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Indigenous populations in Canada are disproportionately affected by early childhood caries. The Healthy Smile, Happy Child initiative utilizes a community development approach to encourage community uptake of evidence-based early childhood oral health promotion strategies. Sharing circles and focus groups elicited First Nations and Metis (Indigenous peoples of mixed Indigenous-European, primarily French, ancestry) views on the challenges of keeping children caries-free. We share participants’ experiences and viewpoints on implementation research strategies, principles and protocols that are sensitive to Indigenous community-based contexts.

Introduction Les caries de la petite enfance sont un problème de santé publique, et le fardeau considérable subi par les enfants autochtones met en lumière les inégalités en matière de santé buccodentaire au sein des populations au Canada. Les obstacles sont le manque d’accès aux soins de santé buccodentaire et l’absence d’une promotion de la santé buccodentaire culturellement adaptée. Cette étude visait à déterminer où et comment les parents, les familles et les membres des collectivités des Premières Nations et des Métis apprennent à prendre soin de la santé buccodentaire des jeunes enfants, et quelles idées et suggestions ils ont sur la façon de diffuser l’information et de promouvoir la santé buccodentaire des jeunes enfants au sein des collectivités autochtones. Méthodologie Les cercles de partage et les groupes de discussion ont mobilisé huit groupes de participants (n = 59) échantillonnés par choix dans quatre collectivités du Manitoba. Une approche relevant de la théorie ancrée a guidé l’analyse thématique des données enregistrées sur bande audio et transcrites. Résultats Les participants ont dit avoir tiré leurs connaissances sur la santé buccodentaire de parents, de la famille et d’amis, de fournisseurs de soins primaires, lors des programmes prénataux, dans les écoles et en ligne. Certains utilisaient des remèdes traditionnels. Les recommandations des participants ont été de transmettre de l’information qui soit culturellement adaptée par l’entremise de programmes et d’ateliers communautaires et prénataux, des écoles et des garderies, d’affiches, de dépliants envoyés par la poste et de communications téléphoniques (appels et textos) aux parents et aux familles, et au moyen des médias sociaux. Il a été recommandé, afin d’encourager une bonne hygiène buccale, de distribuer des produits d’hygiène buccale interactifs et attrayants pour les enfants. Conclusion De l’information et des ressources sur la santé buccodentaire fondées sur des données probantes et adaptées aux collectivités des Premières Nations et des Métis pourraient, si elles étaient fournies de façon stratégique, atteindre un plus grand nombre de familles et modifier la trajectoire actuelle de la santé buccodentaire des jeunes enfants.

Background Associations between body mass index (BMI) and caries have been reported. Aim To evaluate the direction of the relationship between BMI and severe early childhood caries (S-ECC). Design Children were recruited as part of a larger prospective cohort study assessing changes in nutritional status following dental rehabilitation under general anaesthetic. Pre-operative anthropometric measurements were used to calculate BMI z-scores (BMIz). Operative reports were reviewed to calculate caries scores based on treatment rendered. Analysis included descriptive statistics, bivariate analyses, and simple and multiple linear regression. Results Overall, 150 children were recruited with a mean age of 47.7 ± 14.2 (SD) months; 52% female. Over 42% were at risk for overweight, overweight or obese. Although simple linear regression demonstrated a significant positive association between dmfs score and BMIz, adjusted multiple linear regression found no significant relationship between BMIz and dmfs, but highlighted a relationship between BMI z-score and family income, Registered First Nations Status and physical activity. Conclusions Although a significant relationship between BMI and S-ECC was not found, poverty was a key confounding variable. As both S-ECC and obesity are known predictors of future disease, it is important for healthcare professionals to identify children at risk. Diet and behaviour modification may play a role in disease prevention.

Prenatal care is a vital and important part of a healthy pregnancy, providing many maternal and health benefits. Despite Canada’s publically funded health care system with universal access, inadequate rates of prenatal care continue to be observed. As a modifiable risk factor, the process variables that influence satisfaction with prenatal care in Canadian settings have received little attention. The objective of this study was to identify the predictors of satisfaction with prenatal care. A cross-sectional, descriptive, correlational design was used to examine the relationships between expectations, interpersonal processes of care, the quality of prenatal care, personal characteristics, and the type of provider with overall satisfaction, and with four dimensions of satisfaction. A convenience sample of 216 pregnant women was surveyed using self-administered questionnaires with women in their third trimester. Multiple linear regression analyses were used to identify predictors of satisfaction. The quality of prenatal care and provider interpersonal style together explained 80% of the variance in overall satisfaction. Patient-centered decision-making was a significant predictor of satisfaction with information, while having a midwife was a predictor of satisfaction with system characteristics. Expectations were not related to satisfaction. Improving quality of care, provider interpersonal style and patient-centered decision making, and improving the structural characteristics of prenatal care may be effective in improving women’s satisfaction and utilization of prenatal care.

Background There is conflicting evidence regarding the association between vitamin D and periodontal disease. The purpose of this study was to explore that relation. Methods This cross-sectional study used data from the Canadian Health Measures Survey for respondents 13-79 years of age. Vitamin D status was determined by measuring plasma 25-hydroxyvitamin D (25(OH)D) concentrations. Periodontal disease was defined by gingival index (GI) and calculated loss of attachment (LOA). Statistical analyses included bivariate tests and multiple logistic regression. Results At the bivariate level, 25(OH)D concentrations below the cutoff levels of 50 nmol/L and 75 nmol/L were associated with GI. However, multiple regression analyses for GI revealed no association with mean 25(OH)D level or either concentration. Although no significant association between LOA and 25(OH)D status was identified at the bivariate level, a statistically significant association was observed between LOA and 25(OH)D levels Conclusion Vitamin D status was inversely associated with GI at the bivariate level, but not at the multivariate level. Conversely, vitamin D status was not associated with LOA at the bivariate level, but it was inversely associated with LOA at the multivariate level. These results provide modest evidence supporting a relation between low plasma 25(OH)D concentrations and periodontal disease as measured by GI and LOA.

Background Caffeine, the most commonly used medication in Neonatal Intensive Care Units, has calciuric and osteoclastogenic effects. Methods To examine the association between the cumulative dose and duration of therapy of caffeine and osteopenia of prematurity, a retrospective cohort study was conducted including premature infants less than 31 weeks and birth weight less than 1500 g. Osteopenia of prematurity was evaluated using chest X-rays on a biweekly basis over 12 weeks of hospitalization. Results The cohort included 109 infants. 51% had osteopenia of prematurity and 8% had spontaneous rib fractures. Using the generalized linear mixed model, caffeine dose and duration of caffeine therapy showed a strong association with osteopenia of prematurity. Steroids and vitamin D were also significantly correlated with osteopenia of prematurity while diuretic use did not show a statistically significant effect. Conclusion The cumulative dose and duration of therapy of caffeine, as well as steroid are associated with osteopenia of prematurity in this cohort. Future studies are needed to confirm these findings and determine the lowest dose of caffeine needed to treat effectively apnea of prematurity.

