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Background: Diagnosis codes in administrative health data are routinely used to monitor trends in disease prevalence and incidence. The International Classification of Diseases (ICD), which is used to record these diagnoses, have been updated multiple times to reflect advances in health and medical research. Our objective was to examine the impact of transitions between ICD versions on the prevalence of chronic health conditions estimated from administrative health data.Methods: Study data (i.e., physician billing claims, hospital records) were from the province of Manitoba, Canada, which has a universal healthcare system. ICDA-8 (with adaptations), ICD-9-CM (clinical modification), and ICD-10-CA (Canadian adaptation; hospital records only) codes are captured in the data. Annual study cohorts included all individuals 18 + years of age for 45 years from 1974 to 2018. Negative binomial regression was used to estimate annual age- and sex-adjusted prevalence and model parameters (i.e., slopes and intercepts) for 16 chronic health conditions. Statistical control charts were used to assess the impact of changes in ICD version on model parameter estimates. Hotelling's T2 statistic was used to combine the parameter estimates and provide an out-of-control signal when its value was above a pre-specified control limit.Results: The annual cohort sizes ranged from 360,341 to 824,816. Hypertension and skin cancer were among the most and least diagnosed health conditions, respectively; their prevalence per 1,000 population increased from 40.5 to 223.6 and from 0.3 to 2.1, respectively, within the study period. The average annual rate of change in prevalence ranged from -1.6% (95% confidence interval [CI]: -1.8, -1.4) for acute myocardial infarction to 14.6% (95% CI: 13.9, 15.2) for hypertension. The control chart indicated out-of-control observations when transitioning from ICDA-8 to ICD-9-CM for 75% of the investigated chronic health conditions but no out-of-control observations when transitioning from ICD-9-CM to ICD-10-CA.Conclusions: The prevalence of most of the investigated chronic health conditions changed significantly in the transition from ICDA-8 to ICD-9-CM. These results point to the importance of considering changes in ICD coding as a factor that may influence the interpretation of trend estimates for chronic health conditions derived from administrative health data. [ABSTRACT FROM AUTHOR]

Summary: We analyzed patterns in recurrent major osteoporotic fracture (MOF) following a first major osteoporotic fracture in a large population-based cohort. Re-fracture risk remained elevated over 10 years, with only modest and inconsistent attenuation in risk over time. Introduction: Recurrent fracture risk remains elevated for up to 25 years, and is reportedly highest in the initial 2 years (imminent risk). Our aim was to characterize early time dependency in re-fracture rates up to 10 years after a first fracture in a population-based cohort. Methods: Using Province of Manitoba (Canada) healthcare databases, we performed a matched cohort study in 22,105 women (mean age 74.1 ± 10.6 years) and 7589 men (mean age 71.8 ± 11.2 years) after a first MOF (age ≥ 50 years) during 1989–2006 and matched fracture-free controls (3 for each case). Incident fractures were ascertained over the next 10 years. Fracture rate ratios (RRs, cases versus controls) stratified by sex and age were computed, and tested for linear trend using linear regression. Joinpoint regression was performed to determine non-linear change in fracture rates over time, with particular attention to the first 2-year post-fracture. Results: RRs for incident MOF and hip fracture exceeded unity for the primary analyses in all subgroups and follow-up intervals. There was a tendency of RRs to decline over time, but this was inconsistent. Absolute rates per 100,000 person-years for fracture cases were consistently greater than for controls in all subgroups and observation times. Among fracture cases, there was a tendency for rates to decline gradually in all subgroups except younger women, but these temporal trends appeared monotonic without an inflection at 2 years. Joinpoint regression analyses did not detect an inflection in risk between the first 2 years and subsequent years. No significant time dependency was seen for incident hip fracture. Conclusions: MOF and hip re-fracture risk was elevated in all age and sex subgroups over 10 years. There was inconsistent and only modest time dependency in early MOF risk, most evident in women after age 65 years. No strong transition in risk was seen between the first 2-year post-fracture and subsequent years. [ABSTRACT FROM AUTHOR]

