Medicine and Health Sciences Commons^™

Overall Survival And Biochemical Failure-Free Survival Comparison Of Brachytherapy Treatment Options Versus External Beam Radiation Therapy For Both Low And Intermediate-Risk Prostate Cancer: A Propensity-Score Matched Analysis, Graham D. Smith

Electronic Thesis and Dissertation Repository

Purpose: This study compares overall survival (OS) and biochemical failure-free survival (bFFS) in low- and intermediate-risk prostate cancer patients that received brachytherapy [low-dose-rate brachytherapy (LDR-BT) or high-dose-rate brachytherapy with external beam radiation therapy (HDR-BT+EBRT)] versus external beam radiation therapy (EBRT) alone.

Materials/Methods: Patient data was obtained from the ProCaRS database, which contains 7974 prostate cancer patients treated at four Canadian institutions. Propensity score (PS) matching was used to generate matched cohorts with balanced baseline prognostic factors.

Results/Conclusions: Final PS matches included two 1:1 intermediate-risk patient matches, LDR-BT vs. EBRT (total n = 254) and HDR-BT+EBRT vs. EBRT (total n=388), and …

The Association Between Heavy Episodic Drinking And Alcohol-Related Unsafe Sex Among Canadian Undergraduate Student Drinkers, Shirley Solomon

Electronic Thesis and Dissertation Repository

Young adults who engage in risky sexual behaviours are placing themselves at risk for serious health problems. This study assessed the extent of alcohol-related unsafe sex among Canadian undergraduate students and examined the association between unsafe sex and heavy episodic drinking as well as drinking motives, drinking locations, age when they first drank alcohol, and illicit drug use. Data were obtained from the 2004 Canadian Campus Survey (N = 4,437). Logistic regression and modified Poisson regression was used to examine associations with unsafe sex. The proportion of students reporting having had unsafe sex was estimated to be at 7.37%. Heavy …

Primary Health Service Use By Mothers And Children From London-Middlesex, Ontario, Catherine Holtz

Electronic Thesis and Dissertation Repository

Primary health service use (P-HSU) may be influenced by predisposing and enabling factors measured at individual- and contextual-levels but is equitable when driven by need factors. Objectives: 1) Estimate the effect of residential location on maternal and child P-HSU; 2) Assess P-HSU inequity by determining whether the effects of need factors on P-HSU are dependent on predisposing and enabling factors; 3) Describe perceived unmet healthcare needs in the maternal-child population observed to have inequitable P-HSU. Methodology: The sample of 1451 mother-child pairs was from a prenatal cohort recruited from London, Ontario between 2002 and 2004, with follow-up until children were …

Neonatal And Developmental Outcomes Of Late Preterm And Early Term Birth, Hilary K. Brown

Electronic Thesis and Dissertation Repository

Research suggests increased risk for adverse outcomes associated with late preterm (34-36 weeks) and early term (37-38 weeks) birth versus full term (39-41 weeks). However, it remains unclear to what extent these outcomes are associated with physiological immaturity or factors leading to or associated with early birth.

The first objective was to elucidate the role of gestational age in determining risk of poor neonatal outcomes in the context of biological determinants of preterm birth. A retrospective cohort study of singletons delivered at 34-41 weeks to London-Middlesex (Canada) mothers was conducted using perinatal and discharge abstract databases (N=38,807, 2002-2011). Modified Poisson …

The Stress Process Model For Community-Dwelling Adults With Mental Disorders, Samantha Davie

Electronic Thesis and Dissertation Repository

Background: Although stress has been linked to poor mental health outcomes for various populations, less is known about the impact of stress on individuals already diagnosed with mental disorders. Objective: Explore the association between stress and general psychological distress (GPD), using the stress process model. Design: Data were collected in 2011 from community-dwelling adults who have had at least one diagnosed mental disorder for at least one year in their lifetime (n=380), and are cross-sectional in nature. Multivariable linear regression was used to assess the association between stress and GPD, with various psychological resources, such as coping, social support, and …

