Public Health Commons^™

Self-Disclosure Among Male Survivors Of Child Sexual Abuse: Service Providers’ Perspective, Marudan Sivagurunathan

Electronic Thesis and Dissertation Repository

Previous research regarding child sexual abuse (CSA) indicates significant gender differences in disclosure rates: specifically, males are less likely to disclose their child sexual abuse in comparison to females. CSA can have lasting impact on a child’s emotional, physical, and psychological wellbeing. Trauma studies show support and early intervention is necessary for CSA survivors to re-establish a sense of safety and to experience better quality of life. Service providers play a key role in providing care and support for male CSA survivors. However, little is known about service providers, who work with male CSA survivors, and their perceptions and attitudes …

Staying Current In Your Field Of Interest: Tips For Aspiring Students As Researchers, Dor D. Abelman

Health Studies Publications

Undergraduate students are becoming increasingly involved in research. They already posses the skills required to make meaningful contributions to their field of interest. Some important components of their success relates to a student's ability to stay up to date in the research of their field, and to learn practical skills pertaining to the publishing process. This article hopes to help with this through presenting easy-to-follow summary tables and short paragraphs on tips for success. Topics include staying up to date in a practical way, getting involved, reaching out for help, and publication. For students, by students, this report is relatable …

Assessing Physical Activity And Sedentary Time In The Early Years, Leigh M. Vanderloo

Electronic Thesis and Dissertation Repository

The overall purpose of this dissertation was to explore young children’s (18 months to 5 years) physical activity and sedentary time. Study 1 assessed the physical activity and sedentary time among a sample of toddlers from London, Canada using two data processing approaches. Study 2 explored the impact of three different early learning environments, and their respective characteristics (e.g., staff behaviours, equipment, sedentary opportunities, etc.), on preschoolers’ activity levels. Study 3 examined differences in two popular accelerometers used to measure young children’s physical activity and sedentary time to better understand measurement discrepancies.

Study 1 revealed that toddlers engaged in 37.27 …

Cost-Effectiveness Of Selective Laser Trabeculoplasty (Slt) Versus Argon Laser Trabeculoplasty (Alt) In Uncontrolled Open Angle Glaucoma Patients Having At Least One Full Previous Slt: An Economic Evaluation Alongside An Ongoing Randomized Controlled Clinical Trial, Muhammad Rakibuz-Zaman

Electronic Thesis and Dissertation Repository

Background and objective: ALT and SLT are both safe and effective for glaucoma treatment. We performed a cost-effectiveness analysis (CEA) of SLT versus ALT for a six-month follow-up period in uncontrolled open angle glaucoma patients having at least one full previous SLT from an ongoing RCT. Methods: Trial based treatment costing and IOP reduction at 6-month follow-up from baseline for both intervention arms were calculated. A decision tree model was developed considering possible clinical pathways of patients undergoing repeat laser trabeculoplasty. CEA among ALT and SLT was done, and ICERs were calculated from both societal and ministry perspective. One way …

The Lived Palliative Care Experiences Of Community-Dwelling Older Adults With Dementia In South Western Ontario, Kristina M. Kokorelias

Electronic Thesis and Dissertation Repository

Palliative care is often suggested for individuals with dementia, yet there remains great uncertainty surrounding best delivery of care to individuals wishing to die at home. The aim of this phenomenological study was to understand the experiences of both individuals with dementia who receive palliative care in the community, and their informal family caregivers. Hermeneutic thematic analysis of semi-structured interviews from ten participant dyads revealed key themes. The themes for older adults with dementia were: belonging at home and acceptance of terminal illness; the themes for informal caregivers were: impact of dementia, double strain and home as a source of …

Sample Size Formulas For Estimating Intraclass Correlation Coefficients In Reliability Studies With Binary Outcomes, Mengxiao Xu

Electronic Thesis and Dissertation Repository

Introduction: Measurement errors can seriously affect quality of clinical practice and medical research. It is therefore important to assess such errors by conduct- ing studies to estimate a coefficients reliability and assessing its precision. The intraclass correlation coefficient (ICC), defined on a model that an observation is a sum of information and random error, has been widely used to quantify reliability for continuous measurements. Sample formulas have been derived for explicitly incorporation of a prespecified probability of achieving the prespecified precision, i.e., the width or lower limit of a confidence interval for ICC. Although the concept of ICC is applicable …

Evaluation Of Sexual Orientation Items In Population Health Surveys Among Canadians: A Mixed Methods Approach, Christoffer Dharma

Electronic Thesis and Dissertation Repository

A single item sexual orientation question has been asked in Statistics Canada health surveys to identify health inequalities in Canada. Using a mixed methods study with convenience sample of Canadians, we evaluated this question in comparison to a set of US questions that includes domains of sexual identity, behaviour and attraction. The single item question had an 85.8% sensitivity and 100% specificity in capturing sexual minorities from the broadest definition (n = 311). Chance-corrected agreements with sexual identity, 12 months and life time sexual behaviour were 0.89, 0.39 and 0.48 respectively. Both trans and cisgender people revealed that there were …

