Public Health Commons^™

Multiple-Modality Exercise And Mind-Motor Training To Improve Mobility In Older Adults: A Randomized Controlled Trial, Narlon Cassio Boa Sorte Silva, Dawn P. Gill, Michael A. Gregory, John Bocti, Robert Petrella

Lifestyle Research Team

Objective:

To investigate the effects of multiple-modality exercise with or without additional mind-motor training on mobility outcomes in older adults with subjective cognitive complaints.

Methods:

This was a 24-week randomized controlled trial with a 28-week no-contact follow-up. Community-dwelling older adults underwent a thrice -weekly, Multiple-Modality exercise and Mind-Motor (M4) training or Multiple-Modality (M2) exercise with an active control intervention (balance, range of motion and breathing exercises). Study outcomes included differences between groups at 24 weeks and after the no-contact follow-up (i.e., 52 weeks) in usual and dual-task (DT, i.e., serial sevens [S7] and phonemic verbal fluency [VF] tasks) gait velocity, …

Medical Sciences 4300: London-Middlesex Suicide Prevention Council, Harshith Bhaskar, Adnan Husein, Ramin Javaheri-Poya, Sabrina Jetly, Christopher Nguyen, Serena Tejpar

Community Engaged Learning Final Projects

Suicide is an issue that affects people of all backgrounds, and takes the lives of many individuals every year. The London-Middlesex Suicide Prevention Council (LMSPC), an organization established in 1990, seeks to provide suicide prevention training to members of the community. They seek to engage community members in prevention and intervention by recognizing warning signs that may exist among the London-Middlesex region. The three main programs that strive to deliver these skills are ASIST, ASK, and safeTALK, each with a slightly different focus. LMSPC’s current goal is to increase access to these services through external grants and potential partnerships. Our …

Carbohydrates And Fungal Toxin Exposure Influence The Vaginal Microbiota, Metabolome, And Reproductive Health Of Women, Stephanie L. Collins

Electronic Thesis and Dissertation Repository

The reproductive health of women is influenced by microorganisms and their metabolites, namely those representing the vaginal microbiota and those producing toxins that are ingested. To manipulate the vaginal microbiota toward a health-associated, Lactobacillusdominant state, an approach adopting prebiotic lactulose was taken. Using batch culture, lactulose supported Lactobacillus maintenance and positively altered metabolites, while not disrupting indigenous L. crispatus epithelial adherence. The vagina also harbours abundant glycogen, but initial assumptions that lactobacilli utilize it were incorrect. I have now shown that glycogen selectively stimulates organisms associated with dysbiosis and L. iners in a self-limiting manner. Other compounds such as environmental …

Chronic Disease Risk Prediction Models And Their Impacts On Behavioural And Health Outcomes: A Systematic Review And Meta-Analysis, Patrick Kim

Electronic Thesis and Dissertation Repository

Risk prediction models are tools that predict an individual’s risk of developing a health outcome. They were developed to influence patient management by guiding preventive interventions, with the goal of reducing the incidence of new diseases. Studies examining their impacts are uncommon, and no consensus regarding their effects has been reached. This systematic review sought to determine the impact of risk prediction models for chronic diseases on physician behaviour, patient behaviour, and patient health outcomes. Twenty-two studies were found to be eligible for review. The results demonstrated that: 1) physician behaviour may be positively influenced, though a statistically significant result …

Hockey Fans In Training: A Pilot Pragmatic 1 Randomized Controlled Trial, Robert Petrella, Dawn P. Gill, Guangyong Zou, Ashleigh De Cruz, Brendan Riggin, Cassandra Bartol, Karen Danylchuk, Kate Hunt, Sally Wyke, Cindy M. Gray, Christopher Bunn, Merrick Zwarenstein

Lifestyle Research Team

Introduction Hockey Fans in Training (Hockey FIT) is a gender-sensitized weight loss and healthy lifestyle program. We investigated 1) feasibility of recruiting and retaining overweight and obese men into a pilot pragmatic randomized controlled trial and 2) potential for Hockey FIT to lead to weight loss and improvements in other outcomes at 12 wk and 12 months.

Methods Male fans of two ice hockey teams (35–65 yr; body mass index ≥28 kg·m−2) located in Ontario (Canada) were randomized to intervention (Hockey FIT) or comparator (wait-list control). Hockey FIT includes a 12-wk active phase (weekly, coach-led group meetings including provision of …

Optimization Of The Hockey Fans In Training (Hockey Fit) Weight Loss And Healthy Lifestyle Program For Male Hockey Fans, Wendy Blunt, Dawn P. Gill, Shannon Sibbald, Brendan Riggin, Roseanne Pulford, Ryan Scott, Karen Danylchuk, Cindy M. Gray, Sally Wyke, Christopher Bunn, Robert Petrella

Lifestyle Research Team

BACKGROUND:

The health outcomes of men continue to be poorer than women globally. Challenges in addressing this problem include difficulties engaging men in weight loss programs as they tend to view these programs as contrary to the masculine narrative of independence and self-reliance. Researchers have been turning towards sports fans to engage men in health promotion programs as sports fans are typically male, and tend to have poor health habits.

