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Reports suggest possible risks of adverse cardiovascular reactions, including heart failure, associated with non-ergot dopamine agonist (DA) use in Parkinson’s disease (PD). The objectives of our review were to evaluate the risk of heart failure and other adverse cardiovascular reactions in PD patients who received a non-ergot DA compared with other anti-PD pharmacological interventions, placebo, or no intervention. Studies were identified via searches of six bibliographic databases. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were eligible for study inclusion. Random-effect meta-analyses were performed to estimate adverse cardiovascular reaction risks. Quality of evidence was assessed using GRADE. In total, forty-four studies (thirty-six RCTs and eight NRS) satisfied our inclusion criteria. A single RCT found no significant difference in the risk of heart failure with ropinirole compared with bromocriptine (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.07 to 2.04; low certainty). Conversely, three case–control studies reported a risk of heart failure with non-ergot DA treatment. The quality of evidence for the risk of heart failure was judged as low or very low. Findings suggest that non-ergot DA use may be associated with adverse cardiovascular outcomes, including heart failure. Studies are needed to better understand cardiovascular risks associated with PD treatment.

Introduction Caregivers of children with health problems experience poorer health than the caregivers of healthy children. To date, population-based studies on this issue have primarily used survey data. Objectives We demonstrate that administrative health data may be used to study these issues, and explore how non-categorical indicators of child health in administrative data can enable population-level study of caregiver health. Methods Dyads from Population Data British Columbia (BC) databases, encompassing nearly all mothers in BC with children aged 6-10 years in 2006, were grouped using a non-categorical definition based on diagnoses and service use. Regression models examined whether four maternal health outcomes varied according to indicators of child health. Results 162,847 mother-child dyads were grouped according to the following indicators: Child High Service Use (18%) vs. Not (82%), Diagnosis of Major and/or Chronic Condition (12%) vs. Not (88%), and Both High Service Use and Diagnosis (5%) vs. Neither (75%). For all maternal health and service use outcomes (number of physician visits, chronic condition, mood or anxiety disorder, hospitalization), differences were demonstrated by child health indicators. Conclusions Mothers of children with health problems had poorer health themselves, as indicated by administrative data groupings. This work not only demonstrates the research potential of using routinely collected health administrative data to study caregiver and child health, but also the importance of addressing maternal health when treating children with health problems. Keywords Population data, linked data, case-mix, children with special health care needs

Researchers with an interest in examining and better understanding the social context of children suffering from neurodevelopmental disabilities can benefit by using data from a wide variety of Statistics Canada surveys as well as the information contained in administrative health databases. Selective use of a particular survey and database can be informative particularly when demographics, samples, and content align with the goals and outcomes of the researcher’s questions of interest. Disabilities are not merely conditions in isolation. They are a key part of a social context involving impairment, function, and social facilitators or barriers, such as work, school and extracurricular activities. Socioeconomic factors, single parenthood, income, and education also play a role in how families cope with children’s disabilities. Statistics indicate that five per cent of Canadian children aged five to 14 years have a disability, and 74 per cent of these are identified as having a neurodevelopmental condition and disability. A number of factors must be taken into account when choosing a source of survey data, including definitions of neurodevelopmental conditions, the target group covered by the survey, which special populations are included or excluded, along with a comparison group, and the survey’s design. Surveys fall into categories such as general health, disability-specific, and children and youth. They provide an excellent opportunity to look at the socioeconomic factors associated with the health of individuals, as well as how these conditions and disabilities affect families. However rich the information gleaned from survey data, it is not enough, especially given the data gaps that exist around the health and well-being of children and older youths. This is where administrative and other data can be used to complement existing data sources. Administrative data offer specific information about neurological conditions that won’t be collected in general population surveys, given the nature of such surveys. While researchers can glean information from survey data such as functional health and disability, social inclusion or exclusion, and the role of social determinants in the lives of these children and their families, administrative data can identify rare neurodevelopmental conditions and disabilities not captured in general surveys. Analyzing information from all these sources can lead to a more nuanced understanding of the economic and social impacts, and functional limitations in daily living, that patients and their families experience with certain neurodevelopmental conditions and disabilities. Statistics Canada surveys offer a plethora of information for researchers interested in neurodevelopmental disabilities and social determinants of health. As these surveys are national in their scope, they provide a wealth of information for statistical analysis from people across Canada. This information can be used to inform researchers, policy makers, and families of people who live with neurodevelopmental conditions and disabilities. For example, sophisticated microsimulation modelling techniques have been conducted to project the health and economic impacts from such disabilities 20 years into the future. Such projections will be vital for policy-makers tasked with designing services and programs to assist these people. Much work remains to be done, however. Statistics Canada has already begun working on the potential for using administrative data to conceptualize childhood disability, as well as using data that has been anonymized in national administrative databases to study the health of Canada’s children. These are excellent bases from which to build future research.