Objectives Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non-restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward SDF. Aim To understand Indigenous community members' views on pediatric dental surgery to treat ECC under general anesthesia (GA) and receptivity to SDF as an alternative to restorative surgery. Methods Focus groups and sharing circles congruent with an Indigenous ways of gathering information were conducted. Three interviewers engaged eight groups of First Nation and Metis communities in three rural Indigenous communities and ne metropolitan urban setting in Manitoba, Canada. Overall, 59 individuals participated. Open coding was guided by grounded theory and further analysis using Nvivo 12 software™. Results Participants mean age was 35.6 years, 88 percent (52 individuals) had a least one child, and 32 percent (19 individuals) were employed. Eight themes emerged, including respondents' fear of dental surgery under GA, fear of pain after dental surgery, parents' need for more information before accepting SDF treatment, and concern about the black staining of treated lesions. Conclusions Indigenous parents' acceptance of SDF as a treatment option is contingent on having more information and assurance that treatment under GA can be avoided. Understanding Indigenous parents' views may ensure better acceptance of SDF as a minimally invasive treatment option to manage ECC. A cautious and informative approach to SDF implementation in Indigenous communities is recommended.

There is conflicting evidence regarding the association between vitamin D and periodontal disease. The purpose of this study was to explore that relation.This cross-sectional study used data from the Canadian Health Measures Survey for respondents 13-79 years of age. Vitamin D status was determined by measuring plasma 25-hydroxyvitamin D (25(OH)D) concentrations. Periodontal disease was defined by gingival index (GI) and calculated loss of attachment (LOA). Statistical analyses included bivariate tests and multiple logistic regression.At the bivariate level, 25(OH)D concentrations below the cutoff levels of 50 nmol/L and 75 nmol/L were associated with GI. However, multiple regression analyses for GI revealed no association with mean 25(OH)D level or either concentration. Although no significant association between LOA and 25(OH)D status was identified at the bivariate level, a statistically significant association was observed between LOA and 25(OH)D levels75 nmol/L on multiple regression analysis. However, mean 25(OH)D concentrations and those50 nmol/L were not associated with LOA on multiple regression analysis.Vitamin D status was inversely associated with GI at the bivariate level, but not at the multivariate level. Conversely, vitamin D status was not associated with LOA at the bivariate level, but it was inversely associated with LOA at the multivariate level. These results provide modest evidence supporting a relation between low plasma 25(OH)D concentrations and periodontal disease as measured by GI and LOA.

Laboratories have noted marked increases in the analysis of 25-hydroxy vitamin D (25(OH)D) in recent decades. Our objectives were to describe the annual number of 25(OH)D tests, examine the characteristics of those tested and those ordering them, and determine the proportion of potentially unnecessary tests in Manitoba.Manitoba residents who were tested between 2006/7 and 2012/13 had their data anonymously linked to Manitoba Centre for Health Policy comprehensive administrative datasets. Patient and physician characteristics, location of residence, and 25(OH)D concentrations were determined. Descriptive statistics and multivariable regression models were utilized.There was a quadrupling in testing from 2006 to 2013, with20,000 tests performed in 2012/13. The median annual number of tests was one per patient; the maximum was10 tests per year. Adult females had twice the number of tests compared to males (p 0.001). There was a rise in 25(OH)D concentrations over time with hypervitaminosis D increasing disproportionately (2006/7 to 212/13 (0% vs. 0.15%, p 0.001)). Apparently unnecessary testing rose by 1/3 over time, frequently ordered by Family Medicine practitioners. A revised 25(OH)D requisition resulted in striking reduction of 25(OH)D requests (~80%).Manitoba noted a rapid increase in testing, and rise in 25(OH)D concentrations with levels that may be associated with toxicities; both have been reported in other jurisdictions. There appeared to a striking rise in 'unnecessary' tests. We similarly report the benefit of the implementation of a mandatory requisition specifying eligibility criteria for 25(OH)D and education about appropriate testing.

Objectives The Free First Visit (FFV) program was implemented in 2010 to promote early preventive dental visits for children

The purpose of this study was to assess the relationship between vitamin D status and dental caries in Canadian school-aged children participating in the Canadian Health Measures Survey (CHMS). The CHMS was a national cross-sectional study involving physical assessments, laboratory analysis, and interviews. Analysis was restricted to data for 1,017 children 6 to 11 y of age. Outcome variables included the presence of caries and overall total caries score (dmft/DMFT index). Levels of 25-hydroxyvitamin D (25(OH)D) were measured from serum samples obtained from participants. Bivariate analysis, logistic regression for the presence of caries, and multiple linear regression for total caries scores were used. Significance was set at P ≤ 0.05. Overall, 56.4% of children experienced caries, and the mean dmft/DMFT score was 2.47 (95% CI 2.09 to 2.84). The unadjusted odds of children with 25(OH)D levels ≥75 nmol/L having experienced caries was 0.57 (95% CI 0.39 to 0.82), while the odds for caries at the ≥50 nmol/L level was 0.56 (95% CI 0.39 to 0.89). After controlling for other covariates, backward logistic regression revealed that the presence of caries was significantly associated with 25(OH) levels

Objective A number of predictive models have been developed to identify patients at risk of hospital readmission. Most of these have focused on readmission within 30 days of discharge. We used population-based health administrative data to develop a predictive model for hospital readmission within 12 months of discharge in Winnipeg, Canada. Methods This was a retrospective cohort study with derivation and validation data sets. Multivariable logistic regression analyses were performed and factors significantly associated with readmission were selected to construct a risk scoring tool. Results Several variables were identified that predicted readmission (i.e. older age, male, at least one hospital admission in the previous two years, an emergent (index) hospital admission, Charlson comorbidity score >0 and length of stay). Discrimination power was acceptable (C statistic =0.701). At a median risk score threshold, the sensitivity, specificity, positive and negative predictive values were 45.5%, 79%, 68.8% and 58.6%. Conclusions This predictive model demonstrated that hospital readmission within 12 months of discharge can be reasonably well predicted based on administrative data. It will help health care providers target interventions to prevent unnecessary hospital readmissions.

