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Introduction: Osteoporosis is a bone disease that results in morbidity, mortality, and high healthcare cost. Glucocorticoid (GC) therapy is the most common cause of secondary osteoporosis. The use of aromatase inhibitors (AI) in postmenopausal women results in increases in bone loss of up to 2.5 times. A fracture may be the only clinical manifestation of osteoporosis, hence screening in terms of bone mineral density (BMD) testing to identify those requiring treatment and initiation of osteoporotic treatment when indicated are important steps in the management of the disease. Objective: Assess rates of receipt of BMD tests, and treatment of osteoporosis, and their trends over time in two separate cohorts of high-dose GC users and female breast cancer patients on AI. Method: Administrative healthcare data was used to conduct a retrospective population-based cohort study of individuals ≥ 40 years of age on GC, and AI between 1997 and 2017. BMD test, and treatment rates, trends over time, and prescribing physician specialties were assessed. Results: Both BMD testing and treatment rates were low (4.4% and 9.1%, respectively) in our cohort of high-dose GC users (n = 49,753). Treatment rates remained stable and below 17.0% throughout the 20-year study period between1997 and 2017, in the cohort of AI users (n= 6,726), while BMD test rates increased dramatically from 9.8% at the beginning of the study to 61.8% by the end of the study. For the GC cohort, treatment rates increased from 3.9% at the beginning of the study, to 15.0% in 2003, decreasing steadily thereafter to 6.8% by the end of the study. The majority of the first prescriptions for high-dose GC (74.2%) and AI (53.7%) were written by general practitioners and oncologists, respectively. Conclusion: Although BMD testing rates increased substantially in AI users over the 20-years study span, and FRAX score analysis showed that individuals most at risk had the highest treatment rates in both high-dose GC and AI users

Introduction: Osteoporosis is a bone disease that results in morbidity, mortality, and high healthcare cost. Glucocorticoid (GC) therapy is the most common cause of secondary osteoporosis. The use of aromatase inhibitors (AI) in postmenopausal women results in increases in bone loss of up to 2.5 times. A fracture may be the only clinical manifestation of osteoporosis, hence screening in terms of bone mineral density (BMD) testing to identify those requiring treatment and initiation of osteoporotic treatment when indicated are important steps in the management of the disease. Objective: Assess rates of receipt of BMD tests, and treatment of osteoporosis, and their trends over time in two separate cohorts of high-dose GC users and female breast cancer patients on AI. Method: Administrative healthcare data was used to conduct a retrospective population-based cohort study of individuals ≥ 40 years of age on GC, and AI between 1997 and 2017. BMD test, and treatment rates, trends over time, and prescribing physician specialties were assessed. Results: Both BMD testing and treatment rates were low (4.4% and 9.1%, respectively) in our cohort of high-dose GC users (n = 49,753). Treatment rates remained stable and below 17.0% throughout the 20-year study period between1997 and 2017, in the cohort of AI users (n= 6,726), while BMD test rates increased dramatically from 9.8% at the beginning of the study to 61.8% by the end of the study. For the GC cohort, treatment rates increased from 3.9% at the beginning of the study, to 15.0% in 2003, decreasing steadily thereafter to 6.8% by the end of the study. The majority of the first prescriptions for high-dose GC (74.2%) and AI (53.7%) were written by general practitioners and oncologists, respectively. Conclusion: Although BMD testing rates increased substantially in AI users over the 20-years study span, and FRAX score analysis showed that individuals most at risk had the highest treatment rates in both high-dose GC and AI users

Emergency Department (ED) usage among people who are homeless is higher than in the general population; however, myths regarding people who are homeless inappropriately using the ED are present in public and scholarly discourse. Further, minimal research has investigated ED use among those who are homeless in a Canadian context, or regarding how those who are homeless understand the role of the ED in their healthcare. Study 1 explores the question of which factors predict ED use among people who are homeless in a Canadian sample. Participants (n = 483) from a local, longitudinal Housing First demonstration project consented to the linkage of their survey responses regarding housing, health and social service use to the provincial administrative health data repository. Predictor relationships were analyzed using negative binomial longitudinal mixed modelling. In the full model ED visits were positively and reliably predicted by Indigenous ancestry, high needs mental illness, pre-baseline ED use, and concurrent increased social assistance, primary care visits, ratings of physical health, substance use problems and case management visits. Study 2 addresses the question of how participants understand the role of the ED in their healthcare and day-to-day lives. A subset of participants from Study 1 were recruited (n = 16) to participate in semi-structured interviews regarding their ED stories and experiences. Interviews were analyzed using narrative analysis. Set within the context of narratives of disempowerment, participants storied the ED in differing ways. The findings indicate that participants understand the ED to be a public, accessible space where they could exert agency in obtaining necessary healthcare. ED narratives were also paradoxical, storying it as a fixed place of transient care in their transient lives; as a result, they were isolated, and yet belonged. Each study is accompanied by a discussion of the implications of their respective findings. The thesi