Understanding Views Of Evidence In Public Health Practice And Decision Making In Ontario, Sara Masood

Electronic Thesis and Dissertation Repository

Background: Perceptions of evidence by public health managers, practitioners and policy makers is one of the key determinants of evidence uptake. Therefore, understanding views of evidence in both practice and policy decision making is important to bridge the evidence-practice and policy gap in public health. Objectives & Methods: Two studies are presented in this thesis. The first is a systematic review synthesizing studies exploring the use of research evidence in public health decision making between 2010-2016. The second study is a qualitative descriptive study examining understandings about evidence in Ontario public health units by comparing perspectives from managers and frontline …

The Role Of Postural Stability And Other Factors In Distal Radius Fracture, Sheena Saju Philip

Electronic Thesis and Dissertation Repository

The objective of the thesis was to describe the factors leading to falls in distal radius fracture (DRF) events, explore patient perceived risk of falls, and postural stability. A mixed method study described the type of fall in DRF patients (n= 1454) and patient perceived contributing factors (n=29). A prospective cohort study examined the postural stability and related fall risk of DRF participants (n=137) in Biodex Balance System (BBS) and compared to normative values. Environmental factors were a major contributor to DRF events. Older adults (44 to 65 years) had the highest rate of DRF (female: male ratio of 2:1). …

Disability And Return To Work Following Musculoskeletal Injury, Qiyun Shi

Electronic Thesis and Dissertation Repository

Musculoskeletal disorders (MSDs) are injuries, damage or disorders affecting the musculoskeletal system including muscles, ligaments, nerves, tendons, bones or cartilage etc. MSDs are highly prevalent and associated with sickness absence, reduced work efficiency, job changes and earlier retirement.. They also affect daily activity and social functioning. Although many MSDs are accompanied by minor symptoms and settled spontaneously, approximately 10% of the workforce with MSDs have difficulty resuming their original work or exit the workforce permanently. Return to work after MSDs is complex, and is influenced by many factors including physical, psychological, economic and social factors.

Although there are extensive studies …

Standing Up For Student Health: An Application Of The Health Action Process Approach For Reducing Student Sedentary Behavior., Wuyou -. Sui

Electronic Thesis and Dissertation Repository

Sedentary behavior (SB) has been associated with chronic diseases, such as Hypertension and Obesity; the risk appears greater the longer one engages in SB. University Students are a high-risk population for excessive SB due to academic responsibilities. Increasing frequency/length of breaks from sitting is an effective way to attenuate effects of SB. The Health Action Process Approach (HAPA) is a proven health behavior change model for behaviors like nutrition, but has yet to show effectiveness for increasing non-sedentary behaviors. Forty-five university students (12 Males, Mean age 23.3) were randomized into HAPA-intervention (sedentary behavior) or HAPA-control (nutrition) groups. Occupational Student and …

Environmental Heat And Acute Kidney Injury In Older Adults: A Matched Case-Control Study, Rebecca K. Mctavish

Electronic Thesis and Dissertation Repository

This matched case-control study examined the association between environmental heat exposure and hospital encounters with acute kidney injury (AKI) among adults, 66 years and older, in the province of Ontario, Canada. We matched 52,913 cases who had an AKI event during the warm seasons (April to September) of 2005 to 2012 with 174,222 controls who did not have an AKI event. We matched cases to controls on date, age, sex, residential status, income, and history of chronic kidney disease using a variable one to four matching ratio. We classified heat periods as three consecutive days where the 95th percentile of …

Social Connectedness, Social Support And The Health Of Older Adults: A Comparison Of Immigrant And Native-Born Canadians, Natalie Iciaszczyk

Electronic Thesis and Dissertation Repository

Considerable research exists on the influence of social relationships for health in old age. However, few studies have compared the associations of social connectedness and social support with the health of older adults. Using data from the CCHS-Healthy Aging, this study examines how these constructs are related to the self-reported health status of immigrant and native-born adults aged 65+. Results show that social connectedness and social support are differently associated with health in later life; whereas connectedness is linked to better health, social support is negatively related with health once levels of social connectedness are considered. Furthermore, these associations hold …

A Gender-Sensitized Weight Loss And Healthy Lifestyle Program For Overweight And Obese Male Hockey Fans: Effects On Dietary Behaviours, Ashleigh De Cruz