Extracting body‐wave arrivals from ambient seismic recordings remains a challenging task, largely because ambient records are usually dominated by surface‐wave energy. Most ambient seismic data‐processing strategies aimed at enhancing body‐wave energy focus on a cross‐correlation plus stack methodology. While this approach is useful for interferometric investigations, it effectively squares the magnitude of unwanted coherent noise events (e.g. surface waves, burst‐like or strong monochromatic energy) that commonly overpower ambient body‐wave signal. Accordingly, coherent noise events are usually treated with a binary accept‐or‐reject decision of individual data windows based on root‐mean‐squared energy considerations. Applying a data‐processing workflow to uncorrelated ambient seismic data represents an alternate strategy for mitigating coherent noise. However, this pre‐stack methodology requires significant computational effort due to the often terabyte‐sized data volumes. To make this approach feasible, we outline an automated processing workflow to automatically identify and mitigate coherent noise events that otherwise does not severely degrade the remaining waveforms. After each processing step, we apply a number of quality control measures to monitor the convergence rate of cross‐correlation plus stack waveforms and for evidence of emerging body‐wave reflection events. We apply the processing flow to an ambient seismic data set acquired on a large‐N array at a mine site near Lalor Lake, Manitoba, Canada. Our quality control analyses suggest that automated preprocessing of uncorrelated ambient seismic recordings successfully mitigates unwanted impulsive and monochromatic coherent noise events. Accordingly, we assert that applying an automated data‐processing approach would be beneficial for body‐wave and other imaging and inversion analyses applied to ambient seismic recordings. [ABSTRACT FROM AUTHOR]

Summary: Little is known about post-acute care following hip fracture surgery. We investigated discharge destinations from surgical hospitals for nine Canadian provinces. We identified significant heterogeneity in discharge patterns across provinces suggesting different post-acute recovery pathways. Further work is required to determine the impact on patient outcomes and health system costs. Introduction: To examine discharge destinations by provinces in Canada, adjusting for patient, injury, and care characteristics. Methods: We analyzed population-based hospital discharge abstracts from a national administrative database for community-dwelling patients who underwent hip fracture surgery between 2004 and 2012 in Canada. Discharge destination was categorized as rehabilitation, home, acute care, and continuing care. Multinomial logistic regression modeling compared proportions of discharge to rehabilitation, acute care, and continuing care versus home between each province and Ontario. Adjusted risk differences and risk ratios were estimated. Results: Of 111,952 previously community-dwelling patients aged 65 years or older, 22.5% were discharged to rehabilitation, 31.6% to home, 27.0% to acute care, and 18.2% to continuing care, with significant variation across provinces (p < 0.001). The proportion of discharge to rehabilitation ranged from 2.4% in British Columbia to 41.0% in Ontario while the proportion discharged home ranged from 20.3% in Prince Edward Island to 52.2% in British Columbia. The proportion of discharge to acute care ranged from 15.2% in Ontario to 58.8% in Saskatchewan while the proportion discharged to continuing care ranged from 9.3% in Manitoba and Prince Edward Island to 22.9% in New Brunswick. Adjusting for hospital type changed the direction of the provincial effect on discharge to continuing care in two provinces, but statistical significance remained consistent with the primary analysis. Conclusions: Discharge destination from the surgical hospital after hip fracture is highly variable across nine Canadian provinces. Further work is required to determine the impact of this heterogeneity on patient outcomes and health system costs. [ABSTRACT FROM AUTHOR]

