Public Health Commons^™

Examining Public Health Risk Communication Via Social Media By Provincial And Local Health Authorities In Ontario During The Covid-19 Pandemic, Marc Resendes

Electronic Thesis and Dissertation Repository

Risk communication campaigns are essential during public health crises to inform the public about ways to mitigate, alleviate and manage potential risks. The purpose of this study was to describe risk communication on social media by Ontarian health authorities amid COVID-19, in addition to examining the strategies that guided their social media use. This was completed through (a) a narrative review of risk communication literature; (b) a qualitative content analysis of select health authority Twitter messaging following three major COVID-19 milestones; and (c) key informant interviews with those coordinating social media responses to COVID-19. Information giving and news updates were …

Community Health Workers And Trainers Perspectives On Education And Practice: A Qualitative Case Study In The Context Of Maternal And Child Health In Rwanda, Damilola Toki

Electronic Thesis and Dissertation Repository

Achieving global health-care goals hinges on a health workforce that is available, competent, and productive. Chronic health worker shortages impede the abilities of health systems to provide equitable services, especially in low-resource settings.

Global consensus on bridging health workforce gaps calls for alternatives such as using community health workers (CHWs) to achieve health-care aims. CHWs are laypeople who are closely connected with communities and provide frontline health services. Although CHWs are an integral part of workforces in many countries, with potential to inform global health systems, CHW programs continue to operate on the fringe and are fraught with challenges.

This …

Health Care Utilization By Immigrants With Multimorbidity: A Population Based Cross-Sectional Study Of The 2015-2016 Canadian Community Health Survey (Cchs), Chinmoy Talukder

Electronic Thesis and Dissertation Repository

Immigrants face unique healthcare barriers, which can negatively impact their health and health service use. Those with multimorbidity face a particular challenge as multimorbidity is associated with increased need for healthcare. The purpose of this study was to compare healthcare utilization, as measured by number of visits to family physicians and specialists, between immigrants and Canadian-born populations with multimorbidity, stratified by sex and for specific chronic diseases. A cross-sectional analysis using 2015-2016 Canadian Community Health Survey (CCHS) was conducted. After adjusting for relevant covariates, no statistically significant differences in visits to family physicians or specialists were observed between immigrants and …

The Impact Of Interruptions In Gender-Affirming Medical Care During Covid-19 On Anxiety And Depression Among Trans And Non-Binary People In Canada: A Longitudinal Study, Sara Todorovic

Electronic Thesis and Dissertation Repository

Background. Transgender and non-binary (TGNB) populations experience disproportionally high levels of anxiety and depression; it is imperative we investigate how the COVID-19 pandemic may have impacted the mental health of TGNB communities. Methods. Among a Canadian sample of TGNB persons aged >=15 years, we used multiple linear regression to examine whether interruptions in gender-affirming care were associated with anxiety and depression, and whether that effect was modified by pre-pandemic mental health. Results. Anxiety and depression levels were high both pre-pandemic and during the pandemic. Approximately a quarter of TGNB persons experienced interruptions in hormonal care. After adjusting for confounders, there …

The Role And Importance Of Social Support During Recovery Following Distal Radius Fracture, Ogheneruona Mi Idoghor Ikpen

Electronic Thesis and Dissertation Repository

This thesis explored how social support changes with time and differs across genders within 1-year post distal radius fracture (DRF). It also examines the effect of social support on the patient-rated wrist evaluation (PRWE) score and health-related quality of life (HRQoL) of DRF patients at 3 months post-fracture. In this cohort study, patient-reported social support (emotional/informational, tangible, affectionate and positive social interaction) was measured using the Medical Outcomes Study (MOS) social support survey, and HRQoL was measured using the 36-Item Short-Form Survey (SF-36). Social support significantly decreased at 3 months in comparison to baseline, 6 months and 1 year (with …

An Epidemic Amidst A Pandemic: A Critical Policy Analysis Of Supervised Consumption Sites, Vanisa Ezukuse

