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This study examined academic and social outcomes for high-risk youths in Manitoba, using longitudinal, population-based data. All children born in Manitoba in 1984-1985 who resided in Winnipeg the year they turned 18 were included in analyses (N = 11,703). High risk youths were defined as those involved with child welfare services, living in poverty, and/or having a mother who was a teen at first childbirth. Of youths with one risk factor, 41 to 57 per cent failed to complete high school, and 84 per cent of those with all three risk factors did not complete high school, compared with only 18 per cent of youths with none of the risk factors. Multiple risk factors put youths at an even greater disadvantage. Similar poor outcomes for high risk youths were observed for performance in grade 9, unemployment in early adulthood, and teen births. The findings suggest an intractable cycle of risk and disadvantage with far-reaching social and economic implications. (Contains 2 footnotes, 2 tables, and 5 figures.)

All children born in Manitoba in 1984 were tracked for 18 years to assess their grade-12 performance on a provincial examination according to a student's socio-economic status. The proportion of youths in families receiving social assistance judged to have passed their language arts exam dropped from 80 per cent to 12 per cent, depending on whether one counts only those in the cohort who took the test on time in 2002 or all youths born in 1984 who should have taken the test in 2002. Getting better data on performance and doing something about the discrepancies should become a Canadian priority. (Contains 5 tables and 3 notes.)

Data from a population-based repository in Manitoba showed that students who are male, young for grade, and in Grades 1, 2, 7, and 8 were the most likely to be retained. After controlling for key student factors including socioeconomic status, school changes, and key school characteristics including stability of the student body, retention was a strong predictor of high school withdrawal rates. The odds of student withdrawal were 3 times higher for students who have been retained once and almost 8 times higher for students who had been retained more than once. Not only do withdrawal rates suggest that retention is potentially harmful, but also Grade 3 standards test results taken in consecutive years by retained students indicate that only one in four retained students improve their score. These results generally replicate the research done in the United States. (Contains 5 tables and 3 notes.)

Being able to anticipate future needs for health services presents a challenge for health planners. Using existing population projections, two models are presented to estimate the demand for hospital beds in regions of Manitoba in 2020. The first, a current-use projection model, simply projects the average use for a recent three-year period into the future. The second, a 10-year trend analysis, uses Poisson regression to project future demand. The current-use projection suggests a substantial increase in the demand for hospital beds, while the trend analysis projects a decline. The last projections are consistent with ongoing increases in rates of day surgeries and declines in lengths of stay. The current-use projections need to be considered in the context of relatively low occupancy rates in rural hospitals and previous research on appropriateness of stays in acute care hospitals. If measures are taken to ensure more appropriate use of acute care hospital beds in the future, then the current-use projections of bed shortages are not a cause for concern.

Previous studies report geographic variation in the use of home care services. In the province of Manitoba, home care is a core service that Manitoba's twelve regional health authorities (RHAs) are obligated to deliver. Manitoba's RHAs range from remote northern and rural southern regions to a major city, resulting in different challenges for delivering home care. Given this potential for inconsistent delivery and the previous findings of regional variation in other settings, the objective of this study was to measure and assess variation in the use of home care across Manitoba's RHAs. We used data from the Provincial Home Care Program's client registry, other health care administrative databases, and Vital Statistics. Home care use was measured using multiple indicators, including rates of population use, use after hospitalization, before entry to a long-term care facility, and before death. While some important differences emerged, overall we found comparable use of home care across Manitoba.

Administrative home care data from the Manitoba Support Services Payroll (MSSP) system for fiscal years 1995/1996 to 1998/1999 were utilized to study home care client characteristics and changes in home care use over time. Patterns in home care access and use after hospitalization, before admission to a nursing home, and before death were examined. The study found that the majority of home care clients were female, aged 65 and over, and not married. The proportion of Manitobans using home care increased slowly, but significantly, over the 4 years. The greatest increases were found among the older age groups. The average number of days that clients received home care before death or before admission to a nursing home was stable over time, while a significant increase over time in home care use after hospitalization was experienced. These findings can be useful to regional health authorities for planning and budgeting.

Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP to population ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the volume of care received and provided over the period, contribute to this paradox. Given the relationship between age and FP use in fiscal year 1991/1992, an aging population should have been associated with a 2 per cent increase in visits by 2000/2001. Likewise, given the relationship between FP age and workloads in 1991/1992, an aging workforce should have been associated with a 12 per cent increase in service provision a decade later. Yet visit rates and average FP workloads remained unchanged. There was an increase in age-specific rates of FP use among older adults and a decline in rates among the young, and an increase in age-specific workloads such that older FPs provided many more services than their predecessors (30%) and younger FPs provided many fewer (20%). In terms of impact on future requirements for FPs, both changes in age-specific rates of use, and changes in age-specific patterns of FP productivity, trump population aging as key drivers.

Canadians have expressed concern that access to family physicians (FP) has declined. Anonymized physician services data for 1991/1992 to 2000/2001 were used to evaluate changes in supply and age-specific rates of use of FPs and specialists in Winnipeg, Manitoba. Physician-to-population ratios declined 7.5 per cent, FP-to-population ratios declined 4.8 per cent, and specialist-to-population ratios declined 10.0 per cent. Among the general population, FP visit rates declined 3 per cent. Among older adults, physician visit rates increased 2.3 per cent, FP visit rates increased 10.9 per cent, and specialist visit rates declined 15.7 per cent. By comparison, we document declines in FP use by those younger than 5 years (25.5%) and those 6 to 19 years of age (18.6%). Increases in FP and declines in specialist use occurred primarily among those aged 65 to 84 years. By 2000/2001 older adults accounted for 25 per cent of all FP encounters. Gains in FP use among older adults was less attributable to the presence of more seniors and more related to the fact that a higher proportion of them are visiting a FP each year and, potentially, substituting primary for secondary care.