Public Health Commons^™

Conceptualizing Youth Participation In Children’S Health Research: Insights From A Youth-Driven Process For Developing A Youth Advisory Council, Mohammad El-Bagdady, Krishna Arunkumar, Drew Bowman, Stephanie Coen, Christina Ergler, Jason Gilliland, Ahad Mahmood, Suraj Paul

Geography & Environment Publications

Given the power asymmetries between adults and young people, youth involvement in research is often at risk of tokenism. While many disciplines have seen a shift from conducting research on youth to conducting research with and for youth, engaging children and teens in research remains fraught with conceptual, methodological, and practical challenges. Arnstein’s foundational Ladder of Participation has been adapted in novel ways in youth research, but in this paper, we present a new rendering: a ‘rope ladder.’ This concept came out of our youth-driven planning process to develop a Youth Advisory Council for the Human Environments Analysis Laboratory, an …

Normalizing Masculinity: Explaining Processes, Factors, And Contexts That Influence How Rural Male Farmers Seek Health Information In Southwest Ontario, Bradley C. Hiebert

Electronic Thesis and Dissertation Repository

Disproportionately high mortality and morbidity rates experienced by rural men are often related to the high prevalence of rural male farmers (RMFs) who are consistently exposed to chemicals, animal waste, and dust, or injured or killed while working. This dissertation aimed to explain processes by which RMFs seek health information (HI), and how these processes are influenced by rural social, cultural, political, and geographical factors.

Three studies were conducted as part of this dissertation. The first study was a literature review that explored the relationship between rural men’s health, health information seeking (HIS) theory, and masculinity theory. The second study …

Examining Climate Change-Health Nexus In Ghana, Lucia Kafui Hussey

Electronic Thesis and Dissertation Repository

Climate change is one of today’s most pressing global issues with its physical, biological and social impacts widely recognized. One area of concern is its potential health consequences. The postulated health effects from climate change are far-reaching that climate change induced health risks are signaled as the most pressing problems to public health in the 21^st century. Although developing countries such as Ghana had been suggested as a vulnerable hotspot for the health consequences of climate change, there is a paucity of empirical research on climate change and its health linkages in the country.

The purpose of this dissertation …

Assessment Of Interprofessional Team Collaboration Scale (Aitcs): Further Testing And Instrument Revision., Carole Orchard, Linda L Pederson, Emily Read, Cornelia Mahler, Heather Laschinger

Nursing Publications

INTRODUCTION: The need to be able to assess collaborative practice in health care teams has been recognized in response to the direction for team-based care in a number of policy documents. The purpose of this study is to report on further refinement of such a measurement instrument, the Assessment of Interprofessional Team Collaboration Scale (AITCS) first published in 2012. To support this refinement, two objectives were set: Objective 1: to determine whether the items from the data collected in 2016 load on the same factors as found for the 2012 version of the 37-item AITCS. Objective 2: to determine whether …

Cognitive Impairment And The Mediterranean Diet: A Canadian Perspective, Ivan Culum

Electronic Thesis and Dissertation Repository

Global life expectancy has increased steadily over the past century and is projected to continue increasing. Life expectancy increases are co-occurring with a reduction of fertility rates in many economically developed countries, which is resulting in an aging population, meaning that the proportion of older adults within the total world population will continue to increase. This is of particular concern as there is a rise of chronic neurodegenerative diseases among older adults, such as dementia, where the number of global deaths more than doubled since the turn of the century, making dementia the fifth leading cause of death worldwide. Dementia …

Prognostic Predictive Model To Estimate The Risk Of Multiple Chronic Diseases: Constructing Copulas Using Electronic Medical Record Data, Jason E. Black

Electronic Thesis and Dissertation Repository

Introduction: Multimorbidity, the presence of two or more chronic diseases in an individual, is a pressing medical condition. Novel prevention methods are required to reduce the incidence of multimorbidity. Prognostic predictive models estimate a patient’s risk of developing chronic disease. This thesis developed a single predictive model for three diseases associated with multimorbidity: diabetes, hypertension, and osteoarthritis.

Methods: Univariate logistic regression models were constructed, followed by an analysis of the dependence that existed using copulas. All analyses were based on data from the Canadian Primary Care Sentinel Surveillance Network.

Results: All univariate models were highly predictive, as demonstrated by their …

Magnetic Field Frequency-Response For Human Magnetophosphene Perception And Associated Eeg Modulations, Cadence M. Baker

Electronic Thesis and Dissertation Repository

Background: Magnetophosphenes are among the most reliably reported effects resulting from magnetic induction. The frequency dependence of the perception threshold is crucial, as guideline agencies use this information to set exposure limits whose purpose is to protect public and workers.

