Manitoba Research Articles

Survey and first report of the soybean cyst nematode (Heterodera glycines Ichinohe) in soybean fields in the province of Manitoba, Canada

The Soybean Cyst Nematode (SCN), Heterodera glycines (Ichinohe 1952), is a major soybean (Glycine max (L.) Merr.) pest worldwide. In Canada, SCN is present in Ontario and Quebec. Past surveys conducted in Manitoba failed to report the pest. Nevertheless, the nematode is expected to be present in Manitoba as it has spread rapidly northwards in North Dakota and Minnesota. Thus, the objective of this study was to survey soybean fields in Manitoba for the presence of SCN. In October 2017, soil samples were collected from 30 commercial soybean fields in Manitoba. A modified Fenwick elutriator was used to recover cysts. Cysts were identified based on morphological characters, PCR with species-specific primers for H. glycines (COXIII and SCAR), and DNA sequencing of four regions of the genome. Four fields were positive for SCN and had 2.9, 0.95, 3.9, and 1.81 eggs per 100 g soil. In 2021, an additional soybean field showing stunting and yellowing symptoms and swollen nematode females on roots was sampled. The SCN population density of this symptomatic headland area centre was 7,797 eggs per 100 cm3 soil. The SCN population from this field was of HG type 7 (race 3). Three positive fields were located along the Red River border crossing in the rural municipalities of Rhineland, Emerson-Franklin, and Montcalm. One field was in the rural municipality of Norfolk-Treherne, and the symptomatic field was in Thompson municipality, away from the Red River border. This study reports the first finding of H. glycines and SCN disease in Manitoba.

Opportunistic measurement of sagittal abdominal diameter with bone densitometry predicts death and cardiovascular events

Abstract Supine sagittal abdominal diameter (SAD), also known as abdominal height, has been proposed as a simple measure for assessing abdominal adiposity. We aimed to determine whether SAD from dual-energy X-ray absorptiometry (DXA) performed for osteoporosis assessment predicts major adverse cardiovascular events (MACE) using the population-based DXA registry for the Province of Manitoba, Canada. The study population comprised 72,974 individuals aged 40 years and older with baseline DXA assessment between February 1999 and March 2018. Incident MACE (composite of all-cause mortality, acute myocardial infarction [MI], non-hemorrhagic stroke) was ascertained from linked healthcare databases. During mean 8.4 years follow-up (611,862 person-years), 14,457 (18.8%) individuals experienced incident MACE. Risk stratification was greatest with SAD/weight ratio, with area under the curve (AUC) for MACE and its components ranging from 0.582 for acute MI to 0.620 for death (all p<0.001), all significantly better than with body mass index (BMI) (p<0.001). In multivariable-adjusted models, each SD increase in SAD/weight was associated with increased risk for MACE (hazards ratio [HR] 1.20, 95% CI 1.18-1.22), death (HR 1.22, 95% CI 1.20-1.25), acute MI (HR 1.19, 95% CI 1.14- 1.24), and stroke (HR 1.17, 95% CI 1.12-1.22). A linear gradient was seen across SAD/weight quintiles (all p-trend<0.001), with adjusted HR for MACE 1.61 (95% CI 1.50-1.72) for highest versus lowest quintile. Results were similar when further adjusted for BMI, in non-obese and obese individuals (p-interaction for obesity = 0.141), and in both women and men (p-interaction for sex = 0.471). In conclusion, SAD measured opportunistically at the time of DXA testing is predictive of death and major cardiovascular events in individuals undergoing osteoporosis assessment.

Spatial and temporal analyses of Dermacentor variabilis (Say) (Acari: Ixodidae) in central and eastern Canada.

