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Article ; Online: Closing the loop: From system-based data to evidence-influenced policy and practice.

Katz, Alan / Brownell, Marni / Enns, Jennifer E / Nickel, Nathan C

International journal of population data science

2022 Volume 6, Issue 3, Page(s) 1701

Abstract: For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff ...

Abstract	For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to support evidence-informed policy and program development in an effort to ensure that policy initiatives provide the greatest benefit possible to individuals and society as a whole. Using the widely recognized whole-population Manitoba Population Research Data Repository, which comprises approximately 100 different datasets from multiple sectors, we employ sophisticated and state-of-the-art research methods and data science technologies, and then translate the results into meaningful insights or recommendations for policy-makers. Our long and productive history of working with policy-makers has taught us much about making our research relevant to policy-makers. In this article, we outline some examples of how research evidence has been used to influence policy in Manitoba, and the key lessons we have learned about what makes relationships between researchers and policy-makers work. In essence, policy-makers have supported the growth of the Repository over the last 30 years, because researchers have "closed the loop" by sharing valuable and policy-relevant research results with them. This ability to inform policies, programs and service delivery with scientific evidence continues to benefit individuals, communities and our society as a whole.
MeSH term(s)	Administrative Personnel ; Health Policy ; Humans ; Manitoba ; Policy Making ; Research Personnel
Language	English
Publishing date	2022-02-25
Publishing country	Wales
Document type	Journal Article
ISSN	2399-4908
ISSN (online)	2399-4908
DOI	10.23889/ijpds.v7i1.1701
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Article ; Online: The effect of disease co-occurrence measurement on multimorbidity networks: a population-based study.

Monchka, Barret A / Leung, Carson K / Nickel, Nathan C / Lix, Lisa M

BMC medical research methodology

2022 Volume 22, Issue 1, Page(s) 165

Abstract: Background: Network analysis, a technique for describing relationships, can provide insights into patterns of co-occurring chronic health conditions. The effect that co-occurrence measurement has on disease network structure and resulting inferences has ...

Abstract	Background: Network analysis, a technique for describing relationships, can provide insights into patterns of co-occurring chronic health conditions. The effect that co-occurrence measurement has on disease network structure and resulting inferences has not been well studied. The purpose of the study was to compare structural differences among multimorbidity networks constructed using different co-occurrence measures. Methods: A retrospective cohort study was conducted using four fiscal years of administrative health data (2015/16 - 2018/19) from the province of Manitoba, Canada (population 1.5 million). Chronic conditions were identified using diagnosis codes from electronic records of physician visits, surgeries, and inpatient hospitalizations, and grouped into categories using the Johns Hopkins Adjusted Clinical Group (ACG) System. Pairwise disease networks were separately constructed using each of seven co-occurrence measures: lift, relative risk, phi, Jaccard, cosine, Kulczynski, and joint prevalence. Centrality analysis was limited to the top 20 central nodes, with degree centrality used to identify potentially influential chronic conditions. Community detection was used to identify disease clusters. Similarities in community structure between networks was measured using the adjusted Rand index (ARI). Network edges were described using disease prevalence categorized as low (< 1%), moderate (1 to < 7%), and high (≥7%). Network complexity was measured using network density and frequencies of nodes and edges. Results: Relative risk and lift highlighted co-occurrences between pairs of low prevalence health conditions. Kulczynski emphasized relationships between high and low prevalence conditions. Joint prevalence focused on highly-prevalent conditions. Phi, Jaccard, and cosine emphasized associations involving moderately prevalent conditions. Co-occurrence measurement differences significantly affected the number and structure of identified disease clusters. When limiting the number of edges to produce visually interpretable graphs, networks had significant dissimilarity in the percentage of co-occurrence relationships in common, and in their selection of the highest-degree nodes. Conclusions: Multimorbidity network analyses are sensitive to disease co-occurrence measurement. Co-occurrence measures should be selected considering their intrinsic properties, research objectives, and the health condition prevalence relationships of greatest interest. Researchers should consider conducting sensitivity analyses using different co-occurrence measures.
MeSH term(s)	Canada/epidemiology ; Chronic Disease ; Humans ; Multimorbidity ; Prevalence ; Retrospective Studies
Language	English
Publishing date	2022-06-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041362-2
ISSN	1471-2288 ; 1471-2288
ISSN (online)	1471-2288
ISSN	1471-2288
DOI	10.1186/s12874-022-01607-8
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Article ; Online: Look before you leap: can we draw causal conclusions from breastfeeding research?

