Is geographical isolation associated with poorer outcomes for Northern Manitoba First Nation communities?
Bibliographic record
Abstract
Abstract Background: For First Nations, geographical isolation is often simultaneously presented as protective (less direct exposure racism, colonial encroachment on land, dispossession, and colonial imposition) and as a risk factor (lack of opportunities to participate in the formal economy, poorer access to services including healthcare). Our study sought to test the assumption that geographical isolation is associated with poorer population health outcomes among First Nations in Manitoba. Methods: We conducted a population-based retrospective time-trend analysis using administrative data housed at the Manitoba Centre for Health Policy. The study included all Manitoba residents eligible under the Manitoba Health Services Plan (1984-2014). We measured premature mortality rates (PMR), and trends in hospitalization rates and length of stay (LOS) for Ambulatory Care Sensitive Conditions (ACSC) in northern and southern First Nations (FN) communities in Manitoba.Results: The PMR was significantly higher in northern FN compared to southern FN. Hospitalization rates for mental health-related conditions were significantly higher in the northern First Nation communities compared to all Manitoba, and rising (southern, change=1.52%, P=0.015; northern, change=5.49%, P<0.0001), and significantly higher in northern compared to southern FN communities. The LOS for all ACSC increased significantly for all Manitoba (change=0.63%, P=0.0011) but not for FN communities. The LOS for mental health-related conditions increased only for the southern FN communities (% change=1.67, P=0.0032). Conclusions: Our results show higher PMR in northern communities, declining slower than for any other Manitoba communities. Our results also show lower hospitalization rate for ACSC in the north, suggesting barriers to prevention and early diagnosis. There remains a large gap in ACSC hospitalization rates between FN and all Manitobans. Further research is warranted to understand the relationship between the changes in the rates of ACSC and the difference in the rates between northern and southern communities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".