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The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention.

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.)

Background: Little information exists on health of children with developmental disabilities (DDs) in the Canadian province of Manitoba. Method: The present authors linked 12 years 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. Results: 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. Conclusions: 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.

Introduction: Traumatic physical injuries are the number one cause of hospitalization and death among children in Canada. The majority of these injuries are preventable. The burden from injury can be reduced through prevention programs tailored to at-risk groups, however, existing research does not provide a strong explanation of how social factors influence a child's risk of injury. We propose a theoretical framework to better understand social factors and injury in children and will examine the association between these social factors and physical traumatic injury in children using large population-wide data. Methods and analysis: We will examine data from 11,000 children hospitalized for traumatic physical injury and 55,000 matched uninjured children by linking longitudinal administrative and clinical data contained at the Manitoba Centre for Health Policy. We will examine 14 social determinants of child health measures from our theoretical framework, including receipt of income assistance, rural/urban status, socioeconomic status, children in care, child mental disorder, and parental factors (involvement with criminal justice system, education, social housing, immigration status, high residential mobility, mother's age at first birth, maternal Axis I mental disorder, maternal Axis II mental disorder and maternal physical disorder) to identify groups and periods of time when children are at greatest risk for traumatic physical injury. A conditional multivariable logistic regression model will be calculated (including all social determinant measures) to determine odds ratios and adjusted odds ratios (95% confidence interval) for cases (injured) and controls (non-injured). Ethics and dissemination: Health Information Privacy Committee (HIPC No. 2017/2018-75) and local ethics approval (H2018-123) were obtained. Once social measures have been identified through statistical modelling, we will determine how they fit into a Haddon matrix to identify appropriate areas for intervention. Knowing these risk factors will guide decision-makers and health policy. [ABSTRACT FROM AUTHOR]

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children. [ABSTRACT FROM AUTHOR]

As a result of the colonization of Canada, Metis have faced many political and socioeconomic challenges, one of which is the lower educational achievement of Metis students vs other Canadian students. In this study, we examined whether full-time kindergarten (FTK) vs half-time kindergarten (HTK) was associated with improved educational outcomes for Metis students in Manitoba using linked, population-based administrative data from 1998/99-2012/13. The cohort included 271 FTK and 405 HTK Metis students. We used generalized linear models with binomial distribution to calculate predicted probabilities and risk ratios for the outcomes (assessments of numeracy and literacy in Grades 3, 7 and 8; student engagement in Grade 7; high school graduation). However, we observed no significant differences in outcomes between FTK and HTK students, suggesting that FTK is not sufficient to overcome the structural barriers to academic success Metis students may face. [ABSTRACT FROM AUTHOR]

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 < 0.001). 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.

Background: There is evidence that the primary care provided for persons with an intellectual disability living in the community has been inadequate. Hospitalization rates for ambulatory care sensitive (ACS) conditions are considered an indicator for access to, and quality of, primary care. The objective of this research was to identify ACS conditions that are applicable to persons with an intellectual disability. Materials and Methods: We developed and distributed a survey questionnaire using a modified Delphi process. The participants were clinicians with experience working with people with an intellectual disability. Results: All eleven conditions that were considered ACS for the general population met the three primary inclusion criteria. Study participants suggested five other conditions of which four met the primary criteria: constipation, gastroesophageal reflux, epilepsy, and schizophrenic disorders. Conclusions: There is a very high degree of agreement as to what constitutes an ACS condition for persons with an intellectual disability. The final list has the potential to be used with other populations with cognitive disabilities and outside of Canada.

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.)

Early childhood antibiotic exposure induces changes in gut microbiota reportedly associated with the development of attention-deficit/hyperactivity disorder (ADHD). We conducted a population-based cohort study to examine the association between antibiotic use in the first year of life and ADHD risk. We included children born in Manitoba, Canada, between 1998 and 2017. Exposure was defined as having filled 1 or more antibiotic prescriptions during the first year of life. ADHD diagnosis was identified in hospital abstracts, physician visits, or drug dispensations. Risk of developing ADHD was estimated using Cox proportional hazards regression in a high-dimensional propensity score–matched cohort (n = 69,738) and a sibling cohort (n = 67,671). ADHD risk was not associated with antibiotic exposure in the matched-cohort (hazard ratio = 1.02, 95% confidence interval: 0.97, 1.08) or in the sibling cohort (hazard ratio = 0.96, 95% confidence interval: 0.89, 1.03). In secondary analyses of the matched cohort, ADHD risk increase was observed in those exposed to 4 or more antibiotic courses or a duration longer than 3 weeks. These associations were not observed in the sibling cohort. We concluded that antibiotic exposure in the first year of life does not pose an ADHD risk on a population level. [ABSTRACT FROM AUTHOR]

The current study examined school readiness for children placed in care of child protection services before age 5. This association was assessed using a population-based cohort of children born in Manitoba, Canada, between 2000 and 2009 (n = 53,477) and subcohorts of discordant siblings (one sibling taken into care, one sibling not taken into care; n = 809) and discordant cousins (n = 517). In the population analysis, children placed in care were significantly less likely to be ready for school; this difference was not seen in the discordant sibling or cousin analysis. The findings suggested that differences in school readiness for children placed in care are a result of broader social factors affecting families, not placement into care. [ABSTRACT FROM AUTHOR]

