia E, Tan Q, Yogendran M, Katz C, Bolton JM, Falk J, Kowalec K, Chateau D, Delaney JC, Logsetty S, Spiwak R, Enns MW, Sareen J, Alessi-Severini S, Olafson K, Eltonsy S, Leong C. Adherence to Psychotropic Medication Before and During COVID-19: A Population-Wide Retrospective Observational Study. J Clin Psychopharmacol 2023:00004714-990000000-00144. [PMID: 37314400 DOI: 10.1097/jcp.0000000000001713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and associated public health measures have shifted the way people access health care. We aimed to study the effects of the COVID-19 pandemic on psychotropic medication adherence. METHODS A retrospective cohort study using administrative data from the Manitoba Centre for Health Policy Manitoba Population Research Data Repository was conducted. Outpatients who received at least 1 prescription for an antidepressant, antipsychotic, anxiolytic/sedative-hypnotic, cannabinoid, lithium, or stimulants from 2015 to 2020 in Manitoba, Canada, were included. Adherence was measured using the proportion of individuals with a mean possession ratio of ≥0.8 over each quarter. Each quarter of 2020 after COVID-19-related health measures were implemented was compared with the expected trend using autoregression models for time series data plus indicator variables. Odds ratio of drug discontinuation among those previously adherent in 2020 was compared with each respective quarter of 2019. RESULTS There were 1,394,885 individuals in the study population in the first quarter of 2020 (mean [SD] age, 38.9 [23.4] years; 50.3% female), with 36.1% having a psychiatric diagnosis in the preceding 5 years. Compared with the expected trend, increases in the proportions of individuals adherent to antidepressants and stimulants were observed in the fourth quarter (October-December) of 2020 (both P < 0.001). Increases in the proportions of individuals with anxiolytic and cannabinoid adherence were observed in the third quarter (July-September) of 2020 (both P < 0.05), whereas a decrease was seen with stimulants in the same quarter (P < 0.0001). No significant changes were observed for antipsychotics. All drug classes except lithium had decreases in drug discontinuation in previously adherent patients during the pandemic compared with 2019. CONCLUSIONS Improved adherence to most psychotropic medications in the 9 months after public health restrictions were enacted was observed. Patients who were already adherent to their psychotropic medications were less likely to discontinue them during the pandemic.
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Affiliation(s)
- Brandon Froese
- From the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba
| | - Gian Aquino
- From the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba
| | - Eunice Valencia
- From the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba
| | - Qier Tan
- Manitoba Centre for Health Policy
| | | | - Cara Katz
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jamie Falk
- From the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba
| | | | - Dan Chateau
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Joseph C Delaney
- From the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba
| | | | | | - Murray W Enns
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Kendiss Olafson
- Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sherif Eltonsy
- From the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba
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7
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Tsheten T, Chateau D, Dorji N, Pokhrel HP, Clements AC, Gray DJ, Wangdi K. Impact of COVID-19 on mental health in Bhutan: a way forward for action. Lancet Reg Health Southeast Asia 2023; 11:100179. [PMID: 37020787 PMCID: PMC10008798 DOI: 10.1016/j.lansea.2023.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/14/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to impact mental health and wellbeing globally. There is a lack of scientific documentation highlighting the mental health impact of COVID-19 in Bhutan. We present the mental health burdens and control measures taken, and suggest ways to further strengthen mental health services in Bhutan. During the pandemic, a rise in depression and anxiety had been reported in Bhutan. Depression rose from an average prevalence of 9 per 10,000 between 2011 and 2019 to 16 per 10,000 in 2020 and 32 per 10,000 in 2021. Similarly, anxiety rose from an average prevalence of 18 per 10,000, to 29 per 10,000 in 2020, and 55 per 10,000 in 2021. Psychological impacts related to isolation due to lockdowns, economic losses, and poor coping abilities were associated with negative outcomes. Stigma and discrimination towards mental health disorders discouraged mentally distressed people from seeking care. In response to increased demand, Bhutan’s government initiated a range of interventions including home delivery of medicines and tele-counselling to people in need of urgent mental health care. Mental health care in Bhutan can be further improved through investment in services and human resources, and decentralization of services to the community.
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Affiliation(s)
- Tsheten Tsheten
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia,Royal Centre for Disease Control, Ministry of Health, Bhutan,Corresponding author: (Address: 62 Mills Road, Acton, ACT 2601, Australia; Contact number: +61 0401206070; )
| | - Dan Chateau
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Nima Dorji
- Punakha District Hospital, Ministry of Health, Bhutan
| | | | - Archie C.A. Clements
- Telethon Kids Institute, Nedlands, Australia,Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | - Darren J Gray
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kinley Wangdi
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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8
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Aboulatta L, Kowalec K, Leong C, Delaney JA, Falk J, Alessi-Severini S, Chateau D, Tan Q, Kearns K, Raimondi C, Vaccaro C, Lavu A, Haidar L, Peymani P, Eltonsy S. Preterm birth and stillbirth rates associated with socioeconomic disparities during COVID-19 pandemic: a population-based cross-sectional study. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001686. [PMID: 36806202 PMCID: PMC9943698 DOI: 10.1136/bmjpo-2022-001686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Conflicting evidence exists on the impact of the COVID-19 pandemic restrictions on preterm birth (PTB) and stillbirth rates. We aimed to evaluate changes in PTB and stillbirth rates before and during the pandemic period and assess the potential effect modification of socioeconomic status (SES). METHODS Using the linked administrative health databases from Manitoba, Canada, we conducted a cross-sectional study among all pregnant women, comparing 3.5 years pre-pandemic (1 October 2016 to 29 February 2020) to the first year of the pandemic (1 March 2020 to 31 March 2021). We used generalised linear models to assess the quarterly rates of PTB (<37 weeks) and stillbirths. We calculated the predicted trends based on pre-pandemic period data. Finally, we evaluated the PTB and stillbirth rates among lower and higher SES pregnant women (average annual household income) using subgroup analysis and interaction models. RESULTS We examined 70 931 pregnancies in Manitoba during the study period. The risk of PTB increased by 7.7% (95%CI 1.01 to 1.13) and stillbirths by 33% (95% CI 1.08 to 1.64) during the pandemic period. Following COVID-19 restrictions implemented in March 2020, there were increases in the quarterly rates of both PTB (immediate increase (β2)=1.37; p=0.0247) and stillbirths (immediate increase (β2)=0.12; p=0.4434). Among the lower income groups, the pandemic restrictions resulted in an immediate relative increase in PTB and stillbirth rates by 20.12% (immediate increase (β2)=3.17; p=0.0057) and 27.19% (immediate increase (β2)=0.48; p=0.0852). However, over the pandemic, the overall PTB rate significantly decreased as a rebound effect by 0.85% per quarter (p=0.0004), whereas the overall stillbirth rate did not decrease significantly (slope decrease (β3) =-0.01; p=0.8296) compared with the pre-pandemic period. The quarterly rates during the pandemic among the higher income group decreased by 0.39% (p=0.1296) for PTB and increased by 0.07% (p=0.1565) for stillbirth. We observed an effect modification by SES for PTB rates (p=0.047). CONCLUSION While the onset of COVID-19 pandemic restrictions was not associated with significant effects on stillbirth rates, we observed an immediate and rebound effect on PTB rates. The impact of COVID-19 on preterm birth was dependent on SES, with higher influence on families with lower SES. Further studies are needed to detect future trend changes during pandemic waves after 2021 and assess potential underlying mechanisms.
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Affiliation(s)
- Laila Aboulatta
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kaarina Kowalec
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christine Leong
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph A Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Qier Tan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Katherine Kearns
- Department of Family Medicine, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christina Raimondi
- Department of Family Medicine, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine Vaccaro
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alekhya Lavu
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lara Haidar
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Payam Peymani
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada .,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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9
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Slater J, Pilli B, Hinds A, Katz A, Urquia ML, Sanguins J, Green C, Cidro J, Chateau D, Nickel N. Food Behaviours and Health Indicators in Manitoba Adolescents and Relation to the Healthy Eating Index. Int J Environ Res Public Health 2023; 20:2007. [PMID: 36767375 PMCID: PMC9916364 DOI: 10.3390/ijerph20032007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Adolescence is a vital period of growth and development, both of which are dependent on adequate nutrition; however, concerns persist about poor nutrition and inappropriate food behaviours. In addition to nutrition assessment, the context of food and health behaviour is necessary to understand how dietary choices are shaped and related to diet quality. This study describes food-related behaviours and health indicators associated with dietary quality among adolescents in Manitoba, Canada. A stratified two-stage sampling method was used to collect data on the diet, food behaviours and health indicators of 1587 grade nine students. Diet quality was analysed using the Healthy Eating Index-Canada. Several food behaviours and health indicators varied by gender and school region (urban, rural, northern). The Independent Samples t-test and one-way ANOVA (analysis of variance) assessed differences between groups on the Healthy Eating Index-Canada. Higher Healthy Eating Index-Canada scores were found for those eating family dinners more frequently; consuming breakfast and lunch more frequently; consuming breakfast at home; eating lunch and morning snacks at school; purchasing fewer meals and snacks from cafeterias and vending machines; believing that food and nutrition education is important; not attempting to lose weight; being classified as 'healthy weight'; and getting more sleep. Many Manitoba youth are exhibiting food and health behaviours that increase their risk of having a poor diet.
