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Objective and Approach Most studies have focused on women’s IPV victimization but perpetration and bi-directional violence remain understudied. Using linked criminal justice and population registers in Manitoba, Canada, we assessed the risk of death according to the role in IPV incidents (accused-only, victim-only, bidirectional, none). In this retrospective matched cohort study, we assembled a cohort of 212,068 adults who were followed from April 2004 to March 2023 to assess IPV incidents and subsequent death. Those involved in an IPV incident were 1:3 matched to persons with no history of IPV based on birth year, sex and marital status at the time of the incident. Results Men comprised 85% of accused-only, 21% of victim-only, and 50-51% in the other two groups. Overall, compared to those without IPV involvement, the adjusted Hazard Ratios for all-cause mortality were 1.38 [95% Confidence Intervals (CI): 1.28, 1.49] for accused-only, 1.39 (1.29, 1.50) for victim-only and 1.45 (1.19, 1.77) for bidirectional IPV. The associations were stronger among women, particularly that of bidirectional violence [1.24 (0.97, 1.60) among men and 1.92 (1.39, 2.66) among women]. Similar patterns were found for intentional mortality [0.96 (0.56, 1.64) among men and 2.43 (1.27, 4.65) among women]. Conclusions There are clear sex inequities in IPV involvement. Any type IPV involvement is associated with higher risk of death, particularly among women, who comprise most of the victims. Implications Use of linked criminal justice data allows studying the consequences of IPV victimization, perpetration and bidirectional violence and monitor gender inequities over time.

Objectives Over three decades ago, the Aboriginal Justice Inquiry identified structural racism in Canada’s justice system. Although rates of youth criminal charges and incarcerations have declined substantially since then, it is unclear whether First Nations youth are treated differently than non-First Nations youth for similar offences. Our study addressed this question. Approach This retrospective cohort study of youth born 1991-2001 and living in Manitoba between ages 12-17 used whole-population linked administrative data to identify youth charged with a crime (N=13,543). First Nations youth (n=7,081) were compared with all other Manitoba (AOM) youth (n=6,462) on whether their criminal charge proceeded or was dropped, deferred or diverted. The study applied an intersectionality theoretical framework. Individual (age, type and severity of charge, ever in child protection care, youth and/or mother diagnosed mental disorder, maternal incarceration, number of siblings, urban/rural residence) and social strata (First Nations identity, income, sex) factors were adjusted for using multi-level models. Results After accounting for other factors, First Nations youth had a higher risk of a charge proceeding than AOM (adjusted Relative Risk (aRR) 1.16, 95% CI 1.12-1.20). There was no difference in charges proceeding for male First Nations youth compared with male AOM, whereas among females, the risk was greater for First Nations (aRR 1.31, 95% CI 1.26-1.36). Low income and a history of being in the care of the child protection system increased the risk of charges proceeding for AOM only (aRR 1.16, 95% CI 1.13-1.18; aRR 1.13, 95% CI 1.07-1.20); for First Nations, there was no increased risk of charges proceeding associated with these intersecting factors. Conclusion These findings provide quantitative evidence of the intersecting structural racism in the youth criminal justice system previously identified by First Nations leaders. Future research will follow this cohort to determine whether more judicial sanctions are applied to First Nations youth throughout the justice process, including within criminal courts and corrections.

Objectives PAX, a mental health promotion approach, has been shown to decrease negative mental health outcomes and improve academic achievement. These effects have yet to be shown among Indigenous children. We evaluated PAX for improving First Nations children’s outcomes following a research process wherein community members and researchers work more collaboratively. Approach Building on a long-term relationship with Swampy Cree Tribal Council, community members, First Nations leaders and researchers worked together through all phases of the project. This cluster randomized controlled trial used population-based health, social services, and education administrative data that allowed de-identified individual-level linkages across all databases through a scrambled health number. Our cohort of 725 children from 20 First Nations schools were randomized to PAX (n=469, 11 schools) or wait-list control (n=256, 9 schools). We used propensity score weighting and multi-level modeling to estimate the differences over time (2011 up to 2020) between children exposed to PAX and those who were not. Results Differences in baseline characteristics were found between the two groups of children, despite the cluster randomization. After applying propensity score weights, children in the PAX group had significantly greater decreases in conduct problems (β:-1.08, standard error(se):0.2505, p

