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Introduction: Early childhood is a key period to establish policies and practices that optimise children's health and development, but Canada lacks nationally representative data on social indicators of children's well-being. To address this gap, the Early Development Instrument (EDI), a teacher-administered questionnaire completed for kindergarten-age children, has been implemented across most Canadian provinces over the past 10 years. The purpose of this protocol is to describe the Canadian Neighbourhoods and Early Child Development (CanNECD) Study, the aims of which are to create a pan-Canadian EDI database to monitor trends over time in children's developmental health and to advance research examining the social determinants of health., Methods and Analysis: Canada-wide EDI records from 2004 to 2014 (representing over 700,000 children) will be linked to Canada Census and Income Taxfiler data. Variables of socioeconomic status derived from these databases will be used to predict neighbourhood-level EDI vulnerability rates by conducting a series of regression analyses and latent variable models at provincial/territorial and national levels. Where data are available, we will measure the neighbourhood-level change in developmental vulnerability rates over time and model the socioeconomic factors associated with those trends., Ethics and Dissemination: Ethics approval for this study was granted by the Behavioural Research Ethics Board at the University of British Columbia. Study findings will be disseminated to key partners, including provincial and federal ministries, schools and school districts, collaborative community groups and the early childhood development research community. The database created as part of this longitudinal population-level monitoring system will allow researchers to associate practices, programmes and policies at school and community levels with trends in developmental health outcomes. The CanNECD Study will guide future early childhood development action and policies, using the database as a tool for formative programme and policy evaluation., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To assess the relationship between the 5 min Apgar score and developmental vulnerability at 5 years of age., Design: Population-based retrospective cohort study., Setting: Manitoba, Canada., Participants: All children born between 1999 and 2006 at term gestation, with a documented 5 min Apgar score., Exposure: 5 min Apgar score., Main Outcome Measures: Childhood development at 5 years of age, expressed as vulnerability (absent vs present) on five domains of the Early Development Instrument: physical health, social competence, emotional maturity, language and cognitive development, and communication skills., Results: Of the 33,883 children in the study, most (82%) had an Apgar score of 9; 1% of children had a score <7 and 5.6% had a score of 10. Children with Apgar scores <10 had higher odds of vulnerability on the physical domain at age 5 years compared with children with a score of 10 (eg, adjusted OR (aOR) for Apgar 9=1.23, 95% CI 1.05 to 1.44). Similarly, children with Apgar scores of <10 were more vulnerable on the emotional domain (eg, aOR for Apgar 9=1.20, 95% CI 1.03 to 1.41). Nevertheless, the Apgar-based prognostic model had a poor sensitivity for physical vulnerability (19%, 95% CI 18% to 20%). Although the Apgar score-based prognostic model had reasonable calibration ability and risk-stratification accuracy for identifying developmentally vulnerable children, classification accuracy was poor., Conclusions: The risk of developmental vulnerability at 5 years of age is inversely associated with the 5 min Apgar score across its entire range, and the score can serve as a population-level indicator of developmental risk., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Limited research exists examining long-term mental and physical health outcomes in adult survivors of pediatric burns. The authors examine the postinjury lifetime prevalence of common mental and physical disorders in a large pediatric burn cohort and compare the results with matched controls. Seven hundred and forty five survivors of childhood burns identified in the Burn Registry (<18 years old and total BSA >1% between April 1, 1988 and March 31, 2010) were matched 1:5 to the general population based on age at time of injury (index date), sex, and geographic residence. Postinjury rate ratio (RR) was used to compare burn cases and control cohorts for common mental and physical illnesses through physician billings, and hospital claims. RR was adjusted for sex, rural residence, and income. Compared with matched controls, postburn cases had significantly higher RR of all mental disorders, which remained significant (P < .05) after adjustment (major depression RR = 1.5 [confidence limit {CL}: 1.2-1.8], anxiety disorder RR = 1.5 [CL: 1.3-1.8), substance abuse RR = 2.3 [CL: 1.7-3.2], suicide attempt RR = 4.3 [CL: 1.6-12.1], or any mental disorder RR = 1.5 [CL: 1.3-1.8]). The relative rate of some physical illnesses was also significantly increased in burn survivors: arthritis RR = 1.2 (CL: 1.1-1.4), fractures RR = 1.4 (CL: 1.2-1.6), total respiratory morbidity RR = 1.1 (CL: 1.02-1.3), and any physical illness RR = 1.2 (CL: 1.1-1.3). Adult survivors of childhood burn injury have significantly increased rates of postburn mental and physical illnesses. Screening and appropriate management of these illnesses is essential when caring for this population.

Background: There is no consensus in the literature regarding the impact of false positive newborn screening results on early health care utilization patterns. We evaluated the impact of false positive newborn screening results for medium-chain acyl-CoA dehydrogenase deficiency (MCADD) in a cohort of Ontario infants., Methods: The cohort included all children who received newborn screening in Ontario between April 1, 2006 and March 31, 2010. Newborn screening and diagnostic confirmation results were linked to province-wide health care administrative datasets covering physician visits, emergency department visits, and inpatient hospitalizations, to determine health service utilization from April 1, 2006 through March 31, 2012. Incidence rate ratios (IRRs) were used to compare those with false positive results for MCADD to those with negative newborn screening results, stratified by age at service use., Results: We identified 43 infants with a false positive newborn screening result for MCADD during the study period. These infants experienced significantly higher rates of physician visits (IRR: 1.42) and hospitalizations (IRR: 2.32) in the first year of life relative to a screen negative cohort in adjusted analyses. Differences in health services use were not observed after the first year of life., Conclusions: The higher use of some health services among false positive infants during the first year of life may be explained by a psychosocial impact of false positive results on parental perceptions of infant health, and/or by differences in underlying health status. Understanding the impact of false positive newborn screening results can help to inform newborn screening programs in designing support and education for families. This is particularly important as additional disorders are added to expanded screening panels, yielding important clinical benefits for affected children but also a higher frequency of false positive findings.

