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Sleep And Multimorbidity In The Canadian Longitudinal Study On Aging, Shreni Patel

Electronic Thesis and Dissertation Repository

Sleep health is a latent construct comprising various sleep measures such as duration, quality, initiation, maintenance, and daytime sleepiness. This thesis compared the association of two measures of sleep health, a conventional summary score and a pooled index, with incident multimorbidity over a 3-year follow-up in 30,097 middle- to older-aged adults from the Canadian Longitudinal Study on Aging. At baseline, approximately 26% and 29% of participants with multimorbidity displayed poor sleep patterns according to additive and pooled indexing methods. Longitudinal analysis indicated that those with additive scores of 4 to 5 at baseline had a 1.54 (95% CI: 1.18, 2.03) …

Primary Care Physician Engagement In Health System Transformation: A Case Study, Atharv Joshi

Electronic Thesis and Dissertation Repository

Primary care physician engagement is essential in enhancing organizational performance, system efficacy, and provider collaboration; yet limited literature exists within health systems research. This thesis explored physician engagement throughout the development of an organization known as the London Middlesex Primary Care Alliance (LMPCA). This thesis used a qualitative case study approach guided by a constructivist paradigm. The findings revealed six themes which contributed to the development of the LMPCA and provided insight into how physicians were engaged within health systems work. Unique to this study were two facilitators for engagement: the role of a transformation lead and the use of …

Ontario Adults' Mental Health, Wellbeing, And Prosocial Behaviour During The First 16 Months Of The Covid-19 Pandemic: A Longitudinal Study, Katie J. Shillington

Electronic Thesis and Dissertation Repository

The overall purpose of this dissertation was to provide a detailed assessment of the mental health, wellbeing, and prosocial behaviour of Ontario adults aged 30–59 (those at highest risk for losing years of healthy life due to chronic disease) during the first 16 months of the COVID-19 pandemic (April 2020–August 2021). To address this dissertation’s purpose specifically, four distinct yet thematically connected articles were written. Article 1 provides the starting point of this program of research via an overview of Ontario adults’ inter-related health behaviours (i.e., physical activity, sedentary behaviours, and dietary intake) and outcomes including, mental health, and wellbeing …

A Descriptive Intersectional Analysis Of Anticipated Discrimination In Transgender And Non-Binary People In Canada, Rachel Girimonte

Electronic Thesis and Dissertation Repository

Background: Anticipating discrimination may lead to poor physical and mental health outcomes for transgender and nonbinary (TGNB) individuals. It is important to take an intersectional approach to understand how anticipated discrimination is unequally distributed among TGNB Canadians.

Methods: Among a Canadian community sample of TGNB people aged ≥14 years, the Intersectional Discrimination Index – Anticipated discrimination (InDI-A) measure was validated. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) and multiple linear regression were used to compare mean anticipated discrimination across ethnoracial and sex/gender intersections.

Results: A one-factor model of the InDI-A was supported with a satisfactory fit. Racialized participants, …

The Influences Of The Mindfulness Ambassador Program On Graduate Students, Varsha Vasudevan

Electronic Thesis and Dissertation Repository

The two-fold primary purpose of this pilot study was to: (1) explore, qualitatively, the influence of the Mindfulness Ambassador Program (MAP) on graduate students’ experiences of stress and their relationship with themselves and meaningful others; and (2) investigate, quantitatively, if participation in the MAP elicited changes in graduate students’ levels of stress, self-awareness, interpersonal skills, and/or social connectedness. The secondary purpose of this study was to gain an understanding of graduate students’ satisfaction with the MAP. This one-group mixed-method study utilized a brief demographic questionnaire, open-ended questions, semi-structured interviews, two MAP-specific program questionnaires, the Perceived Stress Scale, the Situational Self-Awareness …

Sociodemographic Factors And The Risk Of Paediatric Out-Of-Hospital Cardiac Arrest, Samina Idrees

Electronic Thesis and Dissertation Repository

Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. This thesis aims to explore the relationship between sociodemographic factors and POHCA. The findings from our systematic review indicate that there are racial disparities in POHCA risk and in the provision of bystander cardiopulmonary resuscitation. There was little evidence of sociodemographic disparities in bystander defibrillation, survival and neurological outcome, particularly across adjusted analyses. The findings from our case-control study in Ontario, Canada, indicate that children living in marginalized areas have an elevated risk of experiencing POHCA. We also found that children living in northern urban or …

