Canadian Province Of Manitoba Research Articles

Performance measurement of a Canadian provincial tuberculosis programme: Manitoba, 2008-2012.

Performance measurement assists tuberculosis (TB) programmes in understanding areas of strength and weakness, and planning for improvements. Canada currently does not have a national comprehensive system for the measurement and analysis of TB programme performance. To analyse the performance of a Canadian provincial TB programme using measures and targets based on those published by the US Centers for Disease Prevention and Control for 2015. Using provincial surveillance data from the Canadian province of Manitoba, we analysed key programme performance outcome measures (treatment completion, early detection, human immunodeficiency virus [HIV] testing, paediatric TB, retreatment, and contact elicitation and assessment) for people diagnosed with TB between 2008 and 2010. Significant outcome variation was found between Indigenous and non-Indigenous populations as well as within populations. The reporting rate of HIV testing was low. High rates of paediatric TB among Indigenous populations, particularly in rural areas, were found. Significantly better performance in HIV testing and reporting as well as in contact investigation was found for rural compared with urban Indigenous populations. Foreign-born persons had the lowest contact assessment rate. This study of TB programme performance in Manitoba demonstrates the viability of the approach in the Canadian context, and could help to identify key areas for TB programme improvement.

Rising incidence of psychiatric disorders before diagnosis of immune-mediated inflammatory disease.

After the diagnosis of immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), the incidence of psychiatric comorbidity is increased relative to the general population. We aimed to determine whether the incidence of psychiatric disorders is increased in the 5 years before the diagnosis of IMID as compared with the general population. Using population-based administrative health data from the Canadian province of Manitoba, we identified all persons with incident IBD, MS and RA between 1989 and 2012, and cohorts from the general population matched 5 : 1 on year of birth, sex and region to each disease cohort. We identified members of these groups with at least 5 years of residency before and after the IMID diagnosis date. We applied validated algorithms for depression, anxiety disorders, bipolar disorder, schizophrenia, and any psychiatric disorder to determine the annual incidence of these conditions in the 5-year periods before and after the diagnosis year. We identified 12 141 incident cases of IMID (3766 IBD, 2190 MS, 6350 RA) and 65 424 matched individuals. As early as 5 years before diagnosis, the incidence of depression [incidence rate ratio (IRR) 1.54; 95% CI 1.30-1.84) and anxiety disorders (IRR 1.30; 95% CI 1.12-1.51) were elevated in the IMID cohort as compared with the matched cohort. Similar results were obtained for each of the IBD, MS and RA cohorts. The incidence of bipolar disorder was elevated beginning 3 years before IMID diagnosis (IRR 1.63; 95% CI 1.10-2.40). The incidence of psychiatric comorbidity is elevated in the IMID population as compared with a matched population as early as 5 years before diagnosis. Future studies should elucidate whether this reflects shared risk factors for psychiatric disorders and IMID, a shared final common inflammatory pathway or other aetiology.

Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada

IntroductionBreast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding...

HLA-A, B, DRB1, DQA1, DQB1 alleles and haplotype frequencies in Dene and Cree cohorts in Manitoba, Canada

BackgroundFirst Nations in the Canadian province of Manitoba have disproportionately high rates of epidemic and endemic TB. Gene polymorphisms that modulate HLA Class I and II antigens are among the risk markers for TB, along with other biologic, and social determinants of health. HLA-A, B, DRB1, DQA1, DQB1 were typed in two Manitoba First Nation indigenous groups to identify and compare the frequency of gene polymorphisms that may influence susceptibility or resistance to TB. MethodsParticipants who self-identified as either Dene or Cree enrolled into the study from two First Nation communities in Manitoba, Canada. Genomic DNA was extracted from blood samples collected with informed consent from Dene (N=63) and Cree (N=42) First Nation study participants. Participants self-reported having treated active TB, treated latent TB or no TB. HLA Class I and II molecules were typed using sequence-specific oligonucleotide (SSO) probes from commercially available kits. ResultsThe rates of treated active and latent TB were marginally higher among the Dene than the Cree participants (p=0.112). Class I and II HLA loci were in Hardy-Weinberg equilibrium in both the Dene and Cree groups. In this exploratory analysis of TB and HLA allele frequencies in Dene and Cree cohorts HLA-A*03 and HLA-DQB1*05:03 were significantly associated with TB. ConclusionsThe high incidence of TB in both Dene and Cree populations in Canada requires both biomedical and socioeconomic prevention and control measures. Among the former, an understanding of HLA diversity among First Nations groups may aid the development of new effective vaccine and therapeutic modalities that depend on the interaction between small molecules and specific HLA epitopes.

