Public Health Commons^™

Pearl Harvesting Autism, Mariya Gruntovskaya

Electronic Thesis and Dissertation Repository

This thesis addresses the difficulties of on-line information searching as it relates to the topic of autism. A review of existing search strategies is presented and their limitations are discussed. A new method for deriving a set of search-terms for comprehensive searching, Pearl Harvesting, was tested here to determine the necessary search terms (i.e., synonym ring) for ERIC and PsycINFO databases. Once discovered and validated, a synonym ring can be copied and pasted directly into the search box of the database, providing a simple, thorough and time saving way of conducting on-line research in the field. This easily used method …

The Impact Of Resource Availability On Patterns Of Discharge To Inpatient Rehabilitation After Stroke In Ontario, Canada, Matthew J. Meyer

Electronic Thesis and Dissertation Repository

Stroke is a leading cause of death and disability in Canada. As patients, their families, and their friends adjust to life after stroke, organized rehabilitation can play an important role in functional recovery and improving quality of life. Best-practice recommendations suggest that moderately-to-severely impaired patients receive care in an inpatient rehabilitation unit and more mildly impaired patients in out-of-hospital settings (outpatient clinics or in-home). However, data from Ontario (Canada’s most populous province) suggest that post-stroke rehabilitation resources in both settings may be lacking. This has led to concern that some patients may be receiving rehabilitation that is not appropriate for …

The Impact Of Financial Incentives For Cervical Cancer Screening In Ontario's Primary Care Delivery Models, Ciara Pendrith

Electronic Thesis and Dissertation Repository

Physicians practicing in capitation-based Family Health Organizations and fee-for-service-based Family Health Groups receive bonuses for delivering preventive care, including cervical cancer screening, while those practicing in the traditional fee-for-service model do not. Financial incentives were introduced to increase Ontario’s cervical screening rate to 85%. To date, the impact of incentives for cervical screening on screening rate and cost-effectiveness have not been assessed. Patient-level data obtained from the Institute for Clinical Evaluative Sciences were used to estimate primary care model screening rates and cancer treatment costs. A microsimulation model was developed from published cervical cancer natural history models and parameterized using …

Exploring Health Care Access For Gay, Bisexual, And Other Men Who Have Sex With Men Living In Middlesex County, Ontario, Todd A. Coleman

Electronic Thesis and Dissertation Repository

Published research suggests gay, bisexual, and other men who have sex with men (GB-MSM) present in health care with additional, distinct psychosocial and sexual health concerns compared to heterosexual men, emphasizing the importance of access to health care for these groups.

This exploratory thesis used data from the online survey (n=202) of the Health in Middlesex Men Matters (HiMMM) Project – a community-based study examining health care access for GB-MSM living in Middlesex County, Ontario. For each manuscript, blockwise modified Poisson regression models were fit sequentially with predisposing, enabling, and need variables, as theorized by the Behavioral Model of Health …

Access To The Local Aids Service Organization Among African, Caribbean And Other Black Residents Of Middlesex-London, Ontario, Canada, Soraya Blot

Electronic Thesis and Dissertation Repository

The migration of people from HIV-endemic countries has altered the demographics of the HIV epidemic in high-income countries. In Canada, most people from HIV-endemic countries are of African descent. While they are an established priority group for HIV-related services, they can face access difficulties. This study uses quantitative data from the Black, African and Caribbean Canadian Health Study to evaluate AIDS service organization access in Middlesex-London, Ontario, using the Andersen-Gelberg model for vulnerable populations and an overarching intersectionality framework. In bivariate analysis, older age, having a primary care provider, less inappropriate fear of contagion and less time in Canada were …

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 …

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 …

Trends In The Utilization Of Antiglaucoma Medication: An Analysis Of Canadian Drug Insurance Claims, Kwun (Bryan) Hung Chan

Electronic Thesis and Dissertation Repository

Objectives: To assess: i) utilization of generic anti-glaucoma drugs in Canada; ii) the impact of the 2010 Ontario Drug System Reform on generic anti-glaucoma drug usage in Ontario.