Emergency Department (ED) usage among people who are homeless is higher than in the general population; however, myths regarding people who are homeless inappropriately using the ED are present in public and scholarly discourse. Further, minimal research has investigated ED use among those who are homeless in a Canadian context, or regarding how those who are homeless understand the role of the ED in their healthcare. Study 1 explores the question of which factors predict ED use among people who are homeless in a Canadian sample. Participants (n = 483) from a local, longitudinal Housing First demonstration project consented to the linkage of their survey responses regarding housing, health and social service use to the provincial administrative health data repository. Predictor relationships were analyzed using negative binomial longitudinal mixed modelling. In the full model ED visits were positively and reliably predicted by Indigenous ancestry, high needs mental illness, pre-baseline ED use, and concurrent increased social assistance, primary care visits, ratings of physical health, substance use problems and case management visits. Study 2 addresses the question of how participants understand the role of the ED in their healthcare and day-to-day lives. A subset of participants from Study 1 were recruited (n = 16) to participate in semi-structured interviews regarding their ED stories and experiences. Interviews were analyzed using narrative analysis. Set within the context of narratives of disempowerment, participants storied the ED in differing ways. The findings indicate that participants understand the ED to be a public, accessible space where they could exert agency in obtaining necessary healthcare. ED narratives were also paradoxical, storying it as a fixed place of transient care in their transient lives; as a result, they were isolated, and yet belonged. Each study is accompanied by a discussion of the implications of their respective findings. The thesi

Emergency Department (ED) usage among people who are homeless is higher than in the general population; however, myths regarding people who are homeless inappropriately using the ED are present in public and scholarly discourse. Further, minimal research has investigated ED use among those who are homeless in a Canadian context, or regarding how those who are homeless understand the role of the ED in their healthcare. Study 1 explores the question of which factors predict ED use among people who are homeless in a Canadian sample. Participants (n = 483) from a local, longitudinal Housing First demonstration project consented to the linkage of their survey responses regarding housing, health and social service use to the provincial administrative health data repository. Predictor relationships were analyzed using negative binomial longitudinal mixed modelling. In the full model ED visits were positively and reliably predicted by Indigenous ancestry, high needs mental illness, pre-baseline ED use, and concurrent increased social assistance, primary care visits, ratings of physical health, substance use problems and case management visits. Study 2 addresses the question of how participants understand the role of the ED in their healthcare and day-to-day lives. A subset of participants from Study 1 were recruited (n = 16) to participate in semi-structured interviews regarding their ED stories and experiences. Interviews were analyzed using narrative analysis. Set within the context of narratives of disempowerment, participants storied the ED in differing ways. The findings indicate that participants understand the ED to be a public, accessible space where they could exert agency in obtaining necessary healthcare. ED narratives were also paradoxical, storying it as a fixed place of transient care in their transient lives; as a result, they were isolated, and yet belonged. Each study is accompanied by a discussion of the implications of their respective findings. The thesi

Objective: Although many children are placed in care of child protection services each year, very little is known about how having a child placed in care affects the health and well-being of biological mothers. This study aims to address this gap in knowledge. Methods: The linkable administrative data housed at the Manitoba Centre for Health Policy were used to create several cohorts of mothers whose children were born in Manitoba, Canada, identified through child protection case files. Maternal health and social outcomes in the years before and after having a child taken into care were compared using generalized estimating equations. Poisson regression models were used to obtain relative rates of mental health-related outcomes for mothers whose children were taken into care and mothers whose children died. Incidence rate ratios of suicide attempts and completions were obtained using fixed-effects Poisson regression models. Finally, Cox proportional hazard regression models determined rates of avoidable and unavoidable mortality among mothers whose children were taken into care. Results: Compared with mothers whose children were not placed in care, mothers whose children were taken into care have significantly higher rates of anxiety, substance use, physician visits, hospitalizations, prescriptions, and income assistance use in the years before their children were taken into care; rates increased significantly in the years after. These mothers also had significantly higher rates of depression, anxiety, substance use, physician visits for mental illness, hospitalizations for mental illness, and psychotropic medication use in the years after custody loss compared with mothers who experienced the death of a child. Rates of suicide attempts, death by suicide, avoidable mortality and unavoidable mortality were also higher among mothers whose child was taken into care. Conclusion: Mothers whose children are taken into care often face many challenges in the years leading u

