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OBJECTIVES: Breastfeeding is associated with improved health. Surveillance data show that breastfeeding initiation rates have increased; however, limited work has examined trends in socio-economic inequalities in initiation. The study's research question was whether socio-economic inequalities in breastfeeding initiation have changed over the past 20 years. METHODS: This population-based study is a project within PATHS Equity for Children. Analyses used hospital discharge data for Manitoba mother-infant dyads with live births, 1988-2011 (n=316,027). Income quintiles were created, each with ~20% of dyads. Three-year, overall and byquintile breastfeeding initiation rates were estimated for Manitoba and two hospitals. Age-adjusted rates were estimated for Manitoba. Rates were modelled using generalized linear models. Three measures, rate ratios (RRs), rate differences (RDs) and concentration indices, assessed inequality at each time point. We also compared concentration indices with Gini coefficients to assess breastfeeding inequality vis-a-vis income inequality. Trend analyses tested for changes over time. RESULTS: Manitoba and Hospital A initiation rates increased; Hospital B rates did not change. Significant inequalities existed in nearly every period, across all three measures: RRs, RDs and concentration indices. RRs and concentration indices suggested little to no change in inequality from 1988 to 2011. RDs for Manitoba (comparing initiation in the highest to lowest income quintiles) did not change significantly over time. RDs decreased for Hospital A, suggesting decreasing socio-economic inequalities in breastfeeding; RDs increased for Hospital B. Income inequality increased significantly in Manitoba during the study period. CONCLUSIONS: Overall breastfeeding initiation rates can improve while inequality persists or worsens. KEY WORDS: Health status disparities; social determinants of health; social class; breast feeding OBJECTIFS: L'allaitement est associe a une meilleure sante. Selon les donnees de surveillance, les taux d'initiation de l'allaitement maternel augmentent, mais peu d'etudes examinent les tendances des inegalites socioeconomiques dans l'initiation de l'allaitement. Notre question de recherche etait de savoir si les inegalites socioeconomiques dans l'initiation de l'allaitement maternel ont change au cours des 20 dernieres annees. METHODE: Cette etude populationnelle s'inscrit dans le programme PATHS Equity for Children. Nos analyses ont utilise les donnees de sortie d'hopital du Manitoba pour les dyades mere-nourrisson avec naissances vivantes de 1988 a 2011 (n=316 027). Des quintiles de revenu ont ete crees, contenant chacun ~20% des dyades. Les taux d'initiation de l'allaitement maternel sur trois ans, globaux et par quintile, ont ete estimes pour l'ensemble du Manitoba et pour deux hopitaux. Des taux ajustes selon l'age ont ete estimes pour le Manitoba. Les taux ont ete modelises a l'aide de modeles lineaires generalises. Trois indicateurs, les ratios des taux (RT), les differences de taux (DT) et les indices de concentration, ont permis d'evaluer l'inegalite a chaque point dans le temps. Nous avons aussi compare les indices de concentration aux coefficients de Gini pour evaluer l'inegalite dans l'allaitement par rapport a l'inegalite des revenus. Des analyses des tendances ont servi a deceler les changements au fil du temps. RESULTATS: Les taux d'initiation du Manitoba et de l'hopital A ont augmente; les taux de l'hopital B n'ont pas change. Des inegalites significatives etaient presentes dans pratiquement toutes les periodes et pour les trois indicateurs: RT, DT et indices de concentration. Les RT et les indices de concentration ont fait etat de changements faibles ou nuls dans l'inegalite de 1988 a 2011. Les DT pour le Manitoba (comparant l'initiation du quintile de revenu superieur au quintile inferieur) n'ont pas significativement change au fil du temps. Les DT ont diminue pour l'hopital A, ce qui pourrait signaler une baisse des inegalites socioeconomiques dans l'allaitement; les DT ont augmente pour l'hopital B. L'inegalite des revenus a significativement augmente au Manitoba sur la periode de l'etude. CONCLUSIONS: Les taux d'initiation de l'allaitement maternel peuvent s'ameliorer globalement alors que l'inegalite subsiste ou s'aggrave. MOTS CLES: disparites d'etat sanitaire; determinants sociaux de la sante; classe sociale; allaitement maternel, Evidence regarding the maternal/child health and economic outcomes associated with infant feeding practices has led to increased support for breastfeeding. (1-3) Systematic reviews have identified several factors that predict whether [...]

