Public Health Commons^™

Exploring The Mental Health Experiences Of African, Caribbean, And Black Youth In London, Ontario, Lily Yosieph

Electronic Thesis and Dissertation Repository

This qualitative study explores the mental health experiences of African, Caribbean, and Black (ACB) youth in London, Ontario, investigating how the factors of race, gender, culture, and place have shaped their perceptions and experiences of mental health. The data collection and analysis were conducted using a phenomenological approach and a critical lens informed by feminist, intersectionality, and critical race theories. These data illuminate the ways in which these young people’s attitudes toward mental health and help-seeking strategies are impacted by broader social constructs and community expectations, which they navigate and often resist in their everyday lives. Their insights can provide …

Impact Of Covid-19 On The Italian And American Healthcare Systems : A Comparative Assessment, Bita Pejam, Jennifer Lam

All Reports

This report aims to examine and assess the impact of the COVID-19 global pandemic on the healthcare systems of the United States of America and Italy; two of the most heavily affected nations. Using data from December 2019 to January 2021, several consultations, and policy reviews, we identify risks and notable areas of issue in each nations’ approach to combating the virus. We focus our report particularly on the health policies and the governmental structures in place that contributed to each nations’ initial method of alleviating the impact of COVID-19. Our report compares the two healthcare systems and proposes a …

Experiential Learning Final Report: Western Heads East X Mikono Yetu And Crhesi, Rebecca Jackson

SASAH 4th Year Capstone and Other Projects: Publications

Over the summer of 2020, I completed an internship with Western Heads East (WHE), a collaboration between Western University and African Partners. During this internship, I worked alongside two of my peers to design a website for the non-governmental organization “Mikono Yetu” to showcase the important work they are doing surrounding female empowerment and economic independence. During the Fall term of my final year at Western, I completed a placement with The Centre for Research on Health Equity and Social Inclusion (CRHESI). For this placement, I created an infographic that outlined the barriers migrant agricultural workers currently face to accessing …

Health Systems And Health Care Management Panel, Nitin Mohan

Africa-Western Collaborations Day 2020

8 graduate student/recent graduate presentations on varying topics of health systems and health care management. Moderated by Dr. Nitin Mohan. Reporting of panel done by current GHS students of the 2021 class. Abstracts can be found under "Africa-Western Collaborations Day 2020 Abstracts". Presenters as follows:

Gojjam Limenih, "What Are We Doing? Is Exporting Anti-Depressants the Answer to the Mental Health Needs of the Global South?"

Jean Pierre Ndayisenga et al., "Rwandan Nursing and Midwifery Faculty's Experiences of Applying Knowledge about Teaching Methodology to Practice in Academic and Clinical Settings with Students"

Mary Ndu, "A Literature Review of Barriers to Scaling …

Understanding The Determinants Of The Cost Of Coronary Artery Bypass Graft Surgery, Hun Lee

Electronic Thesis and Dissertation Repository

Introduction: The relationship between patient demographics, clinical factors, and cost of coronary artery bypass graft (CABG) is complex. Investigation of these relationships is important to aid clinical practice and inform reimbursement models. This thesis analyzes multiple different domains in order to understand the significant factors that impact the cost of CABG at the London Health Sciences Centre (LHSC).

Methods: Model selection, construction of nested descriptive models, exploration of mediation analysis of the impact of peri-operative factors and cost through length of stay, and construction of estimative models were performed.

Results: Several baseline characteristics, socio-demographics, peri-operative variables, and post-operative variables were …

Cost-Effectiveness Analysis Of Pharmacogenomics (Pgx) Based Warfarin, Apixaban And Rivaroxaban Compared To Standard Warfarin For Atrial Fibrillation Patients In Canada, Aneeka Hafeez

Electronic Thesis and Dissertation Repository

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based warfarin, apixaban and rivaroxaban compared to standard warfarin therapy for atrial fibrillation (AF) patients in Canada. A decision-analytic Markov model was developed to compare lifetime costs and quality-adjusted life years (QALYs) from the public healthcare payer perspective. The parameters applied in the model were derived from published literature and some costs from the IC/ES databases. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard warfarin, PGx-based warfarin care had an ICER of 17,727/QALY and apixaban had an ICER of $64,853/QALY gained. Apixaban dominated rivaroxaban. The probabilistic sensitivity …