Introduction: Oral cancer therapy has more than doubled in the past 10 years and all indications are that the pipeline of new and emerging cancer therapies continues to include a higher percentage of oral drugs. With the increased availability of oral oncology products, patients can have access to their medications in community pharmacies and avoid the burden of travel and waiting time in cancer clinics or hospitals. However, this shift in care may also pose some challenges such as adherence to the treatment, safe use of the oncology products and increased costs to patients and the health care system. This study examined the impact of this shift to greater use of oral chemotherapy, looking at adherence, drug interaction management and cost through a series of health policy changes. Methods: Administrative health data between April 1, 2000 and March 31, 2015 from the Manitoba Centre for Health Policy Repository were used for this study. Dispensation records were used to assess drug utilization, measure adherence, analyze drug interactions and calculate medication costs. Results: Adherence was examined using imatinib as the case example. High levels of adherence (>90%) were found throughout the study period regardless of insurance coverage. The clinically important drug interaction between tyrosine kinase inhibitors and proton pump inhibitors was assessed for medication provided by community pharmacies. Over 1/3 of patients received these interacting drugs together with little evidence of interventions to manage this interaction. During the study period, the cost of oral oncology medications rose more than 7 fold from $2,682,805 to $21,311,652, with increases in the rate of prescribing (20 to 29 per 1000 people) and increases in the cost of oncology prescriptions ($113 to $549 per prescription). Conclusion: Although oral therapy provides advantages and greater flexibility for cancer patients which is reflected in a high degree of adherence, additional policy reform an

Background: The use of benzodiazepines and z-drugs remains controversial given their potential for misuse and harm. Investigation of their use in Manitoba remains important for monitoring and improving prescribing patterns. Methods: Administrative data was used to conduct i) drug utilization study from 2001-2016, and ii) incident-user cohort study of patients with anxiety/insomnia. Results: i) Z-drug use increased on all measures while only dose intensity increased for benzodiazepines. Higher utilization occurred among females and those ≥65 years. ii) The proportion of patients who became long-term users (>6months) in their first episode of use ranged from 4.5-9.6%. Males, older age, socioeconomically deprived, use of opioids or psychotropic agents, and poor physical health, were associated with long-term use. Conclusion: While less than one in 10 were considered a long-term user of these agents, further investigation into whether specific factors associated with long-term use requires consideration during the prescribing of these agents is warranted.

Objective: Although many children are placed in care of child protection services each year, very little is known about how having a child placed in care affects the health and well-being of biological mothers. This study aims to address this gap in knowledge. Methods: The linkable administrative data housed at the Manitoba Centre for Health Policy were used to create several cohorts of mothers whose children were born in Manitoba, Canada, identified through child protection case files. Maternal health and social outcomes in the years before and after having a child taken into care were compared using generalized estimating equations. Poisson regression models were used to obtain relative rates of mental health-related outcomes for mothers whose children were taken into care and mothers whose children died. Incidence rate ratios of suicide attempts and completions were obtained using fixed-effects Poisson regression models. Finally, Cox proportional hazard regression models determined rates of avoidable and unavoidable mortality among mothers whose children were taken into care. Results: Compared with mothers whose children were not placed in care, mothers whose children were taken into care have significantly higher rates of anxiety, substance use, physician visits, hospitalizations, prescriptions, and income assistance use in the years before their children were taken into care; rates increased significantly in the years after. These mothers also had significantly higher rates of depression, anxiety, substance use, physician visits for mental illness, hospitalizations for mental illness, and psychotropic medication use in the years after custody loss compared with mothers who experienced the death of a child. Rates of suicide attempts, death by suicide, avoidable mortality and unavoidable mortality were also higher among mothers whose child was taken into care. Conclusion: Mothers whose children are taken into care often face many challenges in the years leading u

Introduction: Oral cancer therapy has more than doubled in the past 10 years and all indications are that the pipeline of new and emerging cancer therapies continues to include a higher percentage of oral drugs. With the increased availability of oral oncology products, patients can have access to their medications in community pharmacies and avoid the burden of travel and waiting time in cancer clinics or hospitals. However, this shift in care may also pose some challenges such as adherence to the treatment, safe use of the oncology products and increased costs to patients and the health care system. This study examined the impact of this shift to greater use of oral chemotherapy, looking at adherence, drug interaction management and cost through a series of health policy changes. Methods: Administrative health data between April 1, 2000 and March 31, 2015 from the Manitoba Centre for Health Policy Repository were used for this study. Dispensation records were used to assess drug utilization, measure adherence, analyze drug interactions and calculate medication costs. Results: Adherence was examined using imatinib as the case example. High levels of adherence (>90%) were found throughout the study period regardless of insurance coverage. The clinically important drug interaction between tyrosine kinase inhibitors and proton pump inhibitors was assessed for medication provided by community pharmacies. Over 1/3 of patients received these interacting drugs together with little evidence of interventions to manage this interaction. During the study period, the cost of oral oncology medications rose more than 7 fold from $2,682,805 to $21,311,652, with increases in the rate of prescribing (20 to 29 per 1000 people) and increases in the cost of oncology prescriptions ($113 to $549 per prescription). Conclusion: Although oral therapy provides advantages and greater flexibility for cancer patients which is reflected in a high degree of adherence, additional policy reform an