Access to emergency or urgent surgery has become a serious concern across North America and beyond.1,2 With the evolution of surgical subspecialties there has been a relative decline in the availability of surgeons who provide emergency care, particularly after hours.3–5 Many health care organizations and systems have sought to cope with the problem by consolidating surgical services. There is growing international interest in the acute care surgery (ACS) model, in which designated resources, including the time of designated surgeons, are set aside for emergency and/or urgent surgery. The model may be implemented within a hospital, among hospitals (regionalization), or both. Past research has suggested that within-hospital ACS consolidation can reduce wait times for emergency surgery, and may sometimes improve patient outcomes.6–9 However, the literature is dominated by uncontrolled pre–post studies, which cannot rule out secular trends and other confounders, such as adoption of new surgical practices, as explanations for the observed results. Very few studies have evaluated ACS consolidation on a regional level involving multiple institutions. One study found that mortality and length of stay (LOS) decreased over time within a regionalized ACS service, but it did not compare these rates with those observed before regionalization.10 Another study found no significant change in mortality when high-acuity surgery (including many procedures outside the scope of emergency general surgery) was regionalized; there was an ongoing decline in LOS, but this decline had begun before regionalization.11 To our knowledge, no study has examined wait times at the pan-regional level, taking into account how transfers affect the patient journey. As the ACS model becomes increasingly widespread, there is an urgent need for further evidence on the impacts of ACS consolidation, especially regional consolidation. The Winnipeg Regional Health Authority (WRHA), an urban health region in Western Canada (catchment population 1.2 million), implemented the ACS model to stabilize and sustain call schedules. The region had been unable to fill the gaps through recruitment because there was neither the volume of work nor the resources to support new recruits. This 6-hospital system consolidated emergency general surgery at 3 referral sites, each of which now includes a designated ACS team. A clinical lead or service chief (funded position) is responsible for addressing administrative needs and maintaining call schedules. One surgeon covers the day shift (7:30–16:30) from Monday to Sunday, providing continuity throughout the week. The night shift (16:30–7:30, home-call) rotates among participating surgeons on a daily basis. Remuneration is a blended model of a day and night stipend and fee-for-service. A hospitalist was added to the ACS team at the nonteaching site; hospitalists and/or physician assistants play a smaller role at the teaching sites. The referral hospitals have added daytime ACS slates, but not dedicated emergency operating rooms (ORs). To offset the increased volume of ACS patients at the referral hospitals, both elective general surgery and orthopedic surgery cases have been relocated to the nonreferral hospitals. One hospital became a referral centre in April 2008, another in December 2008. (A third offered ACS throughout the study period but did not invite additional referrals.) The consolidation succeeded in filling call schedules and ensuring reliable access to an on-call surgeon. This study sought to determine the impact of consolidation on patient access and outcomes.

Canada's original people consist of First Nations, Inuit and Metis peoples. Their estimated population is 1.17 million. The total fertility rate for the period 1996-2001 was 2.6 for Aboriginal women versus 1.5 for Canada (Statistics Canada 2006). Thus, a high proportion of this rapidly growing segment of the population are children. Numerous articles have reviewed the health status of Canada's Aboriginal children and shown comparatively high prevalence and incidence of most of the common diseases that affect children. This article highlights some of the more specific disparities, but also attempts to provide some historical context and a few composite case studies that illustrate how the social determinants, colonialism, jurisdictional issues, geography and healthcare can interact to amplify disproportionately the disadvantage these children have in so many ways. Much of the historical detail recounts the contact with First Nations people, the most numerous and the first group to have contact with European settlement.

BACKGROUND: There are limited data regarding complications associated with colonoscopy and flexible sigmoidoscopy in usual clinical practice in Canada.OBJECTIVE: To determine the risk factors for lower gastrointestinal (GI) endoscopy-associated complications in usual clinical practice.METHODS: All outpatient lower GI endoscopies performed in Winnipeg (Manitoba) between April 1, 2004 and March 31, 2006, were identified from the provincial physicians’ claims database. All subsequent hospital admissions within 30 days that documented potential complications associated with lower GI endoscopies were identified from the electronic hospital discharges database and reviewed. Multivariate generalized estimating equation regression analysis was performed to determine independent factors (patient, endoscopist and procedure) associated with the risk of developing complications.RESULTS: There were 29,990 outpatient lower GI endoscopies performed in Winnipeg during the years studied. Seventy-seven (0.26%) procedures were associated with complications requiring hospitalization within 30 days of the index procedure. Stricture dilation (rate ratio [RR] 23.14; 95% CI 6.70 to 76.51), polypectomy (RR 5.93; 95% CI 3.66 to 9.62), increasing patient age (for each year increase in age, RR 1.03; 95% CI 1.01 to 1.05) and performance of endoscopy by low-volume endoscopists (fewer than 200 procedures per year, RR 2.28; 95% CI 1.18 to 4.42) and family physicians (RR 2.23; 95% CI 1.39 to 3.58) were independently associated with complications.CONCLUSIONS: The results of the present study suggest that increasing patient age, complex procedures and performance of the index procedure by low-volume endoscopists are independent risk factors for lower GI endoscopy-associated complications in usual clinical practice. This suggests that it may be time to consider implementing minimum volume requirements for endoscopists performing non-screening lower GI endoscopies.

Dental caries in Indigenous children is a child health issue that is multifactorial in origin and strongly influenced by the determinants of health. The evidence suggests that extensive dental caries has an effect on health and well-being of the young child. This article focuses on early childhood caries as an overall proxy for Indigenous childhood oral health because decay during early life sets the foundation for oral health throughout childhood and adolescence. Strategies should begin with community engagement and always include primary care providers and other community health workers.

Background Defining the complication rate of endoscopy performed across an entire city will capture usual as opposed to referral center data. Objective Our purpose was to evaluate the current practice of colonoscopy and complications associated with lower GI endoscopy in usual clinical practice. Design All admissions within 30 days of an outpatient lower GI endoscopy at any of the 6 adult-care Winnipeg hospitals were identified. This includes endoscopy for both complex and routine patients. A chart audit of all cases with potential complications was performed. Results A total of 24,509 outpatient lower GI endoscopies for adults were performed at the 6 hospitals over the 2 study years (April 1, 2004, to March 31, 2006). There were 303 admissions with potential complications. The colonoscopy completion rate was 65% (72% for gastroenterologists vs 59% for general surgeons, P P = .02, relative risk 2 [95% CI, 1.1-3.7]). Limitations Chart audit was limited to cases requiring admission within 30 days of the index procedure. Conclusions The overall complication rate after lower GI endoscopy in usual clinical practice in Winnipeg is comparable to that previously reported. A higher complication rate after endoscopy by low-volume endoscopists needs to be further evaluated. The reporting of endoscopy must be standardized to enhance outcomes interpretation.

In 2010, the Manitoba Dental Association implemented the Free First Visit (FFV) program to provide access to dental screenings for children under 3 years of age and promote the concept of the age 1 dental visit. In this article, we report on dentists' views of the program.This qualitative study included 3 focus groups held in Winnipeg, Canada. An interview guide was developed to structure discussions.Thirty dentists participated. They were extremely supportive of the FFV program and its continuation. Promoting early visits and providing parents with anticipatory guidance were some reasons dentists participated. The most common reason for not participating was that dentists were already providing free dental care for children. Dentists viewed the goals of the program as increasing public awareness of the importance of early dental visits, establishing dental homes, educating parents, identifying early signs of caries and increasing children's level of comfort in the dental clinic. They indicated that the FFV program prompted some parents to take their children earlier than they might have otherwise. They said that most FFVs were provided to families who were already part of their practice. According to participating dentists, most parents were unaware of the FFV program and did not know about the age 1 visit recommendation. Dentists recommended that the FFV program concentrate on promoting the first visit by age 1 message with the free component as a secondary message. Participants recommended increasing general dentists' involvement in the program as most FFVs are currently provided by pediatric dentists.Most dentists participating in this study were supportive of the FFV program and advocated its continuation in Manitoba.