Sustained Use of Benzodiazepines and Escalation to High Doses in a Canadian Population.

"Antibenzodiazepine" campaigns have been conducted worldwide to limit the prescribing of these drugs because of concerns about inappropriate use and addiction. The causal relationship between long-term use and escalation to high doses has not been proven. This study assessed the extent of dose escalation among individuals who were long-term users of benzodiazepines or Z-hypnotics. A population-based study was conducted in the Canadian province of Manitoba using administrative health databases. Sustained use was defined as continuous use for at least two years (N=12,598). Dose escalation, measured in diazepam milligram equivalents (DMEs) per day and observed at six-month intervals, was assessed by using latent-class trajectory analysis. Characteristics of individuals with sustained use were described. The analysis revealed four distinct groups. Two groups (<8% of the cohort) showed escalation to high doses (over 40 DMEs). More than 55% of high-dose escalators were in the 0- to 44-year age group, 75% lived in urban areas, and approximately 75% had a diagnosis of depression. Clonazepam was the drug most commonly involved with dose escalation; among individuals escalating to doses higher than 60 DMEs, 91% were using clonazepam. Rates of "doctor shopping" and "pharmacy hopping" were higher among younger adults, compared with older adults. Younger adults also had higher rates of concomitant antidepressant therapy. A limited segment of a population that received benzodiazepine prescriptions was classified as sustained users, and a small proportion of that group escalated to doses higher than those recommended by product monographs and clinical guidelines.

Comparing Health Status, Health Trajectories and Use of Health and Social Services between Children with and without Developmental Disabilities: A Population-based Longitudinal Study in Manitoba.

Little information exists on health of children with developmental disabilities (DDs) in the Canadian province of Manitoba. The present authors linked 12years of administrative data and compared health status, changes in health and access to health and social services between children with (n=1877) and without (n=5661) DDs living in the province, matched by age, sex and region of residence. Children with DDs were significantly more likely than children in the matched comparison group to die before the age of 17 and have a history of respiratory illness, diabetes and injury-related hospitalizations. Children with DD also had significantly higher average number of ambulatory physician visits and higher rate of continuity of care. Children with DDs had poorer health status than the matched comparison group. The health disparities experienced by children with DDs persisted over time. Further population-based longitudinal research is needed in this area.

Barriers and facilitators related to implementation of regulated midwifery in Manitoba: a case study.

BackgroundIn 2000, midwifery was regulated in the Canadian Province of Manitoba. Since the establishment of the midwifery program, little formal research has analyzed the utilization of regulated midwifery services. In Manitoba, the demand for midwifery services has exceeded the number of midwives in practice. The specific objective of this study was to explore factors influencing the implementation and utilization of regulated midwifery services in Manitoba.MethodsThe case study design incorporated qualitative exploratory descriptive methods, using data derived from two sources: interviews and public documents. Twenty-four key informants were purposefully selected to participate in semi-structured in-depth interviews. All documents analyzed were in the public domain. Content analysis was employed to analyze the documents and transcripts of the interviews.ResultsThe results of the study were informed by the Behavioral Model of Health Services Use. Three main topic areas were explored: facilitators, barriers, and future strategies and recommendations. The most common themes arising under facilitators were funding of midwifery services and strategies to integrate the profession. Power and conflict, and lack of a productive education program emerged as the most prominent themes under barriers. Finally, future strategies for sustaining the midwifery profession focused on ensuring avenues for registration and education, improving management strategies and accountability frameworks within the employment model, enhancing the work environment, and evaluating both the practice and employment models. Results of the document analysis supported the themes arising from the interviews.ConclusionThese findings on factors that influenced the implementation and integration of midwifery in Manitoba may provide useful information to key stakeholders in Manitoba, as well as other provinces as they work toward successful implementation of regulated midwifery practice. Funding for new positions and programs was consistently noted as a successful strategy. While barriers such as structures of power within Regional Health Authorities and inter and intra-professional conflict were identified, the lack of a productive midwifery education program emerged as the most prominent barrier. This new knowledge highlights issues that impact the ongoing growth and capacity of the midwifery profession and suggests directions for ensuring its sustainability.