Objectives: Female family members affect both the likelihood of adolescent pregnancy and the outcome of that pregnancy. We examined the degree to which an older sister’s adolescent reproductive outcomes affect her younger sister’s reproductive behavior, and whether relationships in adolescent pregnancy among sisters born to adolescent mothers differ from those born to nonadolescent mothers. Methods: We followed a birth cohort in Manitoba, Ontario, Canada, to age 20 using linkable administrative databases housed at the Manitoba Centre for Health Policy. The cohort consisted of 12 391 girls born in Manitoba between April 1, 1984, and March 31, 1996, who had 1 older sister. We used logistic regression models to examine the relationships among familial adolescent pregnancy outcomes. Results: Compared with adolescent girls whose older sister did not have an adolescent pregnancy, adolescent girls whose older sister had an adolescent pregnancy were more likely to have a pregnancy (adjusted odds ratio [aOR] = 2.57), regardless of whether that pregnancy was completed (aOR = 2.56) or terminated (aOR = 2.59). Relationships in adolescent pregnancy among sisters were much stronger for those born to nonadolescent mothers (aOR = 3.16 [older sister completed adolescent pregnancy] and 3.18 [older sister terminated adolescent pregnancy]) than to adolescent mothers (aOR = 1.65 [older sister completed adolescent pregnancy] and 1.77 [older sister terminated adolescent pregnancy]). For younger sisters having an adolescent pregnancy, the odds of her completing the pregnancy were reduced if her older sister had terminated an adolescent pregnancy and her mother had not been an adolescent mother (aOR = 0.38). Conclusions: Younger sisters of adolescents who had a pregnancy may benefit from targeted interventions to reduce their likelihood of adolescent pregnancies. [ABSTRACT FROM AUTHOR]

Background: Concerns have been raised over the practice of transferring nursing home residents to hospital at their end of life. Objective: To examine the family and facility factors that may influence the decision to transfer nursing home residents to hospital in the last month of life. Research design: Secondary data analysis includes a sample of 119 bereaved family members from 21 nursing homes located in Central Canada. Method: A binary logistic regression analysis was conducted to explore the predictors for hospital transfers. Results: Terminal hospital transfers were common: 70% of nursing home residents were sent to hospitals in the last month of their life, and the likelihood of terminal hospital transfers increased by having an adult child as decision-maker (odds ratio (OR) = 5.03; 95% confidence interval (CI) = 1.6, 16; significance level/probability value (p) = 0.007) or having a lower family income (OR = 2.9; 95% CI =1.1, 2.9; p = 0.027). Discussion and implications: The identified predictors for terminal hospital transfers are helpful in targeting and developing interventions to improve end-of-life care. Particular emphasis should therefore be placed on targeting families with low income and children of the nursing home residents for educational initiatives such as advance care planning awareness, in order to prevent terminal hospital transfers. It is hoped that policy-makers and practitioners can start addressing the findings of this study to reduce terminal hospital transfers at end of life and promote quality end-of-life care in nursing homes. [ABSTRACT FROM AUTHOR]

Introduction: International medical graduates (IMGs) seeking licensure in Canada have been recruited to practise in medically underserviced areas, but retention of these physicians remains a concern. This study explored retention of IMG family physicians in Manitoba and its predictors. Methods: We used data from the University of Manitoba, provincial registries and Manitoba Health. Inclusion criteria were IMGs who completed University of Manitoba IMG training or assessment programs, and their return-of-service. Practice location, certification and licensure status were examined. We used logistic regression to consider the effects of a mentorship program, Manitoba residency at application, IMG program and years since program graduation on retention. Results: A total of 197 IMGs met the inclusion criteria. Most IMGs (63.5%) remained in Manitoba, and 59.2% of this group practised outside of Winnipeg. Of those remaining in Manitoba, most (69.6%) held full provincial licensure and national certification. The regression model -was significant (χ²4 = 13.94, p = 0.007), explaining 10% of the variance in retention. Two predictors were significant: years since program graduation and Manitoba residency at the time of application. Conclusion: Long-term retention of IMG physicians remains a concern. Potential interventions likely to increase retention, such as Manitoba residency at application and a focus on mentorship programs, should be further explored. [ABSTRACT FROM AUTHOR]