Objective: The objective of this qualitative descriptive study was to explore the perceptions of women living in inner-city Winnipeg, Canada, about barriers, facilitators, and motivators related to their use of prenatal care. Methods: Individual, semi-structured interviews were conducted in person with 26 pregnant or postpartum women living in inner-city neighborhoods with high rates of inadequate prenatal care. Interviews averaged 67 min in length. Recruitment of participants continued until data saturation was achieved. Inductive content analysis was used to identify themes and subthemes under four broad topics of interest (barriers, facilitators, motivators, and suggestions). Sword’s socio-ecological model of health services use provided the theoretical framework for the research. This model conceptualizes service use as a product of two interacting systems: the personal and situational attributes of potential users and the characteristics of health services. Results: Half of the women in our sample were single and half self-identified as Aboriginal. Participants discussed several personal and system-related barriers affecting use of prenatal care, such as problems with transportation and child care, lack of prenatal care providers, and inaccessible services. Facilitating factors included transportation assistance, convenient location of services, positive care provider qualities, and tangible rewards. Women were motivated to attend prenatal care to gain knowledge and skills and to have a healthy baby. Conclusion: Consistent with the theoretical framework, women’s utilization of prenatal care was a product of two interacting systems, with several barriers related to personal and situational factors affecting women’s lives, while other barriers were related to problems with service delivery and the broader healthcare system. Overcoming barriers to prenatal care and capitalizing on factors that motivate women to seek prenatal care despite difficult living circumstances may help improve use of prenatal care by inner-city women.

Introduction To determine the effectiveness of the Healthy Smile Happy Child (HSHC) project, a community-developed initiative promoting early childhood oral health in Manitoba, Canada. Specific aims were to assess improvements in caregiver knowledge, attitudes, and behaviours relating to early childhood oral health, and the burden of early childhood caries (ECC) and severe ECC (S-ECC). Methods A serial cross-sectional study design was selected to contrast findings following the Healthy Smile Happy Child (HSHC) campaign in four communities with the previous baseline data. One community was a remote First Nation in northern Manitoba and another was a rural First Nation in southern Manitoba. The other two communities were urban centres, one of which was located in northern Manitoba. A community-development approach was adopted for the project to foster community solutions to address ECC. Goals of the HSHC program were to promote the project in each community, use existing community-based programs and services to deliver the oral health promotion and ECC prevention activities, and recruit and train natural leaders to assist in program development and to deliver the ECC prevention program. The HSHC coordinator worked with communities to develop a comprehensive list of potential strategies to address ECC. Numerous activities occurred in each community to engage members and increase their knowledge of early childhood oral health and ultimately lead them to adopt preventive oral health practices for their young children. Children under 71 months of age and their primary caregivers participated in this follow-up study. A -value ≤0.05 was statistically significant. Results 319 children (mean age 38.2±18.6 months) and their primary caregivers participated. Significant improvements in caregiver knowledge and attitudes were observed following the HSHC campaign, including that baby teeth are important (98.8%), that decay involving primary teeth can impact on health (94.3%), and the importance of a dental visit by the first birthday (82.4%). Significantly more respondents indicated that their child had visited the dentist (50.2%) and had started brushing their child's teeth (86.7%) when compared to baseline. Overall, 52.0% had ECC, 38.6% had S-ECC. The mean deft score was 3.85±4.97 (range 0-20). There was no significant change is ECC prevalence between the follow-up and baseline investigations. However, age-adjusted logistic regression for S-ECC in this follow-up study revealed a significant reduction in prevalence compared with the baseline study (=0.021). Similarly, age-adjusted Poisson regression revealed that there were significant reductions in both the decayed teeth and decayed, extracted and filled teeth scores between follow-up and baseline study periods (0.016 and .0001, respectively). Conclusions Follow-up study results suggest that the HSHC initiative may have contributed to improvements in caregiver knowledge, attitudes, and behaviours towards early childhood oral health and subsequently modest yet statistically significant reductions in caries scores and the prevalence of S-ECC.

Background Hospital readmission is costly and potentially avoidable. The concept of virtual wards as a new model of care is intended to reduce hospital readmissions by providing short-term transitional care to high-risk and complex patients in the community. In order to provide information regarding the development of virtual wards in the Winnipeg Health Region, Canada, this study used spatial statistics to identify geographic variations of hospital readmissions in 25 neighborhood clusters. Methods The data were obtained from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy. We used a Bayesian Disease Mapping approach which applied Markov chain Monte Carlo (MCMC) for cluster detection. Results Between 2005/06 and 2008/09, 123,842 patients were hospitalized in all Winnipeg hospitals. Of these, 41,551 (33%) were readmitted to hospital in the year following discharge. Most of these readmitted patients (89.4%) had 1–2 readmissions, while 11.6% of readmitted patients had more than 2 readmissions after initial discharge. The smoothed age- and sex- adjusted relative risk rates of hospital readmission in 25 Winnipeg neighborhood clusters ranged between 0.73 and 1.27. We found that there were spatial cluster variations of hospital readmission across the Winnipeg Health Region. Seven neighborhood clusters are more likely to be significant potential clusters for hospital readmissions (p

Aboriginal people have poor health status, but there is also evidence that they access the health care system less effectively and find it more intimidating than other Canadians. The present paper reviews the evidence for this, details some of the history that has led to the continued disenfranchisement of Aboriginal people and makes some modest suggestions for ways that the health system can work toward better health and health care for Aboriginal people. Efforts should focus on making the entire system more patient-centred, improving cultural competence, increasing Aboriginal presence in the health workforce, and improving access through cultural and language interpreter services and outreach.

Objectives. Vitamin D deficiencies have been documented in several populations, including aboriginal Canadians from isolated northern communities. Such deficiencies can impact the health of both the mother and her infant. This review was performed to determine how widespread vitamin D deficiency is during pregnancy. Study design. Electronic literature search. Methods. A Medline search was conducted using the Mesh terms "pregnancy" and "vitamin D". Those studies meeting the inclusion criteria were reviewed. Results. 35 of 76 studies reported deficient mean, or median, concentrations of 25(OH)D. Low concentrations were reported among different ethnic groups around the world. In addition, deficient concentrations were identified in 3 northern First Nations communities in Manitoba. Conclusions. Such deficiencies are of concern, as the developing fetus acquires its 25(OH)D across the placenta and may influence infant health. Future research is required to resolve the discourse surrounding ambiguous threshold values for vitamin D deficiencies and insufficiencies and to identify effective strategies to improve the vitamin D status of expectant women. Vitamin D supplementation may be necessary for many women during pregnancy, especially those in northern regions where endogenous synthesis may be constrained. (Int J Circumpolar Health 2005; 64(2):112-120) Keywords: pregnancy, review, vitamin D, vitamin D deficiency