Parentocracy Revisited: Still a Relevant Concept for Understanding Middle Class Educational Advantage?

In this paper, we revisit Brown’s (Br J Soc Educ 14: 65–85, 1990) concept of parentocracy which has been informatively applied in educational research in a number of studies in various countries internationally—but almost none in North America. We provide an expanded conceptualization of parentocracy and suggest that it provides a useful encapsulation of a number of similar, and/or complementary, conceptual approaches to understanding middle class educational advantage. Our expanded conceptualization of parentocracy stems from Brown’s (Br J Soc Educ 14: 65–85, 1990) original use, but encompasses both a socio-political ideology that favors parental sovereignty and market solutions in education, as well as a proactive interventionist parenting style premised on fostering child development (and strategically optimizing life opportunities) through structured, progressive skill-enhancing educational and extra-curricular experiences. We offer a discussion of a number of studies that can be seen to exemplify, either expressly or implicitly, these parentocratic tendencies. Finally, using the examples of Schools of Choice policy and French immersion schools in the Canadian province of Manitoba, we explore the implications of parentocratic practices for educational inequality and social reproduction in the 2010s.

‘A river of money flowing south’: cross-border shopping in North Dakota and the insatiable Canadian desire for American goods, 1900–2001

Over the course of the twentieth century, Canadians became increasingly accustomed to crossing the border into the United States to access American goods. Gasoline, alcohol and manufactured goods were cheaper in the US than at home, and fashion items, electronics and linens were available in a wider selection. This article looks at the evolution of cross-border shopping in North Dakota. Residents of the Canadian province of Manitoba flocked to malls and shops in North Dakota, patronizing motels and restaurants on weekends and filling their cars with purchases. This type of shopping tourism provided new opportunities for retailers on the US side of the border. North Dakota businesses advertised in the Manitoba market. Tourist organizations highlighted the availability of nationally advertised goods and the cultural connections between the two nations. Canadians compared prices, calculating how fluctuating exchange rates affected their ability to bring home bargains. While shoppers raved about the savings to be had stateside, they were not generally purchasing necessities but indulging in clothes, toys, small appliances, electronics and alcohol. Spending a weekend staying in motels, eating out and perusing the vast array of available goods became a well-entrenched, pleasurable pastime for Canadians living close to the border.

Effects of a Carbon Tax and Wind Power Penetration on CO2 Emissions in Wholesale Electric Power Markets

During the December 2009 Copenhagen Climate Change Summit, President Barack Obama committed the U.S. to a 83% reduction below 2005 levels in CO2 emissions by 2050. The U.S. Federal Government is thus currently considering several policy options to reduce CO2 emissions. In the U.S. the largest source of CO2 emissions is the electricity sector; in 2012 it was responsible for 32% of total CO2 emissions. This paper develops an empirically-based computational test bed of a wholesale electric power market to analyze how the imposition of a carbon tax and the increased penetration of wind power in such markets could impact CO2 emissions and other key outcomes, such as energy demands, energy prices, market participant profits (by fuel type), and government tax revenues. The test bed captures core features of the Midcontinent Independent System Operator (MISO), the central manager of one of the world's largest energy and operating reserve markets covering parts of fifteen U.S. states and the Canadian province of Manitoba. Another innovation of this paper is that the effects of increases in a carbon tax and wind power penetration are studied jointly. It is shown, for example, that CO2 emissions decrease from 0.23% to 6.17% as the carbon tax and the degree of wind penetration are systematically varied from a base case of zero tax and zero wind. The profits of coal- and oil-fired generation systematically decrease with increases in the carbon tax and/or increases in wind penetration, but the profits of other types of generation exhibit a more complex response. Comparisons with current MISO conditions are also given, and key policy implications are discussed.