Electronic Thesis and Dissertation Repository

This study's primary purpose is to critically appraise current federal and provincial policies regarding supervised consumption sites (SCS), noting intended and unintended consequences; and how these policies could impact SCS users. This study's secondary goal is to compare current policies related to SCS in Alberta, British Columbia, Ontario, and Quebec to provide critical insight and suggestions for ongoing policy development. Carol Bacchi’s (2009) “What is the Problem Represented to Be?” framework was applied to the Canadian policy document with a focus on SCS. Four themes are proposed: Public Health versus Criminality, Presumptions versus Assumptions, Policy Unaccountability, and Policy Duality. It …

Exploring Experiences Of Parents Of A Child With Medical Complexity: A Case Study Approach, Vanessa Rocchese

Electronic Thesis and Dissertation Repository

Parents of children with medical complexity (CMC) have the unique experience of also being their child’s health care provider (HCP). This cross-sectional, qualitative single-case study sought to 1) examine experiences of parental caregivers of CMC whilst navigating healthcare and social systems; and 2) examine influences of urban/rural settings on parental caregiver experiences. An online demographic survey and semi-structured telephone interviews were utilized with two families, one urban (n=1) and one rural (n=2). A thematic analysis was undertaken using both intersectionality and the Conceptual Model of Health-Related Quality of Life-(HRQoL) as frameworks to explore findings. This study revealed that challenges in …

Quantifying Timely Access To Surgery: A Global Modelling Study, Joo-Hyun Jeong

Electronic Thesis and Dissertation Repository

The Lancet Commission on Global Surgery proposed six core indicators to track access to safe, timely, and affordable surgery. We identified published data for countries reporting Indicator 1 (Access to timely essential surgery), defined as a country’s proportion of population living within two hours from the nearest surgery-capable facility, and conducted geospatial analyses to estimate this metric in other countries. In the primary analysis using this data, linear regression models were run to project this indicator for all countries globally according to their Human Development Index; followed by secondary analyses using broader definitions for surgical access, then by sensitivity analyses …

The Impact Of A Dedicated Pediatric Ambulance On Interfacility Transport Dispatch Times: Findings From The Canadian Pediatric Transport Network Database, Tiffany Liu

Electronic Thesis and Dissertation Repository

Introduction: This retrospective cohort study evaluates the impact of a dedicated ambulance on dispatch times of pediatric transports to the London Health Sciences Centre using the Canadian Pediatric Transport Network (CPTN) database.

Methods: After assessing the data quality of the CPTN database, we used multiple linear regressions to examine differences in dispatch times before and after June 2019, when a dedicated ambulance was introduced.

Results: We found that additional measures are needed to improve data quality in the CPTN database. A dedicated ambulance improved ambulance return times but not dispatch times.

Conclusion: Ongoing quality assessment is necessary to improve the …

Residential Greenness And Substance Use, Evan R. Wiley

Electronic Thesis and Dissertation Repository

INTRODUCTION: Research has identified positive associations between green space and health and green space and mental health. Substance use outcomes, however, have received considerably less attention.

OBJECTIVE: The purpose of this study was to investigate associations between residential greenness and patterns of substance use among transitional aged youth (age 15-25) in Canada.

METHODS: This study utilized three waves (2016-2018) of the Canadian Community Health Survey (CCHS) as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multivariable regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 …

Increasing Access To Essential Surgery In Resource Restricted Settings: An Economic Analysis, Anne Zhao

Electronic Thesis and Dissertation Repository

Globally, 5 billion people lack access to safe, timely, and affordable surgical, obstetric, and anaesthetic care. Increasing access to surgery saves lives, promotes economic growth, and drives equitable global development. Essential surgery includes caesarean section, laparotomy, and open fracture treatment, otherwise known as the Bellwether procedures. Thesis objectives included conducting a systematic review examining cost-effectiveness of undergoing or increasing access to Bellwether procedures in resource restricted settings and performing an economic evaluation of increasing access to caesarean section for obstructed labour compared to existing care in the South African Development Community region. Our systematic review found that Bellwether procedures were …

The Contribution Of Memorial University Medical Graduates To The Family Physician Workforce In Newfoundland And Labrador, Emily M. Volpe