This study examines whether mothers who had a child taken into care by child protection services have higher mortality rates compared with rates seen in their biological sisters who did not have a child taken into care. We conducted this retrospective cohort study using linkable administrative data from 3,948 mothers whose oldest child was born in Manitoba, Canada, between April 1, 1992, and March 31, 2015. These mothers were from 1,974 families in which one sister had a child taken into care and one sister did not. We computed rate differences and hazard ratios of all-cause, avoidable, and unavoidable mortality. There were an additional 24 deaths per 10,000 person-years among mothers who had had a child taken into care. Mothers who had a child taken into care had higher rates of mortality due to avoidable causes (hazard ratio = 3.46; 95%c onfidence interval: 1.41, 8.48) and unavoidable causes (hazard ratio = 2.92; 95% confidence interval: 1.01, 8.44). The number of children taken into care did not affect mortality rates among mothers with at least 1 child taken into care. The higher mortality rates--particularly avoidable mortality--among mothers who had a child taken into care indicate a need for more specific interventions for these mothers. [ABSTRACT FROM AUTHOR]

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Background: In Manitoba, Canada, school-based clinics providing sexual and reproductive health services for adolescents have been implemented to address high rates of sexually transmitted infections (STIs) and pregnancies. Methods: The objectives of this population-based study were to compare pregnancy and STI rates between adolescents enrolled in schools with school-based clinics, those in schools without clinics, and those not enrolled in school. Data were from the PATHS Data Resource held in the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy. Adolescents aged 14 to 19 between 2003 and 2009 were included in the study. Annualized rates of pregnancies and positive STI tests were estimated and Poisson regression models were used to test for differences in rates amongst the three groups. Results: As a proportion, pregnancies among non-enrolled female adolescents accounted for 55 % of all pregnancies in this age group during the study period. Pregnancy rates were 2-3 times as high among non-enrolled female adolescents. Compared to adolescents enrolled in schools without school-based clinics, age-adjusted STI rates were 3.5 times (p < .001) higher in non-enrolled males and 2.3 times (p < .001) higher in non-enrolled females. Conclusions: The highest rates for pregnancies and STIs were observed among non-enrolled adolescents. Although provision of reproductive and health services to in-school adolescents should remain a priority, program planning and design should consider optimal strategies to engage out of school youth. [ABSTRACT FROM AUTHOR]

Background: Home visiting programs focused on improving early childhood environments are commonplace in North America. A goal of many of these programs is to improve the overall health of children, including promotion of age appropriate vaccination. In this study, population-based data are used to examine the effect of a home visiting program on vaccination rates in children. Methods: Home visiting program data from Manitoba, Canada were linked to several databases, including a provincial vaccination registry to examine vaccination rates in a cohort of children born between 2003 and 2009. Propensity score weights were used to balance potential confounders between a group of children enrolled in the program (n = 4,562) and those who were eligible but not enrolled (n = 5,184). Complete and partial vaccination rates for one and two year old children were compared between groups, including stratification into area-level income quintiles. Results: Complete vaccination rates from birth to age 1 and 2 were higher for those enrolled in the Families First program [Average Treatment Effect Risk Ratio (ATE RR) 1.06 (95 % CI 1.03-1.08) and 1.10 (95 % CI 1.05-1.15) respectively]. No significant differences were found between groups having at least one vaccination at age 1 or 2 [ATE RR 1.01 (95 % CI 1.00-1.02) and 1.00 (95 % CI 1.00-1.01) respectively). The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile. Conclusions: Home visiting programs have the potential to increase vaccination rates for children enrolled, despite limited program content directed towards this end. Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background Few studies have examined the potential of linked administrative data for research on child health. This analysis describes the application of a non-categorical survey-based tool, the Children with Special Health Care Needs (CSHCN) Screener, to administrative data. Data and methods Five Screener items were applied to data from Population Data British Columbia. Hospital admissions and demographic and community characteristics of a cohort of children aged 6 to 10 in 2006 were examined to validate the use of these items. Results Overall, 17.5% of children were identified as CSHCN. An estimated 14% of children used more medical care and 5.2% had more functional limitations than is usual for children of the same age; 3.3% were prescribed long-term medication; 1.9% needed/received treatment or counselling; and 0.1% needed/received special therapy. Boys were more likely than girls to be identified as CSHCN. Interpretation With some limitations, the CSHCN Screener can be applied to Canadian administrative health data. [ABSTRACT FROM AUTHOR]

Abstract: Information-rich environments in Canada, Australia, and the United Kingdom have been built using record linkage techniques with population-based health insurance systems and longitudinal administrative data. This paper discusses the issues in extending population-based administrative data from health to additional topics more generally connected with well being. The scope of work associated with a multi-faceted American survey, the Panel Study in Income Dynamics (PSID), is compared with that of the administrative data in Manitoba, Canada. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed. [Copyright &y& Elsevier]

Objective: To examine socioeconomic, demographic, and behavioural factors that influence the incidence of methylphenidate use among children aged 4 to 13 years.Method: A total of 11,316 children, aged 2 through 11 years, from Cycle 1 (1994-95) of the National Longitudinal Survey of Children and Youth were followed up 2 years later in Cycle 2 (1996-97). The outcome measure was methylphenidate use in Cycle 2. Individual-level explanatory variables included sex, age, socioeconomic status (SES), mother's age at birth of child, lone-parent family status, parental working status, and hyperactivity-impulsivity and inattention probabilities. Area-level explanatory variables included income and rural or urban residence. We used hierarchical linear modelling to examine individual- and area-level factors that predicted methylphenidate use.Results: The strongest predictors of methylphenidate use were behavioural: children with high hyperactive-impulsive and (or) inattention behaviours in 1994, compared with children low on these behaviours, were 4.5 to 6 times more likely to use methylphenidate 2 years later. SES remained a significant predictor of the incidence of methylphenidate use, even when other significant predictors were held constant, with lower SES being associated with higher use. Area-level income also predicted methylphenidate use.Conclusion: Even when children with similar behavioural symptoms and demographic characteristics were compared, socioeconomic factors had a significant impact on incidence of methylphenidate use. [ABSTRACT FROM AUTHOR]

