Health, Social, Education, and Justice Outcomes of Manitoba First Nations Children Diagnosed with Fetal Alcohol Spectrum Disorder: A Population-Based Cohort Study of Linked Administrative Data.

Objective: To examine health services, social services, education, and justice system outcomes among First Nations children and youth with fetal alcohol spectrum disorder (FASD).

Methods: In this retrospective cohort study, health and social services, education, and justice data were linked with clinical records on First Nations (FN) individuals aged 1 to 25 and diagnosed with FASD between 1999 and 2010 ( = 743). We compared the FN FASD group to non-FN individuals with FASD (non-FN FASD; = 315) and to First Nations individuals (matched on age, sex, and income) not diagnosed with FASD (FN non-FASD; = 2229).

Placement in Care in Early Childhood and School Readiness: A Retrospective Cohort Study.

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.

Structural analysis of health-relevant policy-making information exchange networks in Canada.

Background: Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best-evidence-informed-policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project is the first national-level attempt to (1) map and structurally analyze-quantitatively-health-relevant policy-making networks that connect evidence production, synthesis, interpretation, and use; (2) qualitatively investigate the interaction patterns of a subsample of actors with high centrality metrics within these networks to develop an in-depth understanding of evidence circulation processes; and (3) combine these findings in order to assess a policy network's "absorptive capacity" regarding scientific evidence and integrate them into a conceptually sound and empirically grounded framework.

Methods: The project is divided into two research components.

Maternal depression and anxiety disorders (MDAD) and child development: A Manitoba population-based study.

Objective: To examine the association between maternal depression and anxiety disorders (MDAD) and child development assessed during the kindergarten year.

Methods: Administrative data from several health and social databases in Manitoba, Canada, were used to study 18,331 mother-child pairs. MDAD over the period from one year prior to the child's birth to the kindergarten year was defined using physician diagnoses and filled prescriptions.

Making evidence on health policy issues accessible to the media.

The media shape consumer expectations and interpretations of health interventions, influencing how people think about their need for care and the sustainability of the system. EvidenceNetwork.ca is a non-partisan, web-based project funded by the Canadian Institutes of Health Research and the Manitoba Health Research Council to make the latest evidence on controversial health policy issues available to the media.

Use of health, education, and social services by individuals with fetal alcohol spectrum disorder.

Background: Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of intellectual disability in western society, presenting a significant burden on health, education and social services. Quantifying the burden of FASD is important for service planning and policy and program development.

Objective: To describe the health, education and social service use of individuals with FASD to provide an indication of the burden of service use of the disorder.

Opinion editorials: the science and art of combining evidence with opinion.

In the policy environment, the news media play a powerful and influential role, determining not only what issues are on the broad policy agenda, but also how the public and politicians perceive these issues. Ensuring that reporters and editors have access to information, that is, credible and evidence-based is critical for stimulating healthy public discourse and constructive political debates. EvidenceNetwork.

'The influence of gestational age and socioeconomic status on neonatal outcomes in late preterm and early term gestation: a population based study'.

Background: Infants born late preterm (34 + 0 to 36 + 6 weeks GA (gestational age)) are known to have higher neonatal morbidity than term (37 + 0 to 41 + 6 weeks GA) infants. There is emerging evidence that these risks may not be homogenous within the term cohort and may be higher in early term (37 + 0 to 38 + 6 weeks GA). These risks may also be affected by socioeconomic status, a risk factor for preterm birth.

Evaluation of a newborn screen for predicting out-of-home placement.

A newborn screen designed to predict family risk was examined to: (a) determine whether all families with newborns were screened; (b) evaluate its predictive validity for identifying risk of out-of-home placement, as a proxy for maltreatment; (c) determine which items were most predictive of out-of-home placement. All infants born in Manitoba, Canada from 2000 to 2002 were followed until March 31, 2004 (N = 40,886) by linking four population-based data sets: (a) newborn screening data on biological, psychological, and social risks; (b) population registry data on demographics; (c) hospital discharge data on newborn birth records; (d) data on children entering out-of-home care. Of the study population, 18.

Socio-economic inequities in children's injury rates: has the gradient changed over time?

Introduction: Changing socio-economic gradients in adult health over time have been documented, but little research has investigated temporal changes in child health gradients. Childhood hospitalizations for injury have fallen over the last two decades; whether the socio-economic gradient in childhood injury has changed is unknown.

Methods: Population-based hospital discharge data were used to calculate rates of hospitalization for injury from 1986/87 through 2005/06 for all children under 20 years of age in Manitoba (average yearly number of hospitalizations = 326,357).

Why are some books important (and others not)?

The book Why Are Some People Healthy and Others Not? The Determinants of Health of Populations represented a milestone in our evolving understanding of the determinants of population health. Building on Marc Lalonde's earlier A New Perspective on the Health of Canadians, it created a theoretical framework that could incorporate emerging evidence from a wide range of disciplines. Central to its authors' approach was the observation of heterogeneity, of the systematic differences in health observed when populations are partitioned on characteristics such as income, education, geographic region, etc.

Administrative data and the manitoba centre for health policy: some reflections.

The authors review their 30 years' experience in determining the best research applications for routinely collected data from ministries of health, education and social services. They describe the rich research opportunities afforded by 40 years of data on health - i.e.

Enhancing policymakers' understanding of disparities: relevant data from an information-rich environment.

Context: Information-rich environments, with access and funding provided by government, make it possible to organize longitudinal administrative data to support analyses of policy-relevant questions. This paper describes insights into children's well-being and social equity obtained from data available in Manitoba, Canada, and highlights findings that have engaged policymakers.

Methods: Analyses draw on Manitoba-linked data providing information over time (going back to 1970 in some files) and across space (with residential location documented every six months) for each provincial resident.

The ripples of adolescent motherhood: social, educational, and medical outcomes for children of teen and prior teen mothers.

Objective: We examined medical, educational and social risks to children of teen mothers and children of nonadolescent mothers with a history of teen birth (prior teen mothers) and considered these risks at both the individual and societal level.

Methods: A population-based, retrospective cohort study tracked outcomes through young adulthood for children born in Manitoba, Canada (n = 32 179). chi(2) and logistic regression analyses examined risk of childhood death or hospitalization, failure to graduate high school, intervention by child protective services, becoming a teen mother, and welfare receipt as a young adult.

Rethinking what is important: biologic versus social predictors of childhood health and educational outcomes.

Background: Social risk factors are often less vigorously pursued in clinical assessments of infant risk than are biologic risk factors. We examined the relative importance of early social and biologic risk factors in predicting poor health and educational outcomes in children.

Methods: The study was composed of all infants born in Winnipeg, Canada, during April-December 1984, who were followed up until age 19 years (n = 4667).

How health status affects progress and performance in school: a population-based study.

Objective: To assess the effects of health status at birth and health status in the preschool years on educational outcomes to age 9 in a population-based birth cohort.

Methods: Administrative data were used to follow all children born to Winnipeg mothers in 1990, and remaining in Manitoba until September 2004 (N = 5,873). A structural equation model was used, incorporating latent variables to represent Health Status at Birth, Major Illness and Minor Illness during the preschool years.

From health research to social research: privacy, methods, approaches.

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.

When health services researchers and policy makers interact: tales from the tectonic plates.

There has been a strong push over the last decade for health services researchers to become "relevant," to work with policy makers to translate evidence into action. What has been learned from this interaction? The pooled experiences of health services researchers across the country, including those at the Manitoba Centre for Health Policy (MCHP), suggest five key lessons. First, policy makers pay more attention to research findings if they have invested their own funds and time.

Population-based use of mental health services and patterns of delivery among family physicians, 1992 to 2001.

Objective: To examine 9-year rates of family physician (FP) and psychiatrist use, as well as patterns of mental health services delivery by FPs.

Method: We used population-based data from Winnipeg, Manitoba, to construct mutually exclusive cohorts of adults treated for major or minor mental health disorders in fiscal years 1992-1993 to 2000-2001. For each year, we measured patterns of use in this population and patterns of mental health practice among FPs.

Regional variation in home care use in Manitoba.

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.

Patterns in home care use in 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.