Economic Evaluation Of Potential Applications Of Gene Expression Profiling In Clinical Oncology, Malek Hannouf

Electronic Thesis and Dissertation Repository

Histopathological analysis of tumor is currently the main tool used to guide cancer management. Gene expression profiling may provide additional valuable information for both classification and prognostication of individual tumors. A number of gene expression profiling assays have been developed recently to inform therapy decisions in women with early stage breast cancer and help identify the primary tumor site in patients with metastatic cancer of unknown primary. The impact of these assays on health and economic outcomes, if introduced into general practice, has not been determined. I aimed to conduct an economic evaluation of regulatory-approved gene expression profiling assays for …

The Association Between Women's Autonomy And Women's Hiv/Aids Knowledge And Attitudes In Ethiopia, Fadumo Rirash

Electronic Thesis and Dissertation Repository

Low autonomy resulting from gender inequalities in women has been identified as a contributing factor to the disproportionate impact of HIV/AIDS on women, especially in Sub-Saharan Africa.

This study explored the association between women’s autonomy and HIV/AIDS knowledge and attitudes in Ethiopia using the 2005 and 2011 Ethiopia Demographic and Health Surveys. The women’s spouses’ perceptions of the women’s autonomy and socio-demographic variables associated with HIV/AIDS knowledge and attitudes identified by the literature were included in the analyses. Multiple linear regression identified positive associations between women’s autonomy (and men’s perception of women’s autonomy), socio-demographic variables including education and mass media …

The Impact Of Obesity On Employment Participation And Earnings Among Working-Age Women In Canada: Evidence From The Nphs Longitudinal Data, Samantha L. Larose

Electronic Thesis and Dissertation Repository

Background: The direct medical care costs attributable to obesity are well-known, but little is known about the indirect costs of obesity. In particular, less is known about the impact of obesity on employment participation and earnings, especially among women in Canada.

Objectives: The objectives of this study are to examine the association between obesity and employment participation and earnings, if employed, among Canadian women.

Methods: Data were taken from the last six cycles of the National Population Health Survey from 2000/01-2010/11 longitudinal cohort data from women aged 18-53 years. The association between obesity and labour market participation was analyzed using …

Risk Of Kidney Stones In Living Kidney Donors: A Matched Cohort Study, Sonia Thomas

Electronic Thesis and Dissertation Repository

A kidney stone in a person with one kidney requires urgent attention which may result in surgical and/or hospital attention. We conducted a matched retrospective cohort study to determine if living kidney donors compared to healthy non-donors have a higher risk of: 1) kidney stones with surgical intervention, and 2) hospital encounters for kidney stones. We reviewed and linked information from pre-donation charts to Ontario healthcare databases. We selected healthy non-donors from the general population, matching ten non-donors to every donor, to generate a cohort of 2,019 donors and 20,190 non-donors. There was no difference in the rate of 1) …

The Impact Of Intrauterine Exposure To Gestational Diabetes Mellitus On Early Childhood Body Mass Index Trajectories, Aniq Anam

Electronic Thesis and Dissertation Repository

Background: Although gestational diabetes mellitus (GDM) has been linked to pediatric obesity, there is limited research on the impact of intrauterine exposure to GDM on trajectories of childhood growth. Objective: To assess the effect of prenatal GDM exposure on childhood body mass index (BMI) trajectories. Design: Analyses were conducted using data from cycles 2 to 6 (1994-2004; N=3412 children) of the National Longitudinal Survey of Children and Youth. Latent growth curve modelling (LGCM) was used to model BMI trajectories from age 2 to 10 years with prenatal exposure to GDM as a predictor. Effect modification by breastfeeding was assessed. Results: …

Evaluation Of Ontario's Street Racers, Stunt And Aggressive Drivers Legislation, Aizhan Meirambayeva