Dermacentor variabilis (Say) (Acari: Ixodidae) is a vector for pathogens that can impact human and animal health. The geographic range of this species is expanding, but there are some areas with limited up-to-date information on the distribution of D. variabilis. Therefore, the objective of this study was to describe the spatial and temporal patterns of adult D. variabilis activity in central and eastern Canada. Ticks were collected from companion animals by veterinary clinic staff. Suspected locations of tick acquisition were spatially projected, and a spatial scan statistic was used to identify statistically significant clusters of frequent submissions from veterinary clinics. Submissions were categorised by calendar week to evaluate temporal trends. In total, 1198 adult D. variabilis, one nymphal D. variabilis and one Dermacentor albipictus (Packard) were collected from the provinces of Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia and Prince Edward Island from April 2019 through March 2020. Peaks in adult D. variabilis submissions occurred in May and June. Most of the submissions were received from south-eastern Manitoba, eastern Ontario and central and western Nova Scotia. A statistically significant cluster of frequent submissions that included seven veterinary clinics was identified in Nova Scotia. These findings can be used to determine the locations and times at which humans and their companion animals should be considered at an increased risk of exposure to D. variabilis and the pathogens they carry.

Network Analyses to Explore Comorbidities Among Older Adults Living With Dementia.

Older persons living with dementia (PLWD) often have multiple other chronic health conditions (i.e., comorbidities). Network analyses can describe complex profiles of chronic health conditions through graphical displays grounded in empirical data. Our study compared patterns of chronic health conditions among PLWD residing in and outside of long-term care (LTC) settings. Population-based administrative data, including outpatient physician claims, inpatient records, pharmaceutical records, and LTC records, for the study were from the Canadian province of Manitoba. We included PLWD, ages ≥ 67 years, with two or more other chronic health conditions, who resided in Manitoba from 2017 to 2020. A total of 138 chronic health conditions were ascertained using a modification of the open-source Clinical Classification Software. Networks defined by nodes (health conditions) and edges (associations between nodes) were stratified by residence location (in versus outside LTC). Network properties were described, including: density (ratio of number of edges to number of potential edges), and modularity (associations between and within clusters of health conditions), and the median and interquartile range (IQR) for node degree (number of associations per node). The population comprised 19,672 PLWD, of which 17,534 (89.1%) had two or more chronic health conditions. The median number of co-occurring conditions was similar among PLWD in LTC (median: 6, IQR: 3-10) versus outside LTC (median: 7, IQR: 4-10). Network properties were similar for PLWD and multiple comorbidities residing in versus outside LTC, including node degree (median 11 vs. 12), density (0.15 vs. 0.14), and modularity (0.18 vs. 0.26). Multiple chronic diseases characterize PLWD residing in and outside of LTC. Using network analyses, chronic diseases among PLWD do not form easily distinguishable groups or patterns. This suggests the need for comprehensive clinical assessments, individualized approaches for disease management, and highlights the importance of person-specific care.

A Hierarchical Machine Learning-Based Strategy for Mapping Grassland in Manitoba’s Diverse Ecoregions

Accurate and reliable knowledge about grassland distribution is essential for farmers, stakeholders, and government to effectively manage grassland resources from agro-economical and ecological perspectives. This study developed a novel pixel-based grassland classification approach using three supervised machine learning (ML) algorithms, which were assessed in the province of Manitoba, Canada. The grassland classification process involved three stages: (1) to distinguish between vegetation and non-vegetation covers, (2) to differentiate grassland from non-grassland landscapes, and (3) to identify three specific grassland classes (tame, native, and mixed grasses). Initially, this study investigated different satellite data, such as Sentinel-1 (S1), Sentinel-2 (S2), and Landsat 8 and 9, individually and combined, using the random forest (RF) method, with the best performance at the first two steps achieved using a combination of S1 and S2. The combination was then utilized to conduct the first two steps of classification using support vector machine (SVM) and gradient tree boosting (GTB). In step 3, after filtering out non-grassland pixels, the performance of RF, SVM, and GTB classifiers was evaluated with combined S1 and S2 data to distinguish different grassland types. Eighty-nine multitemporal raster-based variables, including spectral bands, SAR backscatters, and digital elevation models (DEM), were input for ML models. RF had the highest classification accuracy at 69.96% overall accuracy (OA) and a Kappa value of 0.55. After feature selection, the variables were reduced to 61, increasing OA to 72.62% with a Kappa value of 0.58. GTB ranked second, with its OA and Kappa values improving from 67.69% and 0.50 to 72.18% and 0.58 after feature selection. The impact of raster data quality on grassland classification accuracy was assessed through multisensor image fusion. Grassland classification using the Hue, Saturation, and Value (HSV) fused images showed higher OA (59.18%) and Kappa values (0.36) than the Brovey Transform (BT) and non-fused images. Finally, a web map was created to show grassland results within the Soil Landscapes of Canada (SLC) polygons, relating soil landscapes to grassland distribution and providing valuable information for decision-makers and researchers. Future work may include extending the current methodology by considering other influential variables, like meteorological parameters or soil properties, to create a comprehensive grassland inventory across the whole Prairie ecozone of Canada.