Nickel, Nathan C

Journal of human lactation : official journal of International Lactation Consultant Association

2015 Volume 31, Issue 2, Page(s) 209–212

MeSH term(s)	Breast Feeding ; Female ; Humans ; Infant, Newborn ; Observational Studies as Topic ; Pregnancy ; Randomized Controlled Trials as Topic ; Research Design
Language	English
Publishing date	2015-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1138470-0
ISSN	1552-5732 ; 0890-3344
ISSN (online)	1552-5732
ISSN	0890-3344
DOI	10.1177/0890334415572346
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Article ; Online: Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers.

Ewesesan, Roheema / Chartier, Mariette J / Nickel, Nathan C / Wall-Wieler, Elizabeth / Urquia, Marcelo L

BMC pregnancy and childbirth

2022 Volume 22, Issue 1, Page(s) 612

Abstract: Background: Perinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics.: Methods: We conducted a population-based cross- ... ...

Abstract	Background: Perinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics. Methods: We conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15-55 years, who had a live birth and available data from the universal newborn screen completed within 2 weeks postpartum, between January 2000 and December 2017. Immigration characteristics were from the Canadian federal government immigration database. Logistic regressions models were used to obtain Odds Ratios (OR) with 95% confidence intervals (CI) for the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care. Results: More immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more) but lower odds of relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care. Secondary immigrants, whose last country of permanent residence differed from their country of birth, had lower odds of social isolation, relationship distress, and smoking than primary migrants. There were also differences by maternal region of birth. Conclusion: Immigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health indicators than non-immigrants. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.
MeSH term(s)	Canada ; Cross-Sectional Studies ; Emigrants and Immigrants ; Emigration and Immigration ; Female ; Humans ; Infant, Newborn ; Mothers ; Pregnancy ; Refugees/psychology
Language	English
Publishing date	2022-08-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-022-04937-z
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Article ; Online: Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization records and child protection case files.

Kenny, Kathleen S / Wall-Wieler, Elizabeth / Frank, Kayla / Courchene, Lindey / Burton, Mary / Dreaver, Cheryle / Champagne, Micheal / Nickel, Nathan C / Brownell, Marni / Rocke, Cathy / Bennett, Marlyn / Urquia, Marcelo L / Anderson, Marcia

Annals of epidemiology

2024 Volume 91, Page(s) 44–50

Abstract: Purpose: Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future ... ...

Abstract	Purpose: Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS. Methods: Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation). Results: Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns. Conclusions: Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.
MeSH term(s)	Humans ; Infant, Newborn ; Birth Certificates ; Canada ; Child Protective Services ; Hospitals ; Patient Discharge
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1074355-8
ISSN	1873-2585 ; 1047-2797
ISSN (online)	1873-2585
ISSN	1047-2797
DOI	10.1016/j.annepidem.2024.01.001
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Article ; Online: Writing activities and the hidden curriculum in nursing education.

Mitchell, Kim M / McMillan, Diana E / Lobchuk, Michelle M / Nickel, Nathan C

Nursing inquiry

2021 Volume 28, Issue 3, Page(s) e12407

Abstract: Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric-driven competency-based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing ...