Introduction: Childhood vaccination rates in Manitoba populations with low socioeconomic status (SES) fall significantly below the provincial average. This study examined the impact of a pay-for-performance (P4P) program called the Physician Integrated Network (PIN) on health inequity in childhood vaccination rates., Methods: The study used administrative data housed at the Manitoba Centre for Health Policy. We included all children born in Manitoba between 2003 and 2010 who were patients at PIN clinics receiving P4P funding matched with controls at non-participating clinics. We examined the rate of completion of the childhood primary vaccination series by age 2 across income quintiles (Q1-Q5). We estimated the distribution of income using the Gini coefficient, and calculated concentration indices for vaccination to determine whether the P4P program altered SES-related differences in vaccination completion. We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort., Results: The PIN cohort included 6,185 children. Rates of vaccination completion at baseline were between 0.53 (Q1) and 0.69 (Q5). Inequality in income distribution was present at baseline and at study end in PIN and control cohorts. SES-related inequity in vaccination completion worsened in non-PIN clinics (difference in concentration index 0.037; 95 % CI 0.013, 0.060), but remained constant in P4P-funded clinics (difference in concentration index 0.006; 95 % CI 0.008, 0.021)., Conclusions: The P4P program had a limited impact on vaccination rates and did not address health inequity.

Objectives: To review and synthesize the currently available research on whether early intervention for psychosis programs reduce the use of inpatient services., Methods: A systematic review was conducted using keywords searches on PubMed, Embase (Ovid), PsycINFO (ProQuest), Scopus, CINAHL (EBSCO), Social Work Abstracts (EBSCO), Social Science Citations Index (Web of Science), Sociological Abstracts (ProQuest), and Child Development & Adolescent Studies (EBSCO). To be included, studies had to be peer-reviewed publications in English, examining early intervention programs using a variant of assertive community treatment, with a control/comparison group, and reporting inpatient service use outcomes. The primary outcome extracted number hospitalized and total N. Secondary outcome extracted means and standard deviations. Data were pooled using random effects models. Primary outcome was the occurrence of any hospitalization during treatment. A secondary outcome was the average bed-days used during treatment period., Results: Fifteen projects were identified and included in the study. Results of meta-analysis supported the occurrence of a positive effect for intervention for both outcome measures (any hospitalization OR: 0.33; 95% CI 0.18-0.63, bed-days usage SMD: -0.38, 95% CI -0.53 to -0.24). There was significant heterogeneity of effect across the studies. This heterogeneity is due to a handful of studies with unusually positive responses., Conclusion: These results suggest that early intervention programs are superior to standard of care, with respect to reducing inpatient service usage. Wider use of these programs may prevent the occurrence of admission for patients experiencing the onset of psychotic symptoms., (© The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)

Objective: It has only recently been accepted that attention-deficit hyperactivity disorder (ADHD) persists into adulthood. Accordingly, less is known about adult diagnostic and treatment prevalence. We aimed to determine the lifetime prevalence of ADHD diagnosis and psychostimulant prescriptions for young adults in the province of Manitoba and to explore how diagnosis differs according to sociodemographic characteristics and age at diagnosis; and to investigate whether a socioeconomic gradient exists within young adults with a lifetime ADHD diagnosis, as well as the variables that moderate the gradient., Methods: Using the Manitoba Population Health Research Data Repository, our cross-sectional analysis used 24 fiscal years of data (1984/85 to 2008/09) and included all adults aged 18 to 29 during 2007/08 to 2008/09 in Manitoba (n = 207 544) who had a lifetime diagnosis of ADHD (n = 14 762). Regression analyses tested for differences in rates by sex, region, age, age at diagnosis, and socioeconomic status., Results: Lifetime prevalence for ADHD diagnosis (7.11%) and psychostimulant prescriptions (3.09%) differed according to sex, region, and age. In contrast to previous Manitoban research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was not found in young adulthood. When region was accounted for, a small negative gradient in the urban population and a positive gradient in the rural population were evident. People from the highest income quintile were significantly less likely to be diagnosed before age 18, compared with other income quintiles., Conclusions: Given the high lifetime prevalence of ADHD in Manitoban young adults and significant socioeconomic correlates for diagnosis, further investigation into the trajectory of this relatively unexplored population is recommended.

Background: Few studies have explored predictors of early childhood anxiety., Objective: To determine the prenatal, postnatal, and early life predictors of childhood anxiety by age 5., Methods: Population-based, provincial administrative data (N = 19,316) from Manitoba, Canada were used to determine the association between demographic, obstetrical, psychosocial, medical, behavioral, and infant factors on childhood anxiety., Results: Risk factors for childhood anxiety by age 5 included maternal psychological distress from birth to 12 months and 13 months to 5 years post-delivery and an infant 5-minute Apgar score of ≤7. Factors associated with decreased risk included maternal age < 20 years, multiparity, and preterm birth., Conclusion: Identifying predictors of childhood anxiety is a key step to early detection and prevention. Maternal psychological distress is an early, modifiable risk factor. Future research should aim to disentangle early life influences on childhood anxiety occurring in the prenatal, postnatal, and early childhood periods.

Background: Home visiting programs focused on improving early childhood environments are commonplace in North America. A goal of many of these programs is to improve the overall health of children, including promotion of age appropriate vaccination. In this study, population-based data are used to examine the effect of a home visiting program on vaccination rates in children., Methods: Home visiting program data from Manitoba, Canada were linked to several databases, including a provincial vaccination registry to examine vaccination rates in a cohort of children born between 2003 and 2009. Propensity score weights were used to balance potential confounders between a group of children enrolled in the program (n = 4,562) and those who were eligible but not enrolled (n = 5,184). Complete and partial vaccination rates for one and two year old children were compared between groups, including stratification into area-level income quintiles., Results: Complete vaccination rates from birth to age 1 and 2 were higher for those enrolled in the Families First program [Average Treatment Effect Risk Ratio (ATE RR) 1.06 (95 % CI 1.03-1.08) and 1.10 (95 % CI 1.05-1.15) respectively]. No significant differences were found between groups having at least one vaccination at age 1 or 2 [ATE RR 1.01 (95 % CI 1.00-1.02) and 1.00 (95 % CI 1.00-1.01) respectively). The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile., Conclusions: Home visiting programs have the potential to increase vaccination rates for children enrolled, despite limited program content directed towards this end. Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.