Energy management in pump-controlled actuators

Pump-controlled actuators, or more generically, hydrostatic actuators, have the significant advantage of not relying on valves to control the cylinders. This results in much better energy usage compared to traditional valve-controlled systems. However, it is possible to further increase energy efficiency by storing load energy in motoring quadrants and subsequently releasing the stored energy back into the circuit or making it available for other applications. Much work is needed to practically study energy storage in hydrostatic actuators. In this note, we review the two basic ways hydraulic energy can be saved in circuits using accumulators, emphasizing their advantages and drawbacks. The review is followed by a brief description of the current research being carried out at the University of Manitoba in Canada. We aim to show that research in this field is promising and demonstrates that hydraulic power transmission can not only be made efficient but also be used to regenerate load energy that would otherwise go to waste.

Disparities in Child Development by Maternal Birthplace and Child Sex among Kindergarten Children in Manitoba, Canada: A Population-Based Data Linkage Study

Little is known about differences in child developmental vulnerability before school entry according to maternal birthplace and sex. Official immigration records were linked with the Early Development Instrument assessments among children in kindergarten in the province of Manitoba, Canada (2005–2017). Logistic regression was used to estimate odds ratios of vulnerability in five developmental domains associated with maternal birthplace and child sex. Children of immigrant mothers from most birthplaces had higher adjusted odds of developmental vulnerability than non-immigrants in domains related to language and communication skills, except those of the rest of North America & Oceania. Children of Sub-Saharan African mothers were more vulnerable in four domains. Boys were consistently more vulnerable than girls across domains and maternal birthplaces. Children of immigrant mothers exhibited higher developmental vulnerability than non-immigrants in domains related to language and communication skills, potentially reflecting exposure to English and French as second languages.

Expanding data resources beyond “health care”: exploring options and implications

BackgroundPopulation data science has a long history with health care data. Some data centres are expanding to include “health-related” data, including information on other publicly funded services (e.g. education, income and housing supports), and systems (e.g. criminal justice, children in care). We describe what enabled this expansion through three examples from Health Data Research Network Canada. MethodsHDRN Canada members include data centres that provide access to linkable data sets for approved research projects. We use case studies to identify similarities, differences, and lessons learned from the process of expansion in the provinces of Manitoba, New Brunswick and British Columbia. ResultsThe Manitoba Centre for Health Policy has 30+ years of experience with linked data, with a consistent focus on population health. Data sets expanded incrementally, through partnerships across government agencies. Population Data BC has a nearly 30-year history, with recent expansion to health-related data through partnership with a program of one government ministry that operates under distinct legislative authority. The New Brunswick Institute for Research, Data and Training is newer, and helped advocate for legislation changes that enabled an expanded set of linked data to be made available for research. All embed Five Safes principles, and commitments to inclusion, diversity, equity and accessibility and Indigenous data sovereignty in data governance. ConclusionA greater variety of data enables research to answer complex research questions. This kind of expansion can be accomplished through different mechanisms, but in all cases requires attention to ethical and legal principles of population data science.