Electronic Thesis and Dissertation Repository

Recruiting and retaining family physicians (FP) in rural communities has been an ongoing issue in Canada and other developed nations. The objective of this thesis was to analyze the long-term contribution that Memorial University medical graduate FP make to the physician workforce in Newfoundland and Labrador (NL). We found that 47% of our sample ever worked in NL, 15% ever worked in rural NL and 58% who ever worked in NL stayed for at least 10 years. Being from NL was a predictor of working in NL for at least 5 years and 10 years, respectively. Doing at least some …

Social Media Use, Social Connectedness, And Physical Distancing Among University Students During The Covid-19 Pandemic, Olivia Holmes

Electronic Thesis and Dissertation Repository

The overall purpose of this cross-sectional, survey-based study was to examine university students’ social media use, perceptions of in-person and online social connectedness, and feelings about physical distancing during the early phases of the COVID-19 pandemic in Ontario, Canada. University students’ (N = 1,588; M_age = 22.4, SD = 5.1; 80.6% female) survey responses revealed high levels of in-person (M_item = 4.4, SD = 0.8) and online (M_item = 3.8, SD = 0.7) connectedness. Students who reported greater perceptions of connectedness were those whose social media use: (a) had “increased greatly” since the start …

An Exploration Of Trauma-And-Violence Informed Care For Supporting Breastfeeding Practices Among Mothers Who Are At-Risk: The Experiences Of Breastfeeding Social Support, Emila Siwik

Electronic Thesis and Dissertation Repository

Mothers who are at-risk (lack breastfeeding social support, young, of low socioeconomic status, and experienced intimate partner violence) are less likely to maintain breastfeeding practices, compared to mothers who are not at-risk. This study explored at-risk mother’s experiences of participating in a trauma-and-violence informed breastfeeding intervention on perceived formal and informal breastfeeding social support, and breastfeeding practices. This cross-sectional study of nine in-depth interviews used interpretive description at 12-weeks postpartum with mothers who are at-risk. Results found formal support including emphasis on safety and trustworthiness, choice, collaboration, and connection, and skill building to support resilience enabled mothers to continue their …

Health Concerns Of Adolescents And Adults With Spina Bifida, Jessica A. Starowicz

Electronic Thesis and Dissertation Repository

The Transitional and Lifelong Care (TLC) program is a multidisciplinary clinical service providing comprehensive, coordinated care to adolescents and adults with spina bifida (SB). This study sought to identify the most common health concerns among this population at initial consultation and identify patient factors related to these concerns to ultimately improve health care delivery. A retrospective chart review was performed. Descriptive analyses were completed and associations between concerns and patient factors were determined using Spearman’s rho correlation coefficients. A multiple linear regression was performed to estimate the relationship between patient factors and total number of concerns reported. Ninety-four patient charts …

Incidence Of Cancer And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders, Jared C. Wootten

Electronic Thesis and Dissertation Repository

Evidence on cancer incidence in people with psychotic disorders, compared to the general population, is equivocal, although those with psychotic disorders so have more advanced stage of cancer at the time of diagnosis. The objective of this thesis was to compare cancer incidence and stage at diagnosis for people with psychotic disorders, relative to the general population. Our systematic review did not observe a significant difference in overall cancer incidence among people diagnosed with psychotic disorders (RR = 1.08, 95% CI: 1.00 to 1.16), however people with psychotic disorders were more likely to be present with advanced stage cancer at …

Impacts Of Covid-19 Related Changes In Income On Women Experiencing Intimate Partner Violence At Home, Cara Davidson

Electronic Thesis and Dissertation Repository

Introduction: Intimate partner violence (IPV) has increased in Canada due to COVID-19 and associated public health measures. Economic status may be responsible, but this must be validated during COVID-19.

Methods: An online survey was administered to 23 Canadian women to measure their income pre and during COVID-19 and their experiences of IPV in the past 12 months. Factorial ANOVAs and MANOVAs were used to explore the relationship between income and IPV.

Results: Of women responding to both timepoints, 56.5% (n=13) indicated an increase in IPV. Analyses did not suggest that income was significantly related to IPV, apart from the effect …

The Association Between Ethnicity And Caregiver Health, Adetola Aboyeji

Electronic Thesis and Dissertation Repository

Background: Existing research shows that caregiving is associated with several adverse health outcomes. Despite the growing number of caregivers in Canada, little research has been conducted on caregivers' potential unique experiences and outcomes based on their ethnicity. The main objective of this study was to investigate whether ethnicity was associated with a caregiver’s health.