Objective: To describe physicians' diagnosis rates for attention-deficit hyperactivity disorder (ADHD) for children in the province of Manitoba and to describe the rate of psychostimulant medication use by these children.Methods: This descriptive study reviewed the computerized administrative records of physician visits and prescriptions dispensed to examine a population-based, cross-sectional cohort of children diagnosed with ADHD or prescribed stimulant medication, or both. We found 4787 children with a diagnosis of ADHD over a 24-month period or a prescription for stimulant medication over a 12-month period, or both. Rates were calculated by age, sex, region of residence, neighbourhood income level, and physician specialty.Results: Among Manitoba children, 1.52% received a medical diagnosis of ADHD and 0.89% received stimulant medication. Regionally, diagnosis rates for ADHD varied almost 4-fold, and over 8-fold for medications prescribed. Urban areas had higher rates than did rural areas, regardless of physician specialty. Diagnosis and prescription rates varied according to physician specialty, with the highest rates found among pediatricians. An income gradient was evident in rural areas, with rates of ADHD diagnosis and medication prescribed increasing with increased neighbourhood income level.Conclusions: The pattern of regional variation found in this study suggests that the diagnosis and treatment of ADHD in Manitoba are influenced strongly by the practice styles of local physicians. [ABSTRACT FROM AUTHOR]

Examines the health care sector of Manitoba, a province north of Minnesota/North Dakota. Reform of the Canadian health care system; Examination of the outcome; Opposition to health care cuts in Minnesota; Effects of budget cutting; Problems which hospitals in Manitoba face; Importance of health care reform.

Presents opposing arguments on the two-structure health care system in Canada as influenced by financial pressures in the nation. Background on the Canada Health Act of 1984; Description of the two-structure health care system; Evaluation of beliefs regarding private health care in Canada.

Background: Dental problems are the most prevalent chronic disease worldwide, with up to half of all kindergarten children having tooth decay. However, there is a lack of evidence of whether unaddressed dental needs (UDNs) are associated with children's developmental health, a concept reflecting holistic child development - encompassing physical, emotional, and cognitive development. The objective of the current study was to evaluate the relationship between UDNs and developmental health among kindergarten children using the Early Development Instrument (EDI).Methods: We examined associations between teacher reported UDNs and developmental vulnerability on the EDI. Children were included in the study if they were enrolled in kindergarten in publicly-funded schools in Canada between 2010 and 2015, had been in the classroom for at least one month, and had no more than 25% of missing items on the questionnaire.Results: Among 576,264 children who met inclusion criteria (95.4% of eligible children), 2465 (0.4%) were identified as having UDNs by their teachers. Children with UDNs had 4.58 to 8.27 times higher odds of being vulnerable on any of the five developmental domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge), compared to children without UDNs.Conclusion: In this study, teacher-reported UDNs were associated with developmental vulnerability in kindergarten children. Teacher reported unmet dental needs in kindergarten children may be a proxy for poor developmental health at school entry, and thus a marker for supporting both children's oral health and early developmental needs. [ABSTRACT FROM AUTHOR]

This article discusses the criticisms leveled by Evelyn Vingilis and Jacquelyn Burkell in "A Critique of an Evaluation of the Impact of Hospital Bed Closures on Winnipeg, Canada: Lessons to be Learned from Evaluation Research Methods." Vingilis and Burkell repeatedly mention the inadequacy of using only one year of "follow-up" in determining the impact of bed closures in Winnipeg. We couldn't agree more. It was never our intention to have the "First Report," as the name implies, to be the last word on hospital downsizing in Winnipeg. They wrongly suggest that this design is vulnerable to most of the threats to internal and external validity. They are, in fact, correct that the design is vulnerable to the threat of maturation, but interestingly, one of their suggestions for overcoming this threat would only introduce additional threats to internal validity. In a perfect world, health care researchers could monitor a system for years before reporting on the impact of change. In this less than perfect world, however, policy is made and beds are closed.

Rates of child removal by child protective services (CPS) in Manitoba are the highest in Canada with a profoundly disproportionate impact on First Nations families. Despite infants constituting the highest proportion of children affected, no research has examined population-level rates of infant contact with CPS. We examined the incidence of infant contact with different levels of CPS, including termination of parental rights (TPR), according to First Nations status. We identified 217,261 infants (47,416 First Nations; 169,845 non-First Nations) born between 1998 and 2014 in Manitoba, Canada and residing in the province until at least age 5. We used linked administrative data to calculate population-level rates of contact with different levels of CPS by First Nations status, including an open file before age 1, out-of-home placement before age 1, and TPR before age 5. Overall 35.8 % of First Nations infants had an open file, 8.5 % experienced out-of-home placement, and 5.4 % experienced TPR. Among other infants, 8.5 % had an open file, 1.3 % experienced out-of-home placement and 0.7 % experienced TPR. The rate of early-stage contact increased the fastest among First Nations infants, with a rise of 22.4 % in our study period, compared to a rise of 1.7 % among all other infants. CPS contact was exceptionally high among First Nations infants compared to other infants, with early-stage contact accelerating most dramatically over time. Findings support calls to greatly reduce the disruption of system contact in the lives of First Nations families. [ABSTRACT FROM AUTHOR]

