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First Nation people living in Canada experience a high prevalence of type 2 diabetes in pregnancy. In this study, we aimed to describe maternal and neonatal outcomes in First Nation and all other females with type 2 diabetes living in Manitoba, Canada.This was a population-level retrospective cohort study using linked administrative data from Manitoba (2012-2017). We compared First Nation females with type 2 diabetes with all other Manitoban females with type 2 diabetes, using relative risks (RRs) and 95% confidence intervals (CIs).A total of 2181 females with type 2 diabetes were included, and 1218 (55.8%) were First Nation. First Nation females with type 2 diabetes were significantly more likely to experience stillbirth (RR 2.14, 95% CI 1.11-4.13) and perinatal death (RR 2.39, 95% CI 1.37-4.17) than all other Manitoban females with type 2 diabetes. Offspring of First Nation females with type 2 diabetes had a higher risk of most neonatal complications than offspring of all other Manitoban females with type 2 diabetes, including a higher risk of congenital malformations (RR 1.97, 95% CI 1.30-2.99), but First Nation people did not have a higher risk of most maternal complications.First Nation pregnant individuals living with type 2 diabetes experienced a higher risk for adverse pregnancy outcomes than all other Manitoban females with type 2 diabetes. Additional studies are needed to identify both high-risk and protective factors for pregnancy complications in First Nation people living with type 2 diabetes in pregnancy.

Studies on mortality differentials between international immigrants and non-immigrants produced mixed results. The mortality of interprovincial migrants has been less studied. Our objectives were to compare mortality risk between international immigrants, interprovincial migrants, and long-term residents of the province of Manitoba, Canada, and identify factors associated with mortality among migrants.We conducted a retrospective matched-cohort study to examine all-cause and premature mortality of 355,194 international immigrants, interprovincial migrants, and long-term Manitoba residents (118,398 in each group) between January 1985 and March 2019 using linked administrative databases. Poisson regression was used to estimate adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CI).The all-cause mortality risk of international immigrants (2.3 per 1000 person-years) and interprovincial migrants (4.4 per 1000) was lower than that of long-term Manitobans (5.6 per 1000) (aIRR: 0.43; 95% CI: 0.42, 0.45 and aIRR: 0.81; 95% CI: 0.80, 0.84, respectively). Compared with interprovincial migrants, international immigrants showed lower death risk (aIRR: 0.50; 95% CI: 0.47, 0.52). Similar trends were observed for premature mortality. Among international immigrants, higher mortality risk was observed for refugees, those from North America and Oceania, and those of low educational attainment. Among internal migrants, those from Eastern Canada had lower mortality risk than those migrating from Ontario and Western Canada.Migrants had a mortality advantage over non-migrants, being stronger for international immigrants than for interprovincial migrants. Among the two migrant groups, there was heterogeneity in the mortality risk according to migrants' characteristics.RéSUMé: OBJECTIFS: Les études sur les écarts dans la mortalité entre les immigrants internationaux et les non-immigrants produisent des résultats mitigés. La mortalité des migrants interprovinciaux est moins étudiée. Nous avons cherché à comparer le risque de mortalité des immigrants internationaux, des migrants interprovinciaux et des résidents à long terme de la province du Manitoba, au Canada, et à cerner les facteurs associés à la mortalité chez les migrants. MéTHODE: Nous avons mené une étude de cohorte assortie rétrospective pour examiner la mortalité toutes causes confondues et la mortalité prématurée chez 355 194 immigrants internationaux, migrants interprovinciaux et résidents à long terme du Manitoba (118 398 dans chaque groupe) entre janvier 1985 et mars 2019 à l’aide de bases de données administratives maillées. Par régression de Poisson, nous avons estimé les rapports de taux d’incidence ajustés (RTAa) avec des intervalles de confiance (IC) de 95 %. RéSULTATS: Le risque de mortalité toutes causes confondues des immigrants internationaux (2,3 pour 1 000 personnes-années) et des migrants interprovinciaux (4,4 pour 1 000) était plus faible que celui des résidents à long terme du Manitoba (5,6 pour 1 000) (RTAa : 0,43; IC de 95 % : 0,42, 0,45 et RTAa : 0,81; IC de 95 % : 0,80, 0,84, respectivement). Comparativement aux migrants interprovinciaux, les immigrants internationaux présentaient un risque de mortalité plus faible (RTAa : 0,50; IC de 95 % : 0,47, 0,52). Des tendances semblables ont été observées pour la mortalité prématurée. Chez les immigrants internationaux, un risque de mortalité plus élevé a été observé chez les réfugiés, les immigrants de l’Amérique du Nord et de l’Océanie et ceux ayant un faible niveau d’instruction. Chez les migrants intérieurs, ceux de l’Est du Canada présentaient un risque de mortalité plus faible que ceux de l’Ontario et de l’Ouest canadien. CONCLUSION: Les migrants présentaient un avantage sur le plan de la mortalité par rapport aux non-migrants; cet avantage était plus prononcé chez les immigrants internationaux que chez les migrants interprovinciaux. Dans ces deux groupes de migrants, il y avait hétérogénéité dans le risque de mortalité selon les caractéristiques des migrants.