Electronic Thesis and Dissertation Repository

BACKGROUND: Male dietary behaviours have often been associated with overweightness and obesity. Although little research exists to help prevent the problem, this can somewhat be explained by the lack of men engaging in healthy eating and lifestyle change. A gender-sensitized intervention study using hockey as a draw to participate may positively change dietary behaviours and associated health outcomes. METHODS: A 12 week, 12 session, weight loss and healthy lifestyle intervention program was conducted in which overweight and obese male fans of a local hockey team were coached to adopt healthy eating and lifestyle behaviour changes in collaboration with …

Inequalities In Social Determinants Of Health In The Ontario Transgender Population, Rachel E. Giblon

Electronic Thesis and Dissertation Repository

This study examined how everyday living conditions known to influence health outcomes – social determinants of health – differ between transgender Ontarians and the general Ontario population. Previously collected data on social determinants, demographics, health, and health care from trans (n=433) and non-trans individuals (n=39980) living in Ontario were used. Standardized risk differences showed that significantly more trans individuals were underpaid and underemployed, unable to complete their post-secondary education, and had experienced food insecurity, social exclusion and unmet health care needs. Differences were largest comparing trans men to cisgender men of the same age distribution. Findings from this study identified …

The Association Between Social Cohesion And Physical Activity In Communities Across Canada: A Multilevel Analysis, Calvin Yip

Electronic Thesis and Dissertation Repository

Background: In Canada, only 15% of adults meet physical activity guidelines for optimal health. Previous research has suggested that social cohesion may promote physical activity.

Objective: To assess the association between social cohesion and physical activity among adults aged 18 to 64 years in Canada.

Methods: Data from the 2009-2010, 2011-2012, and 2013-2014 cycles (N=245,150) of the Canadian Community Health Survey were used. Physical activity level was operationalized using average daily energy expenditure, social cohesion was determined by self-rated sense of belonging to the local community, and communities were represented by Canada’s Forward Sortation Areas. Multilevel regression models were used …

Catheter Ablation For Atrial Fibrillation: Predicting Recurrence, Kendra Thomas

Electronic Thesis and Dissertation Repository

Background

Catheter ablation has emerged as treatment for atrial fibrillation (AF). Health care-related variables have not been explored as predictors of first ablation outcome. Determining factors associated with arrhythmia recurrence may help select patients likely to benefit. The objective was to identify variables associated with recurrence following AF ablation.

Methods

Retrospective cohort design of 314 AF patients who had undergone first ablation. Follow-up visits occurred at 3, 6 and 12 months. Variables and the outcome of recurrence were modeled with Cox proportional hazards analysis.

Results/Conclusions

After mean follow-up of 239+/-125 days, 110/314 patients (35.0%) experienced recurrence. Adjusted Cox proportional hazards …

Visualizing And Interacting With Social Determinants Of Health, Moutasem Zakkar

Electronic Thesis and Dissertation Repository

Purpose: The purpose of this study is to examine the use of information visualization to represent specific social determinants of health, and to examine the benefits of such representation for health policymaking. Methods: The study developed a prototype for a visualization tool (www.healthvisualization.ca), which represents the conceptual framework for the social determinants of health (CSDH) and new ways to represent related health equity indicators. This tool was used by study participants. The experience of these participants and the usability of the tool were evaluated using qualitative semi-structured interviews. Results: Visualizing the CSDH framework helps to present the social …

Total Versus Partial Splenectomy In Pediatric Hereditary Spherocytosis: A Systematic Review And Meta-Analysis, Leonardo Guizzetti

Epidemiology and Biostatistics Publications

To compare the clinical effectiveness of total (TS) or partial (PS) splenectomy in pediatric hereditary spherocytosis, a systematic review and meta-analysis was performed (PROSPERO registration CRD42015030056). There were 14 observational studies comparing pre- and post- operative hematologic parameters. Secondary outcomes include in-hospital infections, surgical complications, symptomatic recurrence and biliary disease. TS is more effective than PS to increase hemoglobin (3.6 g/dL vs 2.2 g/dL) and reduce reticulocytes (12.5% vs 6.5%) after one year; outcomes following PS are stable for at least 6 years. There were no cases of overwhelming post-splenectomy sepsis. A population-based patient registry is needed for long-term follow-up.

Infants Born Large For Gestational Age And Developmental Attainment In Early Childhood, Cairina E. Frank

Electronic Thesis and Dissertation Repository

Birth weight is a strong predictor of neonatal health outcomes. The majority of literature has focused on those infants born SGA. Infants born LGA have been shown to be at higher risk of immediate obstetrical complications and metabolic deficits, yet less research has focused on subsequent development. This study aims to investigate whether LGA is associated with developmental attainment and to examine the attribution of upstream factors and variables along the causal pathway. Data from the NLSCY was used. LGA was defined as a BW >90^th percentile. Outcomes were poor verbal ability (scoring <15^th percentile on the PPVT-R) and …

Etiology Of Motor Vehicle Collision Fatalities In Urban And Rural Canada, James R. Roos