Evaluating The Implementation Of A Chronic Obstructive Pulmonary Disease Management Program Using The Consolidated Framework For Implementation Research: A Case Study, Stefan Paciocco

Electronic Thesis and Dissertation Repository

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage. Interprofessional teams are effective at providing chronic disease management and care that meets the needs of patients. As part of an ongoing spread, an interprofessional primary care COPD management program was implemented at a family health team in Ontario. A qualitative case study was performed to determine the supporting or hindering factors to the implementation of the program. Data collected was deductively analyzed using the Consolidated Framework for Implementation Research. Eleven constructs were determined to meaningfully affect implementation. Cosmopolitanism, networks and communication, engaging, design …

Visual Analytics Of Electronic Health Records With A Focus On Acute Kidney Injury, Sheikh S. Abdullah

Electronic Thesis and Dissertation Repository

The increasing use of electronic platforms in healthcare has resulted in the generation of unprecedented amounts of data in recent years. The amount of data available to clinical researchers, physicians, and healthcare administrators continues to grow, which creates an untapped resource with the ability to improve the healthcare system drastically. Despite the enthusiasm for adopting electronic health records (EHRs), some recent studies have shown that EHR-based systems hardly improve the ability of healthcare providers to make better decisions. One reason for this inefficacy is that these systems do not allow for human-data interaction in a manner that fits and supports …

Analysis Of Billings Data To Evaluate Patterns Of Mental Health Services In Primary Care And Emergency Departments By Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada, Thy H. Vu

Electronic Thesis and Dissertation Repository

Treating mental illness in primary care improves access to care, but it is unclear how to encourage family physicians to provide adequate mental health services. One approach may be changing how they are remunerated. The objectives of this thesis were to: 1) review the literature on the association between physician remuneration and provision of mental health services, and 2) assess the impact of blended capitation, compared to blended fee-for-service (FFS), on mental health services provision in Ontario. The review found that capitation appears to be associated with fewer services compared to FFS; however, studies of ED visits for mental health …

Diversification Of Research Methodological Approach During Model Enhancements In Health Information System Research, Uche Ikenyei

Africa Western Collaborations Day 2020 Abstracts

No abstract provided.

Epilepsy Risk Among Survivors Of Intensive Care Unit Hospitalization For Sepsis, Tresah C. Antaya, Britney N. Allen, Lucie Richard, Salimah Z. Shariff, Gustavo Saposnik, Jorge Burneo

Neuroepidemiology Research Unit Project Summaries

Research Summary: Key Findings

• 407 (0.28%) patients developed epilepsy within 2 years of their ICU discharge, 103 (25.3%) of whom were exposed to sepsis.
• Sepsis survivors were significantly more likely to develop epilepsy, relative to non-septic ICU survivors.
• Among sepsis survivors, epilepsy risk increased with age and was higher among those with chronic kidney disease.

Is Sabr Cost-Effective In Oligometastatic Cancer? An Economic Analysis Of Sabr-Comet Randomized Trial, Yujie Chen

Electronic Thesis and Dissertation Repository

The phase II randomized study SABR-COMET demonstrated that in cancer patients with 1-5 oligometastatic lesions, stereotactic ablative radiotherapy (SABR) was associated with an improvement in both progression-free survival and overall survival compared to standard of care (SoC). SABR, however, is associated with higher costs and treatment-related toxicity. The objective of this study was to assess the cost-effectiveness of SABR versus SoC in patients with oligometastatic disease.

A time-dependent Markov model with five health states was constructed from the Canadian health care system perspective. Utility values and transition probabilities were derived from the SABR-COMET trial. Costs were obtained from the published …

Construction Of Prediction Models For The Health Utility Index Mark 3 In Ontario And Its Application, Yue Niu

Electronic Thesis and Dissertation Repository

The government of Ontario initiated primary care reform in the early 2000s, leading to a shift away from the traditional fee-for-service (FFS) physician remuneration to incentive-based blended remuneration models. Research on the association between change in physician remuneration and patients' health status is unknown. The objectives of this thesis are to (i) construct a statistical model to predict the Health Utility Index 3 (HUI3) values for all non-institutionalized Ontario residents, and (ii) study the association between the change in physician remuneration models and patients' health status measured by HUI3. The data came from the Canadian Community Health Survey (CCHS) 2000-2001 …