Background Registered midwives, obstetricians/gynecologists, and general or family practice physicians (GPs) provide maternity care across Canada. Few North American studies have assessed whether maternity outcomes differ across these three groups. This study compared maternal and neonatal outcomes of low-risk pregnant women whose birth was attended by registered midwives, obstetricians/gynecologists, and family practice physicians in Winnipeg, Manitoba from 2001/02 to 2012/13. Methods Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates. Results Low-risk births comprised 83,774 (48.7%) of total births ( n = 171,910). The adjusted odds ratio ( aOR), (95% confidence interval) for midwife vs OB/ GYN showed women who had a midwife attend the birth had reduced odds of having an episiotomy 0.47 (0.40-0.54), epidural 0.25 (0.23-0.27), and cesarean delivery 0.13 (0.10-0.16) and their infants had less Neonatal Intensive Care Unit admissions 0.28 (0.18-0.43). The aOR for GP versus OB/ GYN showed women who had a GP had reduced odds of having an epidural/spinal 0.83 (0.79-0.88) and cesarean delivery 0.44 (0.40-0.48). Conclusions The effectiveness of Manitoba maternity services can be improved with increased use of integrated midwifery services. Future research should examine how midwifery and physician-led models of care differ, and the influence of these differences on birth outcomes and cost-effectiveness to the health care system. Improvement of data tracking systems is also needed. [ABSTRACT FROM AUTHOR]

Background: Anogenital warts (AGW) are caused by the most common sexually transmitted infection, human papillomavirus. The objective of this study was to examine AGW incidence from 1990 to 2011 by sex, age, income quintile, and residential area category (urban/rural). The study period included the initiation of school-based HPV vaccination for girls in the sixth grade, which began in 2008. The data presented in this paper may also be useful for establishing baseline rates of AGW incidence which may be used to evaluate the success of the school-based HPV immunization program.Methods: Cases of anogenital warts were identified using Manitoba's administrative databases of Physician Claims and Hospital Discharge Abstracts. Annual age-standardized incidence in Manitoba from 1990 to 2011 was calculated. Incident AGW rates were compared by sex, age group, residential area category (urban/rural), and household income quintile using logistic regression. Joinpoint regression analyses were used to evaluate the time trends of AGW.Results: Prior to 2000, AGW incidence was higher among females than males. However, from 2000 to 2011 the incidence was higher among males and increased steadily over time. AGW incidence tended to peak in younger age groups among females compared to males. Females and males living in urban areas had nearly twice the odds of AGW occurrence compared to those in rural areas.Conclusions: There is a need for education about AGW in male population. The upcoming initiation of HPV vaccination among boys may reduce the incidence and should be evaluated. [ABSTRACT FROM AUTHOR]

Background: Electronic Medical Records (EMRs) are increasingly used in the provision of primary care and have been compiled into databases which can be utilized for surveillance, research and informing practice. The primary purpose of these records is for the provision of individual patient care; validation and examination of underlying limitations is crucial for use for research and data quality improvement. This study examines and describes the validity of chronic disease case definition algorithms and factors affecting data quality in a primary care EMR database. Methods: A retrospective chart audit of an age stratified random sample was used to validate and examine diagnostic algorithms applied to EMR data from the Manitoba Primary Care Research Network (MaPCReN), part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The presence of diabetes, hypertension, depression, osteoarthritis and chronic obstructive pulmonary disease (COPD) was determined by review of the medical record and compared to algorithm identified cases to identify discrepancies and describe the underlying contributing factors. Results: The algorithm for diabetes had high sensitivity, specificity and positive predictive value (PPV) with all scores being over 90%. Specificities of the algorithms were greater than 90% for all conditions except for hypertension at 79.2%. The largest deficits in algorithm performance included poor PPV for COPD at 36.7% and limited sensitivity for COPD, depression and osteoarthritis at 72.0%, 73.3% and 63.2% respectively. Main sources of discrepancy included missing coding, alternative coding, inappropriate diagnosis detection based on medications used for alternate indications, inappropriate exclusion due to comorbidity and loss of data. Conclusions: Comparison to medical chart review shows that at MaPCReN the CPCSSN case finding algorithms are valid with a few limitations. This study provides the basis for the validated data to be utilized for research and informs users of its limitations. Analysis of underlying discrepancies provides the ability to improve algorithm performance and facilitate improved data quality. [ABSTRACT FROM AUTHOR]