Objective: Although many children are placed in care of child protection services each year, very little is known about how having a child placed in care affects the health and well-being of biological mothers. This study aims to address this gap in knowledge. Methods: The linkable administrative data housed at the Manitoba Centre for Health Policy were used to create several cohorts of mothers whose children were born in Manitoba, Canada, identified through child protection case files. Maternal health and social outcomes in the years before and after having a child taken into care were compared using generalized estimating equations. Poisson regression models were used to obtain relative rates of mental health-related outcomes for mothers whose children were taken into care and mothers whose children died. Incidence rate ratios of suicide attempts and completions were obtained using fixed-effects Poisson regression models. Finally, Cox proportional hazard regression models determined rates of avoidable and unavoidable mortality among mothers whose children were taken into care. Results: Compared with mothers whose children were not placed in care, mothers whose children were taken into care have significantly higher rates of anxiety, substance use, physician visits, hospitalizations, prescriptions, and income assistance use in the years before their children were taken into care; rates increased significantly in the years after. These mothers also had significantly higher rates of depression, anxiety, substance use, physician visits for mental illness, hospitalizations for mental illness, and psychotropic medication use in the years after custody loss compared with mothers who experienced the death of a child. Rates of suicide attempts, death by suicide, avoidable mortality and unavoidable mortality were also higher among mothers whose child was taken into care. Conclusion: Mothers whose children are taken into care often face many challenges in the years leading u

Introduction: Oral cancer therapy has more than doubled in the past 10 years and all indications are that the pipeline of new and emerging cancer therapies continues to include a higher percentage of oral drugs. With the increased availability of oral oncology products, patients can have access to their medications in community pharmacies and avoid the burden of travel and waiting time in cancer clinics or hospitals. However, this shift in care may also pose some challenges such as adherence to the treatment, safe use of the oncology products and increased costs to patients and the health care system. This study examined the impact of this shift to greater use of oral chemotherapy, looking at adherence, drug interaction management and cost through a series of health policy changes. Methods: Administrative health data between April 1, 2000 and March 31, 2015 from the Manitoba Centre for Health Policy Repository were used for this study. Dispensation records were used to assess drug utilization, measure adherence, analyze drug interactions and calculate medication costs. Results: Adherence was examined using imatinib as the case example. High levels of adherence (>90%) were found throughout the study period regardless of insurance coverage. The clinically important drug interaction between tyrosine kinase inhibitors and proton pump inhibitors was assessed for medication provided by community pharmacies. Over 1/3 of patients received these interacting drugs together with little evidence of interventions to manage this interaction. During the study period, the cost of oral oncology medications rose more than 7 fold from $2,682,805 to $21,311,652, with increases in the rate of prescribing (20 to 29 per 1000 people) and increases in the cost of oncology prescriptions ($113 to $549 per prescription). Conclusion: Although oral therapy provides advantages and greater flexibility for cancer patients which is reflected in a high degree of adherence, additional policy reform an

Background: The use of benzodiazepines and z-drugs remains controversial given their potential for misuse and harm. Investigation of their use in Manitoba remains important for monitoring and improving prescribing patterns. Methods: Administrative data was used to conduct i) drug utilization study from 2001-2016, and ii) incident-user cohort study of patients with anxiety/insomnia. Results: i) Z-drug use increased on all measures while only dose intensity increased for benzodiazepines. Higher utilization occurred among females and those ≥65 years. ii) The proportion of patients who became long-term users (>6months) in their first episode of use ranged from 4.5-9.6%. Males, older age, socioeconomically deprived, use of opioids or psychotropic agents, and poor physical health, were associated with long-term use. Conclusion: While less than one in 10 were considered a long-term user of these agents, further investigation into whether specific factors associated with long-term use requires consideration during the prescribing of these agents is warranted.