Integrating Gender Identity and Sexual Orientation in Population-Based Administrative Data

Information regarding biological sex is collected for administrative and clinical purposes, and often is conflated with gender in clinical encounters as well as in population-based data studies. Sex is collected as either ‘male’ or ‘female’, adhering to the colonial notion of binary sex and gender identities. Meaningful information on sexual/romantic orientation is also absent from these datasets. Sex, gender, and sexual/romantic (SR) orientation are key aspects informing how people experience the world and how we interpret administrative data. SOGI-HE (Sexual Orientation and Gender Identity – Health Equity) will be the first 2SLGBTQIA+ dataset at the Manitoba Centre for Health Policy by using a novel survey tool to collect information on gender identity, and SR orientation. The data from this survey will be linked into the Population Health Data Repository housed at the Manitoba Centre for Health Policy, enabling analyses that incorporate constructs of sex, gender, and SR orientation. These data will make visible the experiences of the 2SLGBTQIA+ community that have been historically absent from population-based data studies. Data equity and 2SLGBTQIA+ visibility within data play an important role in advancing the field and lays the groundwork for future data linkage projects. In this presentation we will discuss the development of SOGI-HE through community-based research principles and the implications it has on future 2SLGBTQIA+ research conducted in the province of Manitoba (Canada). Further, we will discuss the ethical implications associated with queer data sovereignty in a precarious political climate for 2SLGBTQIA+ people and their rights.

Poverty and Intellectual Development in Childhood.

Objectives and ApproachThe effects of the timing and duration of economic deprivation and maternal mental health on intellectual development is researched using unique linkable databases following almost 90 thousand children born in the Canadian province of Manitoba. This paper studies such questions as: How important are differences in measurement of poverty in assessing intellectual development? How do various differences change over childhood? ResultsConcentrating on those born in 2000-2002 generated a total of 7,424 children having scores on all six measures of intellectual development. Such person-specific information controlled for many individual factors and extended from ages 5 through 17. Major differences were found in the scores associated with exposure to the two kinds of poverty and to poor maternal mental health. In summary, differences emerge by age 5, with administration of the Early Development Index. These differences are largely the same at age 8, even though another measure (the Grade 3 Competencies Index) is used. ConclusionsIf household poverty is taken as a definition of poverty, poverty seems much more important than maternal mental health in affecting a child’s intellectual development. However, if neighborhood poverty is used to define poverty, maternal mental health and poverty have effects on childhood intellectual development which are more similar. Definition plays a critical role in interpretation. ImplicationsThese population-based data, with multiple measures and multiple time points, suggest many analytical possibilities. If childhood conditions are included, the list of medical conditions which might correlate with intellectual development multiplies.

Fears and Fences: Social and Material Barriers to Plains Bison on the Canadian Prairies

Plains Bison once had the largest population and range of any terrestrial herbivore in North America. Bison now occupy less than 2% of their historic range, mostly behind fences of state-run and private organizations. In 2014, Indigenous groups across North America signed The Buffalo Treaty, calling for bison rewilding. This paper examines barriers to rewilding on Canada’s prairies in the provinces of Manitoba, Saskatchewan, and Alberta. Through interviews we asked government and NGO representatives what prevents bison reintroduction and rewilding. Our results suggest that the main barriers are social acceptance and material resources. These findings support previous research in the United States and Europe and provides a foundation for future research that could include other actors, such as landowners, Indigenous organizations, and industry representatives.

The impact of COVID-19 public health measures on the utilization of antipsychotics in schizophrenia in Manitoba – A population-based study

