Evidence For Using Immunosuppressive Treatments When Treating Idiopathic Non-Infectious Uveitis: A Systematic Review And Meta-Analysis, Hargurinder Singh

Electronic Thesis and Dissertation Repository

Idiopathic non-infectious uveitis is the spontaneous inflammation of the eye, which can lead to blindness if not treated correctly. Due to long-term side effects of corticosteroids, 4 classes of off-label immunosuppressive treatments are sometimes used (alkylating agents, inhibitors of T-lymphocyte signalling, antimetabolites and biological modifiers). We conducted a systematic review and meta-analysis to assess the effectiveness of different treatment classes on uveitis patients with similar characteristics. Results of the systematic review concurred with the conclusions from the meta-analysis, which found that all immunosuppressive treatments improved patient vision, with a statistically significant change in logMAR of -0.11 (95% CI of -0.152 …

Physical Exertion As A Risk Factor For Ventricular Arrhythmia: A Prospective Cohort Study, Harpreet S. Chahal

Electronic Thesis and Dissertation Repository

Episodes of physical exertion are associated with an immediately higher risk of cardiovascular events while physical activity over the long-term is cardioprotective. To assess the transient and long-term risk of ventricular arrhythmia (VA), we conducted a nested case-crossover study within a prospective cohort of 97 patients with implantable cardioverter-defibrillators (ICD). Within an hour of episodes of exertion, the risk of VA was 5.3 (95% CI 2.7 – 10.6) times greater compared to periods of rest. The association was higher among patients with aerobic fitness below the median (RR[relative risk]=17.5, 95% 5.2 – 58.5) than for patients with aerobic fitness above …

Factors Impacting Transgender Patients’ Discomfort With Their Family Physicians: A Respondent-Driven Sampling Survey, Greta R. Bauer, Xuchen Zong, Ayden I. Scheim, Rebecca Hammond, Amardeep Thind

Epidemiology and Biostatistics Publications

BACKGROUND: Representing approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada.

METHODS: 433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via …

Survival Outcomes And Treatment Utilization Among Patients With Known And Unknown Primary Tumours In Ontario., Chong Sung Kim

Electronic Thesis and Dissertation Repository

I identify two cohorts of cancer patients with known and unknown primary tumours. Cancer of unknown primary (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Using the Ontario Cancer Registry, Same Day Surgery/Discharge Abstract Database and Ontario Health Insurance Plan, a novel linkage strategy was developed to cross-validate diagnoses. I found CUP patients represent a significant portion of all metastatic cancers. CUP patients with histological confirmed disease, squamous cell histology, or metastases localized to nodal regions had significantly better survival than other CUP patients. Knowledge of the primary …

Identification And Survival Outcomes Of A Cohort Of Patients With Cancer Of Unknown Primary In Ontario, Canada., Chong S Kim, Malek B Hannouf, Sisira Sarma, George B Rodrigues, Peter K Rogan, Salaheddin M Mahmud, Eric Winquist, Muriel Brackstone, Gregory S Zaric

Epidemiology and Biostatistics Publications

BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS).

MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. …

Risk Of Arrhythmia And Mortality From Macrolide Antibiotic Prescription: A Population-Based Cohort Study, Mai H. Trac

Electronic Thesis and Dissertation Repository

Many respiratory tract infections are treated with macrolide antibiotics. Regulatory agencies warn that these antibiotics increase the risk of ventricular arrhythmia. This population-based retrospective cohort study examined the 30-day risk of a hospital encounter with ventricular arrhythmia and all-cause mortality in 503,612 matched pairs of older adults who received a new outpatient prescription for an oral macrolide antibiotic and those prescribed referent antibiotics from 2002 to 2013 in Ontario. Conditional logistic regression was used to measure the association between macrolide exposure and outcomes. Macrolide antibiotics compared with referent antibiotics were not associated with a higher 30-day risk of ventricular arrhythmia …

The Association Between The Neighbourhood Food Environment And Prevalence Of Three Chronic Diseases In Urban Canada: A Cross-Sectional Analysis, Jagraj Singh Pandher