Objective: Although many children are placed in care of child protection services each year, very little is known about how having a child placed in care affects the health and well-being of biological mothers. This study aims to address this gap in knowledge. Methods: The linkable administrative data housed at the Manitoba Centre for Health Policy were used to create several cohorts of mothers whose children were born in Manitoba, Canada, identified through child protection case files. Maternal health and social outcomes in the years before and after having a child taken into care were compared using generalized estimating equations. Poisson regression models were used to obtain relative rates of mental health-related outcomes for mothers whose children were taken into care and mothers whose children died. Incidence rate ratios of suicide attempts and completions were obtained using fixed-effects Poisson regression models. Finally, Cox proportional hazard regression models determined rates of avoidable and unavoidable mortality among mothers whose children were taken into care. Results: Compared with mothers whose children were not placed in care, mothers whose children were taken into care have significantly higher rates of anxiety, substance use, physician visits, hospitalizations, prescriptions, and income assistance use in the years before their children were taken into care; rates increased significantly in the years after. These mothers also had significantly higher rates of depression, anxiety, substance use, physician visits for mental illness, hospitalizations for mental illness, and psychotropic medication use in the years after custody loss compared with mothers who experienced the death of a child. Rates of suicide attempts, death by suicide, avoidable mortality and unavoidable mortality were also higher among mothers whose child was taken into care. Conclusion: Mothers whose children are taken into care often face many challenges in the years leading u

Introduction: Oral cancer therapy has more than doubled in the past 10 years and all indications are that the pipeline of new and emerging cancer therapies continues to include a higher percentage of oral drugs. With the increased availability of oral oncology products, patients can have access to their medications in community pharmacies and avoid the burden of travel and waiting time in cancer clinics or hospitals. However, this shift in care may also pose some challenges such as adherence to the treatment, safe use of the oncology products and increased costs to patients and the health care system. This study examined the impact of this shift to greater use of oral chemotherapy, looking at adherence, drug interaction management and cost through a series of health policy changes. Methods: Administrative health data between April 1, 2000 and March 31, 2015 from the Manitoba Centre for Health Policy Repository were used for this study. Dispensation records were used to assess drug utilization, measure adherence, analyze drug interactions and calculate medication costs. Results: Adherence was examined using imatinib as the case example. High levels of adherence (>90%) were found throughout the study period regardless of insurance coverage. The clinically important drug interaction between tyrosine kinase inhibitors and proton pump inhibitors was assessed for medication provided by community pharmacies. Over 1/3 of patients received these interacting drugs together with little evidence of interventions to manage this interaction. During the study period, the cost of oral oncology medications rose more than 7 fold from $2,682,805 to $21,311,652, with increases in the rate of prescribing (20 to 29 per 1000 people) and increases in the cost of oncology prescriptions ($113 to $549 per prescription). Conclusion: Although oral therapy provides advantages and greater flexibility for cancer patients which is reflected in a high degree of adherence, additional policy reform an

Research shows significant health disparities between persons with and without intellectual and developmental disabilities (IDD). An annual comprehensive preventive care assessment which includes a complete physical exam (CPE) is a recommendation to reduce health disparities experienced by this population. The main purpose of this study was to report rates of CPE among the IDD and non-IDD population over time and to identify characteristics that lead to one receiving a CPE. This was a retrospective cohort study based on several years of administrative data (1995/96 - 2014/15). The study found that CPE rates were higher among the IDD population. History of CPE, history of mental illness, majority of care, region of residence, sex, and socioeconomic status were significant predictors of one receiving a CPE. The results from this study have potential to influence policies, programs and in turn contribute to improving the health of this population.

Background: Identifying maternal risk factors associated with giving birth to children with Fetal Alcohol Spectrum Disorder (FASD) is integral to the development of effective prevention strategies, however, there are no Canadian data in this area. The objective of this dissertation was to utilize population-based linked data to generate a large, representative sample of mothers whose children were diagnosed with FASD to investigate: (1) maternal risk factors associated with giving birth to children with FASD; (2) maternal physical and health outcomes; and (3) maternal usage of health services of the study population. Methods: A cohort of mother-infant dyads from a population of all children born in Manitoba between April 1, 1984 and March 31, 2012 who had an FASD diagnosis from the Manitoba FASD Centre from April 1, 1999 to March 31 2012, with follow-up until December 1, 2013 (study group: n=702). A control group (n=2097) matched 1:3 on date of birth of index child, region of residence, and socioeconomic status was generated to compare exposures and outcomes. Logistic regression analyses were run to determine maternal risk factors for giving birth to children with FASD, and adjusted relative rates for all mental and physical health outcomes, as well as rate of prenatal care, were calculated using generalized estimating equations with a Poisson or Negative Binomial distribution. Results: The following maternal characteristics were identified as having a statistically significant association with giving birth to children with FASD: history of teen pregnancy, being a single mother at birth of the index child, higher gravidity and parity, having a psychiatric disorder and/or physical health disorder up to three years before the birth of the child, and having inadequate prenatal care. Women who gave birth to children with FASD were also more likely to ii be involved with the child welfare system and the justice system, and to take antidepressants during pregnancy. Study

Research shows significant health disparities between persons with and without intellectual and developmental disabilities (IDD). An annual comprehensive preventive care assessment which includes a complete physical exam (CPE) is a recommendation to reduce health disparities experienced by this population. The main purpose of this study was to report rates of CPE among the IDD and non-IDD population over time and to identify characteristics that lead to one receiving a CPE. This was a retrospective cohort study based on several years of administrative data (1995/96 - 2014/15). The study found that CPE rates were higher among the IDD population. History of CPE, history of mental illness, majority of care, region of residence, sex, and socioeconomic status were significant predictors of one receiving a CPE. The results from this study have potential to influence policies, programs and in turn contribute to improving the health of this population.