PurposeDuring the COVID-19 pandemic, public health measures were implemented, yet it is unknown whether these measures affected medication access in those with schizophrenia (SCZ). This study aimed to assess whether the antipsychotic utilization in SCZ changed during the pandemic. MethodsWe used dispensed prescription drug data from the Canadian province of Manitoba in individuals with SCZ using linked administrative data from the Manitoba Population Research Data Repository. The quarterly incident and prevalent dispensation of antipsychotics at two periods were compared with the expected trend (April 1, 2015 to April 1, 2020 and 2021) using linear autoregression. We stratified the primary results by age and sex and examined multiple subgroups. ResultsThere were 9045 individuals with SCZ in the first fiscal quarter of 2020. The prevalent use of the most common antipsychotics were: olanzapine (206.7/1000), risperidone (190.8/1000), quetiapine (174.4/1000), and clozapine (100.9/1000). The overall prevalent use of antipsychotics remained stable during the pandemic compared with the expected trend. A significant decrease in the incident use in April–June 2020 (estimate: -1.3, 95%CI:-2.2,-0.3) was noted compared with the expected. A significantly higher incidence of atypical antipsychotics (estimate: 1.4, 95%CI: 0.2,2.5) and risperidone separately (estimate: 1.8, 95%CI: 0.2,3.3) was noted in 2021 compared with expected. ConclusionThis study found a decline in the receipt of antipsychotics for people with SCZ during the initial implementation of COVID-19 public health measures, particularly on the overall incidence. Future work on investigating the impact of these trends on SCZ outcomes is needed to inform future pandemic-related policies.

The Effect of Smoking Cessation versus Current Smoking on Fracture Risk: The Manitoba BMD Registry

Current tobacco smoking is included in FRAXTM calculator for fracture risk assessment. It is unknown whether previous smoking increases the risk of fracture. The current analysis was performed to compare incident fracture risk associated with current smoking, smoking cessation and non-smoking. The study population comprised 18,115 individuals aged 40 years and older (mean age 68.8 years, 95.1% female) from a large clinical registry of DXA tests for the Province of Manitoba, Canada, with two consecutive visits (mean interval 4.4 years) where current smoking was recorded. Smokers (N=1620) were defined as those reporting current smoking at visit 2 (index date), non-smokers (N=15,942) as answering no to current smoking at both visits, and ex-smokers (N=553) as answering yes to current smoking at visit 1 but no at visit 2. Incident fractures were identified through healthcare data linkage. Compared with non-smokers, risk for any incident fracture (primary outcome) was significantly greater in current smokers (hazard ratio [HR] 1.41, 95% CI 1.19-1.67 adjusted for age/sex; HR 1.22, 95% CI 1.03-1.44 full adjusted) and ex-smokers (HRs 1.56, 95% CI 1.19-2.024 and 1.42, 95% CI 1.09-1.86, respectively). Similar directions and magnitudes of effect were seen for incident major osteoporotic fractures and hip fractures (secondary outcomes), with point estimates for ex-smokers that were close to current smokers. In summary, recent smoking cessation was associated with ongoing increased short-term fracture risk similar to current smoking. Larger studies are needed to better define the time course of fracture risk after smoking cessation.

Negotiating farm femininity in agricultural leadership

A growing number of women in the Canadian Prairie region are advancing into leadership roles in agriculture, which remains a predominantly male domain. In this research we explore how professionally and managerially employed women in agriculture in the provinces of Manitoba, Saskatchewan, and Alberta navigate being a leader in an industry characterized by rural hegemonic masculinity. We explore and examine the personal experiences and observations of these women regarding gender, leadership, and the current state of prairie agriculture as it grapples with being more inclusive, diverse, and equitable. We found that to gain legitimacy as a leader in agriculture women are enacting a complex mix of traditional femininity, anti-affirmative action, and masculine-coded farm credibility. Women are required to be both like a man and like a woman to differentiate themselves—both from men and from one another—as they navigate both similarity and difference in their gender performance. Expanding on the work of Mavin and Grandy’s (2016) work on respectable business femininity, we have conceptualized this performance as “respectable farm femininity” to reflect the specific experiences, and previously unexplored domain of women in agricultural leadership (outside of the on-farm contexts that make up the scholarship in this area). These expectations are rooted in more traditional constructions of rural, hegemonic masculinity, but carry important weight in conferring legitimacy to women in agricultural leadership. This has important implications for how women are able to carve out their career path on the way to leadership.