The incidence of intimate partner violence (IPV) varies according to IPV definitions and data collection approaches. The criminal Justice system assesses IPV through a review of the evidence gathered by the police and the court hearings. We aimed to determine the association between IPV, as identified in criminal Justice disposition records, and subsequent healthcare-identified intentional injury inflicted by others, including violent death. We conducted a retrospective population-based matched-cohort study using linked multisectoral databases. Female adult Manitoba residents identified as victims of IPV in provincial prosecution and disposition records 2004 to 2016 (n = 20,469) were matched to three non-victims (n = 61,407) of similar age, relationship status and place of residence at the date of the IPV incident. Outcomes were first healthcare use for intentional injury and violent death, assessed in Emergency Department visits, hospitalizations and Vital Statistics deaths records. Conditional Cox Regression was used to obtain Hazard Ratios (HR) with 95% confidence intervals (CI). The risk of intentional injury was 8.5 per 1000 women among non-victims of IPV and 55.8 per 1000 women among IPV victims. The Hazard Ratios associated with IPV were 3.8 (95% CI: 3.4, 4.3) for intentional injury and 4.6 (95% CI: 2.3, 9.2) for violent death, after adjustment. IPV victims experienced half the risk of subsequent intentional injury if the accused received a probation sentence. Our findings suggest that Justice involvement represents an opportunity for intersectoral collaborative prevention of subsequent intentional injury among IPV victims. [ABSTRACT FROM AUTHOR]

• A cash benefit was associated with better birth outcomes for low-income Metis families. • Among families who received the benefit, there were fewer low birth weight and preterm births. • Children in families who received the benefit were more likely to be fully vaccinated by age 2. In Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), which provides up to CAD $81.41/month during the second and third trimesters of pregnancy. In research conducted in partnership with the Manitoba Metis Federation, we examined the association of the HBPB with Metis birth and early childhood outcomes. Using the whole-population administrative data repository at the Manitoba Centre for Health Policy, we identified all Metis women who gave birth in Manitoba 2003–2011 and limited the cohort to women who were low-income (receiving income assistance during pregnancy; n = 4891). We adjusted for differences between the treatment (received HBPB; n = 3702) and control (did not receive HBPB; n = 1189) groups with propensity score weighting, and then used propensity score weighted regressions to compare birth and early childhood outcomes between the groups. Receiving the HBPB was associated with a lower risk of low birth weight (adjusted Relative Risk [aRR] 0.74; 95% CI 0.59, 0.94) and preterm (aRR 0.78; 95% CI 0.65, 0.94) births, a higher risk of large-for-gestational-age births (aRR 1.21; 95% CI 1.06, 1.39) and neonatal readmission within 28 days (aRR 1.58; 95% CI 1.05, 2.37). HBPB receipt was also associated with increased childhood vaccinations at age 1 (aRR 1.08; 95% CI 1.00, 1.15) and 2 (aRR 1.12; 95% CI 1.06, 1.18). We observed no significant associations for Apgar scores, small-for-gestational-age births, breastfeeding initiation, birth hospitalization length of stay or child development scores. A modest unconditional prenatal benefit provided to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased large-for-gestational-age births may warrant further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS., Methods: Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation)., Results: Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns., Conclusions: Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kathleen S. Kenny reports financial support was provided by Canadian Institutes of Health Research. Marcelo L. Urquia reports financial support was provided by Canadian Institutes of Health Research., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Cancer is a leading cause of death among adults living with intellectual or developmental disabilities (IDD). However, few epidemiological studies exist worldwide quantifying inequalities in cancer stage at diagnosis and survival for people with IDD relative to those without IDD., Methods: A population-based, retrospective cohort study was conducted using provincial health and social administrative data in Manitoba, Canada. Adults (≥18 years) with a cancer diagnosis between 2004 and 2017 were included. Lifetime IDD was identified before the cancer diagnosis using an established algorithm. Modified Poisson regression with robust error variance was used to estimate the association between IDD status and metastatic cancer at diagnosis. Multivariable Cox proportional hazards analyses were used to the effect of IDD on overall survival following the cancer diagnosis., Results: The staging and prognosis cohorts included 62,886 (n = 473 with IDD) and 74,143 (n = 592 with IDD) cancer patients, respectively. People living with IDD were significantly more likely to be diagnosed with metastatic cancer and die following their cancer diagnosis compared to those without IDD (RR=1.20; 95 % CI 1.05-1.38; HR= 1.53; 95 % CI 1.38-1.71). Significant heterogeneity by sex was identified for cancer survival (p = 0.005)., Discussion: People with IDD had more advanced cancer stage at diagnosis and worse survival relative to those without IDD. Identifying and developing strategies to address the factors responsible that contribute to these disparities is required for improving patient-centred cancer care for adults with IDD., Competing Interests: Declaration of Competing Interest DD reports advisory board attendance for Merck Canada, Novartis, Jazz Pharmaceuticals, Pfizer, and AstraZeneca, honoraria for education content from Boehringer-Ingelheim and Bristol Myers Squibb, and a research grant from AstraZeneca. All other authors report having no conflicts of interest to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