Electronic Thesis and Dissertation Repository

The purpose of this thesis was to conduct a process and outcome evaluation of the deterrent effect of Ontario’s Street Racers, Stunt and Aggressive Drivers Legislation. The focus of this study was on police enforcement (implementation), a change in speeding on the provincial highways (intermediate outcome) as well as on a decrease in both extreme speeding convictions and casualties, measured as a sum of injuries and fatalities (criterion outcomes). The deterrent effect of the legislation on Ontario drivers was examined, using data obtained from the Ministry of Transportation of Ontario. Employing interrupted time series …

Risk Factors For Diabetes Mellitus: A Comparative Analysis Of Subpopulation Differences In A Large Canadian Sample, Michael James Taylor

Electronic Thesis and Dissertation Repository

Objectives: Certain Canadian subpopulations observe numerous modifiable and non-modifiable risk factors for diabetes. This study compares immigrants and Aboriginals (First Nations, Inuit, and Métis) with Canada-born individuals at higher risks for diabetes, and deciphers the determinant differences between them.

Methods: Pooled Canadian Community Health Survey data (2001-2010) were used. Time trends for diabetes within each subsample were calculated using individual survey year prevalence rates; diabetes diagnoses were self-reported (N=33,565). Various risk factors were also examined using logistic regression.

Results: Diabetes prevalence rates significantly increased from 2001 to 2010 for each subpopulation, as well as the total sample: Canada-Born individuals (3.9% …

Violence Among Cocaine And Simultaneous Cocaine And Alcohol Abusers: Results From A Cross-Sectional Study Of Treatment Clients, Sameer Imtiaz

Electronic Thesis and Dissertation Repository

A population known for substantial violence is the substance abuse treatment population. This study assessed: (1) extent of violence, (2) personality and mental health correlates of violence, and (3) sex differences in correlates of violence. Data were obtained from the Patterns and Consequences of Cocaine and Alcohol Use for Substance Abuse Treatment Clients Study (N = 403). Logistic regression with backward elimination procedures and modified Poisson regression were used to assess the study objectives. Violence was reported by 44% of treatment clients. Furthermore, number of other drugs used per week (RR: 1.124, 95% CI: 1.063 - 1.189) and aggressive personality …

An Exploration Of The Relationships Between Markers Of Social Status And Position And Hiv Risk Behaviours In African, Caribbean, And Other Black Populations, Shamara M. Baidoobonso

Electronic Thesis and Dissertation Repository

African, Caribbean, and other Black (ACB) people are a priority group for HIV prevention in Canada, but little is known about the epidemiology of HIV risk in this population. The overall goal of this thesis is to guide HIV prevention interventions for ACB communities. It focuses on social factors that impact HIV vulnerability.

This research used data from the Black, African, and Caribbean Canadian Health Study—a mixed methods study that used 30 semi-structured interviews, and a cross-sectional survey using a structured, self-administered quantitative questionnaire to collect information about HIV and health from 188 ACB people.

The first manuscript compares risk …

Self-Reported Racism, Transphobia, Their Intersection And Impact On Past-Year Hiv Related Sexual Risk Behaviour, Roxanne M. Longman Marcellin

Electronic Thesis and Dissertation Repository

Background: Studies examining HIV prevalence and risk behaviors within trans subgroups have identified them as high risk. Yet few studies have addressed how discrimination impacts this prevalence. Minority stress theory suggests that there is a relationship between minority stress and HIV-related risk behaviour. We hypothesize that multiple minority statuses may result in discriminatory experiences, specifically self-reported transphobia and racism in synchrony with other attributes, that interact to alter past-year HIV-related risk behaviour.