Background & Aims: There have been few population-based studies of health care used by children with inflammatory bowel disease (IBD)., Methods: We identified all children with IBD in the population-based University of Manitoba IBD Epidemiology Database; 651 children with IBD were matched for age, sex, and area of residence with 5950 children without IBD (controls), and followed up for a total of 6419 and 53,875 person-years, respectively. We extracted and analyzed data on IBD type (Crohn's disease vs ulcerative colitis), diagnosis before or after 2002 (era of diagnosis), age, sex, ambulatory care visits and hospitalizations before and after diagnosis, comorbidities, exposure to IBD drugs, and surgeries., Results: Children with IBD were more likely to have visits for gastrointestinal symptoms in each of the 4 years before IBD diagnosis than controls, with no significant effect of era of diagnosis. Children with IBD had more physician encounters for psychosocial diagnoses in the 6 months before or after the IBD diagnosis, as well as in the second year after IBD diagnosis, than controls; 56% of children with IBD were exposed to corticosteroids within the year after their diagnosis, with no decrease over eras of follow-up evaluation. Among children diagnosed from 2002 through 2010, the 8-year actuarial rate of colectomy for those with ulcerative colitis was 8%, and the rate of resective surgery for Crohn's disease was 10%; both of these values were lower than for children diagnosed from 1987 through 2001., Conclusions: In a population-based study from Canada, children with IBD were more likely to have visits for gastrointestinal symptoms in each of the 4 years before IBD diagnosis than children without IBD, indicating a potential delay in diagnosis of this disease. Rates of surgery are decreasing among children with IBD., (Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Introduction: Australian Aboriginal children are more likely than non-Aboriginal children to have developmental vulnerability at school entry that tracks through to poorer literacy and numeracy outcomes and multiple social and health disadvantages in later life. Empirical evidence identifying the key drivers of positive early childhood development in Aboriginal children, and supportive features of local communities and early childhood service provision, are lacking., Methods and Analysis: The study population will be identified via linkage of Australian Early Development Census data to perinatal and birth registration data sets. It will include an almost complete population of children who started their first year of full-time school in New South Wales (NSW), Australia, in 2009 and 2012. Early childhood health and development trajectories for these children will be constructed via linkage to a range of administrative data sets relating to birth outcomes, congenital conditions, hospital admissions, emergency department presentations, receipt of ambulatory mental healthcare services, use of general practitioner services, contact with child protection and out-of-home care services, receipt of income assistance and fact of death. Using multilevel modelling techniques, we will quantify the contributions of individual-level and area-level factors to variation in early childhood development outcomes in Aboriginal and non-Aboriginal children. Additionally, we will evaluate the impact of two government programmes that aim to address early childhood disadvantage, the NSW Aboriginal Maternal and Infant Health Service and the Brighter Futures Program. These evaluations will use propensity score matching methods and multilevel modelling., Ethics and Dissemination: Ethical approval has been obtained for this study. Dissemination mechanisms include engagement of stakeholders (including representatives from Aboriginal community controlled organisations, policy agencies, service providers) through a reference group, and writing of summary reports for policy and community audiences in parallel with scientific papers., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: To determine grade 12 academic performance for children with inflammatory bowel disease (IBD)., Study Design: Children diagnosed with IBD at age<17 years identified from the population-based University of Manitoba IBD Epidemiology Database were matched by age-, sex-, and area of residence to 10 randomly selected controls. Grade 12 educational outcomes (scores on the provincial grade 12 language arts and mathematics standards tests, and enrollment-in-grade-12-by- age-17) were determined by linkage to the province wide Manitoba Education Database. Linear and logistic regression analysis were used to compare the educational outcomes, adjusting for socioeconomic status and comorbidities and evaluate predictors of educational outcomes among children with IBD., Results: Grade 12 educational outcomes among 337 children with IBD were compared with 3093 without IBD. There were no significant differences among the 2 groups in the standardized scores (language arts: P=.31; mathematics: P=.48) or enrollment-in-grade-12-by- age-17 (P=.25). Lower socioeconomic status and diagnosis with mental health problems 6 months prior to and 6 months post-IBD diagnosis were independent predictors of worse educational outcomes. There was no significant effect of age of diagnosis of IBD, type of IBD (ulcerative colitis vs Crohn's disease), use of corticosteroids or immunomodulator agents, hospitalizations, or surgery for IBD., Conclusions: Children with IBD on average achieve similar levels of academic achievement in grade 12 as those without IBD. This study underscores the educational impact of mental health conditions at IBD diagnosis among children., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: Two studies reported an increased risk of autistic disorder in children conceived less than 12 months after a previous birth. Our objective was to examine the association between the interpregnancy interval (IPI) and autism spectrum disorder (ASD) in a Canadian cohort., Methods: Using administrative datasets housed at the Manitoba Centre for Health Policy, we identified pairs of first- and second-born singleton siblings born between 1988 and 2005. Diagnoses of ASD were ascertained by searching physician billing claims, hospital discharge abstracts, education data, and a database containing information on individuals identified for a 2002-2007 ASD surveillance program in Manitoba. Logistic regression models were fit to examine the association between the IPI and ASD in 41,050 second-born siblings where the first-borns did not have ASD, using IPIs of ≥ 36 months as the reference category and specifying three case groups. Case Group 1 included individuals with at least one ASD code (n = 490); Case Group 2 included those with two or more ASD codes (n = 375); and Case Group 3 comprised individuals with a record in the ASD surveillance program database (n = 141)., Results: The adjusted odds ratios (ORs) for IPIs shorter than 12 months ranged from 1.22 (95% CI: 0.91-1.63) for Case Group 1 to 1.72 (95% CI: 0.96-3.06) for Case Group 3. When the case groups were restricted to individuals with more severe ASD, the ORs increased and were significant for Case Groups 1 and 2., Conclusion: Our findings also support an association between short IPIs and more severe ASD.