Exploring Healthcare Consumer Involvement In Clinical Practice Guideline Development, Adam Jordan

Electronic Thesis and Dissertation Repository

Involving healthcare consumers (HCCs) in clinical practice guideline (CPG) development can lead to identification of topics that guidelines should consider. To evaluate the strategies being used to involve HCCs in CPG development, a description of these strategies is needed. This study utilized qualitative description to analyze CPGs and related documents. Professionals involved in CPG development were also interviewed. Patients, family members, and informal caregivers have been involved in the formulation of recommendations, CPG reviewing and editing, and through use of patient resources. According to the results, involving HCCs is done to incorporate patient preferences and values into CPGs, and to …

Uptake Of Colorectal Cancer Screening Tests By Ontario Physicians., Owen Litwin

Electronic Thesis and Dissertation Repository

This population-based study used administrative healthcare data to examine the uptake of tests recommended for colorectal cancer screening by eligible Ontario physicians and non-physicians, and to examine if testing of primary care physicians is associated with greater testing in their patients. Physicians (n=11,434) were matched 1:4 to non-physicians (n=45,736) on age, sex, and geographic location as of April 21, 2016. Uptake of colorectal tests was similar in physicians (67.9%, 95% CI, 67.0–68.7%) and non-physicians (66.6%, 95% CI, 66.2–67.1%). Physicians were more likely than non-physicians to undergo colonoscopy and less likely to undergo fecal occult blood testing. Uptake of colorectal tests …

Working With Youth As Stakeholders In Mental Health System Transformation: An Institutional Ethnography Of A Service Organization In Access Open Minds, Eugenia Canas

Electronic Thesis and Dissertation Repository

As national system- and research-agendas invest heavily in the improvement of youth mental health services delivery, the discursive and policy impetus for the inclusion of youth as advisors has increased. However, we know little about the work of youth engagement (YE) in the everyday realities of a care-delivery organization. Does the engagement of youth advisors ultimately inform care?

This dissertation addresses the knowledge concerns of YE with a detailed account of the experiences of youth advisors, service providers, and an organization in the process of services reform. I used institutional ethnography to (1) reveal the day-to-day work of engaging young …

Measuring Quality Of Life In Patients With Rotator Cuff Disorders, Rochelle Furtado

Electronic Thesis and Dissertation Repository

Rotator cuff disorders (RCDs) are a common musculoskeletal problem with a higher prevalence in women and after the age of 60. Due to the increasing need for patient-centered care, researchers have been directed towards the use of patient reported outcomes (PROs) to evaluate the progress of patient recovery, as the experience varies across individuals.

Recently, the Western Ontario Rotator Cuff Index was reduced in items to create the shortened version of the Western Ontario Rotator Cuff Index (Short-WORC). However, the Short-WORC’s psychometrics have yet to be evaluated. Therefore, this mixed-methods thesis aimed to evaluate the psychometric properties of the Short-WORC …

The Impact Of The Diabetes Management Incentive On Diabetes-Related Services, Hospitalizations, And Mortality Risk In Ontario, Thaksha Thavam

Electronic Thesis and Dissertation Repository

Effective diabetes management provided in primary care has the potential to reduce hospitalizations and mortality. To improve diabetes management, a Diabetes Management Incentive (DMI) was introduced by the Ontario government for family physicians practicing in patient enrolment models. This thesis has three main objectives: 1) review the literature on the association between financial incentives for diabetes care and diabetes-related hospitalizations and mortality; 2) and 3) examine the impact of DMI on: diabetes-related services, diabetes-related hospitalizations, diabetes-related hospitalization costs, and mortality risk in Ontario. A review of the literature on the incentives revealed inconsistent findings. The impact of DMI was assessed …

The Risk Of New-Onset Epilepsy And Refractory Epilepsy In Older Adult Stroke Survivors, Jorge G. Burneo, Tresah C. Antaya, Britney N. Allen, Andrea Belisle, Salimah Z. Shariff, Gustavo Saposnik

Neuroepidemiology Research Unit Project Summaries

Research Summary: Key Findings

• Stroke is a common cause of epilepsy in older adults, but little is known about stroke-related epilepsy or its outcomes in this population.
• 1.1% of older adult stroke survivors developed epilepsy in this study, of whom 12.9% developed refractory epilepsy, indicating that this population is particularly responsive to treatment.
• Over 85% of deaths in this population are not due to stroke or epilepsy.

