Public Health Commons^™

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 …

Parents' Perceptions Of Activity Restrictions In Children With Epilepsy: First Two Years Post-Diagnosis, Nathan C. King

Electronic Thesis and Dissertation Repository

Children with epilepsy are less physically and socially active than their peers. The objective is to explore whether parents represent a barrier to children’s activity, by examining associations between child and family factors and parents’ perceptions of epilepsy-related activity restrictions. Data were from the Health Related Quality of Life in Children with Epilepsy Study, a longitudinal study of children 4-12 years old with new-onset epilepsy. Parents reported on activity restrictions and family factors and neurologists reported on epilepsy-related characteristics at baseline, 6, 12, and 24 months. Linear mixed models were used to model relationships among child and family factors 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 …

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 …

Evaluating The Impact Of Two Different Methods Of Diabetes Self-Management Education On Knowledge, Attitude, And Behaviours Of Patients With Type 2 Diabetes Mellitus, Laura B. Briden

Electronic Thesis and Dissertation Repository

This study compared the effectiveness of diabetes self-management education (DSME) methods by examining changes in knowledge, attitude, and behaviour (KAB) after receiving education. Participants from a convenience sample were randomized into two groups, one receiving education through conversation maps and the other through traditional group education. Participants’ knowledge and attitude changes were measured by using a repeated measures pre-test/post-test design and changes in Hb A1c were observed. Focus groups were conducted after education was received to obtain perceptions and self-reported behaviour changes. Significant knowledge and attitude score changes were observed in the conversation map group after education. When comparing the …

Social Marketing And Falls Prevention: Market Segmentation And Product Positioning, Eric C. Stemmler

Electronic Thesis and Dissertation Repository

The present study sets out to better understand how falls prevention can be marketed and positioned in order to increase participation rates in seniors. Market segmentation was used to create unique marketing mixes for individual groups of seniors. The senior market was segmented into frequent falling males and females, and non-falling males and females. Frequent fallers were defined by having experienced 2 or more falls in the past year, where non-fallers had experienced 1 or less falls. Twelve focus groups were conducted with thirty-five participants (N=35), 65 years or older. Differences were mainly found between number of falls …

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 …

Quality Indicators Of Diabetes Care: An Example Of Remote-Area Aboriginal Primary Health Care Over 10 Years, Julia V. Marley, Carmel Nelson, Vicki O'Donnell, David Atkinson

Aboriginal Policy Research Consortium International (APRCi)

To describe service characteristics of Derby Aboriginal Health Service (DAHS) and document diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes.

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 …

Kerin O’Dea: Improving The Health Of Indigenous Australians, Tony Kirby

Aboriginal Policy Research Consortium International (APRCi)

No abstract provided.

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 Influence Of The Childcare Environment On Physical Activity Among Preschool-Aged Children: A Feasibility Study, Leigh M. Vanderloo

Electronic Thesis and Dissertation Repository

This study sought to: (1) measure moderate-vigorous physical activity (PA) levels of a sample of preschoolers; (2) assess which attributes (e.g., space, equipment, policies) within centre-based childcare environments influence PA; and, (3) pilot the methodology to ensure the feasibility of undertaking a full-scale study. Thirty-one preschoolers from five childcare centres across London, Canada participated. Actical® accelerometers were worn by participants for one day during childcare hours to assess activity levels using a 15-second epoch length. The Environment and Policy Assessment and Observation instrument was used to conduct a full-day evaluation of the childcare environment. On average, participants engaged in 11.45 …

Early Child Care And Adiposity At Kindergarten Entry, Jessica D. Mackle

Electronic Thesis and Dissertation Repository

The association between pre-school child care participation and markers of adiposity at kindergarten entry was examined using parent reported previous child care exposure and directly measured body mass index (BMI) and waist circumference (WC) of kindergarten children (N=201; boys=106, girls=95). It was hypothesized that kindergarten children with previous exposure to full-time non-parent child care (FNPC; >20h/week) would have increased risk of overweight/obesity (BMI≥ 85^th percentile) and high central adiposity (WC ≥80^th percentile) compared to parent care (PC). The data suggest that there was no significant relationship between FNPC (n=112) and risk of overweight/obesity (OR=1.17, …

Exploring Pregnant Women’S Perceptions And Decision Making Of Household Chemicals: Phthalates As A Model, Justin M. Ashley

Electronic Thesis and Dissertation Repository

Recent research has identified a group of plasticizers known as phthalates as potential anti-androgens and a risk to developing male fetuses. A constructivist grounded theory study was used to understand pregnant women and obstetrical care providers’ perceptions of phthalates. Twenty-three pregnant women and twelve obstetrical care providers (Obstetricians, Family Physicians, and Midwives) from Southwestern Ontario participated in semi-structured interviews. Pregnant women and clinicians had little knowledge regarding phthalates and the potential associated risks. Women felt that knowledge of these risks would be important to prenatal counselling while clinicians required more evidence. Two separate but related models emerged from the data …