Background Aboriginal representation in Canadian correctional institutions has increased rapidly over the past decade. We calculated "years of life lost to incarceration" for Aboriginal and non- Aboriginal Canadians.Methods Incarceration data from provincial databases were used conjointly with demographic data to estimate rates of incarceration and years of life lost to provincial incarceration in (BC) and federal incarceration, by Aboriginal status. We used the Sullivan method to estimate the years of life lost to incarceration. Results Aboriginal males can expect to spend approximately 3.6 months in federal prison and within BC spend an average of 3.2 months in custody in the provincial penal system. Aboriginal Canadians on average spend more time in custody than their non-Aboriginal counterparts. The ratio of the Aboriginal incarceration rate to the non-Aboriginal incarceration rate ranged from a low of 4.28 in Newfoundland and Labrador to a high of 25.93 in Saskatchewan. Rates of incarceration at the provincial level were highest among Aboriginals in Manitoba with an estimated rate of 1377.6 individuals in prison per 100,000 population (95% confidence interval [CI]: 1311.8 - 1443.4). Conclusions The results indicate substantial differences in life years lost to incarceration for Aboriginal versus non-Aboriginal Canadians. In light of on-going prison expansion in Canada, future research and policy attention should be paid to the public health consequences of incarceration, particularly among Aboriginal Canadians. [ABSTRACT FROM AUTHOR]

Summary: We examined the independent contribution of income to low bone mineral density in women aged 50 years and older. A significant dose-response association was observed between low income and low (bone mineral density) BMD, which was not explained by clinical risk factors or osteoporotic treatment in the year prior. Introduction: The association between social disadvantage and osteoporosis is attracting increased attention; however, little is known of the role played by income. We examined associations between income and bone mineral density (BMD) in 51,327 women aged ≥50 years from Manitoba, Canada. Methods: Low BMD was defined as a T-score ≥2.5SD (femoral neck or minimum) measured by dual energy X-ray absorptiometry (DXA) 1996-2001. Mean household income was extracted from Canada Census 2006 public use files and categorized into quintiles. Age, weight and height were recorded at time of DXA. Parental hip fracture was self-reported. Diagnosed comorbidities, including osteoporotic fracture and rheumatoid arthritis, were ascertained from hospital records and physician billing claims. Chronic obstructive pulmonary disease was used as a proxy for smoking and alcohol abuse as a proxy for high alcohol intake. Corticosteroid use was obtained from the comprehensive provincial pharmacy system. Logistic regression was used to assess relationships between income (highest income quintile held as referent) and BMD, accounting for clinical risk factors. Results: Compared to quintile 5, the adjusted odds ratio (OR) for low BMD at femoral neck for quintiles 1 through 4 were, respectively, OR1.41 (95 %CI 1.29-1.55), OR1.32 (95 %CI 1.20-1.45), OR1.19 (95 %CI 1.08-1.30) and OR1.10 (95 %CI 1.00-1.21). Similar associations were observed when further adjustment was made for osteoporotic drug treatment 12 months prior and when low BMD was defined by minimum T-score. Conclusions: Lower income was associated with lower BMD, independent of clinical risk factors. Further work should examine whether lower income increases the likelihood of treatment qualification. [ABSTRACT FROM AUTHOR]

Summary: High direct incremental healthcare costs post-fracture are seen in the first year, but total costs from a third-party healthcare payer perspective eventually fall below pre-fracture levels. We attribute this to higher mortality among fracture cases who are already the heaviest users of healthcare ('healthy survivor bias'). Economic analyses that do not account for the possibility of a long-term reduction in direct healthcare costs in the post-fracture population may systematically overestimate the total economic burden of fracture. Introduction: High healthcare costs in the first 1-2 years after an osteoporotic fracture are well recognized, but long-term costs are uncertain. We evaluated incremental costs of non-traumatic fractures up to 5 years from a third-party healthcare payer perspective. Methods: A total of 16,198 incident fracture cases and 48,594 matched non-fracture controls were identified in the province of Manitoba, Canada (1997-2002). We calculated the difference in median direct healthcare costs for the year pre-fracture and 5 years post-fracture expressed in 2009 Canadian dollars with adjustment for expected age-related healthcare cost increases. Results: Incremental median costs for a hip fracture were highest in the first year ($25,306 in women, $21,396 in men), remaining above pre-fracture baseline to 5 years in women but falling below pre-fracture costs by 5 years in men. In those who survived 5 years following a hip fracture, incremental costs remained above pre-fracture costs at 5 years ($12,670 in women, $7,933 in men). Incremental costs were consistently increased for 5 years after spine fracture in women. Total incremental healthcare costs for all incident fractures combined showed a large increase over pre-fracture costs in the first year ($137 million in women, $57 million in men), but fell below pre-fracture costs within 3-4 years. Elevated total healthcare costs were seen at year 5 in women after wrist, humerus and spine fractures, but these were somewhat offset by decreases in total healthcare costs for other fractures. Conclusions: High direct healthcare costs post-fracture are seen in the first year, but total costs eventually fall below pre-fracture levels. Among those who survive 5 years following a fracture, healthcare costs remain above pre-fracture levels. [ABSTRACT FROM AUTHOR]