Background: Few studies have examined the potential of linked administrative data for research on child health. This analysis describes the application of a non-categorical survey-based tool, the Children with Special Health Care Needs (CSHCN) Screener, to administrative data., Data and Methods: Five Screener items were applied to linked administrative health data from Population Data British Columbia. Hospital admissions and demographic and community characteristics for a cohort of children aged 6 to 10 in 2006 were examined to validate the use of these items., Results: Overall, 17.5% of children were identified as CSHCN. An estimated 14% of children used more medical care and 5.2% had more functional limitations than is usual for children of the same age; 3.3% were prescribed long-term medication; 1.9% needed/received treatment or counselling; and 0.1% needed/received special therapy. Boys were more likely than girls to be identified as CSHCN., Interpretation: With some limitations, the CSHCN Screener can be applied to Canadian administrative health data.

Purpose of the Study: This study evaluates a nursing home Fall Management program to see if residents' mobility increased and injurious falls decreased., Design and Methods: Administrative health care use and fall occurrence report data were analyzed from 2 rural health regions in Manitoba, Canada, from June 1, 2003 to March 31, 2008. A quasiexperimental, pre-post, comparison group design was used to compare rates of three outcomes, falls, injurious falls, and falls resulting in hospitalization, by RHA (program vs nonprogram nursing homes) and period (preprogram vs postprogram). Data collectors entered occurrence report information into spreadsheets. This was supplemented with administrative health care use data., Results: The program appears to have benefitted residents-falls trended upward, injurious falls remained stable, and hospitalized falls decreased significantly (0.036-0.021 per person-year [ppy]; p = .043). Compared with nonprogram residents in the postperiod, both groups had the same fall rate, but program residents had significantly fewer injurious falls (0.596-0.746 ppy; p = .02) and hospitalized falls (0.02-0.041 ppy; p = .023)., Implications: These results are among a small body of literature showing that Fall Management was associated with improved outcomes in program nursing homes from pre- to postperiod and compared with nonprogram nursing homes. This research provides some support for the benefits of being proactive and implementing injury prevention strategies universally and pre-emptively before a resident falls, helping to minimize injuries while keeping residents mobile and active. Larger scale research is needed to identify the true effectiveness of the Fall Management program and generalizability of results.

Human and ecosystem health can be damaged by fecal contamination of recreational waters. Microbial source tracking (MST) can be used to specifically detect domestic sewage containing human waste, thereby informing both risk assessment and remediation strategies. Previously, an inter-laboratory collaboration developed standardized PCR methods for a bacterial, an archaeal, and a viral indicator of human sewage. Here we present results for two subsequent years of field testing in fresh and salt water by five laboratories across the U.S. Gulf Coast (two in Florida and one each in Mississippi, Louisiana and Texas) using common standard operating procedures (SOPs) developed previously. Culturable enterococci were enumerated by membrane filtration, and PCR was used to detect three MST markers targeting domestic sewage: human-associated Bacteroides (HF183), Methanobrevibacter smithii and human polyomaviruses BK and JC (HPyVs). Detection of sewage markers in surface waters was significantly associated with higher enterococci levels and with exceedance of the recreational water quality standard in four or three regions, respectively. Sewage markers were frequently co-detected in single samples, e.g., M. smithii and HF183 were co-detected in 81% of Louisiana samples, and HPyVs and M. smithii were co-detected in over 40% of southwest Florida and Mississippi samples. This study demonstrates the robustness and inter-laboratory transferability of these three markers for the detection of pollution from domestic sewage in the waters impacting the Gulf of Mexico over a coastal range of over 1000 miles., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

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., Methods: A retrospective population based cohort of infants born at 34 to 41 weeks of GA was assembled; individual and area-level income was used to develop three socioeconomic (SES) groups. Neonatal morbidity was grouped into respiratory distress syndrome (RDS), other respiratory disorders, other complications of prematurity, admission to a Level II/III nursery and receipt of phototherapy. Regression models were constructed to examine the relationship of GA and SES to neonatal morbidity while controlling for other perinatal variables., Results: The cohort contained 25 312 infants of whom 6.1% (n = 1524) were born preterm and 32.4% (n = 8203) were of low SES. Using 39/40 weeks GA as the reference group there was a decrease in neonatal morbidity at each week of gestation. The odds ratios remained significantly higher at 37 weeks for RDS or other respiratory disorders, and at 38 weeks for all other outcomes. SES had an independent effect, increasing morbidity with odds ratios ranging from 1.2-1.5 for all outcomes except for the RDS group, where it was not significant., Conclusions: The risks of morbidity fell throughout late preterm and early term gestation for both respiratory and non-respiratory morbidity. Low SES was associated with an independent increased risk. Recognition that the morbidities associated with prematurity continue into early term gestation and are further compounded by SES is important to develop strategies for improving care of early term infants, avoiding iatrogenic complications and prioritizing public health interventions.