Negotiating farm femininity in agricultural leadership

A growing number of women in the Canadian Prairie region are advancing into leadership roles in agriculture, which remains a predominantly male domain. In this research we explore how professionally and managerially employed women in agriculture in the provinces of Manitoba, Saskatchewan, and Alberta navigate being a leader in an industry characterized by rural hegemonic masculinity. We explore and examine the personal experiences and observations of these women regarding gender, leadership, and the current state of prairie agriculture as it grapples with being more inclusive, diverse, and equitable. We found that to gain legitimacy as a leader in agriculture women are enacting a complex mix of traditional femininity, anti-affirmative action, and masculine-coded farm credibility. Women are required to be both like a man and like a woman to differentiate themselves—both from men and from one another—as they navigate both similarity and difference in their gender performance. Expanding on the work of Mavin and Grandy’s (2016) work on respectable business femininity, we have conceptualized this performance as “respectable farm femininity” to reflect the specific experiences, and previously unexplored domain of women in agricultural leadership (outside of the on-farm contexts that make up the scholarship in this area). These expectations are rooted in more traditional constructions of rural, hegemonic masculinity, but carry important weight in conferring legitimacy to women in agricultural leadership. This has important implications for how women are able to carve out their career path on the way to leadership.

ALONE, LOST, AND UNPREPARED BY THE SYSTEM: INDIGENOUS CARE LEAVERS’ EXPERIENCES OF AGING OUT OF CHILD WELFARE CARE IN MANITOBA

Limited research has been carried out on Indigenous young people transitioning out of care in Canada. This article provides a coherent and meaningful account of the journey of aging out of care in the province of Manitoba, as presented by 17 Indigenous care leavers. Using a qualitative multilevel approach grounded in first-person narratives, this study focused on incorporating and elevating the voices of Indigenous care leavers. Participants detailed their experiences of planning for the transition and aging out of care, and described their life post-care. The care leavers expressed that the Child and Family Services-led process of planning for and transitioning out of care was unclear and failed to engage them as partners, and as a result left them ill-prepared for life post-care. Additionally, participants’ experiences serve as evidence of enduring gaps in transition supports, namely in mental health and interpersonal supports. These supports were often unavailable or inaccessible, challenges that were amplified during participants’ transition out of care and in the post-care period. The experiential knowledge from this study contributes valuable information to inform responsive child welfare transition policies and practices that are reflective of the experiences and needs of the population it intends to serve.

Standardized ileal amino acid digestibility and performance indices in pullets and laying hens fed expeller-pressed Canadian prairie soybean meal

Soybean meals (SBM) from different locations differ in their protein content, subsequently influencing their amino acid (AA) profile. In this study, standardized ileal digestibility (SID) of AA and growth or production performance were evaluated in pullets and hens fed SBM derived from soybean grown in Western Canada, primarily Manitoba (MB) labelled as A-, B- and C-SBM compared with that from Eastern Canada (Ontario, ON-SBM) and contained 38.3 ± 0.44, 38.6 ± 0.61, 39.4 ± 0.49, or 44.0 ± 0.87% CP, respectively. A N-free diet was used to determine basal ileal endogenous losses of AA. The study included the grower, developer, and layer phases (9-12, 13-16, and 44/59-64-wk old birds, respectively). Although a lower (P = 0.029) SID for cysteine was noted in the grower phase for the C-SBM compared with other SBM, the developer phase had higher (P < 0.05) SID for methionine, phenylalanine, cysteine (more by 4.4, 2.4 and 7.2% units, respectively) on average for SBM samples from MB compared with the ON-SBM. Regardless the source of the SBM, no difference in SID of AA was noted in the layer phase. Overall, in all phases the SID values of most AA in the SBM from MB were comparable with the ON-SBM, which may be linked to higher values of these AA per unit of protein content in the former source. In addition, the growth performance including feed intake, BW gain and feed conversion ratio in pullets, and egg production/quality in layers were similar between treatments. These findings show that the MB-SBM have a comparable feeding value with the ON-SBM, hence represent a suitable alternative protein source for poultry.