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Affiliation(s)
- Joyce Slater
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Bhanu Pilli
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Aynslie Hinds
- Department of Psychology, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Marcelo L. Urquia
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | | | - Chris Green
- Winnipeg Regional Health Authority, Winnipeg, MB R3B 1E2, Canada
| | - Jaime Cidro
- Department of Anthropology, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Dan Chateau
- Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia
| | - Nathan Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
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10
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Friesen KJ, Falk J, Chateau D, Kuo IF, Bugden S. Signal and Noise: Proton Pump Inhibitors and the Risk of Dementia? Clin Pharmacol Ther 2023; 113:152-159. [PMID: 36260313 DOI: 10.1002/cpt.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Abstract
The association between proton pump inhibitor (PPI) use and dementia remains controversial. This cohort study re-examines this issue, addressing shortcomings identified in previous publications using a population-based and a high-dimension propensity-score matched cohort to follow patients for up to 22 years. Cox regression models using baseline characteristics, a lag period, and time-varying variables were used to examine the risk of dementia by cumulative PPI exposure. High-dose PPI users (> 180 days of use) had significantly higher risk of dementia in crude Cox models. After adjustment for medical diagnoses and prescription drug use, these associations disappeared. Among high-dose users starting PPI therapy between 46 and 55 years old, the unadjusted hazard ratio (HR) was 1.55 (95% confidence interval (CI) 1.14, 2.10); the adjusted hazard ratio (aHR) was 1.10 (95% CI 0.80, 1.51). For high-dose users starting therapy between 56 and 65 years, HR = 1.22 (95% CI1.03, 1.44); aHR = 0.99 (95% CI 0.83, 1.17). High-dose users between the ages of 66 and 75 years had no association with the risk of dementia. The use of lag models or time-varying parameters similarly found some association with dementia in crude, but not multivariable Cox models. Although high-dose PPI users were more likely to develop dementia, they were more likely to be diagnosed with dementia risk factors, such as diabetes and cardiovascular disease, which are risk factors for dementia. Controlling for these conditions using multivariable models or a propensity-score matched cohort eliminated this association.
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Affiliation(s)
- Kevin J Friesen
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - I Fan Kuo
- Optimal Use and Evaluation, Clinical Services and Evaluation Branch, Pharmaceutical, Laboratory & Blood Services, British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Shawn Bugden
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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11
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Slater J, Pilli B, Hinds A, Katz A, Urquia ML, Sanguins J, Green C, Cidro J, Chateau D, Nickel N. The Food and Nutrition Security for Manitoba Youth (FANS) study: rationale, methods, dietary intakes and body mass index. BMC Nutr 2022; 8:116. [PMID: 36266659 PMCID: PMC9584280 DOI: 10.1186/s40795-022-00611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Good nutrition and access to healthy foods are essential for child growth and development. However, there are concerns that Canadian children do not have a healthy diet, which may be related to dietary choices as well as lack of access to healthy foods. The FANS (Food and Nutrition Security for Children and Youth) study examined the nutrition and food security status of youth in the province of Manitoba, Canada. This paper describes methods, dietary intakes, and body mass index for the FANS study. METHODS: This cross-sectional study included 1587 Manitoba grade nine students who completed a self-administered web-based survey. Data was collected on demographic characteristics, dietary intake (24-h recall), food behaviors, food security, and self-report health indicators. Dietary data was compared to national dietary guidelines (Dietary Reference Intakes and Canada's Food Guide). Mean and median nutrient and food group intakes were calculated with corresponding measures of variability. Chi-square tests compared percentage of respondents not meeting key nutrients and food groups. Significant differences in percentage of total servings for each food group were determined by a Kruskal-Wallis test, and differences between different caloric groups were assessed using Dunn's test for post-hoc comparisons. RESULTS: Half of study respondents were female (50.5%). Median energy intake was higher in males (2281 kcal) compared with females (1662 kcal), with macronutrient distribution of 52%, 16%, and 32% for carbohydrates, protein, and fats respectively. Most participants consumed inadequate fibre (94%), vitamin D (90%), and calcium (73%), while median sodium intakes exceeded recommendations for males but not females. A majority of participants did not meet Health Canada's recommendations for food group servings: Vegetables and Fruit (93%), Milk and Alternatives (74%), Meat and Alternatives (57%) and Grain Products (43%). Other Foods, including sugar sweetened beverages and juice, were consumed by most participants. Higher energy consumers had a greater proportion of food servings coming from Other Foods. 72.1% of students were classified as having a healthy weight and 25% were classified as overweight or obese. CONCLUSION Poor dietary intakes and body mass index values indicate an urgent need for policy and program strategies to support healthy eating habits and food awareness in Manitoba youth.
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Affiliation(s)
- Joyce Slater
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada.
| | - Bhanu Pilli
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W2, Canada
| | - Marcelo L Urquia
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada
| | | | - Chris Green
- Winnipeg Regional Health Authority, Winnipeg, MB, R3B 1E2, Canada
| | - Jaime Cidro
- Department of Anthropology, University of Winnipeg, Winnipeg, MB, R3B 2E9, Canada
| | - Dan Chateau
- Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia
| | - Nathan Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada
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12
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Pagès N, Gorgui J, Wang C, Wang X, Zhao JP, Tchuente V, Lacasse A, Côté S, King S, Muanda F, Mufike Y, Boucoiran I, Nuyt AM, Quach C, Ferreira E, Kaul P, Winquist B, O’Donnell KJ, Eltonsy S, Chateau D, Hanley G, Oberlander T, Kassai B, Mainbourg S, Bernatsky S, Vinet É, Brodeur-Doucet A, Demers J, Richebé P, Zaphiratos V, Bérard A. The Impact of COVID-19 on Maternal Mental Health during Pregnancy: A Comparison between Canada and China within the CONCEPTION Cohort. Int J Environ Res Public Health 2022; 19:12386. [PMID: 36231687 PMCID: PMC9566261 DOI: 10.3390/ijerph191912386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020-10 October 2020), Canada 2 and China (11 October 2020-16 February 2021). Overall, 2423 participants were recruited, with 1804 participants within Canada 1, 135 within Canada 2 and 484 in China. The mean EDPS scores were 8.1 (SD, 5.1) in Canada 1, 8.1 (SD, 5.2) in Canada 2 and 7.7 (SD, 4.9) in China (p-value Canada 2/China: p = 0.005). The mean GAD-7 scores were 2.6 (SD, 2.9) in China, 4.3 (SD, 3.8) in Canada 1 (p < 0.001) and 5.8 (SD, 5.2) in Canada 2 (p < 0.001). When adjusting for stress and anxiety, being part of the Chinese cohort significantly increased the chances of having maternal depression by over threefold (adjusted OR 3.20, 95%CI 1.77-5.78). Canadian and Chinese participants reported depressive scores nearly double those of other crises and non-pandemic periods. Lockdowns and reopening periods have an important impact on levels of depression and anxiety among pregnant persons.
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Affiliation(s)
- Nicolas Pagès
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Jessica Gorgui
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Chongjian Wang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Xian Wang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Jin-Ping Zhao
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
| | - Vanina Tchuente
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
| | - Anaïs Lacasse
- Health Sciences Department, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC J9X 5E4, Canada
| | - Sylvana Côté
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Medicine, School of Public Health, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Suzanne King
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Flory Muanda
- Department of Epidemiology & Biostatistics, Western University, London, ON N6A 5W9, Canada
- ICES Western, Western University, London, ON N6A 5W9, Canada
| | - Yves Mufike
- Department of Family Medicine, Protestant University in Congo, Kinshasa II, Kinshasa P.O. Box 4745, Democratic Republic of the Congo
| | - Isabelle Boucoiran
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, School of Public Health, University of Montreal, Montreal, QC H3N 1X9, Canada
| | - Anne Monique Nuyt
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Caroline Quach
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Ema Ferreira
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada
- Pharmacy Department, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Padma Kaul
- Department of Medicine, 4-120 Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AL T6G 2R7, Canada
| | - Brandace Winquist
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Kieran J. O’Donnell
- Yale Child Study Center, Department of OB/GYN and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- Douglas Research Center, Department of Psychiatry, McGill University, Montreal, QC H4H 1R3, Canada
| | - Sherif Eltonsy
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Dan Chateau
- Manitoba Center for Health Policy, Winnipeg, MB R3E 3P5, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tim Oberlander
- Department of Pediatrics, School of Population and Public Health, University of BC, Vancouver, BC V6T 1Z4, Canada
| | - Behrouz Kassai
- Faculty of Medicine, Université Claude Bernard Lyon 1, 69003 Lyon, France
- Department of Clinical Epidemiology, UMR 5558 CNRS, Clinical Investigation Centre, Inserm-Hospices Civils de Lyon, Claude Bernard University Lyon 1, 69003 Lyon, France
| | - Sabine Mainbourg
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Department of Clinical Epidemiology, UMR 5558 CNRS, Clinical Investigation Centre, Inserm-Hospices Civils de Lyon, Claude Bernard University Lyon 1, 69003 Lyon, France
| | - Sasha Bernatsky
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, QC H3A 0G4, Canada
| | - Évelyne Vinet
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, QC H3A 0G4, Canada
| | - Annie Brodeur-Doucet
- Dispensaire Diététique de Montréal/Montreal Diet Dispensary, Montreal, QC H3H 1J3, Canada
| | - Jackie Demers
- Dispensaire Diététique de Montréal/Montreal Diet Dispensary, Montreal, QC H3H 1J3, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, CIUSSS de l’Est de l’Ile de Montreal, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC H1T 2M4, Canada
| | - Valerie Zaphiratos
- Department of Anesthesiology and Pain Medicine, CIUSSS de l’Est de l’Ile de Montreal, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC H1T 2M4, Canada
| | - Anick Bérard
- Research Center CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, 69003 Lyon, France
- Faculty of Pharmacy, University of Montreal, Montreal, QC H3T 1J4, Canada
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13
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Bérard A, Kaul P, Eltonsy S, Winquist B, Chateau D, Hawken S, Sprague A, Walker M, Bernatsky S, Abrahamowicz M, Soares de Moura C, Vinet É, Carleton B, Hanley G, Oberlander T, Sheehy O, Gomez YH, Gorgui J, Savu A. The Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO): Comparisons between Quebec, Manitoba, Saskatchewan, and Alberta. PLoS One 2022; 17:e0274355. [PMID: 36126025 PMCID: PMC9488808 DOI: 10.1371/journal.pone.0274355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Given that pregnant women taking medications are excluded from clinical trials, real-world evidence is essential. We aimed to build a Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO) and compare frequency of prematurity, low-birth-weight (LBW), major malformations, multiplicity, and gestational medication use across four provinces. Methods CAMCCO is a collaborative research infrastructure that uses real-world data from large provincial health care databases in Canada; developed with standardized methods to similarly construct population-based pregnancy/child cohorts with longitudinal follow-up by linking administrative/hospital/birth databases. CAMCCO also includes a common repository to i) share algorithms and case definitions based on diagnostic and procedural codes for research/training purpose, and ii) download aggregate data relevant to primary care providers, researchers, and decision makers. For this study, data from Quebec (1998–2015), Manitoba (1995–2019), Saskatchewan (1996–2020), and Alberta (2005–2018) are compared (Chi-square tests, p-values), and trends are calculated using Cochran-Armitage trend tests. Results Almost two-thirds (61%) of women took medications during pregnancy, mostly antibiotics (26%), asthma drugs (8%), and antidepressants (4%). Differences in the prevalence of prematurity (5.9–6.8%), LBW (4.0–5.2%), and multiplicity (1.0–2.5%) were statistically significant between provinces (p<0.001). Frequency of major malformations increased over time in Quebec (7–11%; p<0.001), Saskatchewan (5–11%; p<0.001), and Alberta (from 7–8%; p<0.001), and decreased in Manitoba (5–3%; p<0.001). Cardiovascular and musculoskeletal malformations were the most prevalent. Interpretation Medications are often used among Canadian pregnancies but adverse pregnancy outcomes vary across provinces. Digitized health data may help researchers and care providers understand the risk-benefit ratios related to gestational medication use, as well as province-specific trends.