METHODS:

Developed from the highly successful gender-sensitized Football Fans in Training program, Hockey Fans in Training (Hockey FIT) recruited 80 male hockey fans of the London Knights and Sarnia Sting …

Investigating The Health Meanings Of Young Saudi Women, Tagreed Alnajjar

Electronic Thesis and Dissertation Repository

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

Exploring The Relationship Between Early Severity Of Epilepsy And Depressive Symptoms In Youth Ten Years After Diagnosis, Samanpreet Brar

Electronic Thesis and Dissertation Repository

This study assessed the association between early severity of epilepsy and subsequent depressive symptoms in youth and the extent to which family and clinical factors mediated this relationship. Data were obtained from the Health-Related Quality of Life in Children with Epilepsy Study, a multi-centre prospective study of children with new-onset epilepsy. A multiple linear regression analysis revealed severity of epilepsy 2 years post-diagnosis to be positively associated with depressive symptoms 10 years post-diagnosis (b=2.10, 95%CI:0.42,3.79). The results of generalized estimating equation models found family functioning, family resources, parental depressive symptoms, and antiepileptic drug use to not be mediators. Five-year seizure …

Asset-Based Community Capacity Building: A Process For Expanding A Retirement Home Physical Activity Program, Charlotte W. Crombeen

Electronic Thesis and Dissertation Repository

The population is aging rapidly and physical inactivity and sedentary behaviour are on the rise, a trend noticed at a northern Ontario retirement home looking to improve the choices for, and attendance at, physical activities provided for residents. A community capacity building (CCB) approach using an asset-based, partnership methodology was utilized to create internal and external asset maps. These maps were used to inform potential partnerships within the community. Partnerships were recommended with a university, college, and two high schools, whose staff and students could help to implement new physical activities. Walking and gardening clubs were presented as examples that …

Storied Bodies In Motion And Stillness: Shifting Meanings Of Physical Activity In Women's Life History Narratives, Shellie Mcparland

Electronic Thesis and Dissertation Repository

Gender is a rarely studied social determinant of health. Qualitative methodologies, while underutilized in health promotion, may facilitate understanding of the gender and health relationship. The purpose of this work is to determine if narrative inquiry is a meaningful approach to study the relationship between femininity and physical activity and to examine this relationship within women’s life histories. Five women between 30 and 40 participated in two semi-structured interviews. Data were analyzed holistically, structurally, and categorically.

This dissertation is comprised of five integrated articles, in which I locate myself epistemologically as researcher through a discussion on the feminist underpinnings of …

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

Electronic Thesis and Dissertation Repository

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

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

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

Electronic Thesis and Dissertation Repository

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

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

Electronic Thesis and Dissertation Repository

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

Cognition And Motor Function: A Novel Outcome Measure For Studies On Pre-Dementia Syndromes, Jacqueline K. Kueper

Electronic Thesis and Dissertation Repository

Advances in dementia research have shifted attention towards earlier stages in the natural history, such as Mild Cognitive Impairment. The current gold standard outcome measure, the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, is not optimally responsive to changes in pre-dementia populations. Modifications to scoring methodology and content have improved the measurement performance of the ADAS-Cog. However, no published modifications have addressed a second key shift in the field towards understanding motor function as an important component of dementia and pre-dementia syndromes. This thesis used a Pooled Index approach to combine an ADAS-Cog-Proxy measure with assessments of gait velocity and dual-task cost. …

The Development And Evaluation Of A Smartphone Nutrition Intervention For Adolescents, Sarah A. Cappuccitti

Electronic Thesis and Dissertation Repository

A diet high in fruit and vegetables is associated with the prevention of many chronic diseases; however, only one in ten Canadian students in grades 6 to 12 consume the recommended daily intake of fruits and vegetables. Using smartphones to deliver nutrition interventions is an emerging area of research, although to-date these interventions typically limit their focus to weight loss. The overarching purpose of this research is to redevelop and evaluate an existing smartphone application for an adolescent population. This thesis used a mixed-methods approach to gain adolescent perspectives on how to redevelop the app and to evaluate its use …

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

Electronic Thesis and Dissertation Repository

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

Findings …

Discrimination And Health: Measurement And Impacts On Ontario’S Transgender Communities, Ayden I. Scheim

