The Mental Health of First Nations Children in Manitoba: A Population-Based Retrospective Cohort Study Using Linked Administrative Data: La santé mentale des enfants des Premières Nations au Manitoba : une étude de cohorte rétrospective dans la population, à l'aide de données administratives liées.

OBJECTIVE: First Nations children face a greater risk of experiencing mental disorders than other children from the general population because of family and societal factors, yet there is little research examining their mental health. This study compares diagnosed mental disorders and suicidal behaviours of First Nations children living on-reserve and off-reserve to all other children living in Manitoba. METHOD: The research team, which included First Nations and non-First Nations researchers, utilized population-based administrative data that linked de-identified individual-level records from the 2016 First Nations Research File to health and social information for children living in Manitoba. Adjusted rates and rate ratios of mental disorders and suicide behaviours were calculated using a generalized linear modelling approach to compare First Nations children (n = 40,574) and all other children (n = 197,109) and comparing First Nations children living on- and off-reserve. RESULTS: Compared with all other children, First Nations children had a higher prevalence of schizophrenia (adjusted rate ratio (aRR): 4.42, 95% confidence interval (CI), 3.36 to 5.82), attention-deficit hyperactivity disorder (ADHD; aRR: 1.21, 95% CI, 1.09 to 1.33), substance use disorders (aRR: 5.19; 95% CI, 4.25 to 6.33), hospitalizations for suicide attempts (aRR: 6.96; 95% CI, 4.36 to 11.13) and suicide deaths (aRR: 10.63; 95% CI, 7.08 to 15.95). The prevalence of ADHD and mood/anxiety disorders was significantly higher for First Nations children living off-reserve compared with on-reserve; in contrast, hospitalization rates for suicide attempts were twice as high on-reserve than off-reserve. When the comparison cohort was restricted to only other children in low-income areas, a higher prevalence of almost all disorders remained for First Nations children. CONCLUSION: Large disparities were found in mental health indicators between First Nations children and other children in Manitoba, demonstrating that considerable work is required to improve the mental well-being of First Nations children. Equitable access to culturally safe services is urgently needed and these services should be self-determined, planned, and implemented by First Nations people.

Maximizing Student Outcomes in Schools: Data-Driven Individualized Education Program Goals and Objectives Aligned to the Standards.

PURPOSE: Federal and state laws require schools to be accountable for student performance on measures of academic achievement in literacy, mathematics, and science skills; monitor high school graduation rates; and track student growth and academic progression throughout the grade levels. Success on these measures gives students pathways to postsecondary options in the workforce, technical education, or college/university education. Speech-language pathologists (SLPs) can utilize existing data sources in the school in conjunction with their knowledge of diagnostics and treatment of cognition, language, and culture to maximize student outcomes beyond the therapy room and in the curriculum standards. METHOD: This clinical focus article will review methods of data collection from existing sources in the students' grade level and academic content curriculum. Utilization of information and input from parents, teachers, paraprofessionals, and others who support the student's academic endeavors will be discussed for Individualized Education Program Present Levels of Academic Achievement and Functional Performance and goal development. Procedures for the SLP to collect independent data aligned to standards-based curriculum will be explored. Consideration will be given for utilizing data to develop future goals and objectives. The benefits of data collection for monitoring student progress and success in the grade-level or alternate standards will be highlighted through case examples. Techniques for classroom-based services, model lessons, coaching, and co-teaching will be presented. CONCLUSIONS: SLPs are recognized as specialized instructional support personnel who have unique knowledge and expertise for diagnosing and treating speech/language impairments (S/LI) disabilities. By understanding how they can use existing data and apply it to developing intervention plans, SLPs can ensure students with S/LI disabilities experience the maximum potential for outcomes in academic and functional success. Data-driven tools and methods aligned to the grade-level standards and curriculum are one of the most powerful tools in an SLP's toolbox. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24869592.

English language proficiency, prior knowledge, and student success in an international Chinese accounting program.