Background: Identifying maternal risk factors associated with giving birth to children with Fetal Alcohol Spectrum Disorder (FASD) is integral to the development of effective prevention strategies, however, there are no Canadian data in this area. The objective of this dissertation was to utilize population-based linked data to generate a large, representative sample of mothers whose children were diagnosed with FASD to investigate: (1) maternal risk factors associated with giving birth to children with FASD; (2) maternal physical and health outcomes; and (3) maternal usage of health services of the study population. Methods: A cohort of mother-infant dyads from a population of all children born in Manitoba between April 1, 1984 and March 31, 2012 who had an FASD diagnosis from the Manitoba FASD Centre from April 1, 1999 to March 31 2012, with follow-up until December 1, 2013 (study group: n=702). A control group (n=2097) matched 1:3 on date of birth of index child, region of residence, and socioeconomic status was generated to compare exposures and outcomes. Logistic regression analyses were run to determine maternal risk factors for giving birth to children with FASD, and adjusted relative rates for all mental and physical health outcomes, as well as rate of prenatal care, were calculated using generalized estimating equations with a Poisson or Negative Binomial distribution. Results: The following maternal characteristics were identified as having a statistically significant association with giving birth to children with FASD: history of teen pregnancy, being a single mother at birth of the index child, higher gravidity and parity, having a psychiatric disorder and/or physical health disorder up to three years before the birth of the child, and having inadequate prenatal care. Women who gave birth to children with FASD were also more likely to ii be involved with the child welfare system and the justice system, and to take antidepressants during pregnancy. Study

Research shows significant health disparities between persons with and without intellectual and developmental disabilities (IDD). An annual comprehensive preventive care assessment which includes a complete physical exam (CPE) is a recommendation to reduce health disparities experienced by this population. The main purpose of this study was to report rates of CPE among the IDD and non-IDD population over time and to identify characteristics that lead to one receiving a CPE. This was a retrospective cohort study based on several years of administrative data (1995/96 - 2014/15). The study found that CPE rates were higher among the IDD population. History of CPE, history of mental illness, majority of care, region of residence, sex, and socioeconomic status were significant predictors of one receiving a CPE. The results from this study have potential to influence policies, programs and in turn contribute to improving the health of this population.

Background: Identifying maternal risk factors associated with giving birth to children with Fetal Alcohol Spectrum Disorder (FASD) is integral to the development of effective prevention strategies, however, there are no Canadian data in this area. The objective of this dissertation was to utilize population-based linked data to generate a large, representative sample of mothers whose children were diagnosed with FASD to investigate: (1) maternal risk factors associated with giving birth to children with FASD; (2) maternal physical and health outcomes; and (3) maternal usage of health services of the study population. Methods: A cohort of mother-infant dyads from a population of all children born in Manitoba between April 1, 1984 and March 31, 2012 who had an FASD diagnosis from the Manitoba FASD Centre from April 1, 1999 to March 31 2012, with follow-up until December 1, 2013 (study group: n=702). A control group (n=2097) matched 1:3 on date of birth of index child, region of residence, and socioeconomic status was generated to compare exposures and outcomes. Logistic regression analyses were run to determine maternal risk factors for giving birth to children with FASD, and adjusted relative rates for all mental and physical health outcomes, as well as rate of prenatal care, were calculated using generalized estimating equations with a Poisson or Negative Binomial distribution. Results: The following maternal characteristics were identified as having a statistically significant association with giving birth to children with FASD: history of teen pregnancy, being a single mother at birth of the index child, higher gravidity and parity, having a psychiatric disorder and/or physical health disorder up to three years before the birth of the child, and having inadequate prenatal care. Women who gave birth to children with FASD were also more likely to ii be involved with the child welfare system and the justice system, and to take antidepressants during pregnancy. Study

Research shows significant health disparities between persons with and without intellectual and developmental disabilities (IDD). An annual comprehensive preventive care assessment which includes a complete physical exam (CPE) is a recommendation to reduce health disparities experienced by this population. The main purpose of this study was to report rates of CPE among the IDD and non-IDD population over time and to identify characteristics that lead to one receiving a CPE. This was a retrospective cohort study based on several years of administrative data (1995/96 - 2014/15). The study found that CPE rates were higher among the IDD population. History of CPE, history of mental illness, majority of care, region of residence, sex, and socioeconomic status were significant predictors of one receiving a CPE. The results from this study have potential to influence policies, programs and in turn contribute to improving the health of this population.