It is well established that adverse childhood experiences (ACEs) are associated with detrimental health outcomes in adulthood. Less is known about the relationships between ACEs and education outcomes and among adolescents. The aim of this study was to examine the associations between ACEs and adolescents' self-reported education outcomes and provincial education assessments among adolescents in Manitoba, Canada. Data were gathered from 1002 adolescents who participated in the Well-Being and Experiences (WE) Study. A subsample of the adolescents (84%) consented to having their WE survey data linked to administrative education databases. Binary and multinomial logistic regression models were computed to examine associations between ACE history and self-reported education outcomes and provincial education assessments, adjusting for sociodemographic variables. Adolescents with an ACE history had significantly increased likelihood of having ever been suspended from school (adjusted odds ratio (aOR) = 3.33, 95% CI 1.60-6.92), of lower grades (adjusted relative risk ratio (aRRR) = 3.21, 95% CI 1.42-7.29), and of chronic school absenteeism (aRRR = 2.45, 95% CI 1.28-4.68) compared with adolescents without an ACE history after adjusting for sociodemographic variables. Findings from this study illuminate the important relationship between childhood adversity and poor education outcomes assessed directly by adolescents. Increasing awareness of the public health risk associated with ACEs and education outcomes may inform education policy and school-based interventions.

Importance: Insulin pumps improve glycemic control and quality of life in children with type 1 diabetes (T1D). Canada's provinces have implemented universal pediatric programs to improve access. However, these programs provide differing financial coverage, allowing for unique cross-jurisdictional comparisons., Objective: To evaluate possible socioeconomic status (SES) disparities in pump uptake in Québec, where pumps are fully funded, with those in Manitoba, where pumps are partially funded., Design, Setting, and Participants: Using health administrative databases and a clinical registry, parallel, population-based cohort studies of children with diabetes were conducted from April 1, 2011, in Québec, and April 1, 2012, in Manitoba, until March 31, 2017. In analysis conducted from July 1, 2019, to November 30, 2021, multivariable Cox proportional hazards regression models were applied to study the association between pump uptake and SES, defined using validated area-based material and social deprivation indices. Children aged 1 to 17 years with T1D were identified using a validated definition in administrative data (Québec) and a clinical registry (Manitoba). Those using pumps before the initiation of provincial programs were excluded., Exposures: Socioeconomic status., Main Outcomes and Measures: Insulin pump uptake., Results: A total of 2919 children with T1D were identified in Québec: 1550 male (53.1%), mean (SD) age at diagnosis, 8.3 (4.4) years, and 1067 (36.6%) were using a pump. In Manitoba, 636 children were identified: 364 male (57.2%), mean (SD) age at diagnosis, 8.8 (4.4) years, and 106 (16.7%) were using a pump. In Québec, the mean age at diagnosis of T1D was lower in children using the pump compared with those not using a pump (7.6 [4.1] vs 8.7 [4.5] years); sex distribution was similar (562 [52.7%] vs 988 [53.3%] male). No differences in mean (SD) age at diagnosis (8.8 [4.4] vs 8.8 [4.3] years) or sex (57 [53.8%] vs 307 [57.9%] male) were noted in both groups in Manitoba. Increasing material deprivation was associated with decreased pump uptake in both Québec (adjusted hazard ratio [aHR] 0.89; 95% CI, 0.85-0.93) and Manitoba (aHR, 0.70; 95% CI, 0.60-0.82). Inclusion of ethnic concentration did not change this association. Socioeconomic disparities in pump uptake were greater in Manitoba than Québec (P = .006 by t test; Cochran Q, 8.15; P = .004; I2 = 87.7%; 95% CI, 52.5%-96.8%)., Conclusions and Relevance: The results of this study suggest that the program of full coverage for pumps available in Québec partially mitigates observed SES disparities in uptake and may be a model to improve access for all children with T1D.