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Affiliation(s)
- Anick Bérard
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France
- * E-mail:
| | - Padma Kaul
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandace Winquist
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Dan Chateau
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Research School of Population Health, Australian National University College of Health and Medicine, Canberra, Australia
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann Sprague
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Mark Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, School of Global & Population Health, McGill University, Montreal, Quebec, Canada
| | - Cristiano Soares de Moura
- Faculty of Medicine, Department of Clinical Epidemiology, McGill University, Montréal, Québec, Canada
| | - Évelyne Vinet
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Canada
| | - Bruce Carleton
- Division of Translational Therapeutics Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim Oberlander
- University of British Columbia, School of Population and Public Health, Department of Pediatrics, Vancouver, British Columbia, Canada
| | - Odile Sheehy
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | | | - Jessica Gorgui
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Anamaria Savu
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
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14
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Nickel NC, Phillips-Beck W, Star L, Okechukwu E, Taylor C, Balogun OD, Brownell M, Casidsid H, Chartier M, Chateau D, Enns J, Katz A, Lavoie J, Lix L, Mahar A, Romanescu R, Urquia M. Documenting First Nations Access to COVID Vaccines: A whole-population linked administrative data study. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesFirst Nations (FN) organizations worked with public health and governments to improve FN access to COVID-19 vaccines by prioritizing FN communities in vaccination initiatives. FN researchers and data scientists partnered to test whether these efforts were associated with increased access to COVID-19 vaccines among FN compared with all other Manitobans.
ApproachThis retrospective cohort study linked whole-population administrative data from (i) the First Nations research file, (ii) COVID testing and vaccination data, and (iii) health and social services for sociodemographic data and information on potential confounders. Several public health policies were created to improve access to COVID vaccines among FN; we tested whether FN received their 1st and 2nd vaccines sooner than all other Manitobans (AOM) using restricted mean survival time models. We adjusted for sociodemographic characteristics, comorbidities, and whether FN lived on- or off-reserve. We conducted sex-specific and effect modification analyses to test whether associations differed by sex.
ResultsPrioritizing FN to receive vaccines was associated with increased vaccine uptake compared with AOM. After adjusting for various confounders, FN received their first dose 15.5 (95% CI 14.9 – 16.0) days sooner than AOM and their second dose 13.9 (13.3 – 14.5) days sooner than AOM. Sex-stratified and subsequent effect modification analyses using interaction terms, found that differences were greater for males than for females: FN males received their first dose 18.1 (17.3 – 18.8) days sooner than AOM males and FN females received their first dose 12.9 (12.2 – 13.7) days sooner than AOM females. This pattern held for second doses as well. FN with comorbidities also received vaccines sooner than AOM with similar comorbidity levels 20.9 days (23.1 – 18.8) among those with 3+ comorbidities.
ConclusionPartnerships between public health entities and FN organizations that respect FN community sovereignty were instrumental in supporting FN health and well-being during COVID-19. Policies and programs that prioritized FN people for vaccines improved uptake saving lives. This partnership-based COVID-19 response can provide a framework for future public health efforts.
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15
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Brownell M, Sinclair S, Nickel N, Turnbull L, Linden R, Ricciardelli R, Au W, Enns J, Chartier M, Urquia M, Mahar A, Wall-Wieler E, Chateau D, Sanscartier M, Casiano H, Quddus F, Lambert D, Ferland I. Quantifying intersecting structural racism in the youth criminal justice system: a whole-population linked administrative data study from Manitoba. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesOver three decades ago, the Aboriginal Justice Inquiry identified structural racism in Canada’s justice system. Although rates of youth criminal charges and incarcerations have declined substantially since then, it is unclear whether First Nations youth are treated differently than non-First Nations youth for similar offences. Our study addressed this question.
ApproachThis retrospective cohort study of youth born 1991-2001 and living in Manitoba between ages 12-17 used whole-population linked administrative data to identify youth charged with a crime (N=13,543). First Nations youth (n=7,081) were compared with all other Manitoba (AOM) youth (n=6,462) on whether their criminal charge proceeded or was dropped, deferred or diverted. The study applied an intersectionality theoretical framework. Individual (age, type and severity of charge, ever in child protection care, youth and/or mother diagnosed mental disorder, maternal incarceration, number of siblings, urban/rural residence) and social strata (First Nations identity, income, sex) factors were adjusted for using multi-level models.
ResultsAfter accounting for other factors, First Nations youth had a higher risk of a charge proceeding than AOM (adjusted Relative Risk (aRR) 1.16, 95% CI 1.12-1.20). There was no difference in charges proceeding for male First Nations youth compared with male AOM, whereas among females, the risk was greater for First Nations (aRR 1.31, 95% CI 1.26-1.36). Low income and a history of being in the care of the child protection system increased the risk of charges proceeding for AOM only (aRR 1.16, 95% CI 1.13-1.18; aRR 1.13, 95% CI 1.07-1.20); for First Nations, there was no increased risk of charges proceeding associated with these intersecting factors.
ConclusionThese findings provide quantitative evidence of the intersecting structural racism in the youth criminal justice system previously identified by First Nations leaders. Future research will follow this cohort to determine whether more judicial sanctions are applied to First Nations youth throughout the justice process, including within criminal courts and corrections.
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16
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Enns JS, Mota NP, Bolton JM, Ekuma O, Chateau D, Paluszek MM, Sareen J, Katz LY. Incidence and Predictors of Suicide Attempts and Suicide Deaths Among Individuals Recently Hospitalized for a Mental Disorder: A Population-Based Study. J Clin Psychiatry 2022; 83. [PMID: 35704710 DOI: 10.4088/jcp.21m14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: To examine the incidence and predictors of suicide attempts and deaths in the year after psychiatric hospitalization. Methods: A population-based dataset was used to develop a cohort of individuals 18 years or older admitted with a mental disorder (defined by ICD-10 codes) from 2005 to 2016 (n = 26,975) in Manitoba, Canada. Using Cox regression, hazard ratios were calculated for each covariate among those who attempted and died by suicide in the year following hospitalization, while adjusting for confounders. Results: In the year following hospitalization for a mental disorder, 0.7% of the individuals died by suicide and 3.5% attempted suicide. Statistically significant risk factors for suicide in the year after discharge from psychiatric hospitalization included male sex (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.10-1.97) and urban location (HR, 1.37; 95% CI, 1.02-1.85) and for attempting suicide included female sex (HR, 0.63; 95% CI, 0.55-0.72), living rurally (HR, 0.66; 95% CI, 0.58-0.75), a previous mental disorder (HR, 1.63; 95% CI, 1.38-1.92), justice involvement (HR, 1.48; 95% CI, 1.28-1.70), and being on income assistance (HR, 1.17; 95% CI, 1.01-1.35) (P < .05 for all). Age (HR, 0.99; 95% CI, 0.99-0.99) (P < .05) was associated with a reduced rate of suicide attempts. Conclusions: Further research into interventions to address the identified risk factors for suicide in the recently discharged population is critical to improve management.
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Affiliation(s)
- Jessica S Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Corresponding author: Jessica S. Enns, MD, 204-470-1213, 771 Bannatyne Ave, Winnipeg, Manitoba, Canada, R3E 3N4
| | - Natalie P Mota
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia, and Manitoba Centre for Health Policy Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michelle M Paluszek
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurence Y Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Enns J, Nickel NC, Chateau D, Katz A, Sarkar J, Lambert D, Brownell M. A Longitudinal Cohort Study of Participation in the Boys & Girls Clubs of Winnipeg. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i1.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionOut-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities.
ObjectiveWe examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes.
MethodsWe linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990$) included children and adolescents who visited BGCW at least once from 2005—2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW.
ResultsParticipation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12—17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18—24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13—19) and sexually transmitted infections among adolescents (aged 13—19) also declined as the frequency of participation in BGCW increased.
ConclusionsThe findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.
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18
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Enns JE, Nickel NC, Chateau D, Katz A, Sarkar J, Lambert D, Brownell M. A longitudinal cohort study of participation in the Boys & Girls Clubs of Winnipeg. Int J Popul Data Sci 2022; 7:1735. [PMID: 35782200 PMCID: PMC9210069 DOI: 10.23889/ijpds.v6i1.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Out-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities. Objective We examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes. Methods We linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990) included children and adolescents who visited BGCW at least once from 2005-2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW. Results Participation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12-17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18-24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13-19) and sexually transmitted infections among adolescents (aged 13-19) also declined as the frequency of participation in BGCW increased. Conclusions The findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.