Electronic Thesis and Dissertation Repository

Research on the association between the neighbourhood food environment and prevalence of chronic diseases is very limited in Canada. The objective of this thesis was to investigate: (i) the associations between the neighbourhood food environment and prevalence of type II diabetes, cardiovascular disease and hypertension among Canadian adults living in urban areas; and (ii) whether or not dietary patterns, obesity and physical activity mediate such associations. Self-reported diagnosis of three chronic diseases, and individual-level socio-demographic and lifestyle variables were taken from the 2009-2010 Canadian Community Health Survey; neighbourhood-level socio-economic data were taken from the 2011 National Household Survey; and the …

The Sixties Scoop Among Aboriginal Veterans: A Critical Narrative Study, Munira Abdulwasi

Electronic Thesis and Dissertation Repository

This study explored the experience of Aboriginal Veterans adopted and/or fostered during the Sixties Scoop using critical narrative inquiry. The objectives were to: 1) understand the lived experience of Aboriginal veterans adopted and/or fostered during the Sixties Scoop, 2) explore any health needs expressed by Aboriginal veterans adopted and/or fostered during the Sixties Scoop, and 3) provide recommendations for the implementation of health services and programs to assist this group of Aboriginal veterans with their health needs. Eight individual interviews were conducted with participants in Kitchener-Waterloo, London, Ottawa, Winnipeg, and Vancouver. All interviews were audio-taped, transcribed verbatim, and analyzed using …

Exploring The Career Pathways, Professional Integration And Lived Experiences Of Regulated Nurses In Ontario, Canada, Godfred O. Boateng

Electronic Thesis and Dissertation Repository

In the context of an enduring shortage of nurses, this study explores the career pathways and experiences of immigrant and Canadian-born nurses in two Ontario cities utilizing a qualitative research design consisting of 70 in-depth interviews. Differences in career entry and experiences of workplace conflict across immigration status and race are explored.

First, I explore successful immigrants’ pathways into the nursing profession and their social and economic integration into the Canadian economy in light of the traditional assimilation and segmented assimilation theories. The study reveals distinct career pathways taken by foreign-born nurses and Canadian born nurses. While Canadian-born nurses have …

Exploring Mothers' Influence On Preschoolers' Physical Activity Levels And Sedentary Time, Alana M. Maltby

Electronic Thesis and Dissertation Repository

Physical activity (PA) patterns continue from childhood into adulthood; therefore, establishing healthy PA levels early is imperative. Mothers have been identified as influencing preschoolers’ activity behaviours; however, a holistic exploration of maternal influence is lacking. The purpose of this study was to explore maternal influence on preschoolers’ PA and sedentary time. Preschoolers (n = 30) and their mothers wore ActicalTM accelerometers, and mothers completed the adapted Environmental Determinants of Physical Activity in Preschool Children - Parent Survey. Direct entry regression analyses were conducted to explore maternal influence (e.g., support, enjoyment) on preschoolers’ activity levels. Maternal support was a significant predictor …

The Effect Of A Multiple Modality Mind-Motor Exercise Intervention On Single And Dual-Task Gait, Balance, And Executive Function, In Community Dwelling Older Adults With A Subjective Cognitive Complaint: A Randomized Controlled Trial., John P. Bocti

Electronic Thesis and Dissertation Repository

Cognitive decline disorders are becoming increasingly prevalent, with older adults at increased risk. Combined exercise has been recently explored as an intervention to help to prevent the decline, however cognitive activation in combination with physical activity has yet to be explored. Therefore, the purpose of the study is to determine the effects of multiple modality exercise programs in combination with a mind-motor task and their effects on mobility and cognitive variables. A total of (n=89) older adults (55+ yrs), with subjective cognitive complaints participated in a multiple modality exercise class, three days a week over six months, with the intervention …

Does Satisfaction With Perinatal Health Care Influence Postpartum Weight Retention?, Andreea Bente

Electronic Thesis and Dissertation Repository

The primary aim of this thesis is to identify whether satisfaction with perinatal health care encounters is associated with lower postpartum weight retention (PPWR). PPWR is the difference between postpartum and pre-pregnancy weight. Principal components analysis confirmed the validity of a summed satisfaction score representing six dimensions: information, compassion, competency, privacy, respect and decision-making. Confounders were identified using a directed acyclic graph. Multivariable linear regression models were constructed using blocks, and backwards elimination. Results reflect a mean PPWR of 2.5 kg, and high satisfaction, with more than 90% of respondents being very satisfied or satisfied on each dimension. The multivariable …