Introduction: There is little experimental evidence of the impact of multi-use recreational trails that support physical activity on cardiovascular disease (CVD). Hypothesis: Neighbourhoods that added multi-use trails would experience a greater decline in CVD events and risk factors compared to neighbourhoods that did not. Methods: We used a difference in differences design to study the addition of four multi-use trails 4-7km in length on CVD-related outcomes using administrative health, census and built environment data available for all citizens 30 years of age and older from Winnipeg, Canada. A 400m buffer stratified intervention and comparison neighbourhoods. Bicycle counts were recorded via electromagnetic counters for 5 years on all trails. The primary and secondary outcomes were composite measures of incident CVD events (mortality, ischemic heart disease, cerebrovascular disease and congestive heart failure) and CVD risk factors (hypertension, diabetes and dyslipidemia) and assessed quarterly for 10 years prior to and 6 years following the intervention. Intervention and comparison areas were propensity score matched, using scores regressed from baseline measures of age, sex, socioeconomic indicators, and built environment attributes that support physical activity. Results: Between 2012 and 2018, 1,429,588 cyclists were recorded on the trails and cycling use varied ~2.0-fold across the trails. Between 2000 and 2018, there were 82,632 CVD events and 201,058 CVD risk events. During the 18-year natural experiment CVD event rates and risk factors declined ~33% in both comparison and intervention neighbourhoods. In propensity score matched regression models, the incident rate ratio was 1.06 (95% CI: 0.90 to 1.24) for CVD events and 0.92 (95% CI: 0.84 to 1.02) for CVD risk factors. Sensitivity analyses revealed greater effect sizes with increasing trail use (incident rate ratios for highest vs lowest cycling counts = 0.85; 95% CI: 0.75 to 0.96 vs 1.08; 95% CI: 0.92 to 1.27). Conclusions: The addition of recreational multi-use trails was not associated with changes in overall CVD events or risk factors in adjacent neighbourhoods, compared to distant neighbourhoods, however, the effects on CVD risk factors may be influenced by trail use.

Our aim in this study was to determine the best administrative data case definition for pregestational diabetes exposure.We compared the performance of case definitions for pregestational diabetes exposure within the administrative health data housed in the Manitoba Population Health Research Repository at the Manitoba Centre for Health Policy with an identified population of women in whom the diagnosis of pregestational diabetes was known from the clinical database of the Manitoba Diabetes Education Resource for Children and Adolescents (DER-CA) (August 12, 1989 through January 28, 2015). The DER-CA database contains maternal diabetes status during pregnancy and also includes women diagnosed with type 2 diabetes in childhood whose pregnancies were thus all complicated by pregestational diabetes exposure. Linkage of mother-child dyads is possible within the Repository. Diagnosis codes from the International Classification of Diseases---ninth or tenth revision and physician tariff codes were used to identify diabetes in the biologic mothers of children with type 2 diabetes identified from the DER-CA database. The timing of the diagnosis of diabetes in the mother with respect to the gestational age of the pregnancy was determined.The best administrative definition of pregestational diabetes exposure was any incident code for diabetes in the mother before the pregnancy of the index child or within the first 25 weeks of pregnancy (sensitivity: 84.77%; positive predictive value: 92%).The definition cited can be used to define pregestational diabetes exposure in studies utilizing administrative data.