Background: The potential influence of asthma control in early life on long-term outcomes in childhood remains largely unknown., Objective: To examine whether asthma control trajectories in the 2 years after diagnosis in preschoolers are associated with long-term unsatisfactory asthma control., Methods: We conducted a multicenter population-based retrospective cohort study, including four Canadian provincial birth cohorts derived from administrative databases. We included preschoolers (aged <5 years) with a diagnosis of asthma, defined as having one hospitalization or two physician visits for asthma within 2 years. Asthma control trajectories, ascertained over four 6-month periods after diagnosis using a validated index, were classified as controlled throughout, improving control, fluctuating control, worsening control, and out of control throughout. Long-term unsatisfactory control was defined as four or more short-acting β 2 -agonist average doses per week or an exacerbation, measured within 6 months before index ages 6, 8, 10, 12, 14, and 16 years. Average risk ratios for long-term unsatisfactory control across all index ages were estimated using a robust Poisson model by province and meta-analyzed with a random effects model., Results: In 50,188 preschoolers with asthma, the pooled average risk of having unsatisfactory control at any index age was 42% (95% confidence interval, 34.6-49.4). Compared with children who were controlled throughout, incrementally higher average risk ratios (95% confidence interval) of long-term unsatisfactory control were observed in each trajectory: improving control, 1.38 (1.28-1.49); fluctuating control, 1.54 (1.40-1.68); worsening control, 1.70 (1.55-1.86) and out of control throughout, 2.00 (1.80-2.21)., Conclusions: Suboptimal asthma control trajectories shortly after a preschool diagnosis were associated with long-term unsatisfactory asthma control. Early control trajectories appear to be promising for predicting the risk for long-term adverse outcomes., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Introduction: Decades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by FN/M/I partners, will generate and distribute evidence on COVID-19 diagnostic testing and vaccination in high-priority FN/M/I populations in Manitoba, with the goal of identifying system-level and individual-level factors that act as barriers to equitable care and thereby informing Indigenous-led public health responses., Methods and Analysis: Our nations-based approach focuses on FN/M/I populations with separate study arms for each group. Linked administrative health data on COVID-19 diagnostic testing and vaccinations are available on a weekly basis. We will conduct surveillance to monitor trends in testing and vaccination among each FN/M/I population and all other Manitobans, map the geographic distribution of these outcomes by health region and tribal council, and identify barriers to testing and vaccination to inform public health strategies. We will follow the course of the pandemic starting from January 2020 and report findings quarterly., Ethics and Dissemination: Ethics approvals have been granted by the University of Manitoba Research Ethics Board and from each of our FN/M/I partners' organisations. Our team is committed to engaging in authentic relationship-based research that follows First Nations, Metis and Inuit research ethics principles. Our FN/M/I partners will direct the dissemination of new information to leadership in their communities (health directors, community health organisations) and to decision-makers in the provincial Ministry of Health. We will also publish in open-access journals. The study will create ongoing capacity to monitor Manitoba's pandemic response and ensure potential health inequities are minimised, with learnings applicable to other jurisdictions where detailed administrative data may not be available., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Early disease morbidity has been associated with asthma persistence in wheezing preschoolers; however, whether asthma control trajectories shortly after diagnosis could influence remission is unknown. We examined the association between asthma control trajectories 2 years post-diagnosis in preschoolers and subsequent disease remission., Methods: We conducted a multicentre population-based retrospective cohort study consisting of 48 687 children with asthma diagnosed before 5 years old and born between 1990 and 2013 in four Canadian provinces who had prolonged disease activity post-diagnosis. Prolonged disease activity was defined as one or more medical visits or medications for asthma every 6-month period for at least four of the six periods post-diagnosis. Follow-up began at 3 years post-diagnosis (at cohort entry). Remission was defined as 2 consecutive years without drug claims or medical visits for asthma or asthma-like conditions following cohort entry. Asthma control trajectories, ascertained over four 6-month periods following diagnosis using a validated index, were classified as: "controlled throughout", "improving control", "worsening control", "out of control throughout" and "fluctuating control". Adjusted Cox models estimated associations between asthma control trajectories and time to remission. A random effects meta-analysis summarised province-specific hazard ratios (HRs)., Results: The pooled remission rate was 8.91 (95% CI 8.80-9.02) per 100 person-years. Compared with children controlled throughout, poorer asthma control was associated with incrementally lower hazard ratios of remission in four other trajectories: improving control (HR 0.89, 95% CI 0.82-0.96), fluctuating control (HR 0.78, 95% CI 0.71-0.85), worsening control (HR 0.68, 95% CI 0.62-0.75) and out of control throughout (HR 0.52, 95% CI 0.45-0.59)., Conclusions: Asthma control trajectories 2 years following a diagnosis in preschoolers were associated with remission, highlighting the clinical relevance of documenting control trajectories in early life., Competing Interests: Conflict of interest: C. Longo has nothing to disclose. Conflict of interest: L. Blais reports grants, personal fees and research contracts from AstraZeneca, grants from Teva, outside the submitted work. Conflict of interest: M. Brownell has nothing to disclose. Conflict of interest: J.M. Quail has nothing to disclose. Conflict of interest: M. Sadatsafavi has nothing to disclose. Conflict of interest: A. Forget has nothing to disclose. Conflict of interest: M-A. Turcot has nothing to disclose. Conflict of interest: Y. Nie has nothing to disclose. Conflict of interest: W. Li has nothing to disclose. Conflict of interest: H. Tavakoli has nothing to disclose. Conflict of interest: Q. Tan has nothing to disclose. Conflict of interest: Y. Fan has nothing to disclose. Conflict of interest: R.W. Platt reports personal fees from Biogen, Amgen, Merck, AbbVie, Pfizer, Elli Lilly and Analysis Group, outside the submitted work. Conflict of interest: F.M. Ducharme reports grants from GlaxoSmithKline Canada and MedTeq, grants and personal fees for lectures from Covis Pharma and Thorasys Inc., unrestricted donations from Novartis and Trudell Medical International, outside the submitted work., (Copyright ©ERS 2021. For reproduction rights and permissions contact permissions@ersnet.org.)

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., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

Objective: To examine the relationship between developmental health and neighbourhood socioeconomic status (SES) in kindergarten children with disabilities., Design: Cross-sectional study using population-level database of children's developmental health at school entry (2002-2014)., Setting: 12 of 13 Canadian provinces/territories., Measures: Taxfiler and Census data between 2005 and 2006, respectively, were aggregated according to custom-created neighbourhood boundaries and used to create an index of neighbourhood-level SES. Developmental health outcomes were measured for 29 520 children with disabilities using the Early Development Instrument (EDI), a teacher-completed measure of developmental health across five domains., Analysis: Hierarchical generalised linear models were used to test the association between neighbourhood-level SES and developmental health., Results: All EDI domains were positively correlated with the neighbourhood-level SES index. The strongest association was observed for the language and cognitive development domain (β (SE): 0.29 (0.02)) and the weakest association was observed for the emotional maturity domain (β (SE): 0.12 (0.01))., Conclusions: The magnitude of differences observed in EDI scores across neighbourhoods at the 5th and 95th percentiles are similar to the effects of more established predictors of development, such as sex. The association of SES with developmental outcomes in this population may present a potential opportunity for policy interventions to improve immediate and long-term outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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.