We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada). One or more child protection agency indicators increased in five of six countries, particularly in infants, possibly as a result of early intervention policies. Comparisons of mean rates between countries showed five-fold to ten-fold differences in rates of agency indicators, but less than two-fold variation in violent deaths or maltreatment-related injury, apart from high rates of violent child death in the USA. These analyses draw attention to the need for robust research to establish whether the high and rising rates of agency contacts and out-of-home care in some settings are effectively reducing child maltreatment., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Few population studies have examined the psychiatric outcomes of children and adolescents in the child welfare system, and no studies have compared outcomes before and after entry into care. Our objective was to assess the relative rate (RR) of suicide, attempted suicide, admission to hospital and visits to physicians' offices among children and adolescents in care compared with those not in care. We also examined these outcomes within the child welfare population before and after entry into care., Methods: We used population-level data to identify children and adolescents 5 to 17 years of age who were in care in Manitoba for the first time between Apr. 1, 1997, and Mar. 31, 2006, and a comparison cohort not in care. We compared the two cohorts to obtain RRs for the specified outcomes. We also determined RRs within the child welfare population relative to the same population two years before entry into care., Results: We identified 8279 children and adolescents in care for the first time and a comparison cohort of 353 050 children and adolescents not in care. Outcome rates were higher among those in care than in the comparison cohort for suicide (adjusted RR 3.54, 95% confidence interval [CI] 2.11-5.95), attempted suicide (adjusted RR 2.11, 95% CI 1.84-2.43) and all other outcomes. However, adjusted RRs for attempted suicide (RR 0.27, 95% CI 0.21-0.34), admissions to hospital and physician visits decreased after entry into care., Interpretation: Children and adolescents in care were at greater risk of suicide and attempting suicide than those who were not in care. Rates of suicide attempts and hospital admissions within this population were highest before entry into care and decreased thereafter.

Introduction: Adverse events (AEs) occur frequently in nursing homes (NHs). Although the literature identifies several AE risk factors, the effect of resident transition on AE risk is less well defined. This article is the first to describe how AE risk varies across several NH transition periods and to define the most vulnerable junctures of an NH stay., Methods: This research was conducted on the population of NH residents in Manitoba, Canada, from April 1, 1999, to March 31, 2004. AEs were captured using physician-based diagnostic claims for hip fractures, other fractures, hospitalized falls, skin ulcers, and respiratory infections. AE rates were compared across several transition periods (eg, following first NH admission from hospital versus elsewhere, after NH transfer, and preceding resident death), before and after adjustment for several resident demographic, clinical, and facility-level factors., Results: Although residents (n = 22,846) spent only 6.6% of all NH days in transition, between 15.3% (skin ulcers) and 27.8% (respiratory infections) of AEs occurred during these times. Except following NH transfers, adjusted AE rates were consistently higher during all transition versus nontransition periods. Among transition periods, adjusted hip fractures, hospitalized falls, and respiratory infections were most strongly associated with resident death. Adjusted skin ulcer and non-hip fracture rates were equally highest during "pre-death" and for new residents admitted from hospital., Conclusions: This article is the first to identify the most vulnerable times of a NH stay. For newly admitted residents, our results also show that previous exposure to a hospital environment, and not simply resident illness, at least partially contributes to increased AE risk. This and additional evidence can help clinicians and administrators to better identify periods of high risk for NH residents, and also to develop more targeted care improvement strategies. More robust and frequently obtained measures of resident illness are required to further examine these issues in more detail., (Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

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. Routinely collected data from the Ministries of Health, Education, and Family Services and Consumer Affairs have been integrated with a population registry., Findings: 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., Conclusions: 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., (© 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.)

Hollow-fiber ultrafiltration (HFUF) and PCR were combined to detect human-associated microbial source tracking marker genes in large volumes of fresh and estuarine Florida water. HFUF allowed marker detection when membrane filtration did not, demonstrating HFUF's ability to facilitate detection of diluted targets by PCR in a variety of water types.

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). Predictors were 3 routinely assessed biologic risks (birth weight, gestational age, and Apgar score) and 3 prominent social factors (mother's age, parent marital status, and socioeconomic status). Outcomes were childhood hospitalization and passage of a required high school examination. Analyses included logistic regression, measures of accuracy, and population attributable risk percent (PAR%)., Results: Biologic and social risk factors were associated with similarly steep poor outcomes gradients. Social risk factors had similar, and in some cases stronger, measures of association and accuracy. Using biologic risk criteria alone misclassified as low-risk 65% of cohort children who had high rates of later hospitalization and examination failure. PAR% associated with social risk factors exceeded biologic risk factors in most cases (eg, hospitalization PAR% = 4.4 for offspring of teen mothers vs. 1.7 for low birth weight)., Conclusions: In a population-based sample of infants followed-up through adolescence, early social risk factors were as threatening as, and more common than, routinely documented biologic risks-frequently identifying otherwise-unrecognized at-risk children. These findings together suggest that rigorous evaluation of social factors should be made a routine part of clinical assessment to more comprehensively and accurately identify infants at risk for later serious health problems and academic failure.

Water quality is frequently impacted by microbial pollution from human and animal feces. Microbial source tracking (MST) can identify dominant pollution sources and improve assessment of health risk compared to indicator bacteria alone. This study aims to standardize and validate MST methods across laboratories in coastal Gulf of Mexico states. Three laboratories evaluated library-independent MST methods for human sewage detection via conventional PCR: (1) human-associated Bacteroidales, (2) human polyomaviruses (HPyVs), and (3) Methanobrevibacter smithii. All methods detected targets in human sewage seeded into buffer, freshwater or marine water (100% sensitivity). The limit of detection (LOD) for human sewage was lowest for the Bacteroidales assay (10(-5)-10(-6) dilution). LODs for HPyVs and M. smithii assays were similar to each other (10(-3)-10(-4)), but were higher than Bacteroidales. The HPyVs assay was 100% specific, showing no cross-reactivity to dog, cow, cat, bird, or wild animal feces among >300 samples from three Gulf Coast regions. The human Bacteroidales assay was 96% specific, but cross-reacted with 10% of dog and some chicken samples. The M. smithii assay was 98% specific with limited cross-reactivity with cow, dog and seagull samples. An experts' workshop concluded that all methods showed sufficient accuracy and reliability to move forward. SOPs will be distributed to collaborating laboratories for further inter-laboratory comparison, and field validation will occur in year 2.