The Experiences Of Criminalized Women When Accessing Health Care Services During Incarceration Within Provincial Jails: A Critical Narrative Study, Shamiram Zendo

Electronic Thesis and Dissertation Repository

Abstract

There has been a noticeable increase in the imprisonment of women in Canada, within the last 20 years. The purpose of this critical inquiry was to capture and promote the voices and stories of criminalized women, in order to serve their interest. Five individual in-depth interviews were conducted with women, who were incarcerated in provincial jail. A critical paradigm was used to explore how socioeconomic and gender inequalities, embedded in the social, political, and historical contexts, influenced criminalized women’s experiences when accessing health care. The findings of this study described how criminalized women experience fragmentation in health care access, …

Epidemiology Of Fracture In Adults With Kidney Disease, Kyla L. Naylor

Electronic Thesis and Dissertation Repository

Fractures are a global health concern, leading to morbidity and mortality. Individuals with reduced kidney function experience bone mineral metabolism changes which can increase fracture risk. Yet, there is little consensus on the fundamentals: prediction, incidence, risk factors, and screening of fractures in kidney disease patients. This thesis addressed these critical areas helping decrease the health burden of fracture in this unique population.

This research used data from the Canadian Multicentre Osteoporosis Study (CaMos) to examine individuals with chronic kidney disease (CKD) (n=320). CaMos is a national longitudinal study designed to collect information on fractures. To examine kidney transplant recipients …

Predictors Of Appropriate Referral To Total Knee Arthroplasty: A Validation Study, Samuel J. Malian

Electronic Thesis and Dissertation Repository

Approximately 45% of referrals from primary care physicians to arthroplasty surgeons are inappropriate. Currently, Canadians are waiting over three months for consultation with an arthroplasty surgeon. Reducing the proportion of inappropriate referrals will reduce the wait time to first consultation with an arthroplasty surgeon. This study’s objective was to validate a model that identified patient-reported predictors of appropriate referrals to arthroplasty. We screened 258 patients attending their first consultation with an arthroplasty surgeon. Participants completed the questionnaires prior to their appointment and the surgeon detailed each consultation outcome on a standardized form. We constructed our validation model using the same …

Maternal Fat Intake During Pregnancy And Breastfeeding Initiation, Rachel Man

Electronic Thesis and Dissertation Repository

Introduction: Breast milk provides health benefits for both mother and child. Prominent reasons for not initiating breastfeeding include lactation problems and perceived insufficient milk supply. Animal studies have shown that a high fat diet is associated with negative changes in the lactation process, while omega-3 supplementation appears to have positive effects. Hypothesis: 1. High maternal fat intake during pregnancy is associated with breastfeeding non-initiation. 2. Long-chain omega-3 fatty acid intake (EPA+DHA) is associated with breastfeeding initiation. 3. Maternal EPA+DHA intake modifies the relationship between total fat intake during pregnancy and breastfeeding initiation. Materials and Methods: The data for this study …

The Healthy Mind, Healthy Mobility Trial: A Novel Exercise Program For Older Adults, Dawn P. Gill, Michael A. Gregory, Guangyong Zou, Teresa Liu-Ambrose, Ryosuke Shigematsu, Vladimir Hachinski, Clara Fitzgerald, Robert Petrella

Lifestyle Research Team

BACKGROUND:

More evidence is needed to conclude that a specific program of exercise and/or cognitive training warrants prescription for the prevention of cognitive decline. We examined the effect of a group-based standard exercise program for older adults, with and without dual-task training, on cognitive function in older adults without dementia.

METHODS:

We conducted a proof-of-concept, single-blinded, 26-wk randomized controlled trial whereby participants recruited from preexisting exercise classes at the Canadian Centre for Activity and Aging in London, Ontario, were randomized to the intervention group (exercise + dual-task [EDT]) or the control group (exercise only [EO]). Each week (2 or 3 …

The Utility Of A Protection Motivation Theory Framework For Understanding Sedentary Behaviour, Tiffany S. Wong