Objectives Given the impact of colonization and responding to Canada’s Truth and Reconciliation Commission, we aimed to provide baseline measures of First Nations children’s health and social outcomes in Manitoba, Canada. We also aimed to create a research process where Indigenous and non-Indigenous researchers work collaboratively and in culturally safe ways. Approach We formed a team consisting of members of First Nation organizations and academic researchers. Knowledge Keepers from Anishinaabe, Cree, Anishininew, Dakota and Dene Nations guided the study, interpreted results and ensured meaningful knowledge translation. This retrospective cohort study utilized population-based health, social services, education and justice administrative data that allowed de-identified individual-level linkages across all databases through a scrambled health number. Adjusted rates and rate ratios were calculated using a generalized liner modeling approach to compare First Nations children (n=61,726) and all other Manitoba children (n=279,087) and comparing First Nations children living on and off-reserve. Results Large disparities between First Nations and other Manitoba children were found in birth outcomes, physical and mental health, health services, education, social services, justice system involvement and mortality. First Nations infants had higher rates of preterm births, large-for-gestational-age births, newborn readmissions to hospital and lower rates of breastfeeding initiation compared with other Manitoba infants. Suicide rates among First Nations adolescents were ten times higher than among other adolescents in Manitoba, yet we found few differences in diagnosis of mood and anxiety disorders between the groups. First Nations children were also seven times more likely to apprehended by child protection services and youth were ten times more likely to be criminally accused. Knowledge Keepers offered their perspectives on these findings. Conclusion These findings demonstrate that an enormous amount of work is required in virtually every area – health, social, education and justice – to improve First Nations children’s lives. There is an urgent need for equitable access to services, and these services should be self-determined, planned and implemented by First Nations people.

Introduction Routine health care information systems only capture a portion of violence against women because some victimized women may not seek health care and some events may not require medical attention. Population-based estimates of the risk of violent injury (VI) among women with a history of intimate partner victimization (IPV) are lacking. Objectives and Approach To determine the risk of violent injury following IPV among women living in Manitoba, Canada, 2004-2016. Linked administrative justice, healthcare, and social databases were used. Exposure began after a woman was first involved with the Manitoba Justice system as a victim of IPV, assessed through provincial prosecution and disposition records. IPV victims (n= 20,469) were matched to three non-victims (n= 61,407) on age, relationship status and place of residence at the date of the IPV incident. The main outcomes were first health care use for violent injury and violent death. Outcomes were assessed through emergency department, hospital and vital statistics records. Conditional Cox Regression was used to obtain Hazard Ratios with 95% confidence intervals (CI). Results The crude risk of VI was 8.5 per 1000 women among non-victims and 55.8 among victims of IPV. Compared to non-victims, IPV victims were 3.8 [95% confidence interval (CI): 3.4, 4.3] times more likely to suffer IIIO and 4.5 [95% CI: 2.3, 9.0] times to have a violent death, after adjustment. Victims had approximately half the risk of VI if the accused is on probation. Conclusion / Implications Justice System-identified victims of IPV are at higher risk of assault and violent death than women not exposed to IPV. Justice involvement represents an opportunity for prevention of violent injury and homicide among IPV victims.

Introduction Children who have a history of involvement in child protection services (CPS) are over-represented in the youth and adult criminal justice systems. There are significant health and socioeconomic implications for individuals involved in either or both CPS and the justice system. Understanding the ‘overlap’ between these two systems would provide insight into the health and social needs of this population. This protocol describes a research programme on the relationship between the child welfare and the youth justice systems, looking specifically at the population involved in both CPS and the youth justice system. We will examine the characteristics associated with involvement in these systems, justice system trajectories of individuals with a history of CPS involvement and early adult outcomes of children involved in both systems.Methods and analysis Administrative data sets will be linked at the individual level for three cohorts born 1991, 1994 and 1998 in Manitoba, Canada. Involvement in CPS will be categorised as ‘placed in out-of-home care’, ‘received in-home services, but was not placed in care’ or ‘no involvement’. Involvement in the youth justice system will be examined through contacts with police between ages 12 and 17 that either led to charges or did not proceed. Individual, maternal and neighbourhood characteristics will be examined to identify individuals at greatest risk of involvement in one or both systems.Ethics and dissemination The study was approved by the University of Manitoba Health Research Ethics Board and permission to access data sets has been granted by all data providers. We also received approval for the study from the First Nations Health and Social Secretariat of Manitoba’s Health Information Research Governance Committee and the Manitoba Metis Federation. Strategies to disseminate study results will include engagement of stakeholders and policymakers through meetings and workshops, scientific publications and presentations, and social media.