Methods: Monthly drug insurance cost and claims from January 2001 to January 2013 were used as proxies for drug utilization. Evaluation of the impact of the 2010 reform was conducted using interrupted time series analysis with ARIMA models.

Results: Generic antiglaucoma medication utilization increased in Ontario during Quarter 3, 2006. Increases in utilization across study provinces were observed in Quarter 4, 2011. The 2010 reform was not associated with …

Children At-Risk For Hearing Impairment: A Retrospective Study Of The Ontario Infant Hearing Program Population, Katherine M. Smith

Electronic Thesis and Dissertation Repository

There is widespread agreement that infant hearing screening programs are effective but such programs may fail to detect all hearing impairment and children can develop subsequent hearing loss after passing the initial screen. This is the core rationale for surveillance programs that are analyzed in this thesis. Infants with hearing risk factors are followed using surveillance programs that include monitoring by audiological assessment.

The study population in this thesis consists of 2,390 children with normal hearing and 248 children with hearing impairment from different referral routes. The Infant Hearing Program Surveillance group is 1.48% of the number of hearing-impaired children. …

Re-Cognizing Power In The Culture Of Dementia Care Knowledge, Ryan T. Deforge

Electronic Thesis and Dissertation Repository

In light of increasing system demands, system regulations, and constrained resources, those living and working with dementia in the long-term care sector are vulnerable to oppressive care practices. This is true so long as our understanding of how social power affects the ways in which dementia care knowledge is created, shared, and enacted remains limited. Based on prolonged field observations and on informal and formal interviews with care recipients, family members, and staff, the aim of this critical qualitative research was to examine the culture of dementia care knowledge in two sites: a specialized dementia care unit in a long-term …

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% …

Understanding First Nations Young Adults' Health Literacy, Ebony Rempel

Electronic Thesis and Dissertation Repository

Relative to non-First Nations, Inuit, and Metis (FNIM) Canadians, FNIM people have poorer health status. A qualitative investigation of the health literacy skill and the health information (HI) needs of young FNIM adults was conducted. Eight single mothers living on-reserve were interviewed. Data analysis generated four main themes along with the subthemes of: (1) Traditional Health (TH), (i) TH Culture Excised, and (ii) Wanting to Know More about TH; (2) HI Needs of First Nations young Mothers; (3) Access to HI, (i) Asking the Doctor / Telehealth (ii) other Female Family and Friends; (4) Online Accessibility, (i) HI Online, (ii) …

Family Physician Access Among Trans People In Ontario: A Cross-Sectional Analysis Of Social Determinants Of Health And Inequality Issues., Xuchen Zong

Electronic Thesis and Dissertation Repository

For trans Ontarians with access to publicly insured health care, this study aimed to determine predictors of not having a family physician, as well as to identify factors that influence a trans patient’s comfort discussing trans status or trans-related health needs with their physician. Previously collected demographic and family physician access related data (n=433) were used. Multiple logistic predictive model showed that age, marital status, education, employment, income-to-needs ratio, and social support independently predicted not having a family physician. Marital status, negative trans-specific experience with family physicians, and perception of family physician's knowledge about trans health needs were identified as …

The Cost-Effectiveness Of Combination Treatment Consisting Of Either Cetuximab Or Panitumumab Plus Folfiri Versus Treatment With Bevacizumab Plus Folfiri As First-Line Treatment For Kras Wild-Type Metastatic Colorectal Cancer Patients In Ontario, Emmanuel M.G. Ewara