Electronic Thesis and Dissertation Repository

Discrimination may contribute to poorer health outcomes experienced by non-dominant social groups. While discrimination and health research has flourished over the past two decades, little attention has been paid to the assessment of multiple forms of discrimination, nor to the health effects of discrimination for transgender persons in Canada. Therefore, this thesis examines the impacts of discrimination on health behaviours among transgender persons in Ontario and develops a new instrument set for evaluating self-reported discrimination irrespective of attribution, the Intersectional Discrimination Index (InDI). The first four manuscripts draw on data from the Trans PULSE Project, a respondent-driven sampling survey of …

Reducing Distortion – Identifying Areas To Improve The Quality Of Randomized Clinical Trials Published In Anesthesiology Journals, Jeffrey T.Y. Chow

Electronic Thesis and Dissertation Repository

Randomized clinical trials (RCTs) provide important evidence to inform clinical decision making; if these trials are of low quality, the resulting clinical decision will likely also be of low quality. The main purpose of this thesis was to conduct a series of methodological surveys that would identify potential areas of improvement in the quality of reporting for RCTs published in anesthesiology journals. Trial registration adequacy, adherence to CONSORT for Abstracts guidelines, and sample size calculation quality were all assessed, with a final chapter exploring the effect of industry funding on these methodological quality measures. While the results suggest improvement over …

Risk Factors For Bk Virus Infection After Kidney Transplantation, London, Ontario 2016, Seyed M Hosseini-Moghaddam

Electronic Thesis and Dissertation Repository

Our objective was to determine the risk factors for BK virus infection in renal allograft recipients in the first year after transplantation. In this cohort, we included all patients who received renal allograft at London Health Sciences Centre (LHSC) between 2012 and 2014. We continued post-transplantation follow-up for one year. Of 175 patients (37% female) with median age (range) of 53 (14-82) years, 40 (22.9%) developed BK viremia (median interval:100 days, range: 35-264). Recipient age, recipient gender, hemodialysis (HD) vs peritoneal dialysis (PD), Human Leukocyte Antigens A1, B35 and Cw4 increased the risk of post-transplant BKV infection. However, donor gender, …

Measuring Community Mobility In Older Adults With Parkinson’S Disease Using A Wearable Gps Sensor And Self-Report Assessment Tools, Lynn Zhu

Electronic Thesis and Dissertation Repository

Community mobility (CM) is an important instrumental activity of daily living associated with quality of life and independence. Measuring the CM of older adults, particularly those with gait disorders such as Parkinson’s disease (PD), is an important way to understand how to help people maintain mobility in the real life setting. CM is measured using self-report measures and emergent technologies, such as wearable Global Positioning System (GPS) sensors. However, the measurement properties of most available assessments have not been compared within a PD population to determine their appropriateness and identify any feasibility issues.

The primary objective of this project was …

Evidence Reversal: An Exploratory Analysis Of Randomized Controlled Trials From The New England Journal Of Medicine, Riaz G. Qureshi

Electronic Thesis and Dissertation Repository

BACKGROUND: Evidence Reversal (ER) is the phenomenon whereby new and stronger evidence contradicts previously established evidence.

OBJECTIVES: To quantify evidence reversals and to determine characteristics associated with reversibility.

METHODS: Original articles from the New England Journal of Medicine (2000 to 2016) were screened for three inclusion criteria: tested a clinical practice; Randomized Controlled Trial design; and tested an established clinical practice. The proportion of RCTs that represented ER was determined. Association of trial characteristics with reversal was explored using logistic regression in order to inform a potential framework of reversibility.

RESULTS: In total, 611 RCTs met the inclusion criteria, of …

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

Electronic Thesis and Dissertation Repository

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

Development Of Clinical Prediction Models For Surgery And Complications In Crohn’S Disease, Leonard M. Guizzetti

Electronic Thesis and Dissertation Repository

Background and Objective: Crohn’s disease (CD)-related complications account for a substantial proportion of IBD-related healthcare expenditure. Identifying patients at risk for complications may allow for targeted use of early therapeutic interventions to alter this natural course. The objective of this project was to develop risk prediction models of CD-related surgery and complications.