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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,Corresponding author: Jennifer E. Enns
| | - Nathan C. Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba,Faculty of Kinesiology and Recreation Management, Rady Faculty of Health Sciences, University of Manitoba
| | - Dan Chateau
- Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Alan Katz
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba,Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba
| | - Drew Lambert
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba
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19
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Sheel M, Wood N, Macartney K, Buttery J, Dinsmore N, Marshall H, Elliott E, Kynaston A, Richmond P, Chateau D, McIntyre P. Severity of Rotavirus-Vaccine-Associated Intussusception: Prospective Hospital-Based Surveillance, Australia, 2007-2018. Pediatr Infect Dis J 2022; 41:507-513. [PMID: 35363642 DOI: 10.1097/inf.0000000000003521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Multiple studies have shown an association between intussusception (IS) and receipt of monovalent or pentavalent rotavirus vaccine (RV) in the previous 21 days. Disease severity is an important consideration for risk-benefit evaluations of RV, but no studies have compared the severity of IS within 21 days of vaccination (vaccine-associated, VA) and later (not temporally-associated, VNA). METHODS We used active hospital-based surveillance in the Australian Paediatric Active Enhanced Disease Surveillance (PAEDS) network (July 2007 to February 2018) to identify infants ≤9 months of age meeting Brighton level 1 criteria for IS. We used five severity levels: (1) no surgery and length of stay (LOS) ≤1 day, (2) no surgery and LOS ≥2 days, (3) surgery, no bowel resection, (4) bowel resection, and (5) ICU admission. RESULTS Of 323 eligible cases, 87 (26.9%) were VA and 236 (73.1%) VNA. VA-IS cases (median 21 weeks; 24.1% ≤14 weeks) were significantly younger than VNA-IS cases (median 28 weeks, 7.2% ≤14 weeks). Cases 0-≤14 weeks of age were significantly more likely than cases ≥25 weeks to require bowel resection (relative risk ratio 4.6, 95% CI, 1.48-14.3). This effect was not associated with RV. After adjustment for age and sex, VA-IS was not significantly overrepresented in severity levels 2-5; adjusted RRR of 1.37 (95% CI: 0.61-3.11) for bowel resection in cases 0-≤14 weeks of age. CONCLUSIONS IS was uncommon but significantly more severe under 14 weeks of age. After adjustment for age and sex, IS severity was not related to RV.
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Affiliation(s)
- Meru Sheel
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales
- The University of Sydney, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney, New South Wales
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales
| | - Nicholas Wood
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales
- The University of Sydney, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney, New South Wales
| | - Kristine Macartney
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales
- The University of Sydney, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney, New South Wales
| | - Jim Buttery
- Department of Infection and Immunity, Monash Children's Hospital, Monash Health, Melbourne, Victoria
- Monash Centre of Health Research and Implementation, Department of Paediatrics, Monash University, Melbourne, Victoria
| | - Nicole Dinsmore
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales
| | - Helen Marshall
- Women's and Children's Health Network and Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Elizabeth Elliott
- The University of Sydney, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney, New South Wales
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney Children's Hospitals Network, Westmead, New South Wales
| | - Anne Kynaston
- Queensland Children's Hospital, Brisbane, Queensland
| | - Peter Richmond
- Wesfarmer's Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia
| | - Dan Chateau
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Peter McIntyre
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales
- The University of Sydney, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney, New South Wales
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Doan T, Ha V, Strazdins L, Chateau D. Healthy minds live in healthy bodies – effect of physical health on mental health: Evidence from Australian longitudinal data. Curr Psychol 2022. [DOI: 10.1007/s12144-022-03053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractIt is well known that physical and mental health are closely related, with growing evidence for biological and behavioural pathways. Mostly the research has focussed on mental health as the key driver of this inter-connection; the extent physical health shapes mental health has received less attention. We aim to derive robust estimates of the unique role physical health may play in shaping mental health outcomes. To do so we use a novel approach, incorporating longitudinal and instrumental variable methods which can address the reciprocal relationship between physical and mental health, and the endogeneity of physical health, before estimating the physical to mental health pathway. A sample of 209,442 observations (or 24,966 unique individuals) aged 15 and over spanning 18 years (2002–2019) was extracted from the Household Income and Labour Dynamics in Australian Survey (HILDA). We find that physical activity and health shocks erode mental health via their impact on physical health with a one point improvement (or worsening) in physical health scores (0–100) resulting in a rise (or decline) of 0.43 points (or 43%) in mental health score.
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22
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Strumpf E, Austin N, Lang A, Derksen S, Bolton J, Brownell M, Gregory P, Chateau D, Heaman M. The effects of early pregnancy loss on health outcomes and health care utilization and costs. Health Serv Res 2022; 57:786-795. [PMID: 35076944 PMCID: PMC9264463 DOI: 10.1111/1475-6773.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/21/2021] [Accepted: 12/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the effects of early pregnancy loss on subsequent health care use and costs. Data Sources Linked administrative health databases from Manitoba, Canada. Study Design This was a population‐based cohort study. The exposure of interest was first recorded ectopic pregnancy or miscarriage (EPM). Outcomes included visits to all ambulatory care providers, family physicians (FPs), specialists, and hospitals, as well as the costs associated with these visits. We also assessed the impact of EPM on a global measure of health service utilization and the incidence and costs of psychotropic medications. Data Collection/Extraction Methods We identified women who experienced their first recorded loss (EPM) from 2003–2012 and created a propensity score model to match these women to women who experienced a live birth, with outcome measures available through 31 December 2014. We used a difference in differences approach with multivariable negative binomial models and generalized estimating equations (GEE) to assess the impact of EPM on the aforementioned health care utilization indicators. Principal Findings EPM was associated with a short‐term increase in visits to, and costs associated with, certain ambulatory care providers. These findings were driven in large part by increased visits/costs to FPs (rate difference [RD]: $19.92 [95% CI: $16.33, $23.51]) and obstetrician‐gynecologists (OB‐GYNs) (RD $9.41 [95% CI: $8.42, $10.40]) in the year immediately following the loss, excluding care associated with the loss itself. We also detected an increase in hospital stays and costs and a decrease in the use of psychotropic medications relative to matched controls. Conclusion Pregnancy loss may lead to subsequent increases in certain types of health care utilization. While the absolute costs associated with post‐EPM care are relatively small, the observed patterns of service utilization are informative for providers and policy makers seeking to support women following a loss.
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Affiliation(s)
- E. Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health & Department of Economics. Leacock Building McGill University Montreal QC Canada
| | - N. Austin
- School of Health Administration Dalhousie University Halifax Nova Scotia Canada
| | - A. Lang
- School of Nursing McGill University Quebec Canada
| | - S. Derksen
- University of Manitoba, Manitoba Centre for Health Policy Manitoba Canada
| | - J. Bolton
- Department of Psychiatry and Manitoba Centre for Health Policy University of Manitoba Winnipeg Manitoba Canada
| | - M. Brownell
- Department of Community Health Sciences & Manitoba Centre for Health Policy, Max Rady College of Medicine, Community Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - P. Gregory
- Red River College, Nursing Department School of Health Sciences and Community Services Winnipeg Manitoba Canada
| | - D. Chateau
- Department of Community Health Sciences & Manitoba Centre for Health Policy University of Manitoba Manitoba Canada
| | - M. Heaman
- College of Nursing & Department of Obstetrics, Gynecology and Reproductive Sciences, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba University of Manitoba Winnipeg Manitoba Canada
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Nickel NC, Enns JE, Sanguins J, O'Conaill C, Chateau D, Driedger SM, Taylor C, Detillieux G, Deh MT, Brownell E, Chartrand AF, Katz A. Patterns of prescription opioid dispensing among Red River Métis in Manitoba, Canada: a retrospective longitudinal cross-sectional study. CMAJ Open 2022; 10:E288-E295. [PMID: 35351781 PMCID: PMC9259467 DOI: 10.9778/cmajo.20210025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Amid rising concern about opioid use across Canada, Métis leaders in Manitoba are seeking information on prescription opioid dispensing in Red River Métis populations to assist with planning and implementing appropriate evidence-based harm-reduction strategies in their communities. We examined patterns of prescription opioid dispensing among Red River Métis and compared them to those among other residents of Manitoba. METHODS We conducted a population-based retrospective cross-sectional study for fiscal years 2006/07-2018/19 using administrative data from the Manitoba Population Research Data Repository and a study designed in partnership with researchers from the Manitoba Métis Federation. We compared age- and sex-adjusted rates of prescription opioid dispensing and mean morphine equivalents (MEQ) between Red River Métis and all other Manitobans aged 10 years or older, in accordance with Indigenous data sovereignty principles. To better understand what was driving any differences in patterns of prescription opioid dispensing between the 2 groups, we stratified the groups by age, sex, urbanicity, number of comorbidities, income quintile and opioid type, and compared patterns in MEQ/person. RESULTS The 2018/19 cohort included 76 755 Red River Métis and 1 117 854 other Manitobans. Other Manitobans were more likely than Red River Métis to be in higher income quintiles and to live in urban areas, and were less likely to have been diagnosed with a mood or anxiety disorder or a substance use disorder in the previous 5 years. The rate of prescription opioid dispensing and the opioid-associated MEQ/person were consistently higher among Red River Métis than among other Manitobans in each study year (p < 0.001). The rate of prescription opioid dispensing declined and the MEQ/person rose among other Manitobans over the study period but did not change among Red River Métis. INTERPRETATION The rate of prescription opioid dispensing and the potency of prescribed opioids were higher among Red River Métis in Manitoba than among other Manitobans. Further investigation into the different dispensing patterns between the 2 groups and the potential opioid-related harms they may herald is warranted.