Electronic Thesis and Dissertation Repository

This study aimed to 1) examine the factor structure and composition of sedentary-derived Protection Motivation Theory (PMT) constructs and 2) determine the utility of these constructs in predicting general and leisure sedentary goal intention (GI), implementation intention (II), and sedentary behaviour (SB). PMT, GI, II constructs, and a modified SB questionnaire were completed by undergraduate students. After completing socio-demographics and the PMT items (n = 787), participants were randomized to complete general or leisure intention and SB items. Irrespective of model, principal axis factor analysis revealed that the PMT items grouped into eight coherent and interpretable factors. Using linear …

Psychotherapy In Family Medicine, Saadia N. Hameed

Electronic Thesis and Dissertation Repository

Abstract

Aim: To explore the perspectives and practice of psychotherapy of family physicians, and analyze Ontario’s mental health policy documents within the context of psychotherapy.

Methods: In the first study descriptive qualitative methodology was used. Eighteen family physicians were interviewed and the results were presented thematically. In the second study, a policy analysis of Ontario’s mental health policy documents was conducted. The qualitative policy analytic methodology of Peter et al. was used.

Findings: Psychotherapy is an effective treatment of mental illness and is practiced by family physicians. Lack of training and time are barriers, while patient needs and …

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 …

University Students' Perceptions Of The Relationship Between Bus Pass Ownership And Physical Activity Levels, Hieu Ly

Electronic Thesis and Dissertation Repository

The purpose of this study was to assess the relationship between university students’: (a) perceptions of having a discounted bus pass and transit-related physical activity; (b) perceptions of having a discounted bus pass and weekly physical activity levels; and (c) transit-related physical activity and weekly physical activity levels. A sample of 545 undergraduate students completed an online survey. The analysis of three correlations and three t-tests illustrated significant relationships between students’ perceptions of the discounted bus pass and their transit-related physical activity, and males’ and females’ weekly physical activity levels. Three major themes emerged from the open-ended responses, which …

Careful, Not Fearful: A Mixed Methods Study To Investigate Fall-Risk Appraisal And Fear Of Falling In Community-Dwelling Older Adults, P. Karen Simmavong

Electronic Thesis and Dissertation Repository

This study investigated older adult’s accuracy in fall-risk judgement and ascertained whether fall-risk appraisal was situation specific or general in nature. Convenience and snowball sampling were used to recruit 30 community-dwelling older adults aged 65 years and older. An embedded correlational mixed methods was utilized to investigate relative and absolute fall-risk judgement, balance confidence, and hazard identification. Using Pearson Product Moment correlations, multiple regressions, and qualitative analysis, the findings suggest older adults are not always accurate in appraising fall-risk. Judgements were specific and not general in nature, as only 9.30% of variance in risk appraisals and 12.96% of variance in …

Evidence-Informed Advocacy: Non-Profit Organizations Use Of Evidence For Policy Influence In Public Health - A Case Study Of Wash Org Uganda, Carolyne Esther Nabalema

Electronic Thesis and Dissertation Repository

Nonprofit organizations play a crucial role in lobbying governments for policy changes besides engaging in direct service delivery. Improved utilization of research and other evidence in health policy and practice will help save lives and improve quality of life. This case study of WashOrg International in East Africa was informed by two major questions 1) how is evidence on water, sanitation and hygiene being used by non-profit organizations to shape policy advocacy activities 2) what kinds of internal capacity exist in WashOrg International to use water, sanitation and hygiene evidence to inform policy advocacy? Data were collected through semi-structured interviews, …

Factors Associated With Success In Pare Testing Among Rcmp Officers, Robert Andre Seguin

Electronic Thesis and Dissertation Repository

The purpose of this integrated article dissertation was to examine the predictive factors for success in the RCMP’s Physical Abilities Requirement Evaluation (PARE) in a retrospective observational study of 13, 709 unique records and a divisional subset of 620 for study two and three. Study one assessed the relative predictive power of the pursuit and body control times, while including covariates of height, weight, age. Significant (p< 0.05) and equally strong effects were for pursuit log odds (LO) of 2.95% CI [2.49, 3.11], and body control time LO of 2.80, 95% CI [2.51, 3.14] with a weak predictor , LO of 0.53, 95% CI [0.38, 0.72]. Not significant were height, weight, and sex with 99 % modeling accuracy.

Study two compared sex and performance factors on six repeated PARE pursuit circuit laps for pacing for both divisional data (535 men, 85 women) and 61 age and BMI matched male/female pairs. …