OBJECTIVES: Inadequate maternal vitamin D (assessed by using 25-hydroxyvitamin D [25OHD]) levels during pregnancy may affect tooth calcification, predisposing enamel hypoplasia and early childhood caries (ECC). The purpose of this study was to determine the relationship between prenatal 25OHD concentrations and dental caries among offspring during the first year of life. METHODS: This prospective cohort study recruited expectant mothers from an economically disadvantaged urban area. A prenatal questionnaire was completed and serum sample drawn for 25OHD. Dental examinations were completed at 1 year of age while the parent/caregiver completed a questionnaire. The examiner was blinded to mothers’ 25OHD levels. A P value ≤ .05 was considered significant. RESULTS: Overall, 207 women were enrolled (mean age: 19 ± 5 years). The mean 25OHD level was 48 ± 24 nmol/L, and 33% had deficient levels. Enamel hypoplasia was identified in 22% of infants; 23% had cavitated ECC, and 36% had ECC when white spot lesions were included in the assessment. Mothers of children with ECC had significantly lower 25OHD levels than those whose children were caries-free (41 ± 20 vs 52 ± 27 nmol/L; P = .05). Univariate Poisson regression analysis for the amount of untreated decay revealed an inverse relationship with maternal 25OHD. Logistic regression revealed that enamel hypoplasia (P < .001), infant age (P = .002), and lower prenatal 25OHD levels (P = .02) were significantly associated with ECC. CONCLUSIONS: This study found that maternal prenatal 25OHD levels may have an influence on the primary dentition and the development of ECC.

The Canadian Dental Association recommends that children have their first visit to a dental professional no later than 12 months of age. In 2010, the Manitoba Dental Association launched the Free First Visit (FFV) program to increase access to early visits in the province. The purpose of the study reported here was to survey dentists about their views on the FFV program and to gain an understanding of their attitudes and practice patterns relating to the oral health of infants and toddlers and first dental visits.A survey was mailed to registered general and pediatric dentists in Manitoba according to a modified Dillman methodology. Dentists were asked about their views on the FFV, their knowledge of early childhood oral health and the timing of first dental visits. Descriptive statistics, bivariate analyses and logistic regression analyses were performed. A p value of 0.05 or less was considered significant.The overall response rate was 63.2% (375 eligible responses out of 593 surveys mailed). The majority of respondents were men (255/373 [68.4%]), and most respondents were general dentists (355/372 [95.4%]). A total of 63.5% (231/364) felt that the FFV program improved access to care, 64.6% (223/345) believed that public awareness of young children's oral health has increased, and 76.2% (266/349) thought that the FFV initiative should continue past the planned end date of March 31, 2013. On average (± standard deviation), respondents thought that the first dental visit should occur at 18.1 ± 10.0 months, but in their practices, they actually recommended a slightly older age (18.9 ± 10.4 months). Compared with results from a previous survey, conducted in 2005, dentists who responded to this survey recommended that children have their first visit at a significantly younger age. A greater proportion of dentists reported seeing children 12-23 months of age in their practices than in the past (81.9% vs. 73.7%).A majority of dentists who responded to the survey approved of the FFV program and thought it should continue. Although these dentists recommended early first dental visits, the average age recommended by respondents was 6 months later than the target age of 12 months. It appears that, over time, dentists are becoming more aware of prevention and management techniques relating to infants and toddlers.

Background.Previous studies have suggested changes in self-concept with successful treatment of primary nocturnal enuresis (PNE), but behavioral changes have not been reported as a consistent associated finding.Objective.To determine if self-concept and behavior change after 6 months of treatment of monosymptomatic PNE by conditioning alarm or desmopressin acetate (DDAVP).Design.Randomized, controlled trial in an inner-city hospital clinic. Subjects were 182 children referred or recruited through media publicity, randomly assigned both to 1 of 8 pediatricians and 1 of 3 treatment groups (alarm, DDAVP, or placebo). Included were children >7 years old with PNE, no daytime symptoms, bladder capacity >50% expected, and wetting >3 times a week. Excluded were children with central nervous system disorders or developmental delays, and those currently on DDAVP or alarm. Subjects completed thePiers-Harris Children's Self-Concept Scale and Harter's Perceived Competence Scale for Children (PCSC) at initial visit and after 6 months of treatment. Parents completed the Achenbach Child Behavior Checklist (CBCL) at the same times.Results.After 6 months of treatment the Piers-Harris total score showed a highly significant treatment by period interaction effect for DDAVP, a significant effect for alarm, and no effect for placebo. For children who achieved 75% dryness the CBCL showed a treatment by improvement interaction effect that was highly significant for DDAVP and placebo with no effect for alarm. For the PCSC there were no treatment or outcome interaction effects.After 6 months of treatment there were significant changes over time unrelated to outcome or treatment in the Piers-Harris Subscales and in the CBCL Internalizing and Externalizing Scores, and the Social Thought and Attention Problems Subscales. The PCSC was more stable with no changes in total score, and positive changes over time in only 2 Subscales, Scholastic and Social.Conclusion.Children's self-concept improved with the type of treatment and amount of success. Parents' perceptions of behavior improve with type of treatment and amount of success. Children rate their self-concept and some physical attributes better after treatment with any of DDAVP, alarm, or placebo regardless of outcome. Frequent follow-up with emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis.

Objective—To evaluate and summarize the house fire injury prevention literature. Methods—MEDLINE (1983 to March 1997) was searched by keyword: fire, burn, etiology, cause, prevention, epidemiology, and smoke detector/alarm. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by keyword: as above, and safety, skills, education, and training. Other sources included references of retrieved publications, review articles, and books; Injury Prevention hand search; government documents; and internet sources. Sources relevant to residential fire injury prevention were selected, evaluated, and summarized. Results—Forty three publications were selected for review, including seven randomized controlled trials, nine quasiexperiments, two natural experiments, 21 prospective cohort studies, two cross sectional surveys, one case report, and one program evaluation. These studies examined the following types of interventions: school (9), preschool (1), and community based educational programs (5); fire response training programs for children (7), blind adolescents (2), and mentally retarded adults (5) and children (1); office based counseling (4); home inspection programs (3); smoke detector giveaway campaigns (5); and smoke detector legislation (1). Conclusions—This review of house fire prevention interventions underscores the importance of program evaluation. There is a need for more rigorous evaluation of educational programs, particularly those targeted at schools. An evidence based, coordinated approach to house fire injury prevention is critical, given current financial constraints and the potential for program overload for communities and schools.