We have developed a simple method for the induction of cataracts in adult zebrafish using hydrogen peroxide. Our method uses a corneal puncture followed by intraocular injection of hydrogen peroxide into the anterior chamber. The procedure can be done rapidly, forming a highly opaque cataract almost immediately, and fish recover quickly. The optical clarity of the lens is gradually regained over time, showing the innate ability of zebrafish to regenerate healthy lens tissue. This technique provides a simple in vivo system with which to assess mutant strains or targeted disruptions to genes expressed in the lens.

Alpha crystallins are small heat shock proteins essential to normal ocular lens function. They also help maintain homeostasis in many non-ocular vertebrate tissues and their expression levels change in multiple diseases of the nervous and cardiovascular system and during cancer. The specific roles that α-crystallins may play in eye development are unclear. Studies with knockout mice suggested that only one of the two mammalian α-crystallins is required for normal early lens development. However, studies in two fish species suggested that reduction of αA-crystallin alone could inhibit normal fiber cell differentiation, cause cataract and contribute to lens degeneration. In this study we used synthetic antisense morpholino oligomers to suppress the expression of zebrafish αA-crystallin to directly test the hypothesis that, unlike mammals, the zebrafish requires αA-crystallin for normal early lens development. Despite the reduction of zebrafish αA-crystallin protein to undetectable levels by western analysis through 4 days of development we found no changes in fiber cell differentiation, lens morphology or transparency. In contrast, suppression of AQP0a expression, previously shown to cause lens cataract, produced irregularly shaped lenses, delay in fiber cell differentiation and lens opacities detectable by confocal microscopy. The normal development observed in αA-crystallin deficient zebrafish embryos may reflect similarly non-essential roles for this protein in the early stages of both zebrafish and mammalian lens development. This finding has ramifications for a growing number of researchers taking advantage of the zebrafish's transparent external embryos to study vertebrate eye development. Our demonstration that lens cataracts can be visualized in three-dimensions by confocal microscopy in a living zebrafish provides a new tool for studying the causes, development and prevention of lens opacities.

This paper reports the use of a large data set of Australian government employees in an analysis of the influence of sex on voluntary labour turnover. Estimates derived from a conventional quit model are used to obtain ceteris paribus sex specific quit probabilities. These suggest that once other relevant variables are held constant, the expected quit differences between men and single women are significantly reduced. The analysis indicates clearly that the use of aggregate statistics may substantially exaggerate turnover differences attributable to sex.

Summary Current Government education policy presents some stark contrasts. While subsidies to secondary students are being increased significantly by an expansion of secondary allowances, individual subsidies at the tertiary level are to be reduced via a system of fees or taxes. This policy development is substantially predicated upon the Government's belief that higher education students tend to come from privileged backgrounds. This study explores that hypothesis by analysing the influence of family background on the transition of Year 12 school-leavers to further education or the labour-force. Excellent data from the Australian Longitudinal Survey are used to focus on some previously under-researched aspects of this question. Six models axe reported, each offering different trade-offs between the competing needs for comprehensive coverage of explanatory variables and data coverage. The strongest result obtained is the consistent significance of the mother's educational qualifications in the child's decision to proceed to further education. Equally interesting is the insignificance of the father's educational level. The paternal variables which influence tertiary outcomes are income and/or occupation. Attendance at a private non-Catholic school is also influential. The paper reports provocative evidence on the outcomes of the children of non-English speaking migrants. While this group is often perceived as educationally disadvantaged by their parents' ethnic origins, the results of this study indicate that they are more likely to proceed to tertiary studies than are the children of English speakers. Part-time employment of school children is an increasingly common phenomenon. The preliminary evidence here indicates that the children involved subsequently have lower representation in tertiary institutions but higher employment probabilities in the labour-force. The results imply that mothers and fathers play different roles in influencing their children's outcomes. But there is often a high degree of correlation between maternal and paternal characteristics which makes it difficult to identify separately their respective influences. In summary, the results suggest that family background matters. But the implications for public policy which aims at redressing imbalances in society are complex. On the one hand the children of the well educated and from private schools are more likely to attend tertiary institutions. On the other hand, the migrant “success” story suggests that motivated individuals have it within their grasp to determine their educational and work outcomes. Together, the results point to the importance of attitudes in determining participation in tertiary education and suggest that attention to this factor could enhance the effects of educational subsidies provided to low income families.