Abstract	Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric-driven competency-based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper-focus on "figuring out" the teacher with minimal focus on the act of writing. Students used a form of behavioral "code-switching" to maximize their grade while considering how their "valuing" of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment.
MeSH term(s)	Canada ; Curriculum/trends ; Education, Nursing, Baccalaureate/methods ; Humans ; Interviews as Topic/methods ; Qualitative Research ; Students, Nursing/psychology ; Students, Nursing/statistics & numerical data ; Writing
Language	English
Publishing date	2021-02-26
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1483798-5
ISSN	1440-1800 ; 1320-7881
ISSN (online)	1440-1800
ISSN	1320-7881
DOI	10.1111/nin.12407
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Article ; Online: Health care provider support and factors associated with breastfeeding beyond infancy: A cross-national study.

Keim, Sarah A / Tchaconas, Alexis / Ford, Jane B / Nickel, Nathan C / Heffern, Debbi / Adesman, Andrew

Birth (Berkeley, Calif.)

2021 Volume 49, Issue 2, Page(s) 233–242

Abstract: Background: Breastfeeding beyond infancy (12 months) remains atypical in the United States, United Kingdom, Canada, and Australia, and the role of health care providers is unclear. The objective of this study was to compare women's perceptions of ... ...

Abstract	Background: Breastfeeding beyond infancy (12 months) remains atypical in the United States, United Kingdom, Canada, and Australia, and the role of health care providers is unclear. The objective of this study was to compare women's perceptions of provider support and other factors affecting breastfeeding beyond infancy across countries, among women who had each successfully breastfed at least one child that long. Methods: Women completed an online questionnaire distributed via La Leche League, USA (2013), about sources and ratings of support for breastfeeding for their oldest child who was breastfed at least 12 months and participant demographics. Multivariable log-binomial regression was used to compare ratings of health care provider support and the importance of 13 factors by country. Results: Some similarities and many differences were observed across countries in support received from providers, whereas modest or no differences were observed in the importance women placed on factors like health benefits and enjoyment of breastfeeding. Of 59 581 women, less than half discussed their decision to breastfeed beyond infancy with their child's provider. United Kingdom women rated their comfort in discussing breastfeeding beyond 12 months with their providers and the support received as lower than United States women. Canadian women gave lower ratings than United States women, but inconsistently. Australian women rarely differed from United States women in their responses. Providers' recommendations were not important to the decision to breastfeed beyond infancy, especially for United Kingdom women. Discussion: Rates of breastfeeding beyond infancy are low in these countries; improving provider support may help achieve global breastfeeding goals.
MeSH term(s)	Australia ; Breast Feeding ; Canada ; Female ; Health Personnel ; Humans ; Infant ; Infant, Newborn ; Male ; Mothers ; United States
Language	English
Publishing date	2021-09-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	604869-9
ISSN	1523-536X ; 0730-7659
ISSN (online)	1523-536X
ISSN	0730-7659
DOI	10.1111/birt.12592
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Article ; Online: A longitudinal cohort study of participation in the Boys & Girls Clubs of Winnipeg.

Enns, Jennifer E / Nickel, Nathan C / Chateau, Dan / Katz, Alan / Sarkar, Joykrishna / Lambert, Drew / Brownell, Marni

International journal of population data science

2022 Volume 7, Issue 1, Page(s) 1735

Abstract: Introduction: Out-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school ... ...

Abstract	Introduction: Out-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities. Objective: We examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes. Methods: We linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990) included children and adolescents who visited BGCW at least once from 2005-2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW. Results: Participation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12-17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18-24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13-19) and sexually transmitted infections among adolescents (aged 13-19) also declined as the frequency of participation in BGCW increased. Conclusions: The findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.
MeSH term(s)	Academic Success ; Adolescent ; Child ; Cohort Studies ; Educational Status ; Female ; Humans ; Longitudinal Studies ; Male ; Pregnancy ; Schools ; Young Adult
Language	English
Publishing date	2022-06-08
Publishing country	Wales
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2399-4908
ISSN (online)	2399-4908
DOI	10.23889/ijpds.v6i1.1735
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Article ; Online: The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study.