Cerebral Blastomycosis: Radiologic-Pathologic Correlation of Solitary CNS Blastomycosis Mass-Like Infection.

Blastomycosis is a fungal infection rarely seen in clinical practice. Endemic to the Midwestern United States as well as the Canadian provinces of Manitoba and Ontario, Blastomyces dermatitidis characteristically involves the skin and lungs. Central nervous system (CNS) involvement, although a rare complication of this disease, can be fatal. The current literature on CNS blastomycosis primarily centers on the spectrum of traditional imaging features of T1- and T2-weighted imaging with which this entity can present. However, here we present the direct histopathologic correlation of the imaging findings of solitary mass like CNS blastomycosis, with an emphasis on the association of diffusion restriction within the lesion with a granulomatous immune response.

Comorbidity increases the risk of hospitalizations in multiple sclerosis.

We aimed to evaluate the association between comorbidity and rates of hospitalization in the multiple sclerosis (MS) population as compared to a matched cohort from the general population. Using population-based administrative data from the Canadian province of Manitoba, we identified 4,875 persons with MS and a matched general population cohort of 24,533 persons. We identified all acute care hospitalizations in the period 2007-2011. Using general linear models, we evaluated the association between comorbidity status and hospitalization rates (all-cause, non-MS-related, MS-related) in the 2 populations, adjusting for age, sex, and socioeconomic status. Comorbidity was common in both cohorts. Over the 5-year study period, the MS population had a 1.5-fold higher hospitalization rate (adjusted rate ratio [aRR] 1.56; 95% confidence interval [CI] 1.44-1.68) than the matched population. Any comorbidity was associated with a 2-fold increased risk of non-MS-related hospitalization rates (aRR 2.21; 95% CI 1.73-2.82) in the MS population, but a nearly 4-fold increase in hospitalization rates in the matched population (aRR 3.85; 95% CI 3.40-4.35). Comorbidity was not associated with rates of hospitalization for MS-related reasons, regardless of how comorbidity status was defined. In the MS population, comorbidity is associated with an increased risk of all-cause hospitalizations, suggesting that the prevention and management of comorbidity may reduce hospitalizations.

A Population-based Observational Study of ICU-Related Outcomes: With Emphasis on Post-Hospital Outcomes

Rationale: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few Intensive Care Units (ICUs). Objective: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs. Methods: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a nine year period we assessed ICU, hospital, 30 day and 180 day mortality rates; ICU and hospital lengths-of-stay; post-hospital utilization of hospital care, ICU care, outpatient physician care, medications, and home care; and post-hospital residence location. We explored data stratified by age, sex, and separate categories of geocoded income for urban and rural residents. For post-hospital utilization variables we compared ICU patients with those admitted to hospitals without the need for ICU care. Measurements and Main Results: After ICU admission there was a high initial death rate, which declined between 30 and 180 days and ther...

A Population-Based Longitudinal Study of Depression in Children With Developmental Disabilities in Manitoba

In this population-based study, prevalence of depression was estimated and compared between children with and without developmental disability (DD). Twelve years of administrative data were linked to identify a cohort of children with DD living in the Canadian province of Manitoba. Children in the study cohort were matched with children without DD as to sex, age, and region of residence. Prevalence of depression was estimated and compared between the two groups using the Generalized Estimating Equations technique. It was found that the estimated prevalence of depression among children with DD was almost twice as high as that of children in the matched comparison group. The estimated relative risk was statistically significant, RR = 2.13 (95% CI: 1.94, 2.33, p < .001). With age, the prevalence of depression among children in both groups increased. These findings suggest an urgent need for the development of mental health promotion programs targeted at children with DD.