Methods: To address these research gaps, we used data from the 2012 Canadian General Social Survey (GSS) Caregiving and Care Receiving. Focusing on caregivers (n=9,552), we examined the association using three measures of health – self-reported overall health, self-reported mental health, and the Health Utility Index3 …

Descriptive Analysis Of Fall-Related Injuries Among Older Adults In Ontario, Nicolette Lappan

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. The purpose of this study was to describe the characteristics of older adults who experienced fall-related injuries (FRIs) and the types of falls that caused them. We analyzed Ontario-wide secondary data from three databases (NACRS, DAD, RPDB) covering 2010-2014. Older adults (≥ 65 years) who visited emergency departments (ED) with FRIs were selected using ICD-10-CA codes for a fall and injury. Counts, measures of central tendency, and prevalence rates (crude, age- and sex-specific, age-standardized) were calculated. There were 304,610 (63.0% females) ED admissions (3,089 per 100,000 population) …

Fall Risk-Increasing Drugs And Gait Performance In Community-Dwelling Older Adults: Results From The Gait And Brain Study, Abdelhady Osman

Electronic Thesis and Dissertation Repository

Medication use and gait impairment are two of the most important risk factors for falls. Several drug classes have been classified as fall risk-increasing drugs (FRIDs). Gait is an important marker of overall health and independence in older adults. The overall aim of this thesis was to examine the relationship between FRIDs and gait performance in older adults through two studies. Firstly, our systematic review of twenty studies on the association between FRIDs and gait performance found that the use of drugs with sedative properties is associated with reduced gait speed. Secondly, we conducted a cross-sectional analysis of data from …

Interplay Between Shift Work, Psychological Distress, Sleep Quality, And Cognitive Performance, Rea Therese Alonzo

Electronic Thesis and Dissertation Repository

Shift work schedules are designed to maintain a continuous operation of goods and services. However, engaging in shift work may impact cognitive functioning. This thesis assessed the relationship between shift work and cognitive performance. Using cross-sectional data from the Canadian Longitudinal Study on Aging, multiple linear regression models were used to investigate the association between shift work and cognitive performance, as well as the moderating effects of psychological distress and sleep quality. Differences by sex and retirement status were also investigated. Shift work was significantly associated with poor performance for executive functioning but not for declarative memory. Poorer cognitive performance …

The Association Of Alcohol Use And Fruit And Vegetable Consumption With Cataracts Among Adults: Results From The Longitudinal Canadian National Population Health Survey (Nphs), Yuguang Kang

Electronic Thesis and Dissertation Repository

Background: Cataracts are the leading cause of blindness globally, so advancing the understanding their etiology is of paramount importance for development of the preventive interventions. The findings for the association of alcohol intake and fruit and vegetable consumption with cataracts in previous literature were inconsistent.

Objective: The first study objective was to assess whether alcohol intake increases the risk of cataracts among adults. The second study objective was to assess whether fruit and vegetable consumption reduces the risk of cataracts among adults.

Methods: A retrospective cohort study design was used. Data were obtained from the Household, Longitudinal component of the …

The Role Of Community Paramedicine Programming In Providing Lift Assists In Southwestern Ontario, Andrew Rosa

Electronic Thesis and Dissertation Repository

Lift assist refers to calls for emergency medical services indicating that an individual has fallen, is unable to mobilize, receives no treatment on scene, and refuses transport to the hospital following paramedic response. As the aging population grows, there is a national increase in the lift assist call type, impacting paramedic services, patient health outcomes, and primary care providers. This qualitative focused ethnography study utilized semi-structured interviews with community paramedics (CPs) to describe the role of CPs in providing lift assists in Southwestern Ontario. Interview transcripts were inductively coded and analyzed to generate themes and broader categories to examine paramedic …

"Man Up": Male Survivors Of Intimate Partner Violence Through The Eyes Of Their Providers, Xavier S. Borsato