Objective: We used population-based administrative prescription medication data to examine regional differences in psychostimulant and antidepressant (AD) use among children from 2 Canadian provinces: British Columbia (BC) and Manitoba (MB)., Method: Using 1997 to 2003 prescription data, annual rates of psychostimulant and AD use were determined for children aged 19 years and under in both provinces. Further comparisons of rates were made according to sex, age group, and specific classes of dispensed medications., Results: During 1997 to 2003, psychostimulant use rose by 44.9% in MB and 13.3% in BC. Among male children, psychostimulant use increased by 40.2% in MB, compared with an increase of only 8.6% in BC. AD utilization was similar between provinces, with increases of 80% and 75% in MB and BC, respectively. In both provinces, AD use was highest among older children., Conclusions: Our observations of regional variation in psychotropic medication use potentially reflect provincial differences in drug benefit policies, disease prevalence, and (or) physician diagnosis and treatment.

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. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed.

The effect of a stormwater conveyance system on indicator bacteria levels at a Florida beach was assessed using microbial source tracking methods, and by investigating indicator bacteria population structure in water and sediments. During a rain event, regulatory standards for both fecal coliforms and Enterococcus spp. were exceeded, contrasting with significantly lower levels under dry conditions. Indicator bacteria levels were high in sediments under all conditions. The involvement of human sewage in the contamination was investigated using polymerase chain reaction (PCR) assays for the esp gene of Enterococcus faecium and for the conserved T antigen of human polyomaviruses, all of which were negative. BOX-PCR subtyping of Escherichia coli and Enterococcus showed higher population diversity during the rain event; and higher population similarity during dry conditions, suggesting that without fresh inputs, only a subset of the population survives the selective pressure of the secondary habitat. These data indicate that high indicator bacteria levels were attributable to a stormwater system that acted as a reservoir and conduit, flushing high levels of indicator bacteria to the beach during a rain event. Such environmental reservoirs of indicator bacteria further complicate the already questionable relationship between indicator organisms and human pathogens, and call for a better understanding of the ecology, fate and persistence of indicator bacteria.

This study compared tonsillectomy rates for Manitoba children across geographic regions and over time. Shortly after the publication of clinical guidelines for tonsillectomy, provincial rates of this procedure dropped by over 25% between 1994/95 and 1996/97. By 1998/99, rates for non-Winnipeg children had increased to pre-guideline levels, whereas the rates for Winnipeg children remained lower. Significant regional variation existed in all years examined, suggesting that quality of care remains an issue for this procedure.

Background: Injury is the leading cause of death among Canadian children between 1 and 19 years, and accounts for one sixth of all hospitalizations of children between 0 and 19 years. We examined the causes of injury in Manitoba children, and the relationship between injury rates and region of residence, premature mortality rate (PMR), and income., Methods: Regional differences in injury death and hospitalization rates, and causes of injury were derived from the Population Health Research Data Repository. The relationship between injury rates and area income levels was assessed and correlations between regional premature mortality rates (PMR) and injury rates were calculated., Results: Motor vehicle crashes were the leading cause of injury mortality. Falls were the leading cause of injury hospitalization. Regional differences were substantial. Rural-urban differences in injury rates were pronounced; northern Manitoba's rates were very high compared to the rest of the province. Regional PMR values correlated significantly with injury mortality and hospitalization rates. Both types of injury rates correlated significantly with income; higher injury rates were associated with lower income levels., Conclusion: Injuries are not random events, but are related to social factors.

Objective: The description of regional variation in children's health requires regional population-based context. But what is the best way to measure the health of a region's population?, Methods: The use of two indicators is described--one a health status measure and the other a measure of socioeconomic wellbeing. It is well known that the population's premature mortality rate (PMR), the age/sex-adjusted rate of death before age 75 years, is highly related to overall health status of an area's residents. Socioeconomic characteristics of an area's residents are also indicative (and likely causative) of health status differences., Results: The Socioeconomic Factor Index (SEFI) was developed at the Manitoba Centre for Health Policy, using a Principal Components Analysis of census data. PMR and SEFI are highly correlated (Spearman's correlation coefficient r = 0.85, p < 0.0001)., Conclusion: PMR can be used as a surrogate measure for both the health status and socioeconomic well-being of regional populations in Manitoba.

Objective: This paper describes the population-based analyses of measures of child health status used throughout this supplement., Methods: The articles in this supplement examine health-related data for children 0 to 19 years. Most analyses cover the period from April 1, 1994 to March 31, 1999. Administrative and survey data were used to assess child health and well-being. For regional comparisons, data were broken down by subregions of Manitoba, called Regional Health Authorities (RHAs), and neighbourhoods of Winnipeg, called Winnipeg Community Areas (Winnipeg CAs). The premature mortality rate (PMR) was used as a proxy of the overall health of the population. All graphs comparing rates among RHAs and Winnipeg CAs rank these subregions in the same order, from lowest to highest PMR. Income was operationalized by dividing the province's population into urban and rural quintiles based upon household income. Other aspects of methodology are discussed., Results: Results are presented in the articles that follow this one., Conclusion: The relationships between key child health indicators and geographic and socioeconomic factors for Manitoba children are discussed in the articles following this one.

Objective: To compare physician and hospital utilization rates by children across subregions of Manitoba., Methods: 1998/99 data for physician visits and hospitalizations for children aged 0 to 19 were extracted from the Population Health Research Data Repository. Rates of utilization were compared across 12 regions (RHAs) within Manitoba, and 12 community areas within Winnipeg. Rates were also compared across premature mortality rates (PMR) and area income levels., Results: Substantial regional variation was found for utilization rates. The hospitalization rate for children from the three northern RHAs (highest PMRs) (114/1000) was almost four times the Winnipeg rate (30/1000) and almost double the rate for the rural south RHAs (lowest PMRs) (59/1000). The variation among regions in physician visits ranged from under 2 visits in 2 of the northern RHAs to almost 4 visits in urban areas. However, the low visit rates in rural RHAs are offset somewhat by greater use of nurses. Hospitalizations and physician visits were also related to area income level., Conclusion: Findings are discussed in terms of health care need.