Cancer incidence, morbidity, and survival in Canadian first nation children: A Manitoba population‐based study from the cancer in young people in Canada (CYP‐C) registry

Health disparities between Canadian First Nation (FN) people and the rest of the national population exist. No studies have specifically documented cancer-related health outcomes in Canadian FN children. The purpose of this study was to describe the incidence of pediatric malignancies in Manitoba FN children, and to compare morbidity patterns and survival between FN and non-FN children with cancer in the Canadian province of Manitoba. A retrospective, population-based review of all children (0-14.99 years) diagnosed with malignancy (2001-2008) in Manitoba, Canada was undertaken using the Cancer in Young People in Canada registry. FN children were compared to the non-FN population for markers of morbidity and survival. The average annual age-standardized incidence rate for all childhood cancers in FN children was 132 per 1,000,000 per year. 240 children were included in the morbidity and survival analyses (38 FN; 202 non-FN). No differences were found between FN and non-FN children in time from first presentation of symptoms to consultation with an oncology specialist or diagnosis, or number of hospital admissions / total days of admission for treatment complications. Overall survival was inferior for FN children in univariable analysis (P = 0.048) but not when risk group was included in a multivariable analysis (P = 0.15). No difference in event free survival or cumulative incidence of relapse was identified. The estimated incidence of childhood cancers in the Manitoba FN population is similar to provincial incidence rates. No differences in morbidity patterns or survival were found between Manitoba FN and non-FN children with cancer.

Lake St. Martin First Nation Community Members’ Experiences of Induced Displacement: “We’re like refugees”

&#x0D; &#x0D; &#x0D; In 2011, a massive flood occurred in the Canadian province of Manitoba, and provincial government officials decided to divert water to Lake St. Martin and First Nation land to protect urban, cottage, and agricultural properties. As a result of this artificial flood, all community members were evacuated, with infrastructures and housing at Lake St. Martin First Nation permanently destroyed. Three years later, 1,064 Lake St. Martin First Nation members reside in urban hotels and other temporary residences. Data from participatory videography and community workshops were analyzed using the sustainable livelihoods framework. Environmentally and developmentally induced displacement transformed an entire First Nation community into refuges in their homeland. Jurisdictional issues and racism prevented provisioning of services to meet their basic needs, help rebuild their lives, and relocate their community. Inclusive evacuation, relocation, and water-management policies and procedures are recommended. &#x0D; &#x0D; &#x0D;

Impact of Population Expansion on Genetic Diversity and Structure of River Otters (Lontra canadensis) in Central North America

Populations of North American river otters (Lontra canadensis) declined throughout large portions of the continent during the early 1900s due to habitat degradation and unregulated trapping. River otters had been extirpated in North Dakota (ND), but the Red River Valley has since been recolonized, with potential source populations including the neighboring states of Minnesota or South Dakota, or the Canadian province of Manitoba (MB). We genotyped 9 microsatellite loci in 121 samples to determine the source population of river otters in the Red River Valley of ND, as well as to assess population structure and diversity of river otters in central North America. Overall, genetic diversity was high, with an average observed heterozygosity of 0.58. Genetic differentiation was low (F ST < 0.05) between river otters in ND and those of Minnesota, suggesting that eastern ND was recolonized by river otters from Minnesota. River otters from MB were genetically distinct from all other sampled populations. Low genetic differentiation (F ST = 0.044) between South Dakota and Louisiana (LA) suggested that reintroductions using LA stock were successful. The genetic distinctiveness of river otters from different geographic regions should be considered when deciding on source populations for future translocations.