Introduction Manitoba Public Health Nurses (PHNs) attempt to visit all families with newborns shortly after discharge from birth hospitalizations. Since 2000, PHNs have completed the Families First Screen (FFS) at these visits, to identify families at risk for child maltreatment. The information captured in FFS is a valuable tool for research. Objectives and Approach Our objective was to clean and validate FFS data and link to health data in the Manitoba repository in order to determine the percent of births in Manitoba hospitals that had FFS. We identified all babies born in Manitoba hospitals 2000-2015 using ICD-9-CM /ICD-10-CA codes. Mothers were identified through the Health Registry (Mom_Baby Link File) using scrambled Personal Health Identification Numbers (sPHINs). FFS data were linked to births via baby’s sPHIN. Determining which FFS records linked to babies required several steps of cleaning and validating the data to account for differences in birthdates between files, missing sPHINs, and multiple records. Results For example, in 2014 there were 16,079 births and 14,002 FFS records; 13,524 FFS had mother and/or baby sPHIN. For those missing baby sPHIN (9,295), 99.8% were retrieved via the Mom_Baby Link File. Linking the FFS to the hospital births we found: 3,043 births didn’t have an FFS; 12,762 had a single FFS, and 274 births had multiple FFS (i.e., baby associated with more than one mother, FFS and/or form date). To ensure that the baby was only associated with one mother and one FFS the most current FFS was kept. We found that in 2014, 81.07% (13,036/16,079) of the births had an FFS. In the longitudinal analysis, the percent of births with an FFS ranged from 74.6% in 2000 to 81.1% in 2014. Conclusion/Implications We were able to achieve good linkage between FFS and health registry data, allowing this rich data source to be used for research on maternal and child health. Information on percent of births with FFS has been shared with policy-makers over the years and changes to screening practices implemented.

Introduction Manitoba has one of the highest rates of children taken into care of child welfare services (Child and Family Services; CFS) in the world, and also one of the highest youth incarceration rates in Canada. Policy-makers recognize there is overlap between these systems; the extent of that overlap is unknown. Objectives and Approach We linked CFS, Justice, and Population Health Registry data to quantify the overlap between having a history of CFS during childhood (0-17 years) and being charged with a crime as a youth (12-17 years). Using a cohort approach, we selected all individuals in Manitoba who were born in 1988 (N=28,178); those not in the province at any time from 12-17 years were excluded, leaving a final cohort of 18,182. The cohort was divided into 3 groups according to CFS involvement: CFS out-of-home care (1,148); CFS in-home services (3,395); no CFS (13,639). Criminal charges between 12-17 years were identified. Results 6.3% of our cohort had CFS out-of-home care, 18.7% received CFS in-home services, and 75% had no CFS involvement. 10.5% of the cohort were charged of a crime between 12-17 years. Almost half (46.6%) of youth who had CFS out-of-home care had criminal charges, compared to 19.4% of youth who had CFS in-home services, and 5.3% of youth with no CFS. Despite accounting for only 6.3% of the cohort, youth who had out-of-home care accounted for 28.0% of youth with criminal charges. Indigenous (First Nations (FN) and Metis) children/youth were over-represented in both systems; for example, 24.5% of FN youth had been in care compared to 3.1% of non-Indigenous; and 32.2% of FN youth were charged with a crime compared to 6.6% of non-Indigenous youth. Conclusion/Implications There is substantial overlap between the child welfare and youth justice systems, with overrepresentation of Indigenous youth in both systems. Culturally appropriate programs and policies aimed at supporting parents, families and communities to care for their own children will likely have long-term positive impacts on the youth justice system.

ABSTRACT Objectives Manitoba has one of the highest rates of children in out-of-home care in the world. Our aims were to: 1) describe characteristics of children in care; 2) determine differences in educational outcomes for children in care, children receiving in-home protection services and children not involved with child welfare; and, 3) identify factors contributing to educational success for children in care. Approach Population-level administrative data from the Population Health Research Data Repository at the Manitoba Centre for Health Policy, were used. Several data sources were linked together at an individual level: child welfare services (e.g., in care, in-home services; hospital birth records (e.g., birth weight, gestational age); health status (e.g., from hospitalizations, physician visits); family risk factors (e.g., maternal prenatal smoking and/or drinking, maternal education); family characteristics (e.g., number of children in family, receipt of income assistance); education assessments at kindergarten, grades 3, 7, 8, 9 and 12. Children in care from 1998 onward were included. Number of children analyzed differed depending on the educational outcome examined: e.g., analyses at kindergarten include 1,893 children in care, 4,229 children receiving in-home services, and 32,280 children not involved with child welfare services; for high school completion these numbers were 11,234, 40,671, and 162,265 respectively. Multivariate regressions identified characteristics associated with educational outcomes for children in care. Results Over one-third of children in care first entered care as infants, and of those, close to half were apprehended at birth. 5.5% of children in Manitoba spent some time in care before their 15th birthday, with an almost tenfold difference for Indigenous (16.6%) and non-Indigenous (1.7%) children. Across the range of educational outcomes, children in care did more poorly than children receiving in-home services, who in turn did more poorly than children with no child welfare involvement. For example, only 33.4% of children in care completed high school compared to 66.8% of children receiving in-home services and 89.3% of children with no child welfare involvement. Adjusting covariates reduced differences but all remained statistically significant. Factors associated with positive outcomes for children in care differed depending on the outcome and included measures like poverty (at Kindergarten, p