Background: Life history studies in health show that some of the key determinants of health inequalities lie in biological and social experiences at the earliest times of life. The objectives of this research were to describe the regional distribution of childhood determinants of adult health, such as school achievement, and the environments which contribute to their development., Methods: Using Manitoba data from the National Population Health Survey, the National Longitudinal Survey on Children and Youth, the Department of Education, Training and Youth, the Department of Family Services and Housing, the Library Association website and the Agriculture and Food website, the regional distribution of Grade 3 standards test scores and neighbourhood resources such as child care services, libraries, sports participation and food costs were determined for 12 Regional Health Authorities and 12 Winnipeg Community Areas, ranked by a measure of population healthiness, the premature mortality rate. Findings were also reported by income level and larger geographic regions., Results: Children living in neighbourhoods with less healthy populations were more likely to have poorer school performance, as indicated by Grade 3 math standards test scores. They were-also more likely to change schools, less likely to participate in sports, and had decreased access to affordable food and licenced day care. They had similar access to library books as children living in more healthy neighbourhoods, although book lending rates were not measured., Conclusion: We documented regional variation in the availability of resources to support healthy childhood development.

Vancomycin-resistant Enterococcus spp. (VRE) were isolated from sewage and chicken feces but not from other animal fecal sources (dog, cow, and pig) or from surface waters tested. VRE from hospital wastewater were resistant to > or =20 microg of vancomycin/ml and possessed the vanA gene. VRE from residential wastewater and chicken feces were resistant to 3 to 5 microg of vancomycin/ml and possessed the vanC gene.

Unlabelled: During the past several years, budget cuts have forced hospitals in several countries to change the way they deliver care. Gilson (Gilson, L. (1998)., Discussion: In defence and pursuit of equity. Social Science & Medicine, 47(12), 1891-1896) has argued that, while health reforms are designed to improve efficiency, they have considerable potential to harm equity in the delivery of health care services. It is essential to monitor the impact of health reforms, not only to ensure the balance between equity and efficiency, but also to determine the effect of reforms on such things as access to care and the quality of care delivered. This paper proposes a framework for monitoring these and other indicators that may be affected by health care reform. Application of this framework is illustrated with data from Winnipeg, Manitoba, Canada. Despite the closure of almost 24% of the hospital beds in Winnipeg between 1992 and 1996, access to care and quality of care remained generally unchanged. Improvements in efficiency occurred without harming the equitable delivery of health care services. Given our increasing understanding of the weak links between health care and health, improving efficiency within the health care system may actually be a prerequisite for addressing equity issues in health.

Objectives: In this project we assessed the impact of 1992 budget cuts ($50 million, or approximately 7% of urban hospitals' budgets) on the relative costliness of Manitoba's hospitals. The cuts targeted the teaching hospitals, those institutions we had found to be particularly costly in a previous Manitoba Centre for Health Policy and Evaluation study., Results: Unexpectedly, we found that because budget cuts were smaller proportionately than the number of beds closed, the care at the teaching hospitals (as well as at several other hospitals) became relatively more, not less, costly. Also quite contrary to public perceptions, once other expenditures such as new hospital programs and expansions were accounted for, the actual change in urban hospital expenditures over the years compared was less than 1%., Conclusions: The study highlighted the importance of monitoring program outcomes.

Objective: To determine if DNA ploidy, hormone receptors, vascular space invasion (VSI), perivascular lymphocytes (PVL), and the oncogenes HER-2/neu, p53, and bcl-2 are independent prognostic indicators for lymph node metastasis and cancer recurrence in clinical stage I endometrial carcinoma., Methods: Among 349 patients with clinical stage I endometrial cancer 31 patients either had lymph node metastases when surgically staged or developed recurrent cancer. Using a case-control matched-pair technique, controls were selected for each of 24 cases by matching for age, histological grade, depth of myometrial invasion, performance of node dissection, and use of adjuvant radiation therapy. In a blinded fashion a pathologist reviewed all histopathology, and all molecular tests were performed on paraffin-embedded tissue samples. Statistical analysis was performed by chi2 and McNemar's tests., Results: VSI was the only histopathological factor significantly related to positive lymph nodes and cancer recurrence (P = 0.01), independent of grade and myometrial invasion. Aneuploidy, oncogene expression (p53, HER-2/neu, bcl-2), and hormone receptors were not significantly related to lymph node metastasis and cancer recurrence., Conclusions: The presence of vascular space invasion is a pathological factor independently associated with a risk of nodal metastasis and cancer recurrence in clinical stage I endometrial cancer. DNA ploidy, oncogene expression, and hormone receptor status do not have more predictive value than standard staging pathological criteria., (Copyright 1997 Academic Press.)

In canada, health care is publicly insured and available to all at no charge. Recently, financial pressures have threatened the system and led to considerable debate about how to save it. One proposal is to permit privately funded health care alongside the public system, resulting in what is popularly called a two-tiered system. This paper presents some of the arguments for and against two-tiered health care. Using as an example cataract surgery-a procedure that is available both publicly and privately-the authors look at some common beliefs about private health care in Canada. They conclude that the growth in private sector cataract surgery does not appear to be related to cutbacks or rationing, that private access does not necessarily shorten waiting times, and that, contrary to popular belief, it is not only the well-to-do who pay for private surgery in Canada.