Objectives—To describe the patterns of protective equipment use by in-line skaters in Winnipeg, Manitoba and nearby rural communities. Methods—In-line skaters were observed for three months in 1996 at 190 urban and 30 rural sites selected using a formal sampling scheme. Age, gender, protective equipment use, skating companions, correct helmet use, and use of headphones were recorded. Results—Altogether 123 in-line skaters were observed at 61 sites, including one rural site. No skaters were observed at the remaining sites. There were 37 adults and 86 children; 56% were male. Helmet use was 12.2% (95% confidence interval (CI ) = 6.4% to 18.0%), wrist guard use was 16.3% (95% CI = 9.7% to 22.8%), knee pad use was 9.8% (95% CI = 5.2% to 16.4%), and elbow pad use was 7.3% (95% CI = 3.4% to 13.4%). Children were more likely to wear a helmet than teens 12‐19 years of age (relative risk (RR) = 30, 95% CI = 4.01 to 225).Adults were more likely to wear wrist guards than children (RR = 4.32, 95% CI = 1.87 to 9.94). No gender diVerences were found. Incorrect helmet use was documented in four skaters; three skaters were wearing headphones. Conclusions—Low rates of protective equipment use were documented in our region, significantly lower than those reported in the literature. Barriers to equipment use are not known, and should be examined by further study. In-line skating safety programs should be developed, promoted, and evaluated. Teens should be targeted for future preventive eVorts. (Injury Prevention 1998;4:198‐202)

Objectives. Several groups in Manitoba, Canada, experience early childhood caries (ECC), including Aboriginal, immigrant, and refugee children and those from select rural regions. The purpose of this pilot study was to explore the views of parents and caregivers from four cultural groups on early childhood oral health and ECC.Methods. A qualitative descriptive study design using focus groups recruited parents and caregivers from four cultural groups. Discussions were documented, audio-recorded, transcribed, and then analyzed for content based on themes.Results. Parents and caregivers identified several potential barriers to good oral health practice, including child’s temperament, finances, and inability to control sugar intake. Both religion and genetics were found to influence perceptions of oral health. Misconceptions regarding breastfeeding and bottle use were present. One-on-one discussions, parental networks, and using laypeople from similar backgrounds were suggested methods to promote oral health. The immigrant and refugee participants placed emphasis on the use of visuals for those with language barriers while Hutterite participants suggested a health-education approach.Conclusions. These pilot study findings provide initial insight into the oral health-related knowledge and beliefs of these groups. This will help to inform planning of ECC prevention and research strategies, which can be tailored to specific populations.

This paper will report on the establishment of the Centres for Health Evidence (CHE) Demonstration Project in both Edmonton at the University of Alberta and in Winnipeg at the University of Manitoba. The CHE Project brings together a variety of partners to support evidence-based practice using Internet-based desktops on hospital wards. There is a discussion of the CHE's cultural and political experiences. An overview of the research opportunities emanating from the CHE Project is presented as well as some early observations about information usage.

The distribution of plasma lipids and their sociodemographic and metabolic correlates were investigated in two Arctic indigenous populations based on two health surveys conducted during 1990-1991 among adults in eight Inuit communities in the Keewatin region of the Northwest Territories, Canada (n = 387), and in four communities in the Chukotka region in the Russian Far North (n = 362). For comparison, data from the Canadian Heart Health Survey were used. The age-sex-specific mean total and low-density lipoprotein (LDL)-cholesterol levels among Inuit in northern Canada either do not differ significantly from the Canadian national population, or, in the case of younger Inuit women, are higher than in Canadians. This represents a temporal change from the results of earlier studies. Chukotka Natives tend to have the lowest total cholesterol (TC) and LDL values of the three populations. The two indigenous populations still enjoy considerably lower levels of triglycerides (TG) and higher levels of high density lipoprotein (HDL) cholesterol than observed in Canada, with the exception of younger Inuit women whose mean TG levels are not significantly different from those of Canadians. The proportion of individuals at risk for ischemic heart disease because of high TG (≥2.3 mmol/L) is 20% among Canadian men but only 2% and 0% among the Arctic Natives, and 11% among Canadian women compared to 6% and 3% in the Keewatin and Chukotka regions, respectively. Such sociodemographic factors as education and marital status do not have a substantial and consistent effect on plasma lipid levels. Women with higher education have lower HDL (in Keewatin) and higher TG (in Chukotka), significant only at the 0.10 level. Among Chukotka men those who reported a lineage without nonindigenous admixture have a higher HDL level (P = 0.048). No difference between the admixed and nonadmixed can be found in the Keewatin. Smoking status has no significant effect on any of the lipid fractions in either population. The two Arctic populations demonstrate an association of some plasma lipids with blood pressure and indices of obesity and central fat patterning commonly observed in other populations. However, plasma glucose does not increase in tandem with increasing levels of lipids, contrary to that observed in the general Canadian population. © 1995 Wiley-Liss, Inc.

Background Severe tooth decay is known to affect the health and well-being of young children. However, little is known about the influence of Severe Early Childhood Caries (S-ECC) on childhood nutritional status. The purpose of this study was to contrast ferritin and haemoglobin levels between preschoolers with S-ECC and caries-free controls. Methods Children were recruited as part of a larger case–control study examining differences in nutritional status between those with and without S-ECC. Preschoolers with S-ECC were recruited on the day of their dental surgery, while caries-free controls were recruited from the community. Parents completed a questionnaire and the child underwent venipuncture. The study was approved by the University’s Health Research Ethics Board. Statistics included descriptive, bivariate and logistic regression analyses. A p value ≤ .05 was significant. A total of 266 children were recruited; 144 with S-ECC and 122 caries-free. Results The mean age was 40.8 ± 14.1 months. The mean ferritin concentration for all children was 29.6 ± 17.9 μg/L while the mean haemoglobin level was 115.1 ± 10.1 g/L. Children with S-ECC were significantly more likely to have low ferritin (p=.033) and low haemoglobin levels (p>.001). Logistic regression analyses revealed that children with S-ECC were nearly twice as likely to have low ferritin levels and were over six times more likely to have iron deficiency anaemia than caries-free controls. Conclusions Children with S-ECC appear to be at significantly greater odds of having low ferritin status compared with caries-free children and also appear to have significantly lower haemoglobin levels than the caries-free control group. Children with S-ECC also appear to be at significantly greater odds for iron deficiency anaemia than cavity-free children.

Objectives. Desmopress in acetate (DDAVP) is promoted to treat nocturnal enuresis but indications for its use are unclear. We reviewed all randomized controlled trials to determine (1) short- and long-term efficacy, (2) responders, (3) dose-response curve, (4) side effects, and (5) comparative efficacy with other treatments. Methods. A Medline search of the English language literature from January 1966 to August 1992, supplemented by contact with the drug companies, yielded 18 articles which were true randomized controlled trials (11 cross-over and 7 parallel studies). Results. The 18 randomized controlled trials included 689 subjects for most of whom some other type of treatment had failed. All studies found decreased mean frequency of wetting ranging from 10% to 91%, but only 24.5% of subjects achieved short-term dryness. One study of DDAVP responders directly tested long-term dryness and 21% stayed dry. In three studies that incidentally reported on long-term effects 5.7% stayed dry after stopping DDAVP. There was wide variation in the type of patient included. Seven studies addressed prognostic factors. Children more than 9 years old and with fewer initial wet nights do better. Four studies seem to include almost exclusively monosymptomatic children with nocturnal enuresis (ie, primary nocturnal enuresis, positive family history, and no urinary symptoms). Results were no better than those which included mixed symptoms. Five studies attempted to address the dose-response issue. Despite some methodological issues, there is probably some dose-response effect. Side effects were infrequent in the 589 subjects who received DDAVP as opposed to placebo. No cases of water intoxication and no significant shifts in electrolytes were reported in the four studies which measured them. Nasal stuffiness, headache, epistaxis, and mild abdominal pain seem to be the only side effects noted, and these were uncommon. Only one study compared DDAVP with conditioning alarms. Alarm patients had 10% fewer wet nights and a better long-term result. Conclusions. DDAVP reduces wet nights in children for whom other treatments have failed but it produces complete dryness in a minority, and this is often a temporary effect. The literature focuses on short-term efficacy. The true role of DDAVP will be known when samples are carefully selected, prognostic factors are examined, and more comparisons with other treatments are conducted focusing on long-term outcomes. On the basis of current knowledge, DDAVP is inferior to conditioning alarms as a primary therapy.