Exploring The Experience Of Disclosing In The Workplace, Jillian Auger

Electronic Thesis and Dissertation Repository

An alarming rate of workplace violence/harassment is observed each year, with negative outcomes that affect the organization (i.e., financial loss) and those directly involved (i.e., job loss, financial strain, fear of being blamed, being labeled a ‘troublemaker’). The literature indicates that, for many victim-survivors, there is little hope for positive outcomes following a disclosure of workplace violence/harassment. In fact, some studies show that negative reactions to disclosure can compound and intensify the impact of violence/harassment on psychological functioning. However, minimal research has been devoted to the experiences of victim-survivors regarding the outcomes of a disclosure. Utilizing virtual semi-structured interviews, the …

Association Of Post-Traumatic Stress Disorder Exposure And Treatment In Pregnancy With Pregnancy, Obstetric And Neonatal Outcomes, Natalie Zitoun

Electronic Thesis and Dissertation Repository

A particular condition for which there is a dearth of pregnancy information is Post-Traumatic Stress disorder (PTSD). This thesis aimed to evaluate PTSD exposure and treatment in pregnancy. Our first study was a systematic review, meta-analysis, and GRADE assessment that reported associations between maternal PTSD exposure with pregnancy, obstetric, and neonatal outcomes. Our second study was a prospective evaluation of pregnancy outcomes after prazosin exposure in the first trimester of pregnant patients who were counselled at the Fetal Risk Assessment from Maternal Exposures (FRAME) clinic. Our review and analysis found positive associations between PTSD in pregnancy and some adverse pregnancy …

Regulatory Implications Of Inadequately Designed Pimavanserin Drug Trials Published With Risk Of Bias On Expedited Regulatory Approval Processes, Benson Law

Electronic Thesis and Dissertation Repository

The objective of this retrospective critical appraisal study was to determine if the trials submitted to the Food and Drug Administration for the expedited approval of pimavanserin was of sufficient methodological quality to ascertain its safety and efficacy. After the general metrics of the trials were assessed, the Risk of Bias 2 tool and the PRagmatic Explanatory Continuum Indicator Summary tool were employed to evaluate the risk of bias and the design suitability of the trials. This study suggests that the decision to approve pimavanserin for the treatment of Parkinson’s Disease Psychosis failed to meet the threshold of evidence normally …

The Resilience And Socioeconomic Status Of Caregivers And School-Aged Children In The Context Of The Covid-19 Pandemic, Julia Yates

Electronic Thesis and Dissertation Repository

Introduction: The COVID-19 pandemic has challenged caregivers’ and school-aged children’s ability to adapt. Their adaptability may be due to their resilience, which socioeconomic status (SES) may impact.

Methods: Surveys were administered to 22 caregivers and 27 school-aged children (7-10 years) living in Ontario to measure their resilience and SES in the context of COVID-19. Correlations were employed to explore relationships between: (1) caregiver and child resilience; and (2) resilience and SES.

Results: Analyses found no significant relationship between caregiver and child resilience, nor resilience and SES in the context of COVID-19. Trends revealed caregivers with normal resilience had a higher …

Return To Play: Impact Of Urbanicity And Socioeconomic Status On Parents’ Attitudes Regarding Their Children's Play And Sport During The Covid-19 Pandemic, Kendall Saravanamuttoo

Electronic Thesis and Dissertation Repository

The COVID-19 pandemic has had a profound impact on the daily routines of parents and children. The primary aim of this study was to explore the influence of socioeconomic status (SES) and urbanicity on parents’ attitudes toward their children’s active play opportunities 6 months and 1.5 years into COVID-19. The secondary objective was to explore how parents’ attitudes at 6 months related to the structured and unstructured play opportunities that children returned to 1 year later, while moderating the effects of SES and urbanicity. A sample of 239 Ontario parents of children (< 12) completed two online surveys (August – December 2020; 2021). In general, parents in communities with urban features (e.g., densely populated areas), single-parents, full-time employed parents, and parents of lower-income were more hesitant to return their children to active play during the pandemic. Findings from this work highlight SES and urbanicity disparities that continue to exist during COVID-19.

Understanding The Knowledge Translation Practices Of Environmental Health Officers In Canada: A Mixed Methods Study, Shawna Bourne-Shields

Electronic Thesis and Dissertation Repository

Though important to Environmental Health Officer (EHO) practice, few research articles explore what evidence-informed practice looks like in environmental health or the factors that influence it. This study set out to understand the barriers to, and facilitators of, research utilization (RU) experienced by EHOs by asking: how do EHO practitioner perceptions of the barriers to RU change during an emergency; what factors influence evidence use during an emergency; and what can be done to ensure access to evidence and support effective and appropriate practice decision-making?