Objective: To determine whether decreasing lengths of stay over time for selected diagnostic categories were associated with increased hospital readmission rates and mean number of physician visits after discharge., Design: Retrospective descriptive study., Setting: The seven large (125 beds or more) acute care hospitals in Winnipeg., Patients: Manitoba residents admitted to any one of the seven hospitals because acute myocardial infarction (AMI), bronchitis or asthma, transurethral prostatectomy (TURP) and uterine or adnexal procedures for nonmalignant disease during the fiscal years 1989-90 to 1992-93. Patients from out of province, those who died in hospital, those with excessively long stays (more than 60 days) and those who were transferred to or from another institution were excluded., Outcome Measures: Length of hospital stay, and rate of readmission within 30 days after discharge for all four categories and mean number of physician visits within 30 days after discharge for two categories (AMI and bronchitis or asthma., Results: The length of stay decreased significantly over the 4 years for all of the four categories, the smallest change being observed for patients with AMI (11.1%) and the largest for those with bronchitis or asthma (22.0%). The readmission rates for AMI, bronchitis or asthma, and TURP showed no consistent change over the 4 years. The readmission rate for uterine or adnexal procedures increased significantly between the first and second year (chi 2 = 4.28, p = 0.04) but then remained constant over the next 3 years. The mean number of physician visits increased slightly for AMI in the first year (1.92 to 2.01) and then remained virtually the same. It decreased slightly for bronchitis or asthma over the 4 years. There was no significant correlation between length of stay and readmission rates for individual hospitals in 1992-93 in any of the four categories. Also, no correlation was observed between length of stay and mean number of physician visits for individual hospitals in 1992-93 in the categories AMI and bronchitis or asthma., Conclusions: Improving hospital efficiency by shortening length of stay does not appear to result in increased rates of readmission or numbers of physician visits within 30 days after discharge from hospital. Research is needed to identify optimal lengths of stay and expected readmission rates.

Objective: To examine the efficiency of Manitoba hospitals by analysing variations in length of stay for patients with similar characteristics., Design: Retrospective study. Multiple regression analyses were used to adjust for patient (case-mix) characteristics and to identify differences in length of stay attributable to the hospital of admission for 14 specific, frequently encountered diagnostic categories and for all acute admissions., Setting: The eight major acute care hospitals in Manitoba., Participants: Manitoba residents admitted to any one of the eight hospitals during the fiscal year 1989-90, 1990-91 or 1991-92. Patients transferred to or from another institution, those with atypically long stays and those who died in hospital were excluded., Outcome Measure: Length of hospital stay., Results: The length of stay was strongly influenced by hospital of admission, even after adjustment for key patient characteristics. Excluding the most seriously ill patients and those with the longest stays, approximately 186 beds could potentially have been saved if each hospital had discharged its patients as efficiently as the hospital with the shortest overall length of stay., Conclusions: A substantial proportion of days currently invested in treating acute care patients could be eliminated. At least some bed closures in Manitoba hospitals could be accommodated simply through more efficient treatment of patients in the remaining beds, without decreasing access to hospital care.

The Manitoba Centre for Health Policy and Evaluation (MCHPE) is a university-based centre funded by the provincial government to provide analyses for use in policy development and management of the health care system. At the government's request, the MCHPE undertook an analysis of bed use in the major hospitals in the province. This article reviews the formulation, execution and delivery of the project to illustrate how health services researchers, administrative data and key actors in the health care system can interact in the policy process.

A gene has been described, Ped (Preimplantation embryo development), that influences the rate of cleavage of preimplantation mouse embryos. Previous studies of linkage of Ped gene phenotype (fast or slow embryo development) and H-2 haplotype (H-2b or H-2k) in backcross embryos from the C57BL/10Sn and B10.BR congenic strains have shown that the Ped gene is located in the H-2 complex, the major histocompatibility complex (MHC) of the mouse. The present study was undertaken to localize the Ped gene to a particular subregion of the H-2 complex. Analysis of the B6.K1 and B6.K2 congenic strains, which differ at only the Q subregion of the MHC, was undertaken to test whether the Ped gene is located in the Q subregion of the MHC. Qa-2 antigen expression was used as a marker for the Q subregion and fast or slow development was used to assess Ped gene phenotype in backcross embryos generated from the mating of (B6.K1 x B6.K2)F1 and B6.K1 mice. The results showed linkage of Ped gene phenotype and Qa-2 antigen expression, which strongly supports the idea that the Ped gene is located in the Q subregion of the MHC. In a further set of experiments, litter size and weight were investigated in the B6.K1 and B6.K2 mice. Pure line and reciprocal crosses were made using sires and dams of both the B6.K1 and B6.K2 genotypes. Traits measured on pups included birth weight, weaning weight and weight per day of age from birth to weaning. Litter traits measured were number born and weaned and survivability. Sex effects existed for weaning weight and weight gain per day of age. Males gained more and were heavier than female pups (P less than 0.05). Pups whose sire or dam were B6.K2 were significantly (P less than 0.05) heavier at birth than those pups whose sire or dam were B6.K1, and B6.K2 homozygous pups were significantly (P less than 0.001) heavier than all others. Litters whose dams were B6.K2 had significantly more pups at birth (P less than 0.05) than those litters whose dams were B6.K1. Results suggest that pups that are heterozygous or homozygous B6.K2 are more apt to be heavier at birth and be in larger litters suggesting that genes in the Q region of the H-2 complex are advantageous to reproductive performance.

We have recently treated three patients who developed a non-Hodgkin's lymphoma after therapy with radiation alone for Hodgkin's disease. The secondary non-Hodgkin's lymphomas occurred 4 years (two patients) and 11.5 years after receiving irradiation. Thirteen additional cases have been reported and are reviewed with attention to the subsequent histology and response to treatment of these secondary non-Hodgkin's lymphomas. The pathogenesis is unknown, but, may be therapy-related or part of the natural history of the lymphocyte predominance subtype of Hodgkin's disease. Possible mechanisms will be discussed. A subset of the patients with secondary lymphomas following radiation therapy alone are curable with chemotherapy. New sites of disease after apparent control of Hodgkin's disease require pathology for confirmation of the disease process and appropriate therapy.

The Hughes liquid crystal light valve (LCLV) has been evaluated for its applicability in writing and reading binary phase-only filters (BPOFs) in optical correlators. Experimental measurements of relevant performance characteristics of the LCLV as well as experimental results demonstrating its use for reconstructing BPOF's are reported. We also find that this device allows a significant optical system throughput. In addition, we discuss generation of the BPOF with a MacIntosh computer system.