Background Acute otitis media (AOM) is a common illness during childhood, for which antibiotics are frequently prescribed. Objectives To determine the effectiveness of a short course of antibiotics (less than seven days) in comparison to a long course of antibiotics (seven days or greater) for the treatment of AOM in children. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 4) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE, EMBASE, MEDLINE In-Process & Other Non-Indexed Citations, CINAHL, BIOSIS Previews, OCLC Papers First and Proceedings First, Proquest Dissertations and Theses (inception to November 2009); International Pharmaceutical Abstracts, the NLM Gateway, ClinicalTrials.gov and Current Controlled Trials (inception to August 2008). Selection criteria Trials were included if they met the following criteria: participants aged one month to 18 years; clinical diagnosis of ear infection; no previous antimicrobial therapy; and randomisation to treatment with less than seven days versus seven days or more of antibiotics. Data collection and analysis The primary outcome of treatment failure was defined as the absence of clinical resolution, relapse or recurrence of AOM during one month following initiation of therapy. Treatment outcomes were extracted from individual studies and combined in the form of a summary odds ratio (OR). A summary OR of 1.0 indicates that the treatment failure rate following less than seven days of antibiotic treatment was similar to the failure rate following seven days or more of treatment. Main results This update included 49 trials containing 12,045 participants. Risk of treatment failure was higher with short courses of antibiotics (OR 1.34, 95% CI 1.15 to 1.55) at one month after initiation of therapy (21% failure with short-course treatment and 18% with long-course; absolute difference of 3% between groups). There were no differences found when examining treatment with ceftriaxone for less than seven days (30% failure in those receiving ceftriaxone and 27% in short-acting antibiotics administered for seven days or more) or azithromycin for less than seven days (18% failure in both those receiving azithromycin and short-acting antibiotics administered for seven days or more) with respect to risk of treatment failure at one month or less. Significant reductions in gastrointestinal adverse events were observed for treatment with short-acting antibiotics and azithromycin. Authors' conclusions Clinicians need to evaluate whether the minimal short-term benefit from longer treatment of antibiotics is worth exposing children to a longer course of antibiotics.

Background Gastro-esophageal reflux (GER) is the refluxing of gastric contents into the esophagus. Fifty per cent of all infants 0 to 3 months regurgitate at least once a day. This drops to 5% once infants are 10 to 12 months old. Three per cent of parents of 10 to 12 month old infants view this as a problem. Objectives To investigate the effectiveness of thickened feeds, positioning, and metoclopramide as compared to placebo in improving the outcome of GER in developmentally normal infants aged one month to two years. Search strategy Trials were identified by searching Cochrane Central Register of Controlled Trials (The Cochrane Library 2003), MEDLINE (January 1966 to 23 January 2003), EMBASE (January 1985 to 27 January 2003), and reference lists of articles. Searches in all databases were updated in April 2009. Selection criteria Randomised studies (parallel or cross over) which evaluated thickened feeds, positional alternations or metoclopramide for the treatment of GER in children between the age of one month and two years who were developmentally normal. Data collection and analysis All three reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. Main results Twenty trials involving 771 children met the inclusion criteria: eight dealt with thickened feeds, five with positioning, and seven with metoclopramide. Few comparisons could be made, and so summary measures were often made with two or three studies. Thickened feeds reduce the regurgitation severity score (standardized mean difference (SMD) -0.94;95% confidence interval -1.35 to -0.52), as well as the frequency of emesis (SMD -0.91; confidence interval -1.22 to -0.61). The reflux index was not reduced (weighted mean difference (WMD) 0.48%; 95% confidence interval -3.27 to 4.23). All five positioning studies utilized esophageal pH monitoring as their outcome measure. Elevating the head of the crib for treating reflux in the supine position is not justifiable. The seven metoclopramide studies used a variety of outcomes. Compared to placebo, metoclopramide appears to reduce daily symptoms ( SMD -0.73; 95% confidence interval -1.16 to -0.30), and reduce the reflux index (WMD -2.80%; 95% confidence interval -5.58 to -0.01). It does increase side effects. Authors' conclusions Thickened feeds are helpful in reducing the symptoms of GER. Elevating the head of the crib in the supine position does not have any effect. Metoclopramide may have some benefit in comparison to placebo in the symptomatic treatment for GER, but that must be weighed against possible side effects. .

The Canadian Institute for Health Information began publishing hospital standardized mortality ratio (HSMR) data for select Canadian hospitals in November 2007. This paper describes the experience of the Winnipeg Regional Health Authority in assessing the validity of the HSMR through statistical analysis, coding definitions and chart audits. We found a lack of empirical evidence supporting the use of the HSMR in measuring reductions in preventable deaths. We also found that limitations in standardization as well as differences in palliative care coding and place of death make inter-facility comparisons of HSMRs invalid. The results of our chart audit show that the HSMR is not a sensitive measure of adverse events as defined by "unexpected death" in the Canadian Adverse Events Study. It should not be viewed as an important indicator of patient safety or quality of care. We discuss the cumulative sum statistic as an alternative to the HSMR in monitoring in-hospital mortality.