Background: Ensuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care., Methods: We studied women giving birth in Manitoba from 2004/05-2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information., Results: Overall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care (N = 68,132). Factors associated with inadequate prenatal care in the population-based model (N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. In the subset model (N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use., Conclusion: The rate of inadequate prenatal care in Manitoba ranged from 10.5-12.5%, and increased significantly over the study period. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care.

Objectives This study examines whether mothers involved with child protection services (CPS) at the birth of their first child had higher rates of postpartum depression and anxiety. Methods A retrospective cohort of mothers whose first child was born in Manitoba, Canada between April 1, 1995 and March 31, 2015 is used. Postpartum depression and anxiety among mothers whose first child was placed in care at birth (n = 776) was compared with mothers who received services from CPS (but whose children were not placed in care) (n = 4,270), and a 3:1 matched group of mothers who had no involvement with CPS in the first year of their firstborn's life (n = 2,328). Adjusted odds ratios (AOR) of depression and anxiety diagnoses in the first year postpartum were obtained from logistic regression models. Adjusted rate ratios (ARR) of antidepressant use obtained using Poisson models. Results Mothers whose children were taken into care have greater odds of having a postpartum depression or anxiety diagnosis than mothers receiving services (AOR = 1.31; 95% CI 1.08-1.59) and those not involved with CPS (AOR = 2.13; 95% CI 1.67-2.73). Among mothers who had a postpartum depression or anxiety diagnosis, mothers whose children were placed in care had significantly higher rates of antidepressant use than mothers receiving services only (ARR = 2.00; 1.82, 2.19) and mothers who were not involved with CPS (ARR = 2.42; 95% CI 1.94-3.51). Conclusions for Practice Targeted programs should be implemented to address postpartum mental illness among mothers who are involved with CPS at the birth of their child.

Purpose: The study's purpose was to determine individual-level and neighbourhood-level risk and protective factors for severe intentional injury among youth., Methods: We conducted a multilevel case-control study using registry data to determine individual-level and neighbourhood-level social determinants associated with severe violent injury/homicide among youth from Winnipeg, Manitoba., Results: The study includes 13 206 youth, aged 12-24 years (1222 cases, 11 984 controls). Individual-level risk predictors of being a victim of violence were male sex (OR 5.72 (95% CI 4.77 to 6.86)) and First Nations (OR 2.76 (95% CI 2.32 to 3.29)). Education was inversely associated with victimisation for individuals under (OR 0.36 (95% CI 0.26 to 0.51)) and over (OR 0.58 (95% CI 0.49 to 0.69)) 18 years. Ever having been in protective care (OR 1.66 (95% CI 1.39 to 1.99)), receiving income assistance from the government (OR 1.26 (95% CI 1.05 to 1.51)) or ever having criminal charges (OR 4.76 (95% CI 4.08 to 5.56)) were also significant predictors of being a victim of violence. Neighbourhood-level risk factors for victimisation included low socioeconomic status (OR 1.14 (95% CI 1.04 to 1.25)) and high levels of assault (OR 1.07 (95% CI 1.04 to 1.10))., Conclusions: This study demonstrates a complex web of risk and protective factors among youth injured by violence. It underscores the ongoing, injurious effects of historical trauma experienced by many Canadian First Nations people. Strong victim-perpetrator overlap suggests that intersectoral policies are needed to address these issues. Our findings highlight the need to improve education and family supports., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: Health disorders early in life have tremendous impact on children's developmental trajectories. Almost 80% of children with health disorders lack the developmental skills to take full advantage of school-based education relative to 27% of children without a health disorder. In Canada, there is currently a dearth of nationally representative data on the social determinants of early childhood development for children with health disorders. Evidence from Canada and other countries indicate that poorer developmental outcomes in typically developing children are associated with lower socioeconomic status (SES). However, to date, it is not known whether this relationship is stronger among children with health disorders. The study's objectives are to estimate the prevalence and to investigate social determinants of developmental outcomes for young children with health disorders, using the Early Development Instrument (EDI)., Methods and Analysis: Study objectives will be achieved through three steps. First, using existing EDI data for 10 provinces and 2 territories collected from 2004 to 2015, we will investigate differences in developmental health outcomes among children with identified health disorders. Second, population-level EDI data will be linked with neighbourhood sociodemographic census data to explore associations between socioeconomic characteristics and rates of specific diagnoses among children aged 5-6 years, including trends over time. Third, for 3 of these 12 regions, additional health and/or education databases will be linked at an individual level. These data will be used to establish differences in EDI outcomes in relation to the age-of-onset of diagnosis, and presence of intervention or treatment., Ethics and Dissemination: Study methodologies have been approved by the Hamilton Integrated Research Ethics Board. The results of the analyses of developmental health outcomes for children with health disorders combined with SES will have implications for both health service delivery and school-based intervention strategies. Results will contribute to a framework for public policy., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The Commission on Social Determinants of Health, sponsored by the World Health Organization, has identified measuring health inequities and evaluating interventions to reduce them as important priorities. We examined whether an unconditional prenatal income supplement for low-income women was associated with reduced population-level inequities in birth outcomes. We identified all mother-newborn pairs from the period 2003-10 in Manitoba, Canada, and divided them into the following three groups: low income exposed (received the supplement); low income unexposed (did not receive the supplement); and not low income unexposed (ineligible for the supplement). We measured inequities in low-birthweight births, preterm births, and breast-feeding initiation among these groups. The findings indicated that the socioeconomic gap in birth outcomes between low-income and other women was significantly smaller when the low-income women received the income supplement than when they did not. The prenatal income supplement may be an important driver in attaining population-level equity in birth outcomes; its success could inform strategies seeking to improve maternal and child health.