Electronic Thesis and Dissertation Repository

While it has been consistently demonstrated that fatal motor vehicle collision (MVC) rates are higher for rural than urban roadways, it remains to be elucidated which collision factors account for this difference. Fatal MVC rates have been demonstrated to be higher in rural locations even when controlling for age, restraint use, and vehicle speed. This study aims to assess which collision factors are most prevalent for fatal rural motor vehicle collisions, and to address how those factors differ in significance between rural and urban regions. Our study indicates that a combination of human, environmental, and vehicular factors may account for …

A Link Between Paediatric Asthma And Obesity: Are They Caused By The Same Environmental Conditions?, Phylicia Gonsalves

Electronic Thesis and Dissertation Repository

The highly associated paediatric conditions of asthma and overweight have seen dramatic increases over the past few decades. This thesis explored air pollution exposure as a potential underlying mechanism of co-morbid asthma and overweight among adolescents aged 12 to 18 years. Data from the Canadian Community Health Survey were merged with a database containing estimates of air pollution as assessed by particulate matter ≤ 2.5 microns (PM_2.5) concentrations at the postal code centroid in southwestern Ontario. Logistic regression was used to conduct the analysis. Adolescents were more likely to be overweight as PM_2.5 concentrations increased. There was …

Improving Patient Adherence: A Look At Causal Knowledge, Treatment Credibility, And Treatment Expectancy, Kyra L. Mackenzie

Undergraduate Honors Theses

Lack of patient adherence to Cardiac Rehabilitation programs is a commonly reported problem (Bryne, Walsh, & Murphy, 2005) and is associated with increased morbidity and re-hospitalization rates (Platt, Green, Jayasinghe, & Morrissey, 2014). Factors that can increase the perceived credibility and expectancy of a treatment program predict better adherence (Nock, Ferriter, & Holmberg, 2007). A better understanding of a treatment rationale may improve treatment credibility and expectancy. For this study, causal knowledge is examined as a way to increase understanding because it has been shown to increase acquisition and retention of novel medical information (Goldszmidt, Minda, Devantier, Skye, & Woods, …

The Globalization Of Healthcare: International Agreements & Ontario Academic Health Science Centres, Andrew D. Scarffe

Electronic Thesis and Dissertation Repository

Health systems are beginning to recognize the tremendous opportunity that globalization and international activities present for Academic Health Science Centres. This study explored the nature of international agreements within Ontario Academic Health Science Centres (OAHSC) and presents the exploratory findings to begin to develop an academically defensible body of literature on the topic. This study employed a constructivist grounded theory qualitative methodology, interviewing 14 participants who hold leadership positions within OAHSCs that actively participate in, or interface with, institutions that participate in international agreements (IAs). A conceptual framework is proposed that highlights the: (1) drivers, (2) barriers, (3) international activities, …

Domestic Homicide And Homicide-Suicide In The Older Population, Brianna L. O'Neil

Electronic Thesis and Dissertation Repository

Extensive research has been conducted on domestic homicide in younger populations; however, very little is known about such incidents in the older population. It is vital that this gap in the literature be filled as Canada’s older population has been increasing. Data for this study was provided by the Ontario Domestic Violence Death Review Committee. Ninety-two domestic homicide and suicide cases were examined to determine whether there were differences between younger age groups (30 to 50 years of age) and older age groups (55 years of age and older). Information was gathered on prominent characteristics and risk factors within cases …

Antenatal Depressive Symptoms And Antidepressant Use In Pregnancy, Jerry Yu-Hsiang Chen

Electronic Thesis and Dissertation Repository

Review of the current literature reveals inconsistent findings on potential associations between antidepressant use during pregnancy and adverse fetal and child health and development. This study aims to examine the effect of antenatal SSRI exposure on several neonatal (preterm birth, small- and large-for-gestational age, Apgar score, and neonatal intensive care unit admission) and child developmental outcomes (measured by Ages and Stages Questionnaire) while controlling for confounding by indication. Data were obtained from the Prenatal Health Project, a longitudinal cohort study of 2,357 women in London, Ontario. Results from univariable analysis discovered that infants exposed to in utero SSRIs were more …

Predictors Of Engagement In Community-Based Therapy For Youths With Mood And Anxiety Disorders, Hailey S. Saunders

Electronic Thesis and Dissertation Repository

The First Episode Mood and Anxiety Program (FEMAP) aims to identify and treat youths with mood and anxiety disorders. This research sought to identify factors associated with engagement in FEMAP, based on extensive data collected by FEMAP researchers. A logistic regression model was built from candidate variables using purposeful selection. Of the 366 participants offered treatment, 87% engaged in FEMAP. Quantity of alcohol consumed per occasion, gender, and anxiety sensitivity were found to be significant predictors of engagement. Gender and anxiety sensitivity interacted with each other such that at low anxiety sensitivity levels, the odds of engaging in FEMAP for …