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Affiliation(s)
- Nathan C Nickel
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man.
| | - Jennifer E Enns
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Julianne Sanguins
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man.
| | - Carrie O'Conaill
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Dan Chateau
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - S Michelle Driedger
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Carole Taylor
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Gilles Detillieux
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Miyosha Tso Deh
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Emily Brownell
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - A Frances Chartrand
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Alan Katz
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Sellers EA, Tan Q(A, Prior H, Chateau D, Wicklow BA, Fransoo R. Pregestational Diabetes Exposure in Utero: Validation of a Definition for Use in Administrative Data. Can J Diabetes 2021; 46:388-391.e3. [DOI: 10.1016/j.jcjd.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
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26
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McCallum R, Distasio J, Chateau D, Sareen J, Medved MI, Hiebert-Murphy D. Longitudinal Mixed Modelling of Emergency Department Use Among a Sample of Homeless Participants in a Housing First Demonstration Trial. J Health Care Poor Underserved 2021; 32:1829-1843. [PMID: 34803046 DOI: 10.1353/hpu.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present Canadian study sought to identify predictors of emergency department (ED) use in a sample of adults who are homeless. Four hundred eighty-three participants were interviewed quarterly for two years, reporting their housing status, income, food security, physical/mental health, and other social determinants of health. Survey data were linked to administrative health and social services data. Predictors of ED visits were analyzed using negative binomial longitudinal mixed modelling. Emergency department visits were positively and reliably predicted by pre-baseline ED use, as well as by concurrent increased social assistance, primary care visits, ratings of physical health, substance use problems, and case management visits. Increased concurrent housing instability and food insecurity, and decreased homelessness history, positively predicted ED visits, but effect reliability was lower. Participant ill health appears to be a primary driver of ED utilization. The findings challenge misconceptions about the appropriateness of ED use among people who are homeless.
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Brandt J, Janzen D, Alessi-Severini S, Singer A, Chateau D, Enns M, Leong C. Risk of long-term benzodiazepine and Z-drug use following the first prescription among community-dwelling adults with anxiety/mood and sleep disorders: a retrospective cohort study. BMJ Open 2021; 11:e046916. [PMID: 34725071 PMCID: PMC8562522 DOI: 10.1136/bmjopen-2020-046916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To measure the incidence of long-term benzodiazepine receptor agonist (BZRA) use among individuals with anxiety, mood and/or sleep disorders. To identify factors associated with long-term use following the first prescription. METHODS This was a population-based retrospective cohort study using administrative databases in Manitoba, Canada. Individuals with anxiety/mood or sleep disorder who received their first BZRA between 1 April 2001 and 31 March 2015 were included. Long-term use was defined as ≥180 days. Logistic regression modelling was used to examine predictors of long-term use. RESULTS Among 206 933 individuals included, long-term BZRA use in the first episode of use was 4.5% (≥180 days) following their first prescription. Factors associated with ≥180 days of use included male sex (adjusted OR (aOR) 1.33, 95% CI 1.27 to 1.39), age ≥65 (aOR 5.15, 95% CI 4.81 to 5.52), income assistance (aOR 1.68, 95% CI 1.55 to 1.81), previous non-BZRA psychotropic (aOR 1.93, 95% CI 1.83 to 2.02) or opioid use (aOR 1.16, 95% CI 1.11 to 1.22), high comorbidity (aOR 1.43, 95% CI 1.32 to 1.55), high healthcare use (aOR 1.46, 95% CI 1.33 to 1.60) and psychiatrist prescriber (aOR 2.11, 95% CI 1.93 to 2.32). CONCLUSIONS Less than 1 in 20 patients use BZRAs ≥180 days in their first treatment episode. Several factors were associated with long-term use following the first prescription and further investigation into whether these factors need to be considered at the point of prescribing is warranted. In light of these findings, future research should examine the predictors of cumulative repeat episodes of BZRA exposure.
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Affiliation(s)
- Jaden Brandt
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Donica Janzen
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Alexander Singer
- Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Murray Enns
- Psychiatry, Univeristy of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine Leong
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
- Psychiatry, Univeristy of Manitoba, Winnipeg, Manitoba, Canada
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Olafson K, Marrie RA, Bolton JM, Bernstein CN, Bienvenu OJ, Kredentser MS, Logsetty S, Chateau D, Nie Y, Blouw M, Afifi TO, Stein MB, Leslie WD, Katz LY, Mota N, El-Gabalawy R, Enns MW, Leong C, Sweatman S, Sareen J. The 5-year pre- and post-hospitalization treated prevalence of mental disorders and psychotropic medication use in critically ill patients: a Canadian population-based study. Intensive Care Med 2021; 47:1450-1461. [PMID: 34495357 DOI: 10.1007/s00134-021-06513-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/18/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. METHODS Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. RESULTS The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92-0.97, p < 0.0001; 5-year APR 0.99, 95% CI 0.98-1.00, p = 0.1), but higher following discharge (1-year APR 1.08, 95% CI 1.05-1.11, p < 0.0001, 5-year APR 1.03, 95% CI 1.01-1.05, p < 0.0001). A high proportion of ICU patients received antidepressant, anxiolytic and sedative-hypnotic prescriptions before and after their hospitalization. In multivariable analyses, ICU exposure was associated with an increase in mood, anxiety and psychotic disorders, and sedative-hypnotics use (p < 0.0001 for all Time × Group interactions). CONCLUSIONS During the 5 years after admission to ICU, there is a significant increase in treated prevalence of mental disorders and psychotropic medication use compared to the 5 years prior to ICU and compared to general population and hospital cohorts. Prevention and intervention programs that identify and treat mental disorders among survivors of critical illness warrant further study.
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Affiliation(s)
- Kendiss Olafson
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada.
| | - Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maia S Kredentser
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Yao Nie
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Marcus Blouw
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada
| | - Tracie O Afifi
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Murray B Stein
- University of California San Diego, La Jolla, CA, USA.,VA San Diego Healthcare System, San Diego Healthcare System, San Diego, CA, USA
| | - William D Leslie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Murray W Enns
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Leong
- Rady Faculty of Health Sciences, College of Pharmacy, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sophia Sweatman
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario, ON, Canada
| | - Jitender Sareen
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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St-Jean A, Chateau D, Dahl M, Ernst P, Daneman N, Sketris IS, Zhang J, Marra F, Quail J, Bugden S. Regional variation in the potentially inappropriate first-line use of fluoroquinolones in Canada as a key to antibiotic stewardship? A drug utilization review study. BMC Infect Dis 2021; 21:733. [PMID: 34344348 PMCID: PMC8330086 DOI: 10.1186/s12879-021-06467-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background Serious adverse effects of fluoroquinolone antibiotics have been described for more than decade. Recently, several drug regulatory agencies have advised restricting their use in milder infections for which other treatments are available, given the potential for disabling and possibly persistent side effects. We aimed to describe variations in fluoroquinolone use for initial treatment of urinary tract infection (UTI), acute bacterial sinusitis (ABS), and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the outpatient setting across Canada. Methods Using administrative health data from six provinces, we identified ambulatory visits with a diagnosis of uncomplicated UTI, uncomplicated AECOPD or ABS. Antibiotic exposure was determined by the first antibiotic dispensed within 5 days of the visit. Results We identified 4,303,144 uncomplicated UTI events among 2,170,027 women; the proportion of events treated with fluoroquinolones, mostly ciprofloxacin, varied across provinces, ranging from 18.6% (Saskatchewan) to 51.6% (Alberta). Among 3,467,678 ABS events (2,087,934 patients), between 2.2% (Nova Scotia) and 11.2% (Ontario) were dispensed a fluoroquinolone. For 1,319,128 AECOPD events among 598,347 patients, fluoroquinolones, mostly levofloxacin and moxifloxacin, ranged from 5.8% (Nova Scotia) to 35.6% (Ontario). The proportion of uncomplicated UTI and ABS events treated with fluoroquinolones declined over time, whereas it remained relatively stable for AECOPD. Conclusions Fluoroquinolones were commonly used as first-line therapies for uncomplicated UTI and AECOPD. However, their use varied widely across provinces. Drug insurance formulary criteria and enforcement may be a key to facilitating better antibiotic stewardship and limiting potentially inappropriate first-line use of fluoroquinolones. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06467-z.
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Affiliation(s)
- Audray St-Jean
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Dahl
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Nick Daneman
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Jianguo Zhang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Quail
- Health Quality Council, Saskatoon, SK, Canada.,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shawn Bugden
- School of Pharmacy, Health Sciences Centre, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada. .,College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Ratnayake I, Shooshtari S, Chateau D, Kristjanson M. Complete physical examinations in Manitoba adults with an intellectual or developmental disability: A retrospective cohort study. J Appl Res Intellect Disabil 2021; 34:1582-1591. [PMID: 34196454 DOI: 10.1111/jar.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Complete physical examinations (CPE) can identify health disparities in persons with intellectual or developmental disabilities. The objective of this study was to determine and compare rates of CPE among Manitoba adults with and without intellectual or developmental disabilities over time and to identify factors that were associated with receiving a CPE. METHOD A retrospective cohort study using linked administrative health and non-health data from 1995 to 2015 was conducted. Poisson and logistic regression were used to calculate CPE rates and examine factors associated with CPE. RESULTS The rates of CPE are decreasing over time and are higher among Manitobans with an intellectual or developmental disability. Characteristics such as being male, living rurally, low socioeconomic status, and high continuity of care led to lower odds of receiving a CPE. CONCLUSIONS The current state of CPE provision to adults with intellectual or developmental disabilities in Manitoba is encouraging but needs improvement.