Summary: Institutionalization after hip fracture occurs in at least 30% of patients in the year following hospital discharge. We demonstrate that the risk of transfer to a long-term care facility, after adjustment for age and burden of co-morbidity, is also increased following fractures at other osteoporotic sites in men and women. For most fractures, men are at greater risk than women. Introduction: High institutionalization rates have been documented following non-traumatic hip fractures; however, there is lack of knowledge regarding the frequency of transfer to long-term care institutions of patients who sustain such fractures at other anatomical sites. Methods: Using the comprehensive health care databases of the province of Manitoba, Canada, we performed a retrospective matched cohort study of community-dwelling men and women aged 50 years and older who sustained an incident non-traumatic fracture between April 1, 1986, and March 31, 2006. Using Cox proportional hazards regression analysis, we estimated the sex-specific relative risk of transfers to long-term care institutions in the year following fracture at osteoporotic sites. Results: We identified a total of 70,264 individuals with incident fractures (70.0% in women) among whom 3,996 new admissions to long-term care institutions were documented in the year following the index fracture. New admissions increased over time ( p < 0.0001 for temporal trends). The age- and co-morbidity-adjusted hazard ratio (HR) of institutionalization following a hip fracture was 4.89 (95% confidence interval [CI], 4.19 to 5.69) in men, and this risk was consistently at least twice that of controls for all other fracture sites (all p < 0.0001). In women, the relative risks were highest subsequent to a hip (HR, 2.79; 95% CI, 2.56 to 3.04) or vertebral fracture (HR, 2.18; 95% CI, 1.82 to 2.62). Conclusions: Non-traumatic fractures at any site have serious consequences, including institutionalization. Men are at greater risk of transfer to long-term care following fracture than women. [ABSTRACT FROM AUTHOR]

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, 18.4% were not screened and 3.0% were placed in out-of-home care at least once during the study period. Infants not screened were twice as likely to enter care compared to those screened (4.9% vs. 2.5%). Infants screening at risk were 15 times more likely to enter care than those screening “not at risk.” Sensitivity and specificity of the screen were 77.6% and 83.3%, respectively. Screening efforts to identify vulnerable families missed a substantial portion of families needing support. The screening tool demonstrated moderate predictive validity for identifying children at risk of entering care in the first years of life. [ABSTRACT FROM PUBLISHER]

Summary: Non-traumatic fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Furthermore, in certain age subgroups of women and men, this rate remained elevated beyond 5 years for fractures of the hip, vertebrae, humerus, and other sites. Introduction: Increased mortality rates have been documented following non-traumatic hip, vertebral, and shoulder fractures. However, data are lacking as to the duration of excess mortality and whether there is increased mortality following fractures at other sites. We determined mortality up to 15 years following incident fractures at typical osteoporotic sites. Methods: Using healthcare databases for the Province of Manitoba, Canada, we identified individuals 50 years and older with an incident non-traumatic fracture between 1986 and 2007. Each fracture case was matched to three fracture-free controls. Generalized linear models were used to test for trends in mortality and to estimate the relative risk for cases after adjusting for co-morbidity and living arrangements. Results: During the study period, we identified 21,067 incident fractures in men followed by 10,724 (50.1%) deaths and 49,197 incident fractures in women followed by 22,018 deaths (44.8%). Seventy-six percent of the fractures were at sites other than the hip and vertebrae. After adjustment for age, number of co-morbidities, and level of dependence in living arrangements, the risk of death in cases, relative to controls, was increased in both sexes for hip, vertebral, humerus, wrist (in men only), and other fracture sites. Post-fracture mortality was higher in men than women. Relative mortality was the highest in the younger age groups across the spectrum of fracture sites. Conclusions: Fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Better understanding of factors associated with increased post-fracture mortality should inform the development of management strategies. [ABSTRACT FROM AUTHOR]