Methods: Data came from the Trans PULSE project, a mixed-methods, community-based research study that used respondent-driven sampling to access 433 trans Ontarians, between May 2009 and …

Screening For Adult Adhd In Ontario: A Cross-Sectional Study Examining Sex Differences, Mental Health Correlates And Substance Use, Deanne Daigle

Electronic Thesis and Dissertation Repository

The vast majority of studies on attention-deficit/hyperactivity disorder (ADHD) are based on samples with inherent age, sex, and referral biases. Therefore, the current study used population-based data to 1) estimate the prevalence of adult ADHD (as well as previous diagnosis and medication use using an ADHD screener) and co-occurring psychiatric distress and substance use in Ontario 2) examine the sex differences in ADHD screening status and co-occurring psychiatric distress and substance use and 3) model ADHD screening status as a risk factor for psychiatric distress using the 2011 cycle of the Centre for Addiction and Mental Health Monitor. A positive …

Antenatal Care Determines Immunization And Care For Fever And Diarrhea In Ghanaian Children, Natalie K. Mcglynn

Electronic Thesis and Dissertation Repository

Enhancing maternal and child health comprise key Millennium Development Goals (MDGs), driving an analysis of whether efforts to improve maternal health through quality antenatal care (ANC) is associated with the recommended health-related care of children in Sub-Saharan Africa, where under-five mortality is the highest.

This study examines ANC as a potential determinant of immunization and appropriate care for fever and diarrhea in Ghanaian children. Data were pooled from the 1998, 2003, and 2008 Ghana Demographic Health Surveys, and Andersen’s Behavioural Model provided the conceptual framework.

Multivariate logistic regression indicated that quality ANC increases the odds of immunization and appropriate care …

Investigating Personality Vulnerability To Suicide Ideation In Community-Residing Older Adults, James Andrew Mcclure

Electronic Thesis and Dissertation Repository

This study assessed associations between suicide ideation and personality characteristics in a sample of community-residing adults 65 years of age and older. Measures of personality, suicide ideation, and depression were administered at two time points 6-12 months apart. Multiple linear regression analyses were employed to investigate cross-sectional and longitudinal associations between personality characteristics and suicide ideation. A total of 106 older adults (mean age=74.2 years, SD=5.8, including 78 women) completed both phases of the study. The majority of participants included in this study were relatively emotionally and psychologically healthy. Within this sample of older adults, more severe suicide ideations was …

Social Support As A Determinant Of Health Related Quality Of Life In Breast Cancer Survivors In California, Faiza Rab

Electronic Thesis and Dissertation Repository

Objective:

To evaluate the relationship between perceived social support and HRQOL (physical and emotional) in low SES breast cancer survivors.

Methods:

A cross-sectional study design was used to measure perceived social support at 18 months and HRQOL at 3 years after breast cancer diagnosis using MOS SS and MOS SF-36, respectively. Multiple regression analyses were used to evaluate the relationship.

Results:

Menopause at the time of diagnosis, adjunct chemotherapy, adjunct radiation therapy, co-morbidities, treatment side effects and depression were negatively associated with PCS scores (p < 0.01). Treatment side effects, anxiety and depression were negatively associated with MCS scores (p < 0.01).

Conclusions:

Perceived social support was not associated with HRQOL in low SES breast cancer survivors …

Weight Status Underestimation Among Canadian Adolescents: An Important And Frequently Overlooked Aspect Of The Childhood Obesity Epidemic, Mary Ellen Kuenzig

Electronic Thesis and Dissertation Repository

Objectives: Overweight adolescents frequently fail to recognize that they are overweight. This project examines the magnitude of weight status underestimation among overweight adolescents and identifies predictors of this underestimation.

Methods: Data from the Canadian Community Health Survey (2001-2010) were used. Overweight adolescents (N=11,452) reporting they were underweight or about right were classified as underestimating their weight. The time trend in underestimation and effects of individual-level characteristics on underestimation were examined using logistic regression. Multilevel analysis examined the effect of weight status of community-based reference groups.

Results: For every 5 overweight male adolescents, 3 underestimated their weight; 2 of 5 overweight …

Evaluating The Montreal Cognitive Assessment (Moca) And The Mini Mental State Exam (Mmse) For Cognitive Impairment Post Stroke: A Validation Study Against The Cognistat, Lauren Friedman

Electronic Thesis and Dissertation Repository

Objective. To identify the better of two commonly used screening tools for detecting probable cognitive impairment in stroke patients in a large regional rehabilitation hospital (ParkwoodHospital,London,Ontario). This was a validation study of the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA), using the Cognistat, as the criterion or ‘gold standard’. It was hypothesized that the MoCA is a superior screening instrument to the MMSE for the detection of cognitive impairment in stroke patients.