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Affiliation(s)
- Iresha Ratnayake
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mark Kristjanson
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
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Guillemette L, Wicklow B, Sellers EAC, Dart A, Shen GX, Dolinsky VW, Gordon JW, Jassal DS, Nickel N, Duhamel TA, Chateau D, Prior HJ, McGavock J. Intrauterine exposure to diabetes and risk of cardiovascular disease in adolescence and early adulthood: a population-based birth cohort study. CMAJ 2021; 192:E1104-E1113. [PMID: 32989023 DOI: 10.1503/cmaj.190797] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is unclear whether intrauterine exposure to maternal diabetes is associated with risk factors for cardiovascular disease and related end points in adulthood. We examined this potential association in a population-based birth cohort followed up to age 35 years. METHODS We performed a cohort study of offspring born between 1979 and 2005 (n = 293 546) and followed until March 2015 in Manitoba, Canada, using registry-based administrative data. The primary exposures were intrauterine exposure to gestational diabetes and type 2 diabetes mellitus. The primary outcome was a composite measure of incident cardiovascular disease events, and the secondary outcome was a composite of risk factors for cardiovascular disease in offspring followed up to age 35 years. RESULTS The cohort provided 3 628 576 person-years of data (mean age at latest follow-up 20.5 [standard deviation 6.4] years, 49.3% female); 2765 (0.9%) of the offspring experienced a cardiovascular disease end point, and 12 673 (4.3%) experienced a cardiovascular disease risk factor. After propensity score matching, the hazard for cardiovascular disease end points was elevated in offspring exposed to gestational diabetes (adjusted hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12-1.79) but not type 2 diabetes (adjusted HR 1.40, 95% CI 0.98-2.01). A similar association was observed for cardiovascular disease risk factors (gestational diabetes: adjusted HR 1.92, 95% CI 1.75-2.11; type 2 diabetes: adjusted HR 3.40, 95% CI 3.00-3.85). INTERPRETATION Intrauterine exposure to maternal diabetes was associated with higher morbidity and risk related to cardiovascular disease among offspring up to 35 years of age.
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Affiliation(s)
- Laetitia Guillemette
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Elizabeth A C Sellers
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Allison Dart
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Garry X Shen
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Vernon W Dolinsky
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Joseph W Gordon
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Davinder S Jassal
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Nathan Nickel
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Todd A Duhamel
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Dan Chateau
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Heather J Prior
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Jonathan McGavock
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Hack TF, Ruether JD, Pitz M, Thiessen B, Degner LF, Chateau D. Impact of consultation recordings on patient-reported outcomes in patients with brain tumors: a parallel randomized controlled trial. Support Care Cancer 2021; 29:5681-5690. [PMID: 33595717 DOI: 10.1007/s00520-021-06038-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to determine the impact of a primary treatment consultation recording on perception of being informed, satisfaction with cancer care, satisfaction with the oncologist, and psychological distress in patients with brain tumors. METHODS This was a prospective, double-blind, parallel, randomized controlled trial conducted in 3 Canadian cities, in which patients who had their initial treatment consultation recorded were assigned to either receive their digital recording or not. It was hypothesized that patients who received their recording would realize statistically significant benefit on the outcomes of interest at 1 week, 3 months, and 6 months post-consultation in comparison to patients who did not receive their recording. Outcome measures included the following: Patient Satisfaction with Cancer Scale, Hospital Anxiety and Depression Scale, PrestMan Satisfaction with Doctor Scale, and Perception of Being Informed Scale. RESULTS Of the 246 eligible patients, 133 participated (60.9% male; age M=52.4 years; 53.4% grade IV disease). Of these, 63 received their consultation recording and 70 did not. Intention-to-treat analysis showed that, compared to baseline, patients who received their consultation recording reported being more fully informed about their disease and treatment at 1 week post-consultation than patients who did not receive their recording (p = 0.007), but this finding was no longer significant at 3 and 6 months. There were no statistically significant differences observed between the two groups on the measures of satisfaction with cancer care, satisfaction with the doctor, and depression or anxiety at any assessment time point, though the study was under-powered. CONCLUSION The study findings show that primary treatment consultation recordings may provide limited benefit beyond brain tumor patients' perception of being informed, despite being highly valued by these patients, and high listening rates among their significant others. The lack of statistical power should be considered when interpreting the findings. TRIAL REGISTRATION ClinicalTrials.gov - NCT01866228.
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Affiliation(s)
- Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada. .,St. Boniface Hospital Research Centre, Winnipeg, MB, Canada. .,Asper Clinical Research Institute, Room CR3018, 369 Taché Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
| | - J Dean Ruether
- Tom Baker Cancer Centre, Calgary, AB, Canada.,Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marshall Pitz
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Thiessen
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Lesley F Degner
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Sanguins J, Nickel NC, Chateau D, Taylor C, Detillieux G, Kloss O, Katz A. Use of Prescription Opioids and Impact of Replacing Oxycontin With Oxyneo On Opioid Use Among Metis Citizens, 2013-2018. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionCanada has one of the highest rates of prescription opioid consumption globally. Little is known about the prevalence and determinants of opioid use among citizens of the Metis nation – one of three Aboriginal groups recognized by the Canadian constitution.
Objectives and ApproachOur objectives were to (i) identify trends in prescription opioid use among Metis citizens from 2006 to 2018 and (ii) identify whether replacing OxyContin with OxyNeo in February 2012 differentially impacted prevalence of opioid use among Metis when compared with all other Manitobans. The Manitoba Metis Federation and the University of Manitoba partnered on this research. We identified prescription opioid use using dispensation records from the province’s drug database, which includes records for all prescription drugs dispensed in community. We defined acute prescription opioid use as ≤28 days prescription and chronic use as ≥ 29 days’ prescription. We tested for differences in annual trends in acute and chronic prescription opioid use between Metis and all other Manitobans. We used an interrupted time series design to test whether replacing OxyContin differentially impacted prevalence of acute and chronic opioid use among Metis when compared with all other Manitobans. We used generalized linear models to test for trends and the impact of replacing OxyContin.
ResultsAcross all years (2006-2018) acute prescription and chronic opioid use was higher among Metis than all other Manitobans. Acute and chronic use decreased in both groups, non-differentially. Replacing OxyContin with OxyNeo was associated with decreased acute opioid use in both Metis and all other Manitobans and had a greater impact on chronic opioid use among Metis than among all other Manitobans. Conclusion / Implications: Findings highlight the differential experiences arising from the historic and ongoing colonial project in Canada, which need to be considered when working to prevent and treat inappropriate Opioid use among Metis.
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Enns J, Brownell M, Nickel N, O’Laney K, Murdock N, Sarkar J, Burland E, Chartier M, Chateau D, Katz A. Participation in Boys & Girls Clubs Of Winnipeg is Associated With Health, Social and Education Outcomes Among First Nation Children. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionThe Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. First Nation children and youth make up a substantial proportion of BGCW participants, but there are few empirical data available on how the programs influence health, social and education outcomes in this population.
Objectives and ApproachWe linked BGCW attendance records for all Manitoba children born 1987-2010 to the individual-level administrative health, social and education data in the population-based Data Repository at the Manitoba Centre for Health Policy in Winnipeg. The comparison group of non-participants was matched on age and neighbourhood of residence. We narrowed the cohort to First Nation participants by linking to datasets containing First Nation identifiers. Education outcomes were examined using a generalized additive model, and health and justice system outcomes with a time-to-event model, adjusted for socioeconomic status, mother's mental health and age at first birth, and involvement in the child welfare system.
Results3,754 First Nation children and youth participated in BGCW from 2005-2016. The comparison group comprised 23,593 First Nation children and youth. Greater BGCW participation was associated with higher likelihood of performing well in grade 3 numeracy, but not other education outcomes (grade 3 reading, grade 7 student engagement or mathematics, grade 7/8 reading/writing, or graduating high school). Greater BGCW participation was also associated with lower risk of becoming involved with the justice system among youth aged 12-17 (i.e., lower risk of being charged with a crime) and with lower risk of teen pregnancy.
Conclusion / ImplicationsParticipation in BGCW programs may contribute to improved health, justice and education outcomes for First Nation children and youth in Winnipeg.
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Nickel NC, Sanguins J, Sarkar J, Enns J, Struck S, Chartier M, Burland E, Quddus F, Hinds A, Chateau D, Chartrand AF, Brownell M. Evaluating Full Day Kindergarten – Is It Associated with Improved Short- And Long-Term Education Outcomes Among Metis Children? Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionEarly education outcomes influence children’s educational trajectories with long-term effects extending into adulthood. Aboriginal peoples face numerous systemic barriers to academic success. It remains unknown if full-day kindergarten (FDK) is associated with improved academic outcomes among Metis children – a distinct Aboriginal people recognized by the Canadian Constitution.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to identify whether FDK was associated with improved short- and long-term outcomes among Metis children. We created a cohort of Metis children by linking several provincial databases held in the Manitoba Population Research Data Repository (1998-2011). Education data were used to identify all Metis children who attended FDK (n=247) vs half day kindergarten (HDK; n=547). FDK children were matched by age and sex to children in HDK. We used a step-wedged design and applied propensity scores to adjust for measured confounding. We tested for differences in grades 3, 7, 8 outcomes and high school graduation using generalized linear models.
ResultsFDK children were more likely to live in a low-income neighbourhood. 72% FDK and 74% HDK students met or approached numeracy expectations in grade 3; and 55% FDK and 48% HDK met or approached numeracy expectations in grade 7. For reading expectations, 77% FDK and 75% HDK met or approached grade 3 reading expectations; in grade 8, 62% in each group met or approached expectations for reading and writing. High school graduation rate for FDK children was 84% and for HDK children was 64%. After adjusting for confounding we found FDK children were more likely to graduate high school than HDK children; other outcomes were non-significant.
Conclusion / ImplicationsKindergarten programs may be insufficient to overcome structural barriers that Metis children face. Culturally appropriate education strategies are needed to support improved outcomes amongst this population.
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Brownell M, Sanguins J, Chartier M, Nickel N, Enns J, Chateau D, Burland E, Sarkar J, Lee JB, Struck S, Hinds A, Quddus F, Chartrand F. Evaluation of The Manitoba Healthy Baby Prenatal Benefit: Is It Improving Birth and Early Childhood Outcomes for Metis Families? Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), a prenatal income supplement. Research has demonstrated positive outcomes associated with HBPB, but it remains unknown if Metis women and children – who are of mixed European and Aboriginal descent and one of the most marginalized populations in Canada -- benefit from the program.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to determine the impact of HBPB on Metis newborn and early childhood outcomes. We included all Metis women giving birth in Manitoba 2003-2011 who received income assistance during pregnancy (n=4,852), adjusting for differences between those receiving (n=3,681) and not receiving (n=1,171) HBPB with propensity score weighting. We used multi-variable regressions to compare outcomes between groups: breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, birth hospitalization length of stay (LOS), neonatal readmissions, infant hospitalizations, vaccinations at age 1 and 2, and child development scores at kindergarten.