Electronic Thesis and Dissertation Repository

Intimate partner violence (IPV) is a complex phenomenon that is often understood with women as the primary recipients of violence and men as the primary perpetrators. However, emerging literature on heterosexual relationships suggests that men also experience interpersonal violence, most often from their female partners. Drawing on research data gathered through semi-structured interviews with service providers (n = 4), this qualitative inquiry explores how gender, power, and the stigma associated with interpersonal violence impact men who have experienced abuse through the perspectives of the service providers who work with them. The findings from this study highlight how traditional constructions …

Analysis Of Health Care Costs Over A One-Year Period Following Anticoagulant Therapy Among Ontario Patients Diagnosed With Atrial Fibrillation, Michael Situ

Electronic Thesis and Dissertation Repository

Atrial fibrillation patients are at high risk of ischemic strokes, which can be drastically reduced using oral anticoagulants (OACs). Warfarin has been the standard OAC for this population but its effectiveness rests on consistent monitoring with the potential for severe bleeding events. Newer OACs, like rivaroxaban and apixaban, address these drawbacks but have a comparatively higher upfront cost. Uncertainty remains over which OAC is cost-saving from a health care system perspective. Using a retrospective cohort study design and inverse probability weighting regression adjustment estimators, one-year health care costs among patients treated with warfarin, rivaroxaban, and apixaban were compared. Compared to …

Characterizing Risk Factors Associated With The Recurrence Of Infective Endocarditis And Mortality Among People Who Inject Drugs, Janica A. Adams

Electronic Thesis and Dissertation Repository

Background. The incidence of infective endocarditis is progressively rising among people who inject drugs.

Methods. A retrospective cohort study was conducted using data from electronic medical records to characterize important predictors that contribute to the recurrence of infective endocarditis and evaluate the associations of survival time and predictors of interest in the presence of competing risks among people who inject drugs. Multivariate logistic and survival regression analyses were carried out to identify factors associated with infective endocarditis recurrence and death.

Results. We identified a significant association between PICC line misuse and infective endocarditis recurrence (OR=2.62, P=0.005). In addition, survival …

Correlates Of Positive Mental Health Among Migrants In Canada, Branka Vujcic

Electronic Thesis and Dissertation Repository

Introduction: Positive mental health is of increasing interest as a public health measure, and is understudied among migrants.

Objective: The purpose of this project was to examine positive mental health and associated factors among migrants in Canada.

Methods: We used the Canadian Community Health Survey (CCHS) 2011-2012 cycles. A total of 28,051 respondents identified as migrants, which accounted for 23.2% of the entire sample. Using multivariable regression models, positive mental health among migrants was compared to non-migrants, and the effects of sociodemographic, lifestyle, and health-related factors were examined.

Results: The present study found that time spent in Canada since migration …

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 …

Association Between Air Pollution And Incidence Of Dementia: A Systematic Review And Meta-Analysis Of Cohort Studies, Ehsan Abolhasani

Electronic Thesis and Dissertation Repository

Objective. To estimate the risk of dementia in association with exposure to air pollutants.

Methods. Six databases were searched. Cohort studies that reported the hazard ratio (HR) of dementia in association with exposure to air pollutants in adults > 40y were included. For all meta-analyses, the random-effects model was used.

Results. A total of 16 and 13 studies were included in the systematic review and the meta-analysis, respectively. Risk of dementia increased by 4% per 1μg/m³ increase in fine particulate matter level (HR, 1.04; 95%CI, [1.02, 1.06]), which was statistically significant. The risk of dementia increased by 3% per 10μg/m …

The Experiences Of Iraqi Refugees In Canada: A Life History Study Of War And Resilience In The Aftermath Of Migration, Nada Nessan

Electronic Thesis and Dissertation Repository

This thesis reports on a life history narrative on the experiences of Iraqi refugees who resettled in Canada after living through war. The aim of this study is to help change the narrow perspectives on the mental health of war affected populations to a broader perception shaped by cultural and social aspects and to inform the development of meaningful and cultural relevant programs and policies with a particular attention to the concept of resilience.

The first part of the study presents the chronological narratives, or profiles. of eight participants. The second part of the study is a thematic discussion of …