This study is among the first Canadian population-based evaluations designed to examine associations of the Triple P – Positive Parenting Program (Triple P) for mother and child outcomes at the community level. Uniquely, this study was conducted independently of program implementation, using data collected for other purposes. Three anonymized British Columbia provincial administrative data sources were used, in addition to program data collected by administrators (Island Health). The study employed a quasi-experimental design to examine benefits of Triple P at the community level, and used sociodemographic community characteristics to match 11 target communities where Triple P was implemented with comparison communities where Triple P was not implemented. The study’s design and analyses took into account the phased-in implementation of Triple P across Vancouver Island (2004–2008), drawing on pre- and post-implementation data for all of the studied communities. Hierarchical linear modeling results showed that children living in communities where the program had been administered were more likely to have been diagnosed with conduct disorders and to have used counseling services. Program intensity was not associated with any of the child health outcomes. For mothers, higher program intensity was associated with lower odds of being diagnosed with mental health conditions. Future research should continue to demonstrate the feasibility of a population-based approach and the use of secondary data along with program data to examine community-based intervention programs.

Background and objectives. Inuit populations may be at increased risk for experiencing poor nutrition or hunger due to limited access and availability to food. The prevalence and correlates of parental perceptions of hunger among a nationally representative sample of Inuit children in Canada have not yet been reported. Design. Data are from the 2006 Aboriginal Children's Survey (ACS). Sociodemographic information, dietary behaviours and hunger status were parent-reported via a household interview for Inuit children aged 2–5 years (n=1,234). Prevalence of hunger was calculated among Inuit children by sociodemographic factors and by dietary behaviours. In addition, a multivariate logistic regression model was conducted to determine factors associated with parental perception of ever experiencing hunger. Results. The prevalence of Inuit children in Canada aged 2–5 years ever experiencing hunger was 24.4%. Children who were reported to have experienced hunger consumed milk and milk products (p0.05). The majority (81%) of Inuit parents/guardians of ever-hungry children sought help from family or friends. Factors associated with an increased likelihood of experiencing hunger include sociodemographic characteristics (such as income and household size), living in an Inuit region and living in a community with cultural activities. Conclusion. About 1 in 4 Inuit children were reported by their parents to have experienced hunger, and hunger was associated with region, sociodemographic and community factors. Future research could further examine the impact of ever experiencing hunger on the health status of Inuit children and their families in Canada.

Researchers with an interest in examining and better understanding the social context of children suffering from neurodevelopmental disabilities can benefit by using data from a wide variety of Statistics Canada surveys as well as the information contained in administrative health databases. Selective use of a particular survey and database can be informative particularly when demographics, samples, and content align with the goals and outcomes of the researcher’s questions of interest. Disabilities are not merely conditions in isolation. They are a key part of a social context involving impairment, function, and social facilitators or barriers, such as work, school and extracurricular activities. Socioeconomic factors, single parenthood, income, and education also play a role in how families cope with children’s disabilities. Statistics indicate that five per cent of Canadian children aged five to 14 years have a disability, and 74 per cent of these are identified as having a neurodevelopmental condition and disability. A number of factors must be taken into account when choosing a source of survey data, including definitions of neurodevelopmental conditions, the target group covered by the survey, which special populations are included or excluded, along with a comparison group, and the survey’s design. Surveys fall into categories such as general health, disability-specific, and children and youth. They provide an excellent opportunity to look at the socioeconomic factors associated with the health of individuals, as well as how these conditions and disabilities affect families. However rich the information gleaned from survey data, it is not enough, especially given the data gaps that exist around the health and well-being of children and older youths. This is where administrative and other data can be used to complement existing data sources. Administrative data offer specific information about neurological conditions that won’t be collected in general population surveys, given the nature of such surveys. While researchers can glean information from survey data such as functional health and disability, social inclusion or exclusion, and the role of social determinants in the lives of these children and their families, administrative data can identify rare neurodevelopmental conditions and disabilities not captured in general surveys. Analyzing information from all these sources can lead to a more nuanced understanding of the economic and social impacts, and functional limitations in daily living, that patients and their families experience with certain neurodevelopmental conditions and disabilities. Statistics Canada surveys offer a plethora of information for researchers interested in neurodevelopmental disabilities and social determinants of health. As these surveys are national in their scope, they provide a wealth of information for statistical analysis from people across Canada. This information can be used to inform researchers, policy makers, and families of people who live with neurodevelopmental conditions and disabilities. For example, sophisticated microsimulation modelling techniques have been conducted to project the health and economic impacts from such disabilities 20 years into the future. Such projections will be vital for policy-makers tasked with designing services and programs to assist these people. Much work remains to be done, however. Statistics Canada has already begun working on the potential for using administrative data to conceptualize childhood disability, as well as using data that has been anonymized in national administrative databases to study the health of Canada’s children. These are excellent bases from which to build future research.