Older Adults' Engagement in Advisory Councils and Committees: The case of Manitoba, Canada

AbstractWhile older adults and family carers have important contributions to make to social and civic life in Canada, meaningful opportunities for engaging in democratic governance are often limited. Using the province of Manitoba as a case study, we ask how relevant advisory councils and committees have been designed and constituted; how have they operated in practice; and what explains their span of influence and effectiveness. Interviews with older adults and family carers show that they want to be involved, that they believe that advisory committees/councils can be effective mechanisms for engagement, and that they think these entities can impact decision‐makers, especially in the health sector.

Fracture Risk Associated with Different Numbers and Combinations of Lumbar Vertebrae: The Manitoba BMD Registry

Bone mineral density (BMD) is widely used for assessment of fracture risk. For the lumbar spine, BMD is typically measured from L1-L4 as it provides the largest area for assessment with the best measurement precision. Structural artifact often confounds spine BMD in clinical practice, and the International Society for Clinical Densitometry (ISCD) recommends removing vertebrae with artifact when reporting spine BMD. In its most recent position statements, the ISCD recommended against the use of a single vertebra when reporting spine BMD but stated that further studies should be done. The current analysis was performed to compare the performance of BMD from different numbers and combination of vertebral levels on fracture prediction in a large clinical registry of DXA tests for the Province of Manitoba, Canada. The study population comprised 39,727 individuals aged 40 years and older (mean age 62.7 years, 91.0 % female) with baseline DXA after excluding those with evidence of structural artifact. Mean follow-up for ascertaining fracture outcomes was 8.7 years. Area under the curve (AUC) for incident fracture risk stratification was statistically significant regardless of the BMD measurement site or fracture outcome. AUC differences with the various numbers and combinations of vertebral levels including a single vertebral body were small (less than or equal to 0.01). More substantial AUC differences were seen for femoral neck and total hip BMD versus L1-L4 BMD, approaching 0.1 for hip fracture stratification. In summary, we found that using combinations of fewer than 4 vertebrae including individual lumbar vertebrae predicted incident fractures. Importantly, differences between these different combinations were small when compared with L1-L4. Spine BMD was a better predictor of incident spine fracture compared to the hip, whereas the hip was better for hip fracture and overall fracture prediction.

Maternity Service Delivery in Manitoba, Canada: A Retrospective Analysis of Three Maternity Care Provider Types

Background: Alleviating shortages in health workforce and delivery of efficient maternity care models are unresolved policy issues in Canada. In the province of Manitoba, obstetricians do the majority of maternity care, family practice physicians take care of low-risk women, and midwives continue to deliver care to about 5% of the low-risk pregnant women. The purpose of this study was to describe how maternity care is provided in Manitoba, based on a revised definition of Most Responsible Provider, and to compare maternal and perinatal outcomes by provider type. Methods: Administrative data were used from the Manitoba Centre for Health Policy (MCHP) to select women who had a low-risk pregnancy. Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates. Results: From 2004/05 to 2012/13, there were a total of 132,918 births in Manitoba. Of those births, 47,083 were identified as high risk (35%), and 85,835 (65%) were identified as low risk. Key findings demonstrate midwifery care compared to obstetrical care was associated with lower odds of interventions such as cesarean section (0.47 [0.40–0.54]), induction (0.42 [0.39–0.49]), and episiotomy (0.48 [0.41–0.55]), but higher odds of postpartum hemorrhage (1.35 [1.18–1.55]), and shorter lengths of stay in hospital (-0.58 [-0.61-0.56]). Family practice physicians also had decreased odds of assisted vaginal delivery (0.82 [0.76–0.89]), epidural use (0.59 [0.57–0.62]) and third- and fourth-degree tears (0.82 [0.73–0.92]), but higher odds of augmentation (1.06 [1.01–1.11]). Results reported for midwives and family practice are compared to obstetricians. Conclusions: A health workforce strategy that optimizes how to address the maternity care needs in the province of Manitoba is needed. There is suboptimal integration of midwifery services that could meet the low-risk population needs. Human health workforce development requires a good understanding of each provider’s role, opportunities for collaboration and integration to be strengthened, and the potential to optimize the outcomes for mothers and infants. This article has been peer reviewed.