Background: Identifying maternal risk factors associated with giving birth to children with Fetal Alcohol Spectrum Disorder (FASD) is integral to the development of effective prevention strategies, however, there are no Canadian data in this area. The objective of this dissertation was to utilize population-based linked data to generate a large, representative sample of mothers whose children were diagnosed with FASD to investigate: (1) maternal risk factors associated with giving birth to children with FASD; (2) maternal physical and health outcomes; and (3) maternal usage of health services of the study population. Methods: A cohort of mother-infant dyads from a population of all children born in Manitoba between April 1, 1984 and March 31, 2012 who had an FASD diagnosis from the Manitoba FASD Centre from April 1, 1999 to March 31 2012, with follow-up until December 1, 2013 (study group: n=702). A control group (n=2097) matched 1:3 on date of birth of index child, region of residence, and socioeconomic status was generated to compare exposures and outcomes. Logistic regression analyses were run to determine maternal risk factors for giving birth to children with FASD, and adjusted relative rates for all mental and physical health outcomes, as well as rate of prenatal care, were calculated using generalized estimating equations with a Poisson or Negative Binomial distribution. Results: The following maternal characteristics were identified as having a statistically significant association with giving birth to children with FASD: history of teen pregnancy, being a single mother at birth of the index child, higher gravidity and parity, having a psychiatric disorder and/or physical health disorder up to three years before the birth of the child, and having inadequate prenatal care. Women who gave birth to children with FASD were also more likely to ii be involved with the child welfare system and the justice system, and to take antidepressants during pregnancy. Study

Herpes zoster is a common disease, affecting up to 30% of the population in their lifetime. We examined the burden of this disease over the period of 1997-2013 using administrative healthcare data to determine changes over time. Key medications used to treat herpes zoster and postherpetic neuralgia became generic, resulting in costs reductions, where was offset by increased drug utilization leaving drug-episode costs unchanged. Mean per-episode medical costs increased moderately. Combined, these resulted in increased outpatient costs over time. However, dramatic reduction in HZ-related hospitalizations countered these trends, resulting in no net change in overall burden. The total healthcare cost of treating HZ and PHN in Manitoba in 2011/12 was $1,997,183, slightly less than the $2,095,633 burden determined for 1997/98, the first study year. Long-term demographic projections suggest the population will continue to grow and age, likely driving the future burden upwards.

Herpes zoster is a common disease, affecting up to 30% of the population in their lifetime. We examined the burden of this disease over the period of 1997-2013 using administrative healthcare data to determine changes over time. Key medications used to treat herpes zoster and postherpetic neuralgia became generic, resulting in costs reductions, where was offset by increased drug utilization leaving drug-episode costs unchanged. Mean per-episode medical costs increased moderately. Combined, these resulted in increased outpatient costs over time. However, dramatic reduction in HZ-related hospitalizations countered these trends, resulting in no net change in overall burden. The total healthcare cost of treating HZ and PHN in Manitoba in 2011/12 was $1,997,183, slightly less than the $2,095,633 burden determined for 1997/98, the first study year. Long-term demographic projections suggest the population will continue to grow and age, likely driving the future burden upwards.

Herpes zoster is a common disease, affecting up to 30% of the population in their lifetime. We examined the burden of this disease over the period of 1997-2013 using administrative healthcare data to determine changes over time. Key medications used to treat herpes zoster and postherpetic neuralgia became generic, resulting in costs reductions, where was offset by increased drug utilization leaving drug-episode costs unchanged. Mean per-episode medical costs increased moderately. Combined, these resulted in increased outpatient costs over time. However, dramatic reduction in HZ-related hospitalizations countered these trends, resulting in no net change in overall burden. The total healthcare cost of treating HZ and PHN in Manitoba in 2011/12 was $1,997,183, slightly less than the $2,095,633 burden determined for 1997/98, the first study year. Long-term demographic projections suggest the population will continue to grow and age, likely driving the future burden upwards.

Social Assistance – also known as welfare – has been a program of last resort for individuals in poverty across Canada for many years. The use of social assistance in early adulthood is of particular interest, as these individuals have a long life of consequences ahead of them. The social assistance program available in Manitoba, Canada – the setting of this study – is Employment and Income Assistance (EIA). This study examines difference in predictors of early adult (ages 18-25) EIA usage across income quintiles of the neighborhoods individuals lived in as they enter young adulthood (age 18) and the type of EIA (General Assistance, Single Parent or Disability) received.

