Outpatient Antibiotic Prescribing by Manitoba Clinicians
Ruth C, Fanella S, Raymond C, Dragan R, Prior H, Dik N, Stevenson D, Koseva I, Valdivia J
Antibiotics are essential to the health of Manitobans. However, the more they are used the more bacteria can develop resistance, making the antibiotics less effective. This study looked at antibiotics dispensed in the community from 2011 to 2016, and how they linked to physician visits and diagnoses. The study found that antibiotic use increased from 2011 to 2016, with highest use in adults aged 65+ and in children under age 5; rates of inappropriate antibiotic use was high and increasing. For conditions that may need antibiotics, the antibiotics being given were often not the ones recommended by guidelines. Physicians and other providers varied widely in how often they prescribed antibiotics for a given condition. The study findings clearly indicate the need for antibiotic stewardship programs to improve antibiotic use in the community. Several other recommendations are also included in the report.
Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba
Chartier M, Brownell M, Star L, Murdock N, Campbell R, Phillips-Beck W, Meade C, Au W, Schultz J, Bowes JM, Cochrane B
The purpose of this report is to provide a sound baseline measure of how First Nations children are doing in order to determine if children’s lives are improving as a result of the Truth and Reconciliation Commission’s Calls to Action. The present report was requested by the Healthy Child Committee of Cabinet to focus on First Nations children in Manitoba and to provide valuable information on their health and well-being – similar to Child Health Atlas reports previously prepared by Manitoba Centre for Health Policy (MCHP). The research team includes members from MCHP, First Nations Health and Social Secretariat of Manitoba (FNHSSM) and Manitoba First Nations Education Resource Centre (MFNERC). The analyses provide comparisons between First Nations children and all other Manitoba children, comparisons between on and off reserve First Nations, and regional comparisons by Regional Health Authority and by Tribal Council Areas. Large disparities between First Nations children and other Manitoba children were found in birth outcomes, physical health, mental health, health & prevention services, education, social services, justice system involvement and mortality. These results must be understood within the broader historical, social, legal and political context.Type 2 Diabetes in Manitoba
Ruth C, Sellers E, Chartrand C, McLeod L, Prior H, Sirski M, Dragan R, Chen H, McDougall C, Schultz J
This deliverable, undertaken in partnership with The First Nation Health and Social Secretariat of Manitoba provides an analysis of trends in incidence and prevalence of for all types of non-gestational diabetes from the 1985 to 2017 allowing comparison to national and international statistics. Then, using the wealth of data within the Repository, especially the Diabetes Education Resource for Children and Adolescents (DER-CA) clinical database, Manitobans diagnosed with type 2 diabetes mellitus (T2DM) were identified and their outcomes over the last 6 years were described. This includes diabetes control, complications, mortality and health service use including hospitalizations, continuity of primary care and specialist care. Multiple analyses were undertaken to examine whether the care received by Manitobans living with T2DM met current guidelines. There are also a number of special analyses in cohorts of people matched to those without diabetes for childhood onset T2DM, T2DM in pregnancy, and for mental health outcomes in adults. Information is presented for different age groups, by sex, by health region and by Tribal Council Area and results were compared between registered First Nation Manitobans and all other Manitobans.
Mental Illness Among Adult Manitobans
Chartier M, Bolton J, Mota N, MacWilliam L, Ekuma O, Nie Y, McDougall C, Srisakuldee W, McCulloch S
Mental illness is prevalent across Manitoba and Canada. Statistics Canada reports that 20% of Canadians will experience a mental illness in their lifetime. This Manitoba report provides valuable background information on the burden of mental illness in the province and some insight into the longer-term associations between childhood/adolescent mental illness and adverse adult outcomes. Specifically, we examined the diagnostic prevalence of mental illness among adults in Manitoba, as well as the healthcare use and justice system involvement of adults with mental illness. To address the mental health needs of certain populations who may be at higher risk of mental illness, this report presents the prevalence in specific populations of Manitoba. A cohort of Manitobans born in the province was also developed to examine the relationship between childhood/adolescent mental disorders and adverse adult outcomes. The findings of this report will be important for planning services and programs to diagnose and treat mental illness. Coordinating services among government departments, including health, social services, education and justice, will also go a long way towards ensuring better care for Manitobans at risk for and suffering from mental illness. Finally, supporting mental health research is an essential part of understanding what works and what is needed to strengthen mental health services for Manitobans.The PAX Program in Manitoba: A Population-Based Analysis of Children's Outcomes
Brownell M, Chartier M, Au W, Schultz J, Stevenson D, Mayer T, Young V, Thomson T, Towns D, Hong S, McCulloch S, Burchill S, Jarmasz J
PAX was piloted in almost 200 schools with close to 5000 Grade 1 students across the province in the 2011/12 school year in a cluster randomized controlled trial implemented by Healthy Child Manitoba. The first part of this deliverable involved transferring the PAX datasets to the Manitoba Population Research Data Repository where these data were assessed through the standard Data Quality Programs. The metadata (e.g. data model, data dictionary) for the databases were developed and an assessment of the content of fields completed. The second part of the deliverable involved linking the PAX datasets with other data in the Repository to evaluate the impact of PAX on outcomes at the end of grade 1, in grade 3 and up to grade 4.
The Mental Health of Manitoba's Children
Chartier M, Brownell M, MacWilliam L, Valdivia J, Nie Y, Ekuma O, Burchill C, Hu M, Rajotte L, Kulbaba C
Canadian studies suggest that 1 in 7 children experience mental disorders at any given time, however less than a third of these children receive the clinical treatment services they require. This project examines the diagnostic prevalence of mental disorders in children according to diagnostic categories such as attention deficit hyperactivity disorder (ADHD), schizophrenia, mood and anxiety disorders and substance use disorder. Use of services for mental disorders, including hospitalizations, physician visits, justice system involvement, and child and family services for those identified with mental disorders are examined, as well as the relationship between mental health and educational outcomes. In addition, the project team is exploring factors that contribute to the development of mental disorders in children. Results from this report will inform ongoing work by the Healthy Child Manitoba Strategy, the Provincial Mental Health Strategy (Rising to the Challenge) and the implementation of a Child and Youth Mental Health Strategy.
Long-Term Outcomes Of Manitoba's Insight Mentoring Program: A Comparative Statistical Analysis
Ruth C, Brownell M, Isbister J, MacWilliam L, Gammon H, Singal D, Soodeen R, McGowan K, Kulbaba C, Boriskewich E
The objective of this report is to examine the outcomes of women and their children who have been involved in the Manitoba InSight program, an intensive mentoring program for women at high risk of having children with Fetal Alcohol Spectrum Disorder (FASD). By linking the clinical data within the InSight program database to the MCHP Repository we examined outcomes both during and after the program, with over 10 years of outcomes for earlier participants. We evaluated the impact on the mental, physical and perinatal health of the women and their children and their involvement with services such as social housing, Families First, prenatal care and Child and Family Services. This report will allow for planning and support of ongoing services to this at risk population and act as a baseline for further studies into FASD and its prevention and management.The Educational Outcomes of Children in Care in Manitoba
Brownell M, Chartier M, Au W, MacWilliam L, Schultz J, Guenette W, Valdivia J
This report presents descriptive and statistical analyses regarding children placed in the care of Manitoba Child and Family Services. The Manitoba Centre for Health Policy (MCHP) was asked to identify factors that contribute to the educational success of children in care in Manitoba and to make recommendations regarding what schools, school districts and the provincial Department of Education and Advanced Learning could to do to further contribute to the educational success of students in care. In order to fulfill this request, MCHP identified 5 main objectives for this report, and each of these will be addressed in this presentation: 1) describe the characteristics of children in care in Manitoba; 2) describe the educational outcomes of children in care in Manitoba; 3) identify factors that are associated with positive (and negative) educational outcomes for children in care in Manitoba; 4) provide information on programs that improve educational outcomes for children in care; and 5) provide recommendations on how educational outcomes for children in care can be improved in Manitoba.
Perinatal Services and Outcomes in Manitoba
Heaman M, Kingston D, Helewa M, Brownell M, Derksen S, Bogdanovic B, McGowan K, Bailly A
This report expands on the analyses by the Ministerial Working Group on Maternal/Newborn Services in 2005 and provides information to support the current work of the Maternal and Child Health Services (MACHS) Taskforce and the ongoing focus of the Healthy Child Committee of Cabinet (HCCC) on maternal health and early childhood development. The report focused on all births to Manitoba women from 2001/02 to 2008/09 and found that generally, women who live in poverty are more likely to have less healthy pregnancies and deliveries. Their babies are more likely to have serious health problems such as premature births and to die within the first year of life. Over 45 indicators of maternal and newborn health and health service use were analyzed in five main areas: a profile of women giving birth in Manitoba, maternal prenatal health, giving birth, maternal postpartum health, and fetal/newborn health. In addition, the report also analyzed several new indicators of maternal and newborn health. Many of the new and old measurements were then compared with national rates.How are Manitoba's Children Doing?