Electronic Thesis and Dissertation Repository

I conducted a cost-effectiveness analysis of combination cetuximbab or panitumumab plus FOLFIRI as first-line treatment for patients with metastatic colorectal cancer (MCRC) from the perspective of the Ontario healthcare payer. I developed a Markov decision analytical model to simulate the lifetime costs and benefits of each treatment option. The model was parameterized using data collected from administrative databases in the province of Ontario and from published clinical trials. In the base case scenario, treatment consisting of bevacizumab plus FOLFIRI was found to dominate other treatment options. The ICER values were found to be sensitive to the efficacy of first-line treatment, …

Obesity And Health Care Utilization Trends In Canada During The Period 1996-7 To 2009-10, Michael Lebenbaum

Electronic Thesis and Dissertation Repository

In Canada, there have been large improvements in the management of chronic diseases attributed to obesity such as diabetes, hypertension and high cholesterol since the 1990s. How this trend has impacted the health care utilization patterns of obese individuals relative to normal weight individuals is unknown in Canada. This study examined health care utilization across categories of body mass index in Canada during the time period 1996 to 2010 using the 1996-7 National Population Health Survey and the 2000-1 and 2009-10 Canadian Community Health Surveys. I found that there were significant declines in the intensity of utilization of general practitioner/family …

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 …

Functional Recovery And Caregiver Support Of Stroke Patients Admitted For Rehabilitation In Singapore Community Hospitals (1996 To 2005), Gerald Koh

Electronic Thesis and Dissertation Repository

Post-acute rehabilitation is the active process where disabled persons realize their optimal recovery potential through therapy after discharge from acute hospital admissions. Community hospitals which are mainly run by family physicians in Singapore provide post-acute rehabilitation, and are similar to US inpatient rehabilitation facilities and Canada’s specialty rehabilitation facilities. This thesis is based on a national dataset of all admissions into community hospitals in Singapore from 1996 to 2005 (ten years) manually extracted from medical records of four sites by the PhD candidate. Four chapters are presented: (1) a systematic review of the rehabilitation indices from published studies and their …

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 …

Preliminary Economic Evaluation Of Brentuximab Vedotin In Relapsed And Refractory Hodgkin Lymphoma: An "Early Look" Model Based On Phase Ii Results, Vusal Babashov

Electronic Thesis and Dissertation Repository

We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin Lymphoma (HL) from health care system perspective in Canada. We developed a Markov decision analytical model to simulate lifetime costs and benefits and parameterized the model using brentuximab phase II clinical trial and cd-link data which is a linked datasets of cancer registry with administrative databases of Ontario, Canada. In the base case scenario, brentuximab treatment led to an increase of 0.352 Quality Adjusted Life Years (QALYs) per person and $108,500 per person, which resulted in incremental cost effectiveness ratio (ICER) of $308,532 per …

Being An Austrian Mother With Rheumatoid Arthritis: An Institutional Ethnography About The Social Organization Of Everyday Life, Birgit Prodinger

Electronic Thesis and Dissertation Repository

This institutional ethnography research explored how women with rheumatoid arthritis, who are mothers, and of employable age, go about their daily lives given their social context. The social context for this research was Austria, which is characterized by social policies based on familialism and an emphasis on employment. This context may open up various resources and possibilities about what women can do and actually do in their daily lives, and thus, directs attention to the situated nature of human occupation.

In institutional ethnography particular attention is given to the social, which suggests that daily life becomes accomplished through coordinated activities …

The Characteristics Of Successful Evidence Retrieval By Nephrologists And The Impact Of Pubmed Search Filters, Salimah Shariff

Electronic Thesis and Dissertation Repository

Background: Clinicians frequently search PubMed to guide patient care. This study investigated the factors that impact successful searching and the utility of PubMed search filters.

Methods: A random sample of nephrologists was surveyed between 2008 and 2010; 160 valid responses were received (72% response rate). One group of 60 respondents was presented with the same two clinical questions, while the other 100 were each presented with a unique clinical question. The clinical questions were based on recently published systematic reviews. Respondents provided the search terms they would type into PubMed to address their clinical question(s). All physician-provided searches …