OBJECTIVES: Prevention strategies are integral to improving the oral health for young Aboriginal children. For such to be effective, it is important to understand the social value that parents and caregivers ascribe to primary teeth. The purpose of this paper is to report caregiver knowledge and attitudes toward preschool oral health and early childhood caries (ECC) from 4 communities in Manitoba. STUDY DESIGN: Cross-sectional study, including a retrospective interview with caregivers. METHODS: Children and their main caregivers served as the sample. Preschoolers underwent a comprehensive dental screening while caregivers completed a questionnaire that explored knowledge and attitudes toward preschool dental health. Caregiver responses were matched with findings from each child's examination. RESULTS: A majority agreed that primary teeth were important, that dental disease could lead to health problems and that a first dental visit should be made by age 1. Caregivers of children with ECC were more likely to believe that caries could not affect a child's health while those who believed primary teeth are important had children with significantly less decay. CONCLUSIONS: Most caregivers believed that primary teeth are important and correctly responded to inquiries about knowledge and attitudes toward oral health. Attitudes on the importance of baby teeth and bottle feeding after one year of age, the effect of rotten teeth on childhood health and night-time nursing emerged as variables most associated with the absence/presence of ECC and deft rates. Incorporating such questioning into caries risk assessments may be a useful means to determine a child's risk for ECC. Keywords: Aboriginal; attitude to health; dental caries; early childhood caries; oral health; preschool child (Int J Circumpolar Health 2007; 66(2):153-167)

This revised and updated second edition, published more than a decade after the first edition, presents the reader with a clear and readable picture of the health of aboriginal people in Canada, how the health status got to be what it is and how history, politics and culture have conspired to create the deplorable situation in which many aboriginal people find themselves today. The book begins with a chapter on who the aboriginal people of Canada are, from whence they came and the probable timing of the arrival of different waves. It describes the immense cultural and linguistic diversity that existed prior to contact and a brief history of what happened postcontact in terms of legislation and cultural and economic changes. This chapter alone is a nice summary for the uninitiated. International Journal of Circumpolar Health 66:1 2007

Objective : Despite the importance of prenatal care, there are no national data and limited provincial data on use of prenatal care by women in Canada, nor is there much information on racial/ethnic disparities in access to prenatal care. This study describes and compares the prevalence and predictors of inadequate prenatal care among Aboriginal and non-Aboriginal women giving birth in Manitoba. Methods : Data were obtained from interviews with 652 postpartum women who delivered a live singleton infant in 2 tertiary hospitals in Winnipeg, Manitoba. We identified inadequate prenatal care, using the Kessner Adequacy of Prenatal Care Index. We used stratified analysis to describe effect-measure modification for predictors of inadequate prenatal care among the Aboriginal and non-Aboriginal subgroups. We conducted a multivariable logistic regression analysis for the total sample. Results : A significantly higher proportion of Aboriginal women (15.7%) than non-Aboriginal women (3.6%) received inadequate prenatal ca re. After controlling for other factors, significant predictors of inadequate prenatal care included low income, low self-esteem, high levels of perceived stress, and Aboriginal background. Conclusion : Women who do not receive adequate prenatal care are more likely to live in poverty, experience highly stressed lives, have low levels of self-esteem, and be Aboriginal. Efforts to improve the provision of prenatal care should be directed toward these women. Racial/ethnic disparities in use of prenatal care need to be addressed.

Preschool oral health is often overlooked as an important aspect of childhood health and well-being. The purposes of this study were to: (1) determine the dental status of 3-year-old children in the community of Carman, Manitoba, Canada; and (2) identify the principal determinants of Early Childhood Caries (ECC) in 2 consecutive years.All children and mothers attending a preschool health screening fair were invited to participate. Study procedures included a retrospective interview with parents and dental examination of the child. Statistical analyses included ANOVA, chi-square, and multiple regression. A P value of.05 denoted significance.A total of 61 children participated (mean age=45.7+/-3.4 months). The prevalence of ECC was 44%, while the mean deft was 2+/-3.3. Increased caries activity and ECC were associated with lower maternal level of education (P.01). Family size was associated with deft scores (P=.03) while the presence of debris was also associated with ECC (P.05).ECC prevalence among these 3-year-olds is less than exhibited among other Canadian preschool children. Factors associated with ECC included debris on the primary teeth and low maternal education. Factors most associated with increased caries activity included low maternal education and increased family size. In addition, parents were able to reliably assess their child's dental health status. Larger epidemiological studies of ECC are needed to better assess prevalence and risk factors. Such data may, therefore, assist in identifying those children at greatest risk for ECC. It may also help in the redirection of scarce resources to effective preventive oral health interventions, as these children have an increased caries burden along the continuum of childhood.

In the province of Manitoba, the incidence of preterm birth has been increasing and the rate is higher among Aboriginal than non-Aboriginal women. The purpose of this study was to identify risk factors for spontaneous preterm birth in Manitoba women, and to compare risk factors among Aboriginal and non-Aboriginal women. A case-control study was performed at two tertiary care hospitals in Winnipeg, Manitoba, Canada from October 1999 to December 2000. Cases delivered a live singleton infant at < 37 weeks gestation (n = 226; 36% Aboriginal), while controls delivered between 37 and 42 weeks gestation (n = 458; 38% Aboriginal). An interview was conducted with each subject on the postpartum unit, and information was collected from the health record. Using stratified analyses to control for race/ethnicity, several risk factors for preterm birth had a uniform effect measure across strata, while others demonstrated heterogeneity. After adjusting for other maternal characteristics in a multivariable logistic regression model, significant risk factors for all women included previous preterm birth, two or more previous spontaneous abortions, vaginal bleeding after 12 weeks gestation, gestational hypertension, antenatal hospitalisation, and prelabour rupture of membranes. In addition, potentially modifiable risk factors included low weight gain during pregnancy and inadequate prenatal care for all women, and high levels of perceived stress for Aboriginal women. These modifiable risk factors lend themselves to public health interventions, and should be targeted in future prevention efforts.

Early childhood caries (ECC) is a devastating form of dental decay affecting many Canadian children, especially those from northern First Nations communities. ECC is multifactorial in origin, and the notion that the principal etiology is inappropriate feeding modalities is no longer tenable.This study was conducted in the community of Garden Hill First Nation, Manitoba, to assess the prevalence of dental decay in young children, to assess risk factors for ECC and to determine the influence of vitamin D supplementation (a modified form of stosstherapy using 100,000 IU vitamin D), both prenatally and at 6 weeks of age, on the oral health of children. The study involved a cross-sectional dental examination of children, an interview with mothers and a maternal chart review.A total of 98 children participated: their mean age was 46.4 +/- 6.3 months. The mean number of decayed, extracted and filled teeth (deft) was 13.7 +/- 3.2. Caries rates were significantly greater among children who had had sugar added to the feeding bottle. Behaviours typically associated with ECC and caries activity, such as poor oral hygiene and late weaning from the bottle, were also exhibited among residents. Although 50% of children had enamel hypoplasia, no statistically significant differences in the amount of enamel hypoplasia and caries were found between those who received modified stosstherapy and those who did not. Not receiving stosstherapy was associated with later eruption time of the first primary tooth (7.2 vs. 5.0 months). Interviews revealed that, during pregnancy, many of the mothers only infrequently consumed foods rich in calcium and vitamin D, elements that are essential to the development of strong bones and teeth.The mean deft for these First Nations preschoolers was high and 50% had enamel defects. Although daily vitamin D supplementation of 400 IU during pregnancy has been known to reduce primary tooth enamel defects, the supplementation previously administered to participants in this study was not found to result in reduced enamel defects or caries. The high caries burden among children from this community reveals the need for effective prevention methods. It is important for pediatricians, family physicians and other health service providers encountering very young children and expectant mothers to be cognizant of ECC and its ramifications, as their education efforts represent the first line of defence.