Brownell M, Chartier M, Santos R, Ekuma O, Au W, Sarkar J, MacWilliam L, Burland E, Koseva I, Guenette W
This study looked at nearly all children in the province 19 and under from the years 2000 to 2010. It measured children's well-being in four areas: physical and emotional health; safety and security; education; and social engagement and responsibility and found Manitoba children have been making some gains in health and social outcomes. Building on past research from MCHP, researchers found children from lower income areas generally experience poorer outcomes than children from high income areas. The study found differences in educational outcomes were not as great as those seen in areas of health however. Inequities tend to increase as children progress through school, suggesting that the early and middle years of childhood may present opportunities for programs and interventions that enables successful learning and reduce gaps.The Early Development Instrument (EDI) in Manitoba: Linking Socioeconomic Adversity and Biological Vulnerability at Birth to Children's Outcomes at Age 5
Santos R, Brownell M, Ekuma O, Mayer T, Soodeen R-A
This report shows differences in children's potential at school are apparent as early as when they're born and is also related to where they live. It focuses on the Early Development Instrument (EDI), a population-based, community-level measurement looking at children's physical, social, emotional, language, and communication skills. Information was collected from children who are entering Kindergarten (age 5 years) province-wide by all Manitoba public school divisions on behalf of the Healthy Child Manitoba Office (HCMO). The study looked deep into social circumstances and identified three factors associated with poor EDI scores. Children born to teen moms, in families on income assistance, or in the care of Child and Family Services, were found to be more at-risk. Anonymized results of the EDI surveys from 2005-2007 were linked with areas of residence. Out of nearly 22,000 children included, they found that EDI scores seemed to be strongly related to how rich or poor the area was. The results show that groups of children facing multiple risks require more attention, and as early in life as possible, to get the help they need to succeed at school and later in life. The report provides planners with insights about when and where resources should be applied.
Evaluation of the Healthy Baby Program
Brownell M, Chartier M, Au W, Schultz J
In 2001 the Healthy Baby Program was introduced in Manitoba by the Healthy Child Manitoba Office. The goal of this program was to increase the health of Manitoba's most vulnerable babies with an income supplement and/or community support programs targeted towards low income mothers and families. This report evaluates the impact the program had on prenatal and perinatal health, as well as health outcomes of children in the program up to their first birthday.
Manitoba Child Health Atlas Update
Brownell M, De Coster C, Penfold R, Derksen S, Au W, Schultz J, Dahl M
It has often been said that one can measure how advanced a society is by how well it meets the needs of its weakest and most frail members. In Manitoba, we are fortunate to live in a society where considerable time and effort has been spent to improve the health of children. Policies and programs have been designed and put into place so that in theory, all children are born with an equal chance of being healthy. And for those children born into circumstances resulting in poorer health, programs exist which try to ensure that they eventually get onto a level playing field. All this work has resulted in children, for the most part, being healthy in Manitoba.
Next Steps in the Provincial Evaluation of the BabyFirst Program: Measuring Early Impacts on Outcomes Associated with Child Maltreatment
Brownell M, Santos R, Kozyrskyj A, Roos N, Au W, Dik N, Chartier M, Girard D, Ekuma O, Sirski M, Tonn N, Schultz J
With recent child deaths in Manitoba caused by maltreatment, the question being asked is how can we prevent this from happening again? This study evaluates the provincial BabyFirst program (now Families First) and its impact on child maltreatment.
How Do Educational Outcomes Vary With Socioeconomic Status? Key Findings from the Manitoba Child Health Atlas 2004
Brownell M, Roos NP, Fransoo R, Guevremont A, MacWilliam L, Derksen S, Dik N, Bogdanovic B, Sirski M
The poorer their neighbourhood, the more likely children are to have difficulties in school, fail standards tests, fail a grade, quit school and have shorter lives. And when do these kids start falling behind? high school? elementary school? grade one? What are the implications? What can be done to change this trend?
Assessing the Health of Children in Manitoba: A Population-Based Study
Brownell M, Martens PJ, Kozyrskyj A, Fergusson P, Lerfald J, Mayer T, Derksen S, Friesen D
Produced in consultation with other groups doing research in this area, MCHP's child-health encyclopaedia gives numerous details on the health of Manitoba's 325,000 children. Included are: physical health status, patterns of health care use, and social determinants of health, such as socioeconomic status and educational achievement.
Considering the Health Care Needs of Children Living in Households Receiving Income Assistance in Manitoba: Family Services and Manitoba Health Pilot Project
Kozyrskyj A, Mustard CA, Derksen S
The primary purpose of this study was to test the feasibility of using anonymized data from the Ministries of Health and Family Services to understand more about the relationship between poverty and health.
The Utilization of Prenatal Care and Relationship to Birthweight Outcome in Winnipeg, 1987-88 (Report #93-01)
Maternal Demographic Risk Factors and the Incidence of Low Birthweight, Manitoba 1979-1989 (Report #91-11-04)
Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
Room 408-727 McDermot Ave.
University of Manitoba
Winnipeg, MB R3E 3P5 Canada