These questions were answered through three studies that used quantitative and qualitative methods. The Barriers …

Socioeconomic Patterning Of Physical Activity Among Middle-Aged To Older Adults, Jane Yuan

Electronic Thesis and Dissertation Repository

Regular physical activity is a well-known protective factor against chronic disease and strongly correlated with healthy aging. However, as physical activity levels tend to decline with age, there is a need to identify barriers which prevent older adults from being physically active. This thesis investigated the relationship between socioeconomic status and meeting physical activity guidelines of 150 minutes or more of moderate- to vigorous- intensity physical activity among middle-aged to older adults in Canada. Using cross-sectional data from the baseline assessment of the Canadian Longitudinal Study on Aging, block-wise multivariable logistic regression was performed to assess the association between socioeconomic …

Social Determinants Of Health And Uptake Of Colorectal Cancer Screening In Canada, Seth F. Kadish

Electronic Thesis and Dissertation Repository

Colorectal cancer (CRC) screening uptake may be associated with social determinants of health and could indicate potential barriers to health service access. The goal of this thesis was to evaluate the association of social determinants with CRC screening in screen-eligible adults. We used Andersen’s Behavioural Model of Health Service Utilization and the PROGRESS-Plus Framework to conceptualize potential social determinants. Our first study was a systematic review of peer-reviewed Canadian studies, and the second was a cross-sectional analysis of data from the Canadian Longitudinal Study on Aging (CLSA). The systematic review found lower uptake was associated with non-White ethno-racial identity, less …

How We Debrief: An Interpretive Description Of Social Service Community Workers' Experiences, Andrea C. Krywucky

Electronic Thesis and Dissertation Repository

The aim of this research was to understand current practices of debriefing being used or not used in community social service organizations and the presumed frameworks or evidence justifying these practices in London, Ontario. The geographical area under concern has seen an increasing poverty gap, lack of affordable housing, toxic drug crisis, with mental health issues being exasperated by the pandemic. Social service agencies are overwhelmed with caseloads, creating an increase in need of care for frontline workers, as they are the first point of contact for many. This research utilized an interpretive description methodology to explore workers’ experiences and …

Rapid Rhino Vs. Merocel: A Retrospective Analysis Of Patients With Anterior Epistaxis Visiting Emergency Rooms In London, Ontario, Dhatri Shukla

Electronic Thesis and Dissertation Repository

When patients present to an emergency room (ER) with a nosebleed, one technique that physicians employ is the application of nasal packing. Merocel is a common nasal pack utilized in ER because of their low cost. Rapid Rhino is a nasal packing that is more comfortable for patients but is more costly than Merocel. Costing for epistaxis treatment is more than initial treatment costs and needs to consider rebleed rates. Using a retrospective cohort study design with covariates adjusted by propensity scores, we compared the costs associated with Merocel, and Rapid Rhino from the hospital and provincial healthcare perspectives. Merocel …

Examining The Socio-Economic And Gendered Structure Of Canada's Live-In Caregiver Program: A Qualitative Study Of Filipina Women's Health Experiences, Andrea Bobadilla

Electronic Thesis and Dissertation Repository

The primary aim of this critical ethnographic study was to examine how Filipina women in the Canadian live-in caregiver program (LCP) negotiate their own physical and mental well-being while managing the complex health needs of their clients. Using global care chain and postcolonial theoretical frameworks, I also sought to identify how multi-scalar forces including caregiving and migrant policies in Canada and South East Asia exacerbate pre-existing gendered and labour inequities faced by these women. The distressing impact of this precarious form of employment on family dynamics and relationships among family members in the Philippines was also explored. Data collection took …

Fertility Preservation Discussions With Transgender People In Canada Prior To Beginning Medical Gender Affirmation, Emily K. Sanders

Electronic Thesis and Dissertation Repository

Background. Prevalence of fertility preservation discussions and procedures, participant characteristics associated with discussions, and prevalence of desire to parent are described.

Methods. Describes, for a clinical sample of < 16-year-olds: medical chart-recorded discussion and procedure prevalence, and desire to parent longitudinally. Describes self-reported discussion prevalence for a community sample of 14- to 39-year-olds. Bivariate and multivariable modified Poisson analyses were conducted for this sample.

Results. Discussion prevalence was confirmed for approximately 80% of the clinical sample, with approximately 20% unconfirmed. Self-reported discussion prevalence was 45% in the community sample. Non-binary gender with female sex at birth, greater family religiosity, and diagnosed mental health condition excluding depression or anxiety were crudely associated with less discussions. Multivariable analyses revealed no statistically significant predictors. Desire to parent was fairly consistent over time.