International student exchange programs have gained popularity as a means to increase enrollments, support international academic partnerships, and improve student preparedness for globalized work environments. However, the relationships between English language proficiency, cultural intelligence, teamwork, self-efficacy, academic success, and other factors within these programs are not clear. This study investigates the correlations among international accounting students' English language proficiency, accounting knowledge, and academic performance in a transnational education program in mainland China. Data were obtained from academic records of 104 accounting students enrolled in the program. A quantitative measuring of the Pearson correlation statistical tests were employed to measure the relationships between English language proficiency and academic performance, as well as between previous accounting knowledge and academic success. The results indicate a statistically significant relationship between English language proficiency and academic performance, and between previous accounting knowledge and academic success. This study has significant implications for transnational education programs, academic institutions, and policymakers and provides insights into effective strategies for enhancing the quality of transnational education programs and promoting the internationalization of higher education.

Association of Pay-for-Performance Reimbursement With Clinical Quality for Minnesota Nursing Homes Residents.

In 2016, Minnesota implemented a new pay-for-performance reimbursement scheme for Medicaid residents in nursing homes, known as Value-Based Reimbursement (VBR). This study seeks to understand whether there is an association between VBR and quality improvement. We use data from 2013 to 2019 including Centers for Medicare and Medicaid Services, Nursing Home Compare, and Long-term care Facts in the US. Using multivariate regression with commuting zone fixed effects, we compare five long-stay and two short-stay clinical quality metrics in Minnesota nursing homes to nursing homes bordering states, before and after VBR was implemented. We find minimal significant changes in quality in Minnesota nursing homes after VBR. Minnesota should reconsider its pay-for-performance efforts.

Tutorial: Data Collection and Documentation Strategies for Speech-Language Pathologist/Speech-Language Pathology Assistant Teams.

PURPOSE: This tutorial outlines an approach for best practices for speech-language pathology assistants (SLPAs) to collect data and document services. The tutorial outlines methods for developing accurate and effective data collection skills and provides instructions and tools for collecting various types of data. The authors discuss the importance of data collection as it relates to the roles and responsibilities of speech-language pathologists (SLPs) and SLPAs. The process of planning for data collection, recording the data, and reporting data to the supervising SLP is outlined. CONCLUSION: Developing competence with a wide variety of data collection methods, data types, and documentation tools will assist SLPAs to accurately communicate the results of the services they provide, therefore enhancing the SLP's ability to make well-informed clinical decisions for the student. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20277726.

Predictors of Tobacco Cessation Among American Indian/Alaska Native Adults Enrolled in a State Quitline.

Background: High rates of smoking are documented among some American Indian and Alaska Native (AI/AN) communities, with potential variability by region and urban/rural settings. Quitlines are a cost-effective strategy for providing evidence-based cessation treatment, but little is known about the effectiveness of quitline services for the AI/AN population. Objectives: This study compared demographic characteristics, tobacco use, and cessation and program utilization behaviors between AI/AN (n = 297) and Non-Hispanic White (NHW; n = 13,497) quitline callers. The study also identified predictors of 30-day cessation at 7-month follow-up among AI/AN callers and determined if predictors were different between AI/AN and NHW callers. Methods: Data from callers to the Arizona Smokers' Helpline between January 2011 and June 2016 were analyzed. Results: At enrollment, AI/AN callers were less likely to use tobacco daily and were less dependent on nicotine compared to NHW callers. Both groups reported similar rates of 30-day cessation at 7-month follow-up (37.3% and 39.7% for AI/AN and NHW callers, respectively). For AI/AN callers, 30-day cessation was significantly associated with tobacco cessation medication use (OR = 2.24, 95% CI: 1.02-4.93), number of coaching sessions (OR = 1.14, 95% CI: 1.04-1.26), and other smokers in the home (OR = 0.41, 95% CI: 0.19-0.91). The effect of other smokers in the home was significantly different between AI/AN and NHW callers (p = .007). Conclusions: Different individual characteristics and predictors of cessation among AI/AN callers compared to NHW callers were documented. Findings may be used to inform the development of culturally-tailored strategies and protocols for AI/AN quitline callers.