Soliman, Youstina / Yakandawala, Uma / Leong, Christine / Garlock, Emma S / Brinkman, Fiona S L / Winsor, Geoffrey L / Kozyrskyj, Anita L / Mandhane, Piushkumar J / Turvey, Stuart E / Moraes, Theo J / Subbarao, Padmaja / Nickel, Nathan C / Thiessen, Kellie / Azad, Meghan B / Kelly, Lauren E

International breastfeeding journal

2024 Volume 19, Issue 1, Page(s) 23

Abstract: Background: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation.! ...

Abstract	Background: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods: Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. Results: A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. Conclusions: In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.
MeSH term(s)	Infant ; Female ; Humans ; Pregnancy ; Breast Feeding ; Lactation ; Domperidone ; Cohort Studies ; Prospective Studies ; Canada ; Prescriptions
Chemical Substances	Domperidone (5587267Z69)
Language	English
Publishing date	2024-04-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2227239-2
ISSN	1746-4358 ; 1746-4358
ISSN (online)	1746-4358
ISSN	1746-4358
DOI	10.1186/s13006-024-00628-x
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Article ; Online: Investigating the effect of early life antibiotic use on asthma and allergy risk in over 600 000 Canadian children: a protocol for a retrospective cohort study in British Columbia and Manitoba.

Lishman, Hannah / Nickel, Nathan C / Sbihi, Hind / Xie, Max / Mamun, Abdullah / Zhang, Bei Yuan / Rose, Caren / Janssen, Patricia / Roberts, Ashley / Azad, Meghan B / Turvey, Stuart / Patrick, David M

BMJ open

2023 Volume 13, Issue 4, Page(s) e067271

Abstract: Introduction: Allergic conditions, such as asthma, hay fever and eczema, are some of the most common conditions impacting children globally. There is a strong incentive to study their determinants to improve their prevention. Asthma, hay fever and ... ...

Abstract	Introduction: Allergic conditions, such as asthma, hay fever and eczema, are some of the most common conditions impacting children globally. There is a strong incentive to study their determinants to improve their prevention. Asthma, hay fever and eczema are influenced through the same immunological pathway and often copresent in children ('the atopic march'). Increasing evidence shows a link between infant antibiotic use and the risk of childhood atopic conditions, mediated through gut microbial dysbiosis during immune system maturation, however, the potential for confounding remains. This study will investigate the relationship between infant antibiotic use and risk of allergic conditions in British Columbian and Manitoban children born over 10 years, adjusting for relevant confounders. Methods and analysis: Provincial administrative datasets will be linked to perform comparable retrospective cohort analyses, using Population Data BC and the Manitoba Population Research Data Repository. All infants born between 2001 and 2011 in BC and Manitoba will be included (approximately 460 000 and 162 500 infants, respectively), following up to age 7. Multivariable logistic regression will determine the outcome risk by the fifth birthday among children who did and did not receive antibiotics before their first birthday. Clinical, demographic and environmental covariates will be explored, and sensitivity analyses performed to reduce confounding by indication. Ethics and dissemination: The University of British Columbia Research Ethics Board (H19-03255) and University of Manitoba Ethics Board (HS25156 (H2021:328)) have approved this study. Data stewardship committees for all administrative datasets have granted permissions, facilitated by Population Data BC and the Manitoba Centre for Health Policy. Permissions from the Canadian Health Infant Longitudinal Development Study are being sought for breastfeeding data (CP185). Findings will be published in scientific journals and presented at infectious disease and respiratory health conferences. A stakeholder committee will guide and enhance sensitive and impactful communication of the findings to new parents.
MeSH term(s)	Infant ; Female ; Child ; Humans ; Retrospective Studies ; Manitoba/epidemiology ; Anti-Bacterial Agents/adverse effects ; British Columbia/epidemiology ; Rhinitis, Allergic, Seasonal ; Hypersensitivity/epidemiology ; Hypersensitivity/drug therapy ; Asthma/drug therapy ; Eczema/epidemiology ; Eczema/drug therapy ; Cohort Studies
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-04-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-067271
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