BACKGROUND: There are limited data regarding complications associated with colonoscopy and flexible sigmoidoscopy in usual clinical practice in Canada.

We have previously shown that during pregnancy the E-twenty-six (ETS) transcription factor ELF5 directs the differentiation of mammary progenitor cells toward the estrogen receptor (ER)-negative and milk producing cell lineage, raising the possibility that ELF5 may suppress the estrogen sensitivity of breast cancers. To test this we constructed inducible models of ELF5 expression in ER positive luminal breast cancer cells and interrogated them using transcript profiling and chromatin immunoprecipitation of DNA followed by DNA sequencing (ChIP-Seq). ELF5 suppressed ER and FOXA1 expression and broadly suppressed ER-driven patterns of gene expression including sets of genes distinguishing the luminal molecular subtype. Direct transcriptional targets of ELF5, which included FOXA1, EGFR, and MYC, accurately classified a large cohort of breast cancers into their intrinsic molecular subtypes, predicted ER status with high precision, and defined groups with differential prognosis. Knockdown of ELF5 in basal breast cancer cell lines suppressed basal patterns of gene expression and produced a shift in molecular subtype toward the claudin-low and normal-like groups. Luminal breast cancer cells that acquired resistance to the antiestrogen Tamoxifen showed greatly elevated levels of ELF5 and its transcriptional signature, and became dependent on ELF5 for proliferation, compared to the parental cells. Thus ELF5 provides a key transcriptional determinant of breast cancer molecular subtype by suppression of estrogen sensitivity in luminal breast cancer cells and promotion of basal characteristics in basal breast cancer cells, an action that may be utilised to acquire antiestrogen resistance.

Police understandings of honour-based crimes (HBCs) and forced marriages (FMs) vary in terms of an individual officer’s level of expertise, knowledge, and experience in handling such situations. This study applied constructivist grounded theory approaches to analyze individual interviews with 32 police officers and 14 civilians in police agencies operating in urban and rural settings in Alberta, Canada. Specifically, this paper seeks to answer how police officers and civilians who work in police agencies experience, make sense of, and understand HBCs. Participants received a hypothetical vignette about a young woman who had reached out to the police. The vignette illustrated various forms of abuse by the woman’s father, the involvement of other actors (mother, brother, family friend) and the culmination in an FM. After reading the vignette, participants were asked to respond to six questions. Analysis revealed that both police and civilians recognized the need in the vignette scenario for intervention, while experiencing uncertainty about how to respond. The findings showed that not everyone in policing would be able to identify reliably the need for police intervention, and that investigations could proceed differently depending on the investigator’s level of knowledge and awareness of HBCs and FMs. Police have achieved some successful interventions, but still lack sufficient guidance on how to respond to these crimes. Clear, appropriate policies regarding which cases need to be directed to specialized domestic violence units for follow-up are needed. A significant finding points to the importance of considering cultural sensitivity discourses as well as the impact of cultural and racist stereotypes when responding to situations like the one outlined in the vignette.

This article examines how a vignette presented to participants during qualitative research interviews was successful in gathering information on the perceptions of 32 police officers and 14 civilians regarding “honor”-based crimes and forced marriages within the context of domestic violence. To my knowledge, this is one of the first methodological papers that presents the process of using a vignette with police on such a sensitive topic. This article offers a reflexive account of some of the methodological considerations I made when constructing the vignette that likely impacted its success. I describe the vignette, discuss how participants reacted to it, and present the themes that emerged to show how it was understood. I then emphasize how first responders engaged in the interview process with the vignette material and how this allowed for a rich, in-depth discussion on an understudied topic. Finally, I discuss the strengths and limitations of this method and make recommendations for future research.