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. 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. Routinely collected data from the Ministries of Health, Education, and Family Services and Consumer Affairs have been integrated with a population registry. Identifying risk factors and presenting outcomes by social groups and by local communities capture the attention of policymakers. Linking an individual's area of residence to census and health data has led to developing measures of population health status and socioeconomic status. These measures focus on whether delivery patterns track health and educational needs, and a population registry makes it possible to describe who is (and is not) served by each program. The nature of health and social research has been changed by the development of information-rich environments. Many findings in Manitoba could not be replicated without a population registry. Engaging decision makers through effective presentations can ensure continuing support for diverse efforts based on these environments, and this article suggests ways of better communicating with policymakers. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the use of two Canadian provincial databases by a systematic review of published studies that used them as a primary data source to answer epidemiologic and health services research questions. Study Design and Setting: PubMed, EMBASE, BIOSIS, and CINAHL (keywords: “Manitoba” 1970–2004 and “Saskatchewan” 1969–2004) and the web sites of the provincial data custodians were searched to address our objective. Broad screening of citations and data abstraction were performed using a predefined collection form. Information on study characteristics, therapeutic areas studied, databases used, authors'' affiliation, and issues related to data validity was recorded. Results: Three thousand nine hundred and forty-nine citations were screened, 610 studies retrieved, and 325 included. In Saskatchewan, the principal research type was assessment of exposures and health outcomes (48.2%) with 50.4% using a cohort or case–control design, whereas, in Manitoba, it was health services utilization (47.8%) and 86.6% were descriptive. Local investigators performed 83.3% of the Manitoba studies, compared with 35.5% of the Saskatchewan studies. Only 6.2% of the studies assessed the validity and reliability of the database for research purposes and few incorporated relevant information about the validity of their diagnostic data. Conclusion: Important differences exist in the administration and use of these databases. Similar systematic evidence synthesis should be conducted on other databases. [Copyright &y& Elsevier]

OBJECTIVES: There is increased interest in determining whether 5-aminosalicylate (5-ASA) use can prevent the development of colorectal cancer (CRC) among patients with inflammatory bowel disease (IBD). The aim of this study was to determine whether use of 5-ASA was associated with a reduced risk of CRC in these patients. METHODS: We extracted from our population-based University of Manitoba Inflammatory Bowel Disease Epidemiology Database the number of patients with a new diagnosis of CRC between the years 1997 and 2000. From within our Inflammatory Bowel Disease Epidemiology Database we extracted a control group of IBD patients who did not develop CRC matched to the case group who did develop CRC by age, sex, diagnosis, year of diagnosis, and geographic area of residence. We linked cases and controls with Manitoba Health's Drug Program Information Network to study 5-ASA use within 2 yr before CRC diagnosis. The Drug Program Information Network database is a population-based database that was established in 1995 and that records all prescription drugs. RESULTS: There were 25 cases of IBD identified as having CRC. These were matched with 348 cases of IBD who did not develop CRC. CRC cases were more likely to be exposed to 5-ASA (odds ratio = 1.46; 95% CI = 0.58-3.73) but this result was not statistically significant. The mean total days of use was 400.9 days ± 185.9 among CRC cases versus 420.2 days ± 241.7 among non-CRC cases (p = 0.92). The prescribed daily dose was 2295 mg/day ± 1041 mg among CRC cases and 1811 mg ± 520 mg among controls (p = 0.21). CONCLUSION: These data do not support 5-ASA as protective in preventing CRC. [ABSTRACT FROM AUTHOR]

Reports that Manitoba is considering posting online physician profiles which may include a record of outcomes of the treatment provided by doctors in the province. Recommendation of the profiles following an inquest into the deaths of a number of pediatric cardiac patients in Winnipeg; Expense and difficulty in compiling the outcomes records.