Purpose: The Canadian Network for Observational Drug Effect Studies (CNODES) studies the benefits and risks of post‐market drugs and evaluates its research mobilization efforts for accountability, demonstrating value, and learning. As part of these evaluation efforts, and acknowledging gender disparity in authorship across many academic disciplines, CNODES examined the relationship between gender and authorship in its own journal articles and the literature citing them. Methods: CNODES articles (published 2012–2017) and all citing articles were identified and extracted using Scopus. Scopus author IDs were used to extract full names and a web service (www.genderapi.com) was used to estimate gender, converting all probabilities <80% to "indeterminate." T‐tests and visualizations were used to compare the proportion of females between CNODES and the citing literature. Results: Twenty‐eight CNODES articles and 463 citing articles were identified. The mean number of authors per article was 9.5 in CNODES articles and 5.7 in the citing literature. CNODES articles had a female authorship rate of 36%, compared to 29% in the citing literature (7% difference, 95% CI: [1%, 13%]). There were no female authors in 14% of CNODES articles versus 36% of the citing literature. Women were first authors in 25% and corresponding authors in 14% of CNODES articles. Conclusions: This analysis provides a benchmark and method to monitor progress in female parity in pharmacoepidemiology authorship. Further work is needed to determine and address barriers and facilitators to women's recruitment and advancement in the field of pharmacoepidemiology. [ABSTRACT FROM AUTHOR]

Abstract Background Métis are descendants of early 17th century relationships between North American Indians and Europeans. This study's objectives were: (1) to compare the health status of the Métis people to all other residents of Manitoba, Canada; and (2) to analyze factors in predicting the likelihood of diabetes and related lower limb amputation. Methods Using de-identified administrative databases plus the Métis Population Database housed at the Manitoba Centre for Health Policy, age/sex-adjusted rates of mortality and disease were calculated for Métis (n = 73,016) and all other Manitobans (n = 1,104,672). Diseases included: hypertension, arthritis, diabetes, ischemic heart disease (age 19+); osteoporosis (age 50+); acute myocardial infarction (AMI) and stroke (age 40+); total respiratory morbidity (TRM, all ages). Using logistic regression, predictors of diabetes (2004/05-2006/07) and diabetes-related lower-limb amputations (2002/03-2006/07) were analyzed. Results Disease rates were higher for Métis compared to all others: premature mortality before age 75 (4.0 vs. 3.3 per 1000, p < .001); total mortality (9.7 vs. 8.4 per 1000, p < .001); injury mortality (0.58 vs. 0.51 per 1000, p < .03); Potential Years of Life Lost (64.6 vs. 54.6 per 1000, p < .001); all-cause 5-year mortality for people with diabetes (20.8% vs. 18.6%, p < .02); hypertension (27.9% vs. 24.8%, p < .001); arthritis (24.2% vs. 19.9%, p < .001), TRM (13.6% vs. 10.6%, p < .001); diabetes (11.8% vs. 8.8%, p < .001); diabetes-related lower limb amputation (24.1 vs. 16.2 per 1000, p < .001); ischemic heart disease (12.2% vs. 8.7%, p < .001); osteoporosis (12.2% vs. 12.3%, NS), dialysis initiation (0.46% vs. 0.34%, p < .001); AMI (5.4 vs. 4.3 per 1000, p < .001); stroke (3.6 vs. 2.9 per 1000, p < .001). Controlling for geography, age, sex, income, continuity of care and comorbidities, Métis were more likely to have diabetes (aOR = 1.29, 95% CI 1.25-1.34), but not diabetes-related lower limb amputation (aOR = 1.13, 95% CI 0.90-1.40, NS). Continuity of care was associated with decreased risk of amputation both provincially (aOR = 0.71, 95% CI 0.62-0.81) and for Métis alone (aOR = 0.62, 95% CI 0.40-0.96). Conclusion Despite universal healthcare, Métis' illness and mortality rates are mostly higher. Although elevated diabetes risk persists for the Métis even after adjusting for sociodemographic, healthcare and comorbidity variables, the risk of amputation for Métis appears more related to healthcare access rather than ethnicity.

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. [ABSTRACT FROM AUTHOR]

Background: Assertive community treatment for first-episode psychosis programs have been shown to improve symptoms and reduce service use. There is little or no evidence on whether these programs can increase access to income assistance and improve medication adherence in first episode psychosis patients. This research examines the impact of the Early Psychosis Prevention and Intervention Service (EPPIS) on these outcomes. Methods: We extracted data on EPPIS patients held in the Data Repository at the Manitoba Centre for Health Policy. The Repository is a comprehensive collection of person-level de-identified administrative records, including data from Manitoba’s health services. We compared income assistance use and antipsychotic medication adherence in EPPIS patients to a historical cohort matched on pattern of diagnosis. Confounders were adjusted through propensity-score weighting with asymmetrical trimming. Odds ratios (OR), hazard ratios (HR) and 95% confidence intervals were calculated. Results: We identified a matched sample of 244 patients and 449 controls. EPPIS patients had a higher rate of income assistance use during the program (67·4% vs. 38·7%; p< 0·0001). EPPIS patients were more likely to have been prescribed at least one antipsychotic medication than the control cohort, both during the program (OR = 15·05; 95%CI 10·81 to 20·94) and after the program ended (OR = 5·20; 95%CI: 4·50 to 6·02). Patients in EPPIS were also more likely to adhere to their medication during the program (OR = 4·71; 95%CI 3·75 to 5·92), and after the program (OR = 2·54; 95%CI 2·04 to 3·16). Conclusion: Enrolment in the EPPIS program was associated with increased adherence to antipsychotic medication treatment and improved uptake of income assistance. [ABSTRACT FROM AUTHOR]

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]