Objectives: Two studies reported an increased risk of autistic disorder in children conceived less than 12 months after a previous birth. Our objective was to examine the association between the interpregnancy interval (IPI) and autism spectrum disorder (ASD) in a Canadian cohort., Methods: Using administrative datasets housed at the Manitoba Centre for Health Policy, we identified pairs of first- and second-born singleton siblings born between 1988 and 2005. Diagnoses of ASD were ascertained by searching physician billing claims, hospital discharge abstracts, education data, and a database containing information on individuals identified for a 2002-2007 ASD surveillance program in Manitoba. Logistic regression models were fit to examine the association between the IPI and ASD in 41,050 second-born siblings where the first-borns did not have ASD, using IPIs of ≥ 36 months as the reference category and specifying three case groups. Case Group 1 included individuals with at least one ASD code (n = 490); Case Group 2 included those with two or more ASD codes (n = 375); and Case Group 3 comprised individuals with a record in the ASD surveillance program database (n = 141)., Results: The adjusted odds ratios (ORs) for IPIs shorter than 12 months ranged from 1.22 (95% CI: 0.91-1.63) for Case Group 1 to 1.72 (95% CI: 0.96-3.06) for Case Group 3. When the case groups were restricted to individuals with more severe ASD, the ORs increased and were significant for Case Groups 1 and 2., Conclusion: Our findings also support an association between short IPIs and more severe ASD.

Background: Few population studies have examined the psychiatric outcomes of children and adolescents in the child welfare system, and no studies have compared outcomes before and after entry into care. Our objective was to assess the relative rate (RR) of suicide, attempted suicide, admission to hospital and visits to physicians' offices among children and adolescents in care compared with those not in care. We also examined these outcomes within the child welfare population before and after entry into care., Methods: We used population-level data to identify children and adolescents 5 to 17 years of age who were in care in Manitoba for the first time between Apr. 1, 1997, and Mar. 31, 2006, and a comparison cohort not in care. We compared the two cohorts to obtain RRs for the specified outcomes. We also determined RRs within the child welfare population relative to the same population two years before entry into care., Results: We identified 8279 children and adolescents in care for the first time and a comparison cohort of 353 050 children and adolescents not in care. Outcome rates were higher among those in care than in the comparison cohort for suicide (adjusted RR 3.54, 95% confidence interval [CI] 2.11-5.95), attempted suicide (adjusted RR 2.11, 95% CI 1.84-2.43) and all other outcomes. However, adjusted RRs for attempted suicide (RR 0.27, 95% CI 0.21-0.34), admissions to hospital and physician visits decreased after entry into care., Interpretation: Children and adolescents in care were at greater risk of suicide and attempting suicide than those who were not in care. Rates of suicide attempts and hospital admissions within this population were highest before entry into care and decreased thereafter.

Objective: To validate a case definition for diabetes in the pediatric age-group using administrative health data., Research Design and Methods: Population-based administrative data from Manitoba, Canada for the years 2004-2006 were anonymously linked to a clinical registry to evaluate the validity of algorithms based on a combination of hospital claim, outpatient physician visit, and drug use data over 1-3 years in youth 1-18 years of age. Agreement between data sources, sensitivity, specificity, negative (NPV) and positive predictive value (PPV) were evaluated for each algorithm. In addition, ascertainment rate of each data source, prevalence, and differences between subtypes of diabetes were evaluated., Results: Agreement between data sources was very good. The diabetes definition including one or more hospitalizations or two or more outpatient claims over 2 years provided a sensitivity of 94.2%, specificity of 99.9%, PPV of 81.6% and NPV of 99.9%. The addition of one or more prescription claims to the same definition over 1 year provided similar results. Case ascertainment rates of both sources were very good to excellent and the ascertainment-corrected prevalence for youth-onset diabetes for the year 2006 was 2.4 per 1,000. It was not possible to distinguish between subtypes of diabetes within the administrative database; however, this limitation could be overcome with an anonymous linkage to the clinical registry., Conclusions: Administrative data are a valid source for the determination of pediatric diabetes prevalence that can provide important information for health care planning and evaluation.

Objective: We used population-based administrative prescription medication data to examine regional differences in psychostimulant and antidepressant (AD) use among children from 2 Canadian provinces: British Columbia (BC) and Manitoba (MB)., Method: Using 1997 to 2003 prescription data, annual rates of psychostimulant and AD use were determined for children aged 19 years and under in both provinces. Further comparisons of rates were made according to sex, age group, and specific classes of dispensed medications., Results: During 1997 to 2003, psychostimulant use rose by 44.9% in MB and 13.3% in BC. Among male children, psychostimulant use increased by 40.2% in MB, compared with an increase of only 8.6% in BC. AD utilization was similar between provinces, with increases of 80% and 75% in MB and BC, respectively. In both provinces, AD use was highest among older children., Conclusions: Our observations of regional variation in psychotropic medication use potentially reflect provincial differences in drug benefit policies, disease prevalence, and (or) physician diagnosis and treatment.