ResultsHBPB receipt was associated with reductions in low birth weight (adjusted Relative Risk (aRR): 0.74 (95% CI: 0.58-0.94)) and preterm births (aRR: 0.78 (0.65-0.94)), and increases large-for-gestational age births (aRR: 1.21 (1.06-1.39)) and neonatal readmissions (aRR: 1.58 (1.05-2.37)). Birth hospitalization LOS was lower for newborns whose mothers received HBPB (Mean Difference 0.29 days). HBPB was associated with increases in vaccinations for children aged 1 (aRR: 1.08 (1.00-1.15)) and 2 (aRR: 1.12 (1.05-1.18)). No significant associations were found for small-for-gestational age births, Apgar scores, breastfeeding initiation, infant hospitalizations or child development scores.
Conclusion / ImplicationsA modest unconditional prenatal income supplement to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased neonatal readmissions warrants further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes.
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Nickel NC, Phillips-Beck W, Campbell R, Chateau D, Sarkar J, Chartier M, Enns J, Burland E, Quddus F, Brownell M. Measuring Community Strengths – Using Data from The First Nations Regional Health Survey Linked with A Whole-Population Administrative Data Repository. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionAdministrative data studies routinely report that First Nations mothers and children experience a disproportionate burden of poor health. Due to the nature of administrative data, research often takes a deficits-oriented approach. First Nations health research needs to consider the role that community- and individual-level strengths play in promoting wellbeing and examine how these interact with the delivery and outcomes of health programs.
Objectives and ApproachThe First Nations Health and Social Secretariat of Manitoba (FNHSSM) and the University of Manitoba partnered to construct measures of community-level strengths that can be linked with administrative data to examine the delivery and outcomes associated with population health programs delivered in First Nations communities.
We linked data from the FNHSSM-administered Regional Health Survey (RHS) with administrative data housed in the Manitoba Population Research Data Repository. We identified 60 questions from the child, youth, and adult versions of the RHS to measure community strengths. We used principal component analysis to identify strength-based constructs. We used Eigen values and percent of variance explained to determine the final number of factors. We used random group resampling and bootstrap methods to test for community-level homogeneity. Community-level factor scores were calculated as the scaled combination of RHS questions within each factor and averaged to the community.
ResultsWe identified 12 constructs of community strength: 5 from child responses, 4 from youth, and 3 from adult responses. Strength-based constructs common to all age groups included knowledge of traditional language, involvement in cultural events, and connection with community.
Conclusion / ImplicationsColonial approaches to health research perpetuate deficit-based dialogues and negative portrayal of First Nations peoples. First Nations health research should consider how community strengths promote health and interact with program delivery. Including measures of community strength leads to richer understandings of factors that promote wellness among First Nations peoples.
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Hamm N, Singal D, Dahl M, Chateau D, Brownell M. Linking Health and Social Data to Assess the Performance of High Dimensional Propensity Scores. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionHigh dimensional propensity scores (HDPS) aim to account for unmeasured confounding. However, it is unclear to what extent HDPS are able to attain this.
Objectives and ApproachThis study aimed to test how well HDPS can account for confounding due to social determinants of health when using only health data. A retrospective cohort study was used to examine the effect of exposure to prescription opioids in utero on childhood outcomes (ADHD, school readiness, NICU admission, and hospitalization within the first year of life). Administrative health and social data were linked at the individual level and HDPS for each outcome were calculated using the mothers’ health data. Exposed and unexposed mother-child dyads were then matched. Standardized differences of mothers’ social factors (history of teen birth, lowest income quintile, ever received income assistance (i.e., welfare), ever lived in social housing, history with child protection services, residential mobility, and contact with the justice system) were compared before and after matching to determine to what degree the HDPS could account for differences in social determinants of health. Additional HDPS analyses were performed with social factors included in the HDPS with the health data.
ResultsBefore matching, standardized differences between exposed and unexposed groups for the social factors ranged between 0.40-0.75. Income assistance and lowest income quintile consistently had the greatest and smallest standardized difference for all outcomes, respectively. After matching, using health data only, standardized differences decreased considerably, ranging from 0.05-0.27. When including social factors into the HDPS, the addition of income assistance produced the smallest standardized differences with a range of 0.01-0.13 for all outcomes.
ConclusionsUsing the HDPS with health data only can reduce confounding due to social factors. If data are available, including income assistance in the HDPS may further reduce confounding for all social determinants of health.
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Enns J, Brownell M, Nickel N, Sanguins J, Sarkar J, Burland E, Chartier M, Chateau D, Katz A. Participation in Boys & Girls Clubs Of Winnipeg is Associated With Health, Social and Education Outcomes Among Metis Children. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionThe Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. Metis children and youth make up a substantial proportion of BGCW participants, but there are few empirical data available on how the programs influence health, social and education outcomes in this population.
Objectives and ApproachWe linked BGCW attendance records for all Manitoba children born 1987-2010 to the individual-level administrative health, social and education data in the population-based Data Repository at the Manitoba Centre for Health Policy in Winnipeg. The comparison group of non-participants was matched on age and neighbourhood of residence. We narrowed the cohort to Metis participants by linking to datasets containing Metis identifiers. Education outcomes were examined using a generalized additive model, and health and justice system outcomes with a time-to-event model, adjusted for socioeconomic status, mother's mental health and age at first birth, and involvement in the child welfare system.
Results1,664 Metis children and youth participated in BGCW from 2005-2016. The comparison group comprised 9,248 Metis children and youth. Greater BGCW participation was associated with higher likelihood of performing well in grade 3 numeracy (boys and girls) and grade 7 student engagement (boys only), but not other education outcomes (grade 3 reading, grade 7 mathematics, grade 7/8 reading/writing, or graduating high school). Greater BGCW participation was also associated with lower risk of becoming involved with the justice system (i.e., lower risk of being charged with a crime) and with lower risk of teen pregnancy.
Conclusion / ImplicationsParticipation in BGCW programs may contribute to improved health, justice and education outcomes for Metis children and youth in Winnipeg.
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Spiwak R, Mullins M, Isaak C, Barakat S, Chateau D, Sareen J. Assessing perceptions of professionalism in medical learners by the level of training and sex. Educ Health (Abingdon) 2020; 33:13-19. [PMID: 32859875 DOI: 10.4103/efh.efh_316_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Canadian medical student and residents' severity ratings of professionalism vignettes were examined to identify the differences in ratings by the level of training and by sex. Methods Eight hundred and thirty-five medical learners (400 medical students and 435 residents) were invited to participate in an online survey measuring medical professionalism. The survey was composed of questions about descriptive information and professionalism vignettes. The tool consists of 16 vignettes examining respondent's ability to recognize the professional and unprofessional behaviors. For each vignette, participants were asked to rate the severity of the infraction as "not a problem" to "severe." Wilcoxon rank sum tests and Fischer's Chi-square tests were used to examine the differences in perceptions of professionalism by the level of training and sex, and logistic regression models were created with the level of training and sex to examine their association with binary vignette responses (not a severe infraction and severe infraction); controlling for the effect of the other variable. Results Overall response rate for the completed survey was 30% (n = 253). Significant differences between males and females were found for lapse in excellence (P ≤ 0.039), inappropriate dress (P ≤ 0.003), lack of altruism (P ≤ 0.033), disrespect (P ≤ 0.013), shirking duty (P ≤ 0.028), and abuse of power (P ≤ 0.006). Females rated all six vignettes as more severe as compared to males. Shirking duty (P ≤ 0.002) was found to have the differences between learner responses. Regressions found sex to be associated with severity of professionalism infractions on seven vignettes. Discussion Future work is needed in the area of professionalism and sex to understand why female and male learners may perceive professionalism differently.
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Affiliation(s)
- Rae Spiwak
- Department of Community Health Sciences, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Melanie Mullins
- Department of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Corinne Isaak
- Department of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Samia Barakat
- Department of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Department of Community Health Sciences, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Nickel NC, Doupe M, Enns JE, Brownell M, Sarkar J, Chateau D, Burland E, Chartier M, Katz A, Crockett L, Azad MB, McGavock JM, Santos R. Differential effects of a school-based obesity prevention program: A cluster randomized trial. Matern Child Nutr 2020; 17:e13009. [PMID: 32815644 PMCID: PMC7729786 DOI: 10.1111/mcn.13009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/19/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
School-based healthy living interventions are widely promoted as strategies for preventing obesity. The peer-led Healthy Buddies™ curriculum has been shown to improve obesity-related outcomes in school-aged children. We examined whether these improvements existed among subgroups of children stratified by sex, income level and urban/rural geography. In a cluster-randomized controlled trial, elementary schools in Manitoba, Canada, were randomly allocated to Healthy Buddies™ (10 schools, 340 students) or standard curriculum (10 schools, 347 students). Healthy Buddies™ participants had 21weekly lessons on healthy eating, physical activity and self-efficacy, delivered by children age 9-12 to children age 6-8. We assessed pre- and post-intervention body mass index (BMI) z-scores, waist circumference, healthy living knowledge, dietary intake and self-efficacy among the younger children. Compared to standard curriculum (n = 154), Healthy Buddies™ participants (n = 157) experienced a greater reduction in waist circumference (-1.7 cm; 95% confidence interval [CI][-2.8, -0.5 cm]) and improved dietary intake (4.6; 95% CI [0.9, 8.3]), healthy living knowledge (5.9; 95% CI [2.3, 9.5]) and self-efficacy (5.3; 95% CI [1.0, 9.5]) scores. In subgroup analyses, effects for waist circumference (-2.0 cm; 95% CI [-3.6, -0.5]), healthy living knowledge (9.1; 95% CI [4.4, 13.8]) and self-efficacy (8.3; 95% CI [3.3, 13.3]) were significant among boys. Dietary intake (10.5; 95% CI [5.5, 15.4]), healthy living knowledge (9.8; 95% CI [4.5, 15.0]) and self-efficacy (6.7; 95% CI [0.7, 12.7]) improved among urban-dwelling but not rural-dwelling children. Healthy Buddies™ was effective for boys and children living in urban settings. Enhanced curricula may be needed to improve program effectiveness for select subgroups of school-aged children.