Methods. The MMSE and the MoCA were administered by occupational therapists and the Cognistat was administered by the student investigator. A second Cognistat was administered …

The Symptom Of Fatigue In Primary Care: A Comparative Study Of Health Care Utilization Patterns Using Electronic Medical Records, Kathryn A. Nicholson

Electronic Thesis and Dissertation Repository

The experience of fatigue has been a common problem among community populations for decades. The symptom of fatigue is also a frequent health complaint in primary care practices. Fatigue patients have been shown to be significantly high users of health care resources, particularly when compared to non-fatigued patient populations. To date, an understanding of the presence and the impact of the symptom of fatigue within the context of the Canadian health care system has been understudied.

The objective of this research was to determine the number of patients who were suffering from the symptom of fatigue within a primary care …

Association Between The Fast-Food Environment And Obesity In Canada: A Cross-Sectional Analysis, Simon Hollands

Electronic Thesis and Dissertation Repository

Frequent fast-food consumption is associated with weight gain therefore it is hypothesized that relative availability of fast-food is a risk factor for obesity. This thesis examined the association between the neighbourhood-level density of fast-food outlets and adult body mass index (BMI) in Canada. Population-based data on BMI and socio-economic variables from the 2008 Canadian Community Health Survey [CCHS] and selected neighbourhood-level socio-economic data from 2006 Canadian Census were merged with a commercial database containing geographic locations of all restaurants in Canada. The association between BMI and fast-food density (per 10,000 people in CCHS respondent’s FSA) was analyzed using ordinary least …

The Relationship Between Diet Quality And Obesity In Canadian Adults: Evidence From The 2004 Canadian Community Health Survey, Kalaivaani Sundararajan

Electronic Thesis and Dissertation Repository

Background: The relationship between diet quality and obesity is unknown in Canadian adults.

Objectives: The objective of this study is to examine the association of diet quality with obesity in Canadian adults.

Methods: Data were taken from the 2004 Canadian Community Health Survey. Three indices were constructed using diet recall data: Diet Quality Index (DQI), Healthy Eating Index (HEI) and Glycemic Index (GI). Obesity was measured with body-mass index. Various confounders were also controlled. Latent-class and ordered probit modeling were used to investigate the association between diet quality and obesity.

Results: Latent-class analysis suggested that the …

Depressive Symptoms In Mothers Of Children With New-Onset Epilepsy: A Prospective Study, Mark Anthony Ferro

Electronic Thesis and Dissertation Repository

Having a child diagnosed with a chronic illness such as epilepsy is a major source of stress for caregivers. Up to half of mothers of children with epilepsy are at increased risk for clinical depression and symptoms of maternal depression are associated with poorer health outcomes in these children. The purpose of this study was to: 1) estimate the prevalence and course of depressive symptoms over 24 months among mothers of children with new-onset epilepsy; 2) identify subgroups of mothers that share similar trajectories of depressive symptoms; and, 3) assess the family factors involved in the causal pathway between maternal …

The Health Of Ontario’S Transgender Communities: Prevalence Of And Risk Factors For Depression, "Do-It-Yourself" Transitions, And Health Effects Of Cross-Sex Hormones And Surgeries, Nooshin Khobzi

Electronic Thesis and Dissertation Repository

The purpose of this dissertation was to develop an understanding of, and draw attention to, the health and service access issues faced by trans (transgender, transsexual, or transitioned) Ontarians. This thesis is based on the Trans PULSE Project, a community-based research (CBR) initiative whose goal is to improve the health of trans people. Data collection was carried out between May 2009 and April 2010 using a quantitative survey. Trans participants were recruited through respondent-driven sampling (RDS), a network-based sampling method developed for the recruitment of hidden populations. Weighted prevalence estimates and 95% confidence intervals were calculated for all variables of …