Researchers with an interest in examining and better understanding the social context of children suffering from neurodevelopmental disabilities can benefit by using data from a wide variety of Statistics Canada surveys as well as the information contained in administrative health databases. Selective use of a particular survey and database can be informative particularly when demographics, samples, and content align with the goals and outcomes of the researcher’s questions of interest. Disabilities are not merely conditions in isolation. They are a key part of a social context involving impairment, function, and social facilitators or barriers, such as work, school and extracurricular activities. Socioeconomic factors, single parenthood, income, and education also play a role in how families cope with children’s disabilities. Statistics indicate that five per cent of Canadian children aged five to 14 years have a disability, and 74 per cent of these are identified as having a neurodevelopmental condition and disability. A number of factors must be taken into account when choosing a source of survey data, including definitions of neurodevelopmental conditions, the target group covered by the survey, which special populations are included or excluded, along with a comparison group, and the survey’s design. Surveys fall into categories such as general health, disability-specific, and children and youth. They provide an excellent opportunity to look at the socioeconomic factors associated with the health of individuals, as well as how these conditions and disabilities affect families. However rich the information gleaned from survey data, it is not enough, especially given the data gaps that exist around the health and well-being of children and older youths. This is where administrative and other data can be used to complement existing data sources. Administrative data offer specific information about neurological conditions that won’t be collected in general population surveys, given the nature of such surveys. While researchers can glean information from survey data such as functional health and disability, social inclusion or exclusion, and the role of social determinants in the lives of these children and their families, administrative data can identify rare neurodevelopmental conditions and disabilities not captured in general surveys. Analyzing information from all these sources can lead to a more nuanced understanding of the economic and social impacts, and functional limitations in daily living, that patients and their families experience with certain neurodevelopmental conditions and disabilities. Statistics Canada surveys offer a plethora of information for researchers interested in neurodevelopmental disabilities and social determinants of health. As these surveys are national in their scope, they provide a wealth of information for statistical analysis from people across Canada. This information can be used to inform researchers, policy makers, and families of people who live with neurodevelopmental conditions and disabilities. For example, sophisticated microsimulation modelling techniques have been conducted to project the health and economic impacts from such disabilities 20 years into the future. Such projections will be vital for policy-makers tasked with designing services and programs to assist these people. Much work remains to be done, however. Statistics Canada has already begun working on the potential for using administrative data to conceptualize childhood disability, as well as using data that has been anonymized in national administrative databases to study the health of Canada’s children. These are excellent bases from which to build future research.

Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits.Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥ 4) were more likely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29-1.88) and delirium (AOR: 1.61, 95% CI: 1.08-2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10-1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01-1.33) within 30-days of discharge.We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.

The purpose of this study was to compare rates of participation for children (4–9 years of age) with neurodevelopmental disorders (NDDs) with and without externalizing behavior problems (EBPs) with children without disability and to examine mediators of the relation between disability and physical activity participation. Data for this study were drawn from Cycle 7 (2006-07) of the Canadian National Longitudinal Survey of Children and Youth (NLSCY). The frequency of children’s participation in organized sports or physical activities varied depending on the child’s health condition with children with NDDs and both NDDs and EBPs participating least in organized sports or physical activities followed by children with EBPs only. In contrast, there were no statistically significant differences by health group for children’s participation in unorganized sports or physical activities. These differences remained even after controlling for the effects of other child and family sociodemographic characteristics, except for children with EBPs only. These findings highlight the importance of considering children’s primary and other existing health conditions as well as family sociodemographic characteristics in order to better understand the factors that influence participation in organized physical activities for children with disabilities.

Language skills in the preschool period are an important indicator of early development and school readiness for children. However, little is known about the association between aspects of the neighborhood and language outcomes for First Nations children. The purpose of the current study was to examine the effects of neighborhood structural and organization features, as well as the mediation of these effects, on the language outcomes of First Nations children aged 2-5 living off reserve. Data from the Aboriginal Children’s Survey was examined. Both neighborhood structure and neighborhood organization were important for language outcomes. In addition, mediation effects were shown, suggesting that family-level as well as neighborhood structural variables are particularly important for the language outcomes of young First Nation children living off reserve.