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 …

Population-Based Placental Weight Ratio Distributions And Determinants Of Placental Weight Ratios, Erin M. Macdonald

Electronic Thesis and Dissertation Repository

The placental weight ratio (PWR) is a common proxy for the balance between fetal and placental growth, and is defined as the placental weight over the birth weight. The objectives were (1a) to establish PWR distributions by gestational age for the overall population and (1b) for small, average and large for gestational age infants (SGA, AGA, LGA) and (2) to determine what pregnancy related conditions were associated with the PWR. The data were obtained using a hospital based retrospective cohort. Nonparametric quantile regression was used for the first and multinomial logistic regression for the second objective. The results show how …

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 …

An Intensive Smoking Intervention For Pregnant Aboriginal And Torres Strait Islander Women: A Randomised Controlled Trial, Sandra J. Eade, Rob W. Sanson-Fisher, Mark Wenitong, Katie Panaretto, Catherine D'Este, Conor Gilligan, Jessica Stewart

Aboriginal Policy Research Consortium International (APRCi)

Objective: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks’ gestation among pregnant Aboriginal and Torres Strait Islander women. Design: Randomised controlled trial. Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n= 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009. Intervention: A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence-based communication skills and engaging the woman’s partner and other adults in supporting the quit …

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 …

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 …

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 …

Cannabis Use In Cape York Indigenous Communities: High Prevalence, Mental Health Impacts And The Desire To Quit, India Bohanna, Alan R. Clough

Aboriginal Policy Research Consortium International (APRCi)

Anecdotal reports suggest that high rates of cannabis use and dependence are significant issues in Indigenous communities in north Queensland; however, there is little scientific evidence to support or refute this.The Cape York Cannabis Project seeks to investigate cannabis use rates, cannabis dependence and mental health impacts for the first time in three Cape York Indigenous communities.

Shift Work And Cardiovascular Events: Systematic Review And Meta-Analysis, Manav V. Vyas

Electronic Thesis and Dissertation Repository

The prevalence of shift work is increasing in the general population. There is conflicting epidemiologic evidence on the association between shift work and cardiovascular disease. We performed a systematic review and meta-analysis of observational studies that measured shift work-cardiovascular disease associations. We screened 12,350 articles and identified 35 eligible studies. The pooled risk ratios (RR) for myocardial infarction, all coronary events and ischemic stroke were 1.23 (95% confidence interval [CI] 1.15 to 1.31, I² = 0), 1.24 (95% CI 1.10 to 1.39, I² = 85%) and 1.05 (95% CI 1.01 to 1.09, I² = 0), respectively. The …

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 …

Physical Activity Among Latino Children In London, Ontario: An Assessment Of Physical Activity Levels, Sedentary Behaviours, And Physical Activity-Related Barriers And Facilitators, Gillian E. Mandich

Electronic Thesis and Dissertation Repository

The purpose of the study was to assess the physical activity (PA) levels, sedentary behaviours, and PA-related barriers and facilitators of a sample of Latino children in London, Canada. Forty boys and 34 girls (mean age = 11.4 years) completed questionnaires related to PA levels, sedentary behaviours, and PA-related barriers and facilitators, and 64 of these children wore an accelerometer for 4 consecutive days. Children spent an average of 53 minutes per day in moderate-to-vigorous PA. The average daily sedentary time for participants was 8.6 hours, and subjective measures revealed that participants spent 3.8 hours per day in front of …

Does Access To A Family Physician Matter For Adolescents?, Bridget L. Ryan, Moira Stewart, M. Karen Campbell, John Koval, Amardeep Thind

RDC@Western Research Highlights

No abstract provided.

The First Year Counts: Cancer Survival Among Indigenous And Non-Indigenous Queenslanders, 1997–2006, Susanna M. Cramb, Gall Garvey, Patricia C. Valery, John D. Williamson, Peter D. Baade

Aboriginal Policy Research Consortium International (APRCi)

Objective: To examine the differential in cancer survival between Indigenous and non-Indigenous people in Queensland in relation to time after diagnosis, remoteness and area-socioeconomic disadvantage.

Design, setting and participants: Descriptive study of population-based data on all 150 059 Queensland residents of known Indigenous status aged 15 years and over who were diagnosed with a primary invasive cancer during 1997–2006.

Main outcome measures: Hazard ratios for the categories of area- socioeconomic disadvantage, remoteness and Indigenous status, as well as conditional 5-year survival estimates.

Results: Five-year survival was lower for Indigenous people diagnosed with cancer (50.3%; 95% CI, 47.8%–52.8%) compared with non-Indigenous …