The Work Of Self-Managing Attendant Services: A Reflexive Ethnographic Study, Erika Katzman

Electronic Thesis and Dissertation Repository

In self-managed attendant services, disabled people organize and manage their own personal support services. ‘Self-managers’ take responsibility to recruit, hire, train and manage ‘attendants’ in order to have greater autonomy in attendant services, and in everyday life. Where the tasks associated with self-managing attendant services are often represented as responsibilities, this research begins with the assumption that these activities constitute work. Following critical disability studies and critical feminist scholarship, work is defined broadly as efforts made to organize and manage attendant services within self-managed models. The research presented adopts a reflexive ethnographic methodological approach to explore multiple perspectives on the …

Wait Times, Resource Use And Patient-Reported Outcomes For Patients Referred For Total Knee Replacement Surgery, Kate Lebedeva

Electronic Thesis and Dissertation Repository

This prospective cohort study evaluated the usual care pathway for patients referred to total knee arthroplasty (TKA). We measured healthcare resource use, costs and health-related quality of life (HRQoL) over the continuum of care. We also determined the proportion of inappropriate referrals and estimated wait times for initial surgical consultation and TKA. We found that two in five patients referred to specialty care were deemed inappropriate surgical candidates. Prior to referral, few conservative treatment options were tried, and many imaging tests ordered by referring providers were unjustified. Overall, the greatest proportion of costs were borne by the patient or private …

Exploring Unmet Healthcare Needs, Healthcare Access, And The Use Of Complementary And Alternative Medicine By Chronic Pain Sufferers- An Analysis Of The National Population Health Survey, Jessica Lachance

Electronic Thesis and Dissertation Repository

Background: Chronic pain is a condition nurses encounter in their practice often; estimated to affect 1 in 5 Canadian adults, resulting in significant disability, a deleterious impact on health and quality of life, and a large financial and operational burden on the health care system. It is a complex and multifactorial phenomenon that despite research efforts remains poorly understood. Consequently, the focus of chronic pain treatment targets the managementof pain to improve quality of life and reduce suffering as much as possible, rather than a curative approach. Chronic pain has been recognized as one of the most pervasive and …

Quality Of Antenatal Care And Its Relationship With Women’S Intended Use Of Their Anc Facility For Delivery: A National Cross-Sectional Study In Kenya, Jisoo Kim

Electronic Thesis and Dissertation Repository

Maternal deaths have been one of the leading causes of deaths in sub-Saharan Africa. Delivering at an institution can prevent the majority of maternal deaths in developing countries. A national cross-sectional survey of Kenya was used to determine if the quality of antenatal care (ANC) provided to women is associated with their intention to deliver at the same facility. Multilevel mixed-effects logistic regression was used to examine this relationship. Quality of ANC variables assessed in this study were not significantly associated with women’s intention to deliver at the same facility. Mothers preferred to deliver at hospitals, rather than clinics/dispensaries. ANC …

Investigating The Health Meanings Of Young Saudi Women, Tagreed Alnajjar

Electronic Thesis and Dissertation Repository

Women’s structural position within society and their family roles significantly influence their health. Previous studies have shown women hold lower health and socioeconomic status because of their gender within the Saudi culture. This study aimed to provide an understanding of how Saudi women value health and define being healthy within their social contexts. Adopting an ethnographic perspective, three focus groups (31 participants in total) were conducted with volunteer undergraduate Saudi female students on campus during a nine-week field trip to the participants’ university, King Abdulaziz University in Jeddah, Saudi Arabia. Three themes were generated from this study that characterize the …

Using A Deliberative Dialogue To Facilitate The Uptake Of Research Evidence In Rehabilitation For Children With Cerebral Palsy, Alisiyah Daya

Electronic Thesis and Dissertation Repository

This study explores how to facilitate the use of research evidence to optimize outcomes for children with cerebral palsy (CP) in practice. Findings from two studies were used as the basis for exploring how to comprehensively assess developmental trajectories of children with CP and plan individualized interventions. Seventeen affiliated stakeholders (e.g. physicians, senior leadership, frontline clinicians, families and youth with CP) participated in this study.