Conclusion. Discussions should be standard practice for …

Association Of Socioeconomic, Racial, And Regional Factors With In-Hospital Management And Outcomes Of Acute Myocardial Infarction Patients In The United States: National Analyses Of 2.8 Million Admissions, Olivia Haldenby

Electronic Thesis and Dissertation Repository

Social determinants of health contribute to variations in clinical outcomes among acute myocardial infarction (AMI) patients. Using the National Inpatient Sample, we conducted retrospective cohort analyses to evaluate the association of income, race, and geography with in-hospital mortality and revascularization procedures among AMI admissions in the United States from 2015 to 2019. Multilevel logistic regression models were used while accounting for hospital clustering and relevant predictors. A sequential model-building approach produced model 1 (unadjusted patient-level exposures), model 2 (lifestyle factors), model 3 (clinical characteristics), and model 4 (fully adjusted hospital-level factors). We identified 2,798,225 AMI hospitalizations (≥18 years) with 1,567,575 …

Social Determinants Of Access To Primary Care In Canada, Feben W. Alemu

Electronic Thesis and Dissertation Repository

Despite the promise of universal care, many Canadians report having unmet healthcare needs. We conducted two studies: (1) a systematic review of studies on social determinants of health (SDH) and unmet need; and (2) a secondary analysis using the Canadian Longitudinal Study on Aging (CLSA) to investigate the association of SDH and (2a) self-reported unmet need and (2b) having a family physician. The review (n=40) found a positive association between unmet need and lower income, mental health and chronic conditions, and negative association with older age, better perceived health and having a family physician. The CLSA analysis found the odds …

Patterns Of Multimorbidity Among Immigrants To Canada: An Analysis Of The Cchs-Imdb, Tasneem Lalva

Electronic Thesis and Dissertation Repository

Background: Multimorbidity is a growing public health concern and is associated with reduced quality of life and adverse health outcomes, yet investigation of multimorbidity among the immigrant population is limited in the Canadian context.

Objectives: To assess the prevalence and correlates of multimorbidity among immigrants to Canada 18 years of age or older.

Methods: Data from the 2007 to 2014 Canadian Community Health Survey linked to the Longitudinal Immigration Database were used. Statistical analysis included descriptive statistics and multivariable regressions.

Results: Among immigrants, 3.5% had multimorbidity. Immigration factors such as recency of immigration, birth region, immigration category as well as …

Severe Lower Extremity Trauma In Ontario: A Linked Population-Based Analysis, Stephanie M. Kim

Electronic Thesis and Dissertation Repository

Open tibia fractures (OTF) are a management challenge. Admission to a trauma center (TC) and a coordinated approach to bony fixation and soft-tissue reconstruction (STR) have been shown to improve outcomes. The objective of this study was to describe patients who had OTF in Ontario and analyze their outcomes. Linked population data pertaining to patients who had OTF between the years 2009-2020 were examined. Demographic information, admission location, and management course were collected. 4240 patients were found. The mean age was 47, and majority were males. Patients admitted to TC had greater proportion of having Injury Severity Score >15, and …

Encouraging Movement Opportunities Through Theory-Informed Video Education In Undergraduate Students: The Move Study, Carmen T. Labadie

Electronic Thesis and Dissertation Repository

This mixed methods randomized control trial explored the impact of a tailored, Health Belief and Transtheoretical Model informed educational video on undergraduate students’: (1) motivational readiness, self-efficacy, and decisional balance about changing sedentary behaviour; (2) levels of sedentary time; and (3) perceptions of sedentary behaviour over time and when compared to a control condition. Students (N = 160) were randomly assigned to the intervention or control group. Participants completed: two previously validated questionnaires at baseline, immediate post-intervention, and one-month follow-up; and open-ended questions at post-intervention (intervention group only). Linear mixed models and inductive content analysis were used. Significant differences …

Forming Authentic And Purposeful Relationships With Racialized Communities From An Anti-Oppressive Lens: A Framework For African, Caribbean, And Black Communities, Jaimeson R. Canie

Electronic Thesis and Dissertation Repository

In collaboration with London InterCommunity Health Centre this research focused on identifying priority areas for anti-Black racism interventions in London, Ontario. Semi-structured interviews were conducted with stakeholders from London’s African, Caribbean, and Black (ACB) communities. Interpretive description methodology guided analysis and interpretation. Participants indicated that anti-Black racism is ever-present in the community, with systemic racism leading to the most harm. Racism should be addressed by creating ACB-specific services and education for non-Black communities; and increased representation, inclusion, and engagement of ACB people within organizations, especially leadership. A framework to direct how organizations can develop authentic and purposeful relationships with ACB …