Examining the relationship between U.S. incarceration rates and population health at the county level.

A collateral consequence of mass incarceration in the United States is its negative effects on population health. Using data from 2015, this study examines the relationship between incarceration rates and population health for a national sample of U.S. counties. To obtain unbiased estimates of the effect of incarceration on health, we use multivariate models which account for the endogeneity of incarceration rates when determining their effect on population health by employing an instrumental variable approach where the robust instrumental (exogenous) variable per capita corrections expenditures is used to predict incarceration rate. We then estimate population health outcomes as a function of predicted incarceration rate alongside factors such as public health spending, indicators of health behavior and control variables in models explaining county-level population health. Consistent with findings from prior research on individuals, families and at the state level, results of our analyses indicate that higher levels of incarceration are associated with higher levels of both morbidity (percentage reporting fair or poor health) and mortality (life expectancy). Implications of these findings for health and criminal justice policy, as well as research, are considered.

Latent tuberculosis treatment completion rates from prescription drug administrative data.

OBJECTIVE: In the province of Manitoba, Canada, given that latent tuberculosis infection (LTBI) treatment is provided at no cost to the patient, treatment completion rates should be optimal. The objective of this study was to estimate LTBI treatment completion using prescription drug administrative data and identify patient characteristics associated with completion. METHODS: Prescription drug data (1999-2014) were used to identify individuals dispensed isoniazid (INH) or rifampin (RIF) monotherapy. Treatment completion was defined as being dispensed INH for ≥ 180 days (INH180) or ≥ 270 days (INH270) or RIF for ≥ 120 days (RIF120). Logistic regression models tested socio-demographic and comorbidity characteristics associated with treatment completion. RESULTS: The study cohort comprised 4985 (90.4%) persons dispensed INH and 529 (9.6%) RIF. Overall treatment completion was 60.2% and improved from 43.1% in 1999-2003 to 67.3% in 2009-2014. INH180 showed the highest completion (63.8%) versus INH270 (40.4%) and RIF120 (27.0%). INH180 completion was higher among those aged 0-18 years (68.5%) compared with those aged 19+ (61.0%). Sex, geography, First Nations status, income quintile, and comorbidities were not associated with completion. CONCLUSIONS: Benchmark 80% treatment completion rates were not achieved in Manitoba. Factors associated with non-completion were older age, INH270, and RIF120. Access to shorter LTBI treatments, such as rifapentine/INH, may improve treatment completion.

Go!: results from a quasi-experimental obesity prevention trial with hospital employees.

BACKGROUND: Worksite obesity prevention interventions using an ecological approach may hold promise for reducing typical weight gain. The purpose of this study was to examine the effectiveness of Go!, an innovative 12-month multi-component worksite obesity prevention intervention. METHODS: A quasi-experimental non-equivalent control group design was utilized; 407 eligible hospital employees (intervention arm) and 93 eligible clinic employees (comparison arm) participated. The intervention involved pedometer distribution, labeling of all foods in the worksite cafeteria and vending machines (with calories, step equivalent, and a traffic light based on energy density signaling recommended portion), persuasive messaging throughout the hospital, and the integration of influential employees to reinforce healthy social norms. Changes in weight, BMI, waist circumference, physical activity, and dietary behavior after 6 months and 1 year were primary outcomes. Secondary outcomes included knowledge, perceptions of employer commitment to employee health, availability of information about diet, exercise, and weight loss, perceptions of coworker support and frequency of health discussions with coworkers. A process evaluation was conducted as part of the study. RESULTS: Repeated measures ANCOVA indicated that neither group showed significant increases in weight, BMI, or waist circumference over 12 months. The intervention group showed a modest increase in physical activity in the form of walking, but decreases in fruit and vegetable servings and fiber intake. They also reported significant increases in knowledge, information, perceptions of employer commitment, and health discussions with peers. Employees expressed positive attitudes towards all components of the Go! CONCLUSIONS: This low-intensity intervention was well-received by employees but had little effect on their weight over the course of 12 months. Such results are consistent with other worksite obesity prevention studies using ecological approaches. Implementing low-impact physical activity (e.g., walking, stair use) may be more readily incorporated into the worksite setting than more challenging behaviors of altering dietary habits and increasing more vigorous forms of physical activity. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (NCT01585480) on April 24, 2012.

Investigating the temporal relationship between individual-level social capital and health in fragile families.

BACKGROUND: The potential for social capital to influence health outcomes has received significant attention, yet few studies have assessed the temporal ordering between the two. Even less attention has been paid to more vulnerable populations, such as low-income women with children. Our objective was to explore how different dimensions of social capital impact future health status among this population. METHODS: This study uses data from the Fragile Families and Child Well-Being (FFCWB) Study, which has followed a cohort of children and their families born in large U.S. cities between 1998 and 2000 to mostly minority, unmarried parents who tend to be at greater risk for falling into poverty. Four separate measures of social capital were constructed, which include measures of social support and trust, social participation, perceptions of neighborhood social cohesion, and perceptions of neighborhood social control. The temporal effect of social capital on self-reported health (SRH) is investigated using logistic regression and we hypothesize that higher levels of social capital are associated with higher levels of self-rated health. RESULTS: After controlling for socioeconomic and demographic factors related to social capital and self-rated health, social support and trust, perceptions of neighborhood social cohesion and control at an earlier point in time were positively associated with higher levels of health four-years later. Social participation was not related to increased health. The empirical results appear robust. CONCLUSION: Higher levels of social capital are predictive of improved health over a four-year time frame. These results suggest that policy initiatives supporting increasing the social capital available and accessible by low-income, urban, minority women are viable for improving health. Such policies may have the potential to reduce socioeconomic health disparities.

Anatomic femorotibial changes associated with tibial plateau leveling osteotomy.

This prospective study evaluated anatomic femorotibial changes utilizing the relationship between the intercondylar notch and the intercondylar eminence following tibial plateau leveling osteotomy (TPLO). We hypothesized that TPLO results in anatomic alteration of the femorotibial joint. Pre- and post-operative computed tomography (CT) scans of cranial cruciate deficient stifle joints treated with TPLO were performed on 25 client-owned dogs. Computed tomography scans were performed at 3 different stifle angles: extension, 135° walking angle, and 90° of flexion. Tibial plateau leveling osteotomy did not result in a significant medial or lateral shift of the intercondylar eminence relative to the intercondylar notch. There was a significant cranial shift of the intercondylar eminence with the stifle in extension following TPLO. In addition, TPLO resulted in a significantly narrowed femorotibial joint space. The biomechanical effects of TPLO and medial meniscal release need to be further defined.

Changements fémoro-tibiaux anatomiques associés à une ostéotomie de nivellement du plateau tibial. Cette étude prospective a évalué les changements fémoro-tibiaux anatomiques en utilisant le lien entre l'échancrure intercondylienne et l'éminence intercondylienne après une ostéotomie de nivellement du plateau tibial (ONPT). Nous avons formulé l'hypothèse que l'ONPT produit une altération anatomique de l'articulation fémoro-tibiale. Des tomodensitogrammes des articulations déficientes du grasset du ligament cruciforme traitées à l'aide de l'ONPT ont été réalisés sur 25 chiens appartenant à des propriétaires. Les tomodensitogrammes ont été réalisés à 3 angles différents : extension, angle ambulatoire à 135° et flexion de 90°. L'ostéotomie de nivellement du plateau tibial n'a pas produit un mouvement médial ou latéral significatif de l'éminence intercondylienne en rapport avec l'échancrure intercondylienne. Il y avait un mouvement crânial significatif de l'éminence intercondylienne du grasset dans l'extension après l'ONPT. De plus, l'ONPT a produit une réduction importante de l'espace fémoro-tibial. Les effets biomécaniques de l'ONPT et du déclenchement du ménisque médial doivent être définis de manière plus précise.(Traduit par Isabelle Vallières).

Prospective evaluation of the incidence of wound infection in rattlesnake envenomation in dogs.