Title: Maternal Mood and Anxiety Disorders and Child School Readiness: A Manitoba Population-Based Study Objective: This study examined the relationship between several features of maternal Mood/Anxiety – timing, recurrence/persistence and severity – and child development on five key areas of school readiness at kindergarten, controlling for health, demographic and socio-economic factors. Methods: Using administrative data to further understand these relationships at a population level and over time, 18,331mother-child pairs were linked using a unique identifier. Maternal Mood/Anxiety was defined using the number of physician visits for mood and anxiety disorders and the number of prescriptions filled for antidepressants or sedatives/hypnotics. The outcome measures were child scores on five domains of the Early Development Instrument, a population-level tool for determining readiness for school at an aggregate level. Structural equation modeling was used to examine the relationship between maternal Mood/Anxiety and child outcomes for individual time periods, Mood/Anxiety recurrence/persistence and Mood/Anxiety severity. Infant health at birth, the family/socio-economic environment, child age and child gender were also entered into the models. Stratified analysis was undertaken to determine whether SES moderates the relationship between Mood/Anxiety and child outcomes. Results: Maternal Mood/Anxiety had a modest significant negative association with EDI scores, particularly for social, emotional and physical development. Prenatal and recurrent Mood/Anxiety were associated with lower scores on all five outcome domains. The influence of maternal Mood/Anxiety was mediated by the family environment, which had a strong, significant association with the outcomes, particularly for language and cognitive development. Infant health at birth was significantly associated with child outcomes, particularly for physical health. Socio-economic status (SES) was a moderator of the re

Social Assistance – also known as welfare – has been a program of last resort for individuals in poverty across Canada for many years. The use of social assistance in early adulthood is of particular interest, as these individuals have a long life of consequences ahead of them. The social assistance program available in Manitoba, Canada – the setting of this study – is Employment and Income Assistance (EIA). This study examines difference in predictors of early adult (ages 18-25) EIA usage across income quintiles of the neighborhoods individuals lived in as they enter young adulthood (age 18) and the type of EIA (General Assistance, Single Parent or Disability) received.

Title: Maternal Mood and Anxiety Disorders and Child School Readiness: A Manitoba Population-Based Study Objective: This study examined the relationship between several features of maternal Mood/Anxiety – timing, recurrence/persistence and severity – and child development on five key areas of school readiness at kindergarten, controlling for health, demographic and socio-economic factors. Methods: Using administrative data to further understand these relationships at a population level and over time, 18,331mother-child pairs were linked using a unique identifier. Maternal Mood/Anxiety was defined using the number of physician visits for mood and anxiety disorders and the number of prescriptions filled for antidepressants or sedatives/hypnotics. The outcome measures were child scores on five domains of the Early Development Instrument, a population-level tool for determining readiness for school at an aggregate level. Structural equation modeling was used to examine the relationship between maternal Mood/Anxiety and child outcomes for individual time periods, Mood/Anxiety recurrence/persistence and Mood/Anxiety severity. Infant health at birth, the family/socio-economic environment, child age and child gender were also entered into the models. Stratified analysis was undertaken to determine whether SES moderates the relationship between Mood/Anxiety and child outcomes. Results: Maternal Mood/Anxiety had a modest significant negative association with EDI scores, particularly for social, emotional and physical development. Prenatal and recurrent Mood/Anxiety were associated with lower scores on all five outcome domains. The influence of maternal Mood/Anxiety was mediated by the family environment, which had a strong, significant association with the outcomes, particularly for language and cognitive development. Infant health at birth was significantly associated with child outcomes, particularly for physical health. Socio-economic status (SES) was a moderator of the re

Social Assistance – also known as welfare – has been a program of last resort for individuals in poverty across Canada for many years. The use of social assistance in early adulthood is of particular interest, as these individuals have a long life of consequences ahead of them. The social assistance program available in Manitoba, Canada – the setting of this study – is Employment and Income Assistance (EIA). This study examines difference in predictors of early adult (ages 18-25) EIA usage across income quintiles of the neighborhoods individuals lived in as they enter young adulthood (age 18) and the type of EIA (General Assistance, Single Parent or Disability) received.

Social Assistance – also known as welfare – has been a program of last resort for individuals in poverty across Canada for many years. The use of social assistance in early adulthood is of particular interest, as these individuals have a long life of consequences ahead of them. The social assistance program available in Manitoba, Canada – the setting of this study – is Employment and Income Assistance (EIA). This study examines difference in predictors of early adult (ages 18-25) EIA usage across income quintiles of the neighborhoods individuals lived in as they enter young adulthood (age 18) and the type of EIA (General Assistance, Single Parent or Disability) received.

The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantl

The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantl