Under-treatment of pain is frequently reported, especially among seniors, with chronic non-cancer pain most likely to be under-treated. Legislation regarding the prescribing/dispensing of opioid analgesics (including multiple prescription programs [MPP]) may impede access to needed analgesics.
To describe access and intensity of use of analgesics among older Manitobans by health region.
A cross-sectional study of non-Aboriginal non-institutionalized Manitoba residents over 65 years of age during April 1, 2002 to March 31, 2003 was conducted using the Pharmaceutical Claims data and the Cancer Registry from the province of Manitoba. Access to analgesics (users/1000/Yr) and intensity of use (using defined daily dose [DDD] methodology) were calculated for non-opioid analgesics, opioids, and multiple-prescription-program opioids [MPP-opioids]. Usage was categorized by age, gender, and stratified by cancer diagnosis. Age-sex standardized rates of prevalence and intensity are reported for the eleven health regions of Manitoba.
Thirty-four percent of older Manitobans accessed analgesics during the study period. Female gender, increasing age, and a cancer diagnosis were associated with greater access and intensity of use of all classes of analgesics. Age-sex standardized access and intensity measures revealed the highest overall analgesic use in the most rural / remote regions of the province. However, these same regions had the lowest use of opioids, and MPP-opioids among residents lacking a cancer diagnosis.
This population-based study of analgesic use suggests that there may be variations in use of opioids and other analgesics depending on an urban or rural residence. The impact of programs such as the MPP program requires further study to describe its impact on analgesic use.
A set of consistent, standardized definitions of intervals and populations on which to report across provinces is needed to inform the Provincial/Territorial Deputy Ministries of Health on progress of the Ten-Year Plan to Strengthen Health Care. The objectives of this project were to: 1) identify a set of criteria and variables needed to create comparable measures of important time-to-cancer-care intervals that could be applied across provinces and 2) use the measures to compare time-to-care across participating provinces for lung and colorectal cancer patients diagnosed in 2004.
A broad-based group of stakeholders from each of the three participating cancer agencies was assembled to identify criteria for time-to-care intervals to standardize, evaluate possible intervals and their corresponding start and end time points, and finalize the selection of intervals to pursue. Inclusion/exclusion criteria were identified for the patient population and the selected time points to reduce potential selection bias. The provincial 2004 colorectal and lung cancer data were used to illustrate across-province comparisons for the selected time-to-care intervals.
Criteria identified as critical for time-to-care intervals and corresponding start and end points were: 1) relevant to patients, 2) relevant to clinical care, 3) unequivocally defined, and 4) currently captured consistently across cancer agencies. Time from diagnosis to first radiation or chemotherapy treatment and the smaller components, time from diagnosis to first consult with an oncologist and time from first consult to first radiation or chemotherapy treatment, were the only intervals that met all four criteria. Timeliness of care for the intervals evaluated was similar between the provinces for lung cancer patients but significant differences were found for colorectal cancer patients.
We identified criteria important for selecting time-to-care intervals and appropriate inclusion criteria that were robust across the agencies that did not result in an overly selective sample of patients to be compared. Comparisons of data across three provinces of the selected time-to-care intervals identified several important differences related to treatment and access that require further attention. Expanding this collaboration across Canada would facilitate improvement of and equitable access to quality cancer care at a national level.
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Manitoba's hospital separations and physician medical files were linked for the fiscal years 1984-85 and 1985-86. The result was a study file consisting of records for 5,293 males and 3,143 females, who, during this period, suffered an Acute Myocardial Infarction (AMI), commonly called a heart attack. Merging the two types of files created a comprehensive data base for these AMI victims. The Manitoba age-sex standardized AMI rate was 38.0 per 10,000 population. Age-specific rates were higher for males than for females for all age groups. Hospitalized cases accounted for 7,201 individuals or 85.4% of AMI victims. Age-sex standardized rates of hospitalization per 10,000 population ranged from 27.1 in the Central region to 36.0 in the Westman region. The Manitoba age-specific rates of hospitalization for males in the 35-54 and 55-64 age groups were about three times the female rates for the same age groups. One quarter of AMI hospitalized victims died in hospital. The Manitoba age-specific death rates for males in the 35-54, 55-64 and 65-74 age groups were double the rates for females in the same age groups. Of the 8,436 AMI victims under study, 86.4% had at least one other concurrent medical condition such as angina, other forms of ischemic heart disease, diabetes, or hypertension. Of AMI victims, 93.8% underwent at least one of the following procedures: coronary artery bypass surgery, angiogram, electrocardiogram, cardiac catheterization, arteriography, or blood cholesterol testing. A higher percentage of procedures was performed on males than on females.
Using the POPULIS framework, this project estimated health care expenditures across the entire population of Manitoba for inpatient and outpatient hospital utilization, physician visits, mental health inpatient, and nursing home utilization.
This estimated expenditure information was then used to compare per capita expenditures relative to premature mortality rates across the various areas of Manitoba.
Considerable variation in health care expenditures was found, with those areas having high premature mortality rates also having higher health care expenditures.
In a medium-sized Canadian city, 581 randomly selected households were contacted and responded to a survey on the impact of parental alcohol problems. Twenty-two per cent of the respondents indicated that at least one of their parents had a drinking problem. The biological father was affected in 81%. Compared with the rest of the sample, the adult children of problem drinkers were younger but they did not differ in income or education. Adult children of problem drinkers were more likely to have parents who were divorced or separated; to be divorced, separated, or remarried themselves; to be heavy drinkers and have indications of alcohol problems; and to use more sources of help for problems with stress and anxiety and problems with alcohol. They did not differ from those without parental drinking problems on measures of current positive and negative affect.
BACKGROUND: Few data exist regarding the epidemiology of Helicobacter pylori infections in aboriginal, including the First Nations (Indian) or Inuit (Eskimo) populations of North America. We have previously found 95% of the adults in Wasagamack, a First Nations community in Northeastern Manitoba, Canada, are seropositive for H. pylori. We aimed to determine the age at acquisition of H. pylori among the children of this community, and if any association existed with stool occult blood or demographic factors. MATERIALS AND METHODS: We prospectively enrolled children resident in the Wasagamack First Nation in August 1999. A demographic questionnaire was administered. Stool was collected, frozen and batch analyzed by enzyme-linked immunosorbent assay (ELISA) for H. pylori antigen and for the presence of occult blood. Questionnaire data were analyzed and correlated with the presence or absence of H. pylori. RESULTS: 163 (47%) of the estimated 350 children aged 6 weeks to 12 years, resident in the community were enrolled. Stool was positive for H. pylori in 92 (56%). By the second year of life 67% were positive for H. pylori. The youngest to test positive was 6 weeks old. There was no correlation of a positive H. pylori status with gender, presence of pets, serum Hgb, or stool occult blood. Forty-three percent of H. pylori positive and 24% of H. pylori negative children were
We estimated age-standardized ratios of infection and hospitalization among Canadian First Nations (FN) populations and compared their distributions with those estimated for non-FN populations in Manitoba, Canada.
For the spring and fall 2009 waves of the H1N1 pandemic, we obtained daily numbers of laboratory-confirmed and hospitalized cases of H1N1 infection, stratified by 5-year age groups and FN status. We calculated age-standardized ratios with confidence intervals for each wave and compared ratios between age groups in each ethnic group and between the 2 waves for FN and non-FN populations.
Incidence and hospitalization ratios in all FN age groups during the first wave were significantly higher than those in non-FN age groups (P
Previous attempts to study the 1918-1919 flu in three small communities in central Manitoba have used both three-community population-based and single-community agent-based models. These studies identified critical factors influencing epidemic spread, but they also left important questions unanswered. The objective of this project was to design a more realistic agent-based model that would overcome limitations of earlier models and provide new insights into these outstanding questions.
The new model extends the previous agent-based model to three communities so that results can be compared to those from the population-based model. Sensitivity testing was conducted, and the new model was used to investigate the influence of seasonal settlement and mobility patterns, the geographic heterogeneity of the observed 1918-1919 epidemic in Manitoba, and other questions addressed previously.
Results confirm outcomes from the population-based model that suggest that (a) social organization and mobility strongly influence the timing and severity of epidemics and (b) the impact of the epidemic would have been greater if it had arrived in the summer rather than the winter. New insights from the model suggest that the observed heterogeneity among communities in epidemic impact was not unusual and would have been the expected outcome given settlement structure and levels of interaction among communities.
Application of an agent-based computer simulation has helped to better explain observed patterns of spread of the 1918-1919 flu epidemic in central Manitoba. Contrasts between agent-based and population-based models illustrate the advantages of agent-based models for the study of small populations.
OBJECTIVE: To determine the total and functional serogroup C antibody response to a quadrivalent meningococcal polysaccharide vaccine in a group of aboriginal infants, children and adolescents. A secondary objective was to determine their prevalence of meningococcal carriage. DESIGN: Open prospective, before and after intervention study. SUBJECTS: Aboriginal children ages 0.5 to 19.9 years, living in a single Northern community and eligible for a public health immunization campaign conducted in all Manitoba native reserve communities to control a meningococcal serogroup C, electrophoretic type (ET) 15 outbreak. No outbreak cases had occurred in the community at the time of the study. METHODS: Total serogroup C capsular polysaccharide antibody (CPA) and functional bactericidal antibody (BA) responses were measured by enzyme-linked immunosorbent assay and bactericidal assay, respectively. RESULTS: Neisseria meningitidis was recovered from the oropharynx of 13 (5.2%) of 249 aboriginal children including 4 (1.6%) serogroup C isolates, all with the designation C:2a:P1.2,5 ET15. Paired sera from 152 children were available for assay. For CPA the geometric mean concentrations and proportions with > or =2 microg/ml before and after immunization were 0.69, 18% and 12.3, 96%, respectively. A significant increase in serum CPA was achieved by children of all ages, with the greatest response occurring after age 11 years. Among infants or =2 microg/ml. For BA the pre- and post-vaccine geometric mean titers were 1.02 and 45.9. The response was significantly associated with age. BA titers > or =1:8 were present, before and after immunization, respectively, in 0 and 0% of infants or =2-year-olds. CONCLUSION: The age-related total and functional group C meningococcal antibody response after quadrivalent polysaccharide vaccine among aboriginals is similar to that reported for Caucasian children. After age 2 all children made excellent CPA and BA responses. In the younger age groups the BA response was blunted but 82 to 95% achieved CPA titers of > or =2 microg/ml.