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Affiliation(s)
- Nathan C Nickel
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Malcolm Doupe
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leah Crockett
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Meghan B Azad
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jon M McGavock
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Santos
- Healthy Child Manitoba Office, Manitoba Education and Training, Manitoba Government, Winnipeg, Manitoba, Canada
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Sareen J, Olafson K, Kredentser MS, Bienvenu OJ, Blouw M, Bolton JM, Logsetty S, Chateau D, Nie Y, Bernstein CN, Afifi TO, Stein MB, Leslie WD, Katz LY, Mota N, El-Gabalawy R, Sweatman S, Marrie RA. The 5-Year Incidence of Mental Disorders in a Population-Based ICU Survivor Cohort. Crit Care Med 2020; 48:e675-e683. [PMID: 32697508 DOI: 10.1097/ccm.0000000000004413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To estimate incidence of newly diagnosed mental disorders among ICU patients. DESIGN Retrospective-matched cohort study using a population-based administrative database. SETTING Manitoba, Canada. PARTICIPANTS A total of 49,439 ICU patients admitted between 2000 and 2012 were compared with two control groups (hospitalized: n = 146,968 and general population: n = 141,937), matched on age (± 2 yr), sex, region of residence, and hospitalization year. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Incident mental disorders (mood, anxiety, substance use, personality, posttraumatic stress disorder, schizophrenia, and psychotic disorders) not diagnosed during the 5-year period before the index ICU or hospital admission date (including matched general population group), but diagnosed during the subsequent 5-year period. Multivariable survival models adjusted for sociodemographic variables, Charlson comorbidity index, admission diagnostic category, and number of ICU and non-ICU exposures. ICU cohort had a 14.5% (95% CI, 14.0-15.0) and 42.7% (95% CI, 42.0-43.5) age- and sex-standardized incidence of any diagnosed mental disorder at 1 and 5 years post-ICU exposure, respectively. In multivariable analysis, ICU cohort had increased risk of any diagnosed mental disorder at all time points versus the hospitalized cohort (year 5: adjusted hazard ratio, 2.00; 95% CI, 1.80-2.23) and the general population cohort (year 5: adjusted hazard ratio, 3.52; 95% CI, 3.23-3.83). A newly diagnosed mental disorder was associated with younger age, female sex, more recent admitting years, presence of preexisting comorbidities, and repeat ICU admission. CONCLUSIONS ICU admission is associated with an increased incidence of mood, anxiety, substance use, and personality disorders over a 5-year period.
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Affiliation(s)
- 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
| | - Kendiss Olafson
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maia S Kredentser
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcus Blouw
- Department of Internal Medicine, Max Rady College of Medicine, 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
| | - 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
| | - Dan Chateau
- 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
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yao Nie
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of 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
| | - Tracie O Afifi
- 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
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - William D Leslie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Psychiatry, 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
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sophia Sweatman
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ruth Ann Marrie
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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McCallum R, Medved MI, Hiebert-Murphy D, Distasio J, Sareen J, Chateau D. Fixed Nodes of Transience: Narratives of Homelessness and Emergency Department Use. Qual Health Res 2020; 30:1183-1195. [PMID: 31342845 DOI: 10.1177/1049732319862532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Discourse in popular media, public policy, and academic literature contends that people who are homeless frequently make inappropriate use of hospital emergency department (ED) services. Although researchers have investigated the ED experiences of people who are homeless, no previous studies have examined how this population understands the role of the ED in their health care and in their day-to-day lives. In the present study, 16 individuals participated in semistructured interviews regarding their ED experiences, and narrative analysis was applied to their responses. Within the context of narratives of disempowerment and discrimination, participants viewed the ED in differing ways, but they generally interpreted it as a public, accessible space where they could exert agency. ED narratives were also paradoxical, depicting it as a fixed place for transient care, or a place where they were isolated yet felt a sense of belonging. Implications for policy and practice are discussed.
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Affiliation(s)
| | - Maria I Medved
- University of Manitoba, Winnipeg, Manitoba, Canada
- The American University of Paris, Paris, France
| | | | - Jino Distasio
- The University of Winnipeg, Winnipeg, Manitoba, Canada
| | | | - Dan Chateau
- 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Struthers A, Metge C, Charette C, Enns JE, Nickel NC, Chateau D, Chartier M, Burland E, Katz A, Brownell M. Understanding the Particularities of an Unconditional Prenatal Cash Benefit for Low-Income Women: A Case Study Approach. Inquiry 2020; 56:46958019870967. [PMID: 31434525 PMCID: PMC6709438 DOI: 10.1177/0046958019870967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We explored the particularities of the Healthy Baby Prenatal Benefit (HBPB), an
unconditional cash transfer program for low-income pregnant women in Manitoba,
Canada, which aims to connect recipients with prenatal care and community
support programs, and help them access healthy foods during pregnancy. While
previous studies have shown associations between HBPB and improved birth
outcomes, here we focus on how the intervention contributed to
positive outcomes. Using a case study design, we collected data from government
and program documents and interviews with policy makers, academics, program
staff, and recipients of HBPB. Key informants identified using evidence and
aligning with government priorities as key facilitators to the implementation of
HBPB. Program recipients described how HBPB helped them improve their nutrition,
prepare for baby, and engage in self-care to moderate the effect of stressful
life events. This study provides important contextualized evidence to support
government decision making on healthy child development policies.
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Affiliation(s)
- Ashley Struthers
- 1 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Colleen Metge
- 2 Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Catherine Charette
- 1 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada.,2 Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E Enns
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C Nickel
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elaine Burland
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Ernst P, Dahl M, Chateau D, Daneman N, Quail J, Sketris IS, Fisher A, Zhang J, Bugden S. Comparative Effectiveness Of Fluoroquinolone Antibiotic Use In Uncomplicated Acute Exacerbations Of COPD: A Multi-Cohort Study. Int J Chron Obstruct Pulmon Dis 2019; 14:2939-2946. [PMID: 31908442 PMCID: PMC6927224 DOI: 10.2147/copd.s226324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/31/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose Fluoroquinolone antibiotics are associated with rare, but severe adverse events. They are frequently used for the treatment of acute exacerbations of COPD (AECOPD). While their effectiveness in severe exacerbations requiring hospitalisation has been well documented, the potential benefit in the ambulatory setting is less clear, especially in uncomplicated patients with COPD. Patients and characteristics We carried out a retrospective cohort study using health care databases from six Canadian provinces in subjects visiting their physician for uncomplicated COPD. Subjects dispensed either a quinolone or other antibiotics were compared using inverse probability of treatment weights with high dimensional propensity scores on 30-day outcomes, including repeat visits, hospitalisation for AECOPD and subsequent antibiotic prescription. Results from each province were combined by random effects meta-analysis. Results We identified 286,866 AECOPD events among 203,642 unique individuals. The frequency of fluoroquinolone use, mostly levofloxacin and moxifloxacin, varied by province and ranged from 8% to 32% of AECOPD antibiotic prescriptions. The risk of a repeat ambulatory care visit was increased among patients who were dispensed a fluoroquinolone compared with other antibiotics (OR 1.32, 95% CI 1.27-1.36). The risk of a hospitalisation for AECOPD was also higher with fluoroquinolones (OR 1.52, 95% CI 1.33-1.74). There was no difference in subsequent antibiotic prescriptions (OR 1.00, 95% CI 0.94-1.07). Conclusion There is no apparent benefit in short-term outcomes with fluoroquinolones as compared to other antibiotics for the ambulatory treatment of AECOPD in uncomplicated patients. These findings support current recommendations that fluoroquinolones be reserved for AECOPD in patients with recurrent exacerbations, significant co-morbidity or requiring hospitalisation.
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Affiliation(s)
- Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Matthew Dahl
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nick Daneman
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Quail
- Health Quality Council, Saskatoon, Saskatchewan, Canada.,Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ingrid S Sketris
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anat Fisher
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jianguo Zhang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shawn Bugden
- School of Pharmacy, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.,College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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50
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Smith M, Hinds A, Prior H, Chateau D. Exploratory Research on the Health and Social Outcomes of Public Housing. Int J Popul Data Sci 2019. [DOI: 10.23889/ijpds.v4i3.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BackgroundUnder the National Housing Strategy, the Canadian government will make historic investments in housing over the next decade. The Canadian Mortgage and Housing Corporation is leading a research strategy to evaluate the impact of these investments. As part of this initiative, the Manitoba Center for Health Policy is conducting a pilot study to determine whether administrative data can be used to assess impacts, specifically looking at health, education and involvement in the justice system.
ApproachUsing administrative data we tested for changes in healthcare use and justice involvement in the two years before and after a cohort of individuals moved into public housing. Additionally, to determine if changes in the outcomes over time were unique to public housing, we included a matched comparison group of individuals who did not reside in public housing. GLM with generalized estimating equations tested for differences over time and between cohorts in the number of hospitalizations, inpatient days, emergency department visits, and contacts with the criminal justice system. The data were modeled using a Poisson distribution (rate ratio, RR).
Results Compared to the matched cohort, individuals accepted into public housing showed a significant decline in number of hospitalizations (pre RR=1.58 (1.53, 1.63), post RR=1.23 (1.19, 1.27), days in hospital (pre RR=1.66 (1.64, 1.68), post RR=1.24 (1.23, 1.26) and visits to the emergency department (pre RR=1.57 (1.52, 1.62), post RR=1.42 (1.38, 1.47). A trend towards fewer involvements with the criminal justice system was also observed (pre RR=1.37 (1.32, 1.43), post RR=1.28 (1.22, 1.34). No significant differences were noted for total respiratory morbidity or high school grades.
ConclusionAdministrative data show good potential to be used for the evaluation of public housing impacts on a wide range of health and social outcomes. Additional indicator comparisons will be reported at the conference.
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