OBJECTIVE: To evaluate the incidence of wound infection following crotalidae envenomation in dogs and determine if the use of prophylactic antibiotics is warranted. DESIGN: Prospective observational study. SETTING: A 24-hour private practice specialty and emergency center in Murrieta, California. ANIMALS: One hundred and two dogs with acute rattlesnake envenomation. INTERVENTIONS: One hundred and forty-three consecutive cases of suspected acute rattlesnake envenomation were evaluated between March of 2012 and May of 2013. One hundred and two cases received no antimicrobials as part of management. Eight cases were placed on prophylactic antimicrobials by the primary care veterinarian prior to referral and were excluded. Two cases were excluded because they were initiated on antimicrobials during hospitalization for reasons unrelated to snakebite. Three cases involved cats and were excluded. Three patients died acutely near the time of presentation and were excluded. Twenty-one cases of suspected envenomation were excluded for lack of strong evidence of snakebite. Four cases were lost to follow-up and were excluded. Follow-up was conducted within 2 weeks either by phone or by direct inspection of the wound. RESULTS: Of the 102 patients included in the study only 1 infection developed. This patient developed an abscess subsequent to suspected compartment syndrome. CONCLUSION: The incidence of wound infection in rattlesnake envenomation is low, and the use of prophylactic antimicrobials is not recommended. The use of antimicrobials should be reserved for wounds with necrosis or abscess and the choice of antimicrobial should be based on a culture and sensitivity of the wound.

Healthcare utilization and costs in persons with insomnia in a managed care population.

OBJECTIVES: To better understand the direct costs of insomnia. Our study aimed to compare healthcare costs and utilization of patients diagnosed with insomnia who received care in a managed care organization with a set of matched controls. DESIGN: Our observational, retrospective cohort study compared 7647 adults with an insomnia diagnosis with an equally sized matched cohort of health plan members without an insomnia diagnosis between 2003 and 2006. We also compared a subset of patients diagnosed with and treated for insomnia with those diagnosed with insomnia but not treated. SETTING: A large Midwestern health plan with more than 600,000 members. RESULTS: Multivariate analysis was used to estimate the association between insomnia diagnosis and costs, controlling for covariates, in the baseline and follow-up periods. Although we cannot conclude a causal relationship between insomnia and healthcare costs, our analysis found that insomnia diagnosis was associated with 26% higher costs in the baseline and 46% in the 12 months after diagnosis. When comorbidities were recognized, the insomnia cohort had 80% higher costs, on average, than the matched control cohort. CONCLUSIONS: These outcomes suggest the need to look beyond the direct cost of insomnia to how its interaction with comorbid conditions drives healthcare cost and utilization.

Evolution of pygmy angelfishes: recent divergences, introgression, and the usefulness of color in taxonomy.

The pygmy angelfishes (genus Centropyge, family Pomacanthidae) are brightly colored species that occupy reef habitats in every tropical ocean. Some species are rarely observed because they occur below conventional scuba depths. Their striking coloration can command thousands of U.S. dollars in the aquarium trade, and closely related species are often distinguished only by coloration. These factors have impeded phylogenetic resolution, and every phylogeographic survey to date has reported discordance between coloration, taxonomy, and genetic partitions. Here we report a phylogenetic survey of 29 of the 34 recognized species (N=94 plus 23 outgroups), based on two mtDNA and three nuclear loci, totaling 2272 bp. The resulting ML and Baysian trees are highly concordant and indicate that the genus Centropyge is paraphyletic, consistent with a previous analysis of the family Pomacanthidae. Two recognized genera (Apolemichthys and Genicanthus) nest within Centropyge, and two subgenera (Xiphypops and Paracentropyge) comprise monophyletic lineages that should be elevated to genus level. Based on an age estimate of 38 Ma for the family Pomacanthidae, Centropyge diverged from the closest extant genus Pygoplites about 33 Ma, three deep lineages within Centropyge diverged about 18-28 Ma, and four species complexes diverged 3-12 Ma. However, in 11 of 13 cases, putative species in these complexes are indistinguishable based on morphology and genetics, being defined solely by coloration. These cases indicate either emerging species or excessive taxonomic splitting based on brightly colored variants.

Essentialist thinking predicts decrements in children's memory for racially ambiguous faces.

Past research shows that adults often display poor memory for racially ambiguous and racial outgroup faces, with both face types remembered worse than own-race faces. In the present study, the authors examined whether children also show this pattern of results. They also examined whether emerging essentialist thinking about race predicts children's memory for faces. Seventy-four White children (ages 4-9 years) completed a face-memory task comprising White, Black, and racially ambiguous Black-White faces. Essentialist thinking about race was also assessed (i.e., thinking of race as immutable and biologically based). White children who used essentialist thinking showed the same bias as White adults: They remembered White faces significantly better than they remembered ambiguous and Black faces. However, children who did not use essentialist thinking remembered both White and racially ambiguous faces significantly better than they remembered Black faces. This finding suggests a specific shift in racial thinking wherein the boundaries between racial groups become more discrete, highlighting the importance of how race is conceptualized in judgments of racially ambiguous individuals.

Prescribing of psychotropic medications to the elderly population of a Canadian province: a retrospective study using administrative databases.

Background. Psychotropic medications, in particular second-generation antipsychotics (SGAs) and benzodiazepines, have been associated with harm in elderly populations. Health agencies around the world have issued warnings about the risks of prescribing such medications to frail individuals affected by dementia and current guidelines recommend their use only in cases where the benefits clearly outweigh the risks. This study documents the use of psychotropic medications in the entire elderly population of a Canadian province in the context of current clinical guidelines for the treatment of behavioural disturbances. Methods. Prevalent and incident utilization of antipsychotics, benzodiazepines and related medications (zopiclone and zaleplon) were determined in the population of Manitobans over age 65 in the time period 1997/98 to 2008/09 fiscal years. Comparisons between patients living in the community and those living in personal care (nursing) homes (PCH) were conducted. Influence of sociodemographic characteristics on prescribing was assessed by generalized estimating equations. Non-optimal use was defined as the prescribing of high dose of antipsychotic medications and the use of combination therapy of a benzodiazepine (or zopiclone/zaleplon) with an antipsychotic. A decrease in intensity of use over time and lower proportions of patients treated with antipsychotics at high dose or in combination with benzodiazepines (or zopiclone/zaleplon) was considered a trend toward better prescribing. Multiple regression analysis determined predictors of non-optimal use in the elderly population. Results. A 20-fold greater prevalent utilization of SGAs was observed in PCH-dwelling elderly persons compared to those living in the community. In 2008/09, 27% of PCH-dwelling individuals received a prescription for an SGA. Patient characteristics, such as younger age, male gender, diagnoses of dementia (or use of an acetylcholinesterase inhibitor) or psychosis in the year prior the prescription, were predictors of non-optimal prescribing (e.g., high dose antipsychotics). During the period 2002/3 and 2007/8, amongst new users of SGAs, 10.2% received high doses. Those receiving high dose antipsychotics did not show high levels of polypharmacy. Conclusions. Despite encouraging trends, the use of psychotropic medications remains high in elderly individuals, especially in residents of nursing homes. Clinicians caring for such patients need to carefully assess risks and benefits.

Genetic network and breeding patterns of a sicklefin lemon shark (Negaprion acutidens) population in the Society Islands, French Polynesia.

Human pressures have put many top predator populations at risk of extinction. Recent years have seen alarming declines in sharks worldwide, while their resilience remains poorly understood. Studying the ecology of small populations of marine predators is a priority to better understand their ability to withstand anthropogenic and environmental stressors. In the present study, we monitored a naturally small island population of 40 adult sicklefin lemon sharks in Moorea, French Polynesia over 5 years. We reconstructed the genetic relationships among individuals and determined the population's mating system. The genetic network illustrates that all individuals, except one, are interconnected at least through one first order genetic relationship. While this species developed a clear inbreeding avoidance strategy involving dispersal and migration, the small population size, low number of breeders, and the fragmented environment characterizing these tropical islands, limits its complete effectiveness.