Social Position and Frailty

This study sought to determine (1) if measures of social position are associated with frailty; (2) if any observed association between social position and frailty is a threshold or gradient effect; and (3) if any observed association is independent of possible confounders. Data were drawn from a sample of 1,751 community-dwelling adults, aged 65 and older, living in the Canadian province of Manitoba in 1991. Education, self-reported income adequacy, and self-reported income satisfaction were used as measures of social position. Frailty was graded based on functional loss, cognition, and urinary incontinence. Multivariate regression analyses revealed, after adjusting for possible confounding factors, that all measures of social position were strongly associated with frailty in a gradient, rather than a threshold, manner. We conclude that social gradients for frailty are present in older adults, although a causal mechanism is not yet clear.

Survey of clinical doses from computed tomography examinations in the Canadian province of Manitoba

The purpose of this study was to document CT doses for common CT examinations performed throughout the province of Manitoba. Survey forms were sent out to all provincial CT sites. Thirteen out of sixteen (81 %) sites participated. The authors assessed scans of the brain, routine abdomen-pelvis, routine chest, sinuses, lumbar spine, low-dose lung nodule studies, CT pulmonary angiograms, CT KUBs, CT colonographies and combination chest-abdomen-pelvis exams. Sites recorded scanner model, protocol techniques and patient and dose data for 100 consecutive patients who were scanned with any of the aforementioned examinations. Mean effective doses and standard deviations for the province and for individual scanners were computed. The Kruskal-Wallis test was used to compare the variability of effective doses amongst scanners. The t test was used to compare doses and their provincial ranges between newer and older scanners and scanners that used dose saving tools and those that did not. Abdomen-pelvis, chest and brain scans accounted for over 70 % of scans. Their mean effective doses were 18.0 ± 6.7, 13.2 ± 6.4 and 3.0 ± 1.0 mSv, respectively. Variations in doses amongst scanners were statistically significant. Most examinations were performed at 120 kVp, and no lower kVp was used. Dose variations due to scanner age and use of dose saving tools were not statistically significant. Clinical CT doses in Manitoba are broadly similar to but higher than those reported in other Canadian provinces. Results suggest that further dose reduction can be achieved by modifying scanning techniques, such as using lower kVp. Wide variation in doses amongst different scanners suggests that standardisation of scanning protocols can reduce patient dose. New technological advances, such as dose-reduction software algorithms, can be adopted to reduce patient dose.

Epidemiology of critically ill patients in intensive care units: a population-based observational study

IntroductionEpidemiologic assessment of critically ill people in Intensive Care Units (ICUs) is needed to ensure the health care system can meet current and future needs. However, few such studies have been published.MethodsPopulation-based analysis of all adult ICU care in the Canadian province of Manitoba, 1999 to 2007, using administrative data. We calculated age-adjusted rates and trends of ICU care, overall and subdivided by age, sex and income.ResultsIn 2007, Manitoba had a population of 1.2 million, 118 ICU beds in 21 ICUs, for 9.8 beds per 100,000 population. Approximately 0.72% of men and 0.47% of women were admitted to ICUs yearly. The age-adjusted, male:female rate ratio was 1.75 (95% CI 1.64 to 1.88). Mean age was 64.5 ± 16.4 years. Rates rose rapidly after age 40, peaked at age 75 to 80, and declined for the oldest age groups. Rates were higher among residents of lower income areas, for example declining from 7.9 to 4.4 per 100,000 population from the poorest to the wealthiest income quintiles (p <0.0001). Rates of ICU admission slowly declined over time, while cumulative yearly ICU bed-days slowly rose; changes were age-dependent, with faster declines in admission rates with older age. There was a high rate of recidivism; 16% of ICU patients had received ICU care previously.ConclusionsThese temporal trends in ICU admission rates and cumulative bed-days used have significant implications for health system planning. The differences by age, sex and socioeconomic status, and the high rate of recidivism require further research to clarify their causes, and to devise strategies for reducing critical illness in high-risk groups.