Methods: Using data from the REACT cluster-randomized clinical trial (N=1898 from 41 community practices), prediction models were developed and internally validated for CD-related surgery and CD-related complications, defined as the first CD-related surgery, hospitalization or complication within 24 months. Performance of each model was assessed in terms of …

Exploring Physical Activity And Screen-Viewing Policies In Canadian Childcare Centres, Emily C. Ott

Electronic Thesis and Dissertation Repository

This study aimed to explore the presence and characteristics of physical activity and screen-viewing regulations in Canadian childcare centres. Using a modified version of the Environment and Policy Assessment and Observation Self-Report tool (EPAO-SR), an online survey was distributed to childcare directors/administrators. A total of 1,290 childcare representatives accessed the survey, 514 provided complete data. Of these, 295 (44%) centres indicated having a written physical activity policy (with the majority regulated at the provincial-level). Characteristics of these policies included amount of time: spent outdoors (395; 63%); in teacher-led active play (101; 16%); and physical activity education for children (91; 16%). …

Indigenous Food Insecurity In Canada: An Analysis Using The 2012 Aboriginal Peoples Survey, Melissa Subnath

Electronic Thesis and Dissertation Repository

Background: Food insecurity in Canada’s Indigenous population continues to be an urgent public health issue, as prevalence is much higher for Indigenous Canadians than non-Indigenous Canadians.

Objective: To examine the associations between social determinants of health, Indigenous-specific factors and food insecurity among off-reserve Indigenous adults aged 20 and older in Canada.

Methods: Data from the 2012 Aboriginal Peoples Survey were used in this analysis. A hierarchical logistic regression model was run to examine relationships between social determinants of health, Indigenous-specific factors and food insecurity.

Results: Younger age, Inuit identity, low income, educational attainment less than high school, lack of employment, …

Promoting Benefits Of Physical Activity Through Persuasive Communication, Priynka Patil

Electronic Thesis and Dissertation Repository

Inactivity early in life can lead to inactively later in life, which can result in negative outcomes. The primary purpose was to determine if gain- or loss-framed messages about physical activity would change the attitudes, intentions, and behaviours of students in the contemplation or preparation stage of the Transtheoretical model. The secondary purpose was to determine if framing the message in terms of the physical health benefits, appearance/social benefits, or mental health benefits (benefit condition) would change attitude, intention and behaviour. Undergraduate female students (N=60) between the ages of 18 and 36 were recruited from the university. The results found …

Multimorbidity Among Adult Primary Health Care Patients In Canada: Examining Multiple Chronic Diseases Using An Electronic Medical Record Database, Kathryn Nicholson

Electronic Thesis and Dissertation Repository

Introduction: The coexistence of multiple chronic diseases within an individual, also known as multimorbidity, is an ongoing challenge for patients, caregivers and primary health care (PHC) providers. An enhanced understanding of the burden of multimorbidity in Canada is needed.

Objectives: This research had two main objectives. Objective One aimed to understand the prevalence of multimorbidity among adult PHC patients, as well as the patterns of unordered and ordered clusters of multiple chronic diseases. Objective Two aimed to determine the natural progression of multimorbidity over time, as well as the patient-, provider- and practice-level predictors of progressing into more complex clinical …

Examining The Impact Of A Population-Based Intervention On Children's Physical Activity Levels: The Grade 5 Act-I-Pass Program In London, Ontario, Christine E. Smith

Electronic Thesis and Dissertation Repository

Childhood obesity is a major public health concern caused in part by decreasing levels of physical activity (PA). Identification of effective population level strategies for increasing children’s PA levels is critical for improving overall health. This thesis is comprised of two studies. Study 1 examines how naturally-occurring population-level PA interventions with children have been evaluated in previous studies by conducting a systematic review. A total of 15 papers were included for review and results suggest that naturally-occurring population-based PA interventions are generally effective in improving PA levels of children in a variety of PA domains. Eleven studies included additional evaluation …

P01. Examining The Community Food Environments For Elementary School-Aged Children In The City Of London And Middlesex County, Ontario, Catherine Dubreck

Western Research Forum

Background: Childhood obesity is a growing public health issue. In Canada, one in four children/youth are overweight or obese. Research suggests diet plays a crucial role in childhood obesity, and that prevalence rates of overweight or obesity among children in a neighborhood may relate to area socioeconomic characteristics and other environmental factors. The community nutrition environment (e.g., the type, location, and accessibility of food outlets) can influence dietary habits.

Methods: Using ArcGIS, public and private elementary school addresses were geocoded, food outlets were mapped, and both junk food outlet density and the modified retail food environment index were …

P34. The Effects Of Standing Desks On Classroom Performance Of University Students, Siobhan Smith

Western Research Forum

Background:

It is well established that there are many health risks associated with prolonged sedentary time.¹ Unfortunately, research conducted on university students is limited but yet they experience excessive periods of sitting time during class and while studying.

Methods:

Recently, we investigated the effect of sitting, dynamic sitting, and standing desks on classroom performance of university students.² Participants performed three 3-minute classroom simulations, one for each of the three desks. The order of the desks and simulations were randomized. Each of the simulations included a different typing and memory task.

Results:

Results showed no significant difference in the …