Data from a deliberative dialogue and interviews were analyzed using grounded theory methods with a pragmatic perspective. The results highlighted that all areas of practice must engage in knowledge translation to be effective. Stakeholders outlined …

Determining The Detective Quantum Efficiency (Dqe) Of X-Ray Detectors In Clinical Environments, Terenz R. Escartin

Electronic Thesis and Dissertation Repository

According to Health Canada, dental and medical radiography accounts for more than 90% of total man-made radiation dose to the general population. Ensuring patients receive the health benefits of diagnostic x-ray imaging without use of higher radiation exposures requires knowledge and understanding of the detective quantum efficiency (DQE). Currently, the DQE is not measured in clinics because it requires specialized instrumentation and specific DQE-expertise to perform an accurate analysis. In this regard, the goals of this thesis were to: 1) address the limitations of measuring the DQE in clinical environments that affects the accuracy of the measurement; 2) develop and …

Predicting Important Patient-Reported Outcomes For Glaucoma Management: Cross-Sectional Study, Lavanya Uruthiramoorthy

Electronic Thesis and Dissertation Repository

The initiative to understand patient-reported outcomes (PROs) has increased to improve glaucoma management. We sought to identify important predictors of four PROs: social support and community integration, presence of depressive symptoms, vision-related quality of life (VRQoL) and preference-based Health-Related quality of life (HRQoL). A cross-sectional study was conducted among patients in London, Ontario (n=250). Regression models, and classification and regression trees were built. Leave-one-out cross-validation assessed the models’ predictive performance. Mobility aid use, best corrected visual acuity (BCVA), income and living arrangements were predictors identified for VRQoL, and social support and community integration. Mobility aid use was also predictive of …

Bariatric Surgery Recipients' Needs For Long-Term Health And Well-Being; Perspectives Of Patients And Providers, Rebecca H. Liu

Electronic Thesis and Dissertation Repository

The overall purpose of this dissertation was to examine what is needed in bariatric surgery programming to support long-term health and well-being from the perspectives of the patient and providers. Study 1 assessed what bariatric surgery recipients perceive they need to best support their long-term health and well-being from a provincial sample (Ontario, Canada), and from an international sample. Study 2 explored the physical, psychological, social, and clinic-related experiences of individuals who underwent bariatric surgery at least two years prior. Study 3 investigated what bariatric clinic staff believe surgery recipients need to best support their long-term health and well-being.

Findings …

Maternal Healthcare Utilization Among Muslim Mothers From India, Pakistan, And Bangladesh: Is There Equity?, Rohin J. Krishnan

Electronic Thesis and Dissertation Repository

To date, literature exploring maternal healthcare utilization among Muslim populations has largely focused on religious differences. However, little research exists exploring maternal healthcare utilization within Muslim populations. This highlights a research gap because studies across religious groups may obscure important variation within Islamic women. The primary objective of this study assessed if there is equity in MHU among Muslim mothers in India, Pakistan, and Bangladesh. Multivariate logistic regression revealed inequities to be present in the three countries. Predicted probabilities revealed a narrower equity gap in MHU in Bangladesh compared to India and Pakistan. The successes of Bangladesh’s recent efforts to …

Understanding The Processes That Shape Cross Sector Service Provision In The Towards Flourishing Mental Health Promotion Strategy: A Secondary Analysis Utilizing Constructivist Grounded Theory Methodology, Shannon E. Winters

Electronic Thesis and Dissertation Repository

In Canada, many national, provincial, and regional policies indicate that working together within and across sectors in health and social care is necessary and expected but evidence to support this call is lacking. This dissertation study explored the concept of cross sector service provision (CSSP), defined as: independent, yet interconnected sectors working together to better meet the needs of service users and improve the quality and effectiveness of service provision. The intent was to advance our understanding of processes involved in shaping service provision offered by two or more sectors. The thesis contains three studies. A Scoping Review that explored …