Perspectives Of Middle Eastern Immigrant Parents Regarding Accessing Healthcare Services For Children During The Covid-19 Pandemic In London, Ontario, Sarvenaz Mehrabi

Electronic Thesis and Dissertation Repository

Background: During the COVID-19 pandemic, immigrants have been disproportionally affected and faced difficulties in accessing healthcare services. While it has been reported that the rate of pediatric healthcare utilization decreased during the COVID-19 pandemic, the reasons behind this decline are unclear. It has been suggested that immigrant children might be affected by the COVID-19 pandemic restrictions regarding accessing healthcare services. This study aims to understand the Middle Eastern immigrant parents’ perspectives regarding their access to healthcare services for their children in the London, Ontario, area during the COVID-19 pandemic.

Methods: This qualitative study was conducted with an interpretive description methodology …

Multimorbidity And Cognition Among Canadian Older Adults: A Three-Decade Perspective, Juan Camilo Vargas Gonzalez

Electronic Thesis and Dissertation Repository

Background: Scarce information exists about whether the relationship between multimorbidity and cognitive decline has changed over the past decades.

Objectives: 1) To summarize knowledge about the association of multimorbidity and cognitive decline by performing a systematic review. 2) To estimate the association between multimorbidity in two cohorts selected three decades apart. 3)To identify which multimorbidity combinations have the strongest associations with cognitive decline 4) To identify protective factors that reduce the risk of cognitive decline in the presence of multimorbidity.

Methods: We performed a systematic review following the PRISMA statement. We then addressed objectives 2-4 by analyzing data from two …

Towards A Conceptual Model Applying Trauma Informed Care Principles And Healthcare Professional Resilience To Interfacility Transport Of Acutely Ill And Preterm Neonates, Megha R. Rao

Electronic Thesis and Dissertation Repository

The purpose of this dissertation was to acquire a greater depth of knowledge surrounding the experiences of the interfacility transport process for acutely ill and preterm neonates based on the perspectives of healthcare professionals and parent-caregivers who are involved. In doing so, an overall goal was to develop a conceptual model that explains how healthcare professionals and parents experience the process while also offering insights into how to foster more positive experiences through clinical interventions that are aligned with Family Centred Care. This program of research is uniquely guided by the paradigms and theoretical frameworks of Trauma Informed Care (TIC), …

Quantifying And Predicting Real-World Iatrogenic Severe Hypoglycemia In Adults With Type 1 Or 2 Diabetes Mellitus (The Inphorm Study, United States), Alexandria A. Ratzki-Leewing

Electronic Thesis and Dissertation Repository

Clinical outpatient strategies to accurately predict diabetes-related iatrogenic severe hypoglycemia (SH) are lacking. To redress this gap, we conducted the first-ever prognosis investigation of guideline-defined (Level 3) SH in the United States (US) (iNPHORM).

Chapter 4 details the design and implementation of iNPHORM: a prospective 12-wave panel survey (2020–2021). N=1206 adults with type 1 or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T1DM or T2DM) were recruited from a US-wide, probability-based internet panel. For one-year, we collected monthly data on SH occurrence (frequencies, detection methods, symptoms, causes, and treatments) and related factors (anthropometric, sociodemographic, clinical, environmental/situational, behavioural, and psychosocial).

iNPHORM …

Using A One Health Approach For The Assessment Of Rabies Control In Rural Victoria Falls, Zimbabwe, Ryan Lapenna

Electronic Thesis and Dissertation Repository

Rabies, a viral zoonotic disease, is widespread in Zimbabwe, with human fatalities reported annually in the country. To supplement the Government’s effort on rabies control, the Victoria Falls Wildlife Trust and Veterinarians for Animal Welfare Zimbabwe have joined forces to carry out dog rabies vaccinations in rural communities adjacent to the major tourist attraction of The Victoria Falls. A One Health approach was used to 1) determine the level of protective rabies antibodies among a sample of rural dogs and 2) collect information and describe the knowledge, attitudes, and practices related to rabies among dog owners. In 2020, blood was …

How Can Single Mothers Care For Themselves And Their Children During The Covid-19 Pandemic?, Lisbeth Alexandra Pino Gavidia

Electronic Thesis and Dissertation Repository

This work investigates how single mothers maintain healthy behaviours for themselves and their children as they try to meet the evolving COVID-19 public recommendations. Everyone has had to adapt to changing public health rules. Single mothers may have unique challenges as they juggle to adapt to changing family responsibilities since they do not have another person helping in the home, and help outside the home may be restricted by public health rules. My research plan addressed these questions to learn more about the experiences of single mothers during the pandemic: 1) What are the changes in family responsibilities? 2) How …