This article explores the roots of the Canadian community service-learning (CSL) movement through a comparative discussion of service-learning in Canada and the United States. The article provides a brief overview of CSL’s historical foundations in both countries, addressing especially how differences in CSL funding infrastructure have distinctly shaped the movement in each country. While national funding bodies and nation-wide institutionalization remain central to CSL in the U.S., Canada’s CSL efforts have predominantly been shaped by the efforts of private foundations and grassroots community agents. This essay analyzes the obstacles and problems currently within Canadian CSL, but also provides recommendations around documentation, sustainability, and the future of CSL in Canada, including the recommendation to maintain a community first approach in Canadian CSL. As it considers how the influence of the United States continues to shape CSL in Canada, and how the two national movements remain distinct from one another, we hope this examination will contribute an historical perspective to scholarship on Canadian CSL and will offer entry points to engage in critical conversations on the emergence of the field.

This paper reports on a pilot project that involved the incorporation of Community Service-Learning (CSL) into a large Introductory Sociology class by drawing on the critical reflections of the six graduate student instructors and the primary instructor who taught the course. Graduate student instructors individually facilitated weekly seminars for about 30 undergraduate students, half of which participated in CSL, completing 20 hours of volunteer work with a local non-profit community organization. We discuss the benefits of incorporating CSL into a large Introductory Sociology class and speculate on the value of our particular course format for the professional development of graduate student instructors. A main finding was the critical importance to graduate students of formal and informal training and collaboration prior to and during the delivery of the course. Graduate students found useful exposure to CSL as pedagogical theory and practice, and appreciated the hands-on teaching experience. Challenges with this course structure include the difficulty of seamlessly incorporating CSL student experiences into the class, dealing with the “CSL”/ “non CSL” student division, and the nature of some of the CSL placements. We conclude by discussing possible methods for dealing with these challenges.

En el presente artículo, los desafíos y restricciones del significado de compromiso con los pacientes son discutidos del punto de vista de la ética relacional. Si la abertura a los otros y su situación es el inicio de la ética, tal como es argumentado por los filósofos vinculados con la ética relacional, entonces, nosotros en el cuidado de salud debemos dirigir esta abertura (o su falta) como siendo vivida por un profesional de la salud dentro de la importancia y de la complejidad de la práctica. Como ha sido argumentado, si la falta de compromiso es el origen de la maleficencia en el sistema de cuidado a la salud, es particularmente urgente establecer límites y comprometerse.

When Marshall McLUHAN famously stated "the medium is the message," he was echoing Martin HEIDEGGER's assertion that through our use of technology we can become functions of it. Therefore, how does adopting computer-assisted qualitative data analysis software affect our research activities and, more importantly, our conception of research? These questions are explored by examining the influence NVivo had upon an interdisciplinary phenomenological research project in health ethics. We identify the software's effects and situate our decision to use it within the Canadian health sciences research landscape. We also explore the challenges of remaining true to our project's philosophical foundations, as well as how NVivo altered our being-in-the-world as researchers. This case demonstrates McLUHAN's claim that new technologies invariably initiate new practices and modes of being, and urges researchers to attend to how we are both shaping and being shaped by software. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs120227

Purpose: The purpose of this study was to identify prenatal, maternal, and early childhood factors associated with surgery to treat severe-early-childhood-caries (S-ECC) using general anesthesia (GA). Methods: A case-control study using administrative health care and social services data examined factors associated with surgery under GA. Subjects included children <72 months old undergoing GA for caries between fiscal years 2005/06 and 2010/11. Controls were children of the same age randomly chosen from the general population. Prenatal, birth, child, and maternal and family characteristics and use of health services were considered. Adjusted odds ratios (OR) and 95 percent confidence intervals (95% CI) were calculated using logistic regressions. Results: There were 16,015 cases reviewed. Variables with a higher likelihood of surgery included: child's age (1.02 (OR), 1.02 to 1.02 (95% CI)); large-for-gestational-age (1.24, 1.19 to 1.30); young maternal age at birth (1.47, 1.04 to 2.07); lower income quintiles (3.24, 3.04 to 3.45); receiving income assistance (1.61, 1.54 to 1.69); more hospital visits (1.17, 1.15 to 1.18); and a history of being "in care/foster care" (1.11, 1.04 to 1.19). Variables with less likelihood of surgery included: initiating breastfeeding before discharge (0.69, 0.67 to 0.72); low five-minute Apgar score (0.88, 0.79 to 0.97); being female (0.96, 0.93 to 0.99); mothers ≥ 30 years old at birth (0.86, 0.82 to 0.89); urban dwellers (0.47, 0.45 to 0.49); and higher physician visits (0.995, 0.99 to 1.00). Conclusion: Understanding risk factors associated with surgery for S-ECC may provide clues about promising prenatal and early childhood oral health interventions. [ABSTRACT FROM AUTHOR]