Objective:Establish the magnetophosphene perception thresholds throughout the extremely low frequency range (0-300 Hz) and evaluate the use of EEG as a biomarker.

Hypothesis:Perception thresholds will be lowest at ~30 Hz. EEG occipital alpha power will decrease upon perception.

Methods:60 participants were exposed to homogenous magnetic fields up to 300 Hz, and 70 mT. EEG alpha power …

The Work Of Self-Managing Attendant Services: A Reflexive Ethnographic Study, Erika Katzman

Electronic Thesis and Dissertation Repository

In self-managed attendant services, disabled people organize and manage their own personal support services. ‘Self-managers’ take responsibility to recruit, hire, train and manage ‘attendants’ in order to have greater autonomy in attendant services, and in everyday life. Where the tasks associated with self-managing attendant services are often represented as responsibilities, this research begins with the assumption that these activities constitute work. Following critical disability studies and critical feminist scholarship, work is defined broadly as efforts made to organize and manage attendant services within self-managed models. The research presented adopts a reflexive ethnographic methodological approach to explore multiple perspectives on the …

Promoting Healthy Beverage Consumption Habits Among Elementary School Children: Evaluating The Healthy Kids Community Challenge 'Water Does Wonders' Interventions In London, Ontario, Bridget R. Irwin

Electronic Thesis and Dissertation Repository

Childhood obesity is a major public health concern and has been attributed to poor diet, among other factors. Sugar-sweetened beverage (SSB) consumption, in particular, has been linked to excess weight gain in childhood, while water consumption is a protective factor. Taking advantage of the Water Does Wonders theme of the Healthy Kids Community Challenge, an initiative by the provincial government to promote water consumption, this thesis uses pre-post surveys of children aged 8-14 years to examine (a) the association between knowledge and beverage consumption habits, and (b) the effectiveness of a school- based education and environment intervention to reduce SSB …

Trends In Obesity And Multimorbidity In Canada., Michael Lebenbaum, Gregory S Zaric, Amardeep Thind, Sisira Sarma

Epidemiology and Biostatistics Publications

Very few studies have examined trends in multimorbidity over time and even fewer have examined trends over time across different body mass index (BMI) groups. Given a general decline in death rates but increased cardiovascular risk factors among individuals with obesity, the trend in the association between obesity and multimorbidity is hypothesized to be increasing over time. The data for our study came from the 1996-97 National Population Health Survey and the 2005 and 2012-13 Canadian Community Health Surveys (N = 277,366 across all 3 surveys). We examined trends in the association between BMI groups and multimorbidity using a logistic …

Risk Indicators Of Non-Severe Hypoglycemia In Type 2 Diabetes: An Analysis Of Real World Data, Natalie Hon Man Au

Electronic Thesis and Dissertation Repository

Non-severe hypoglycemia (NSH) is a common, adverse event arising from the use of insulin/secretagogues to treat type 2 diabetes mellitus (T2DM). This thesis explored risk indicators for the frequency of any NSH, daytime NSH, and nocturnal NSH where outcomes were regarded as event counts and ordinal categories. Real-world data used in this thesis was provided by a population-based sample of Canadian adults with T2DM on insulin and/or secretagogues from the InHypo-DM Study. Count and ordinal outcomes were analyzed using negative binomial regression models and a proportional odds model, respectively. Backward selection was applied to both modelling approaches. Younger age, lower …

Examining The Relationship Between Body Mass Index And Health-Related Quality Of Life Perception Among People With Mental Illness, Fatima Bukair

Electronic Thesis and Dissertation Repository

People suffering from mental illness are three times more likely to die prematurely from ‘natural’ causes than those without mental disorders as a result of their physical condition. Their life expectancy is reduced by 12-19 years. Obesity is commonly associated with mental illness and accounts for increased risk of cardiovascular disease, diabetes mellitus, stroke, heart disease, some cancers and osteoarthritis. This paper examined the relationship between body mass index (BMI) and health-related quality of life perception using the Short-Form Health Survey 36 among people living with mental illness. A Multivariate Multiple Regression model was employed to estimate the variables that …

Child Abuse As A Determinant Of Barriers To Hiv Status Disclosure Among Women In Canada, Siobhan M. Churchill

Electronic Thesis and Dissertation Repository

Introduction: In Canada, people with HIV are legally required to disclose their HIV status to their sexual partners prior to having sex that presents a “realistic possibility of HIV transmission”. This policy has been criticized for failing to consider the safety and autonomy of women with HIV, which can be compromised following disclosure.

Objectives: To investigate whether experiences of childhood physical or sexual abuse (CPSA) affect barriers to HIV disclosure to partners in adulthood, which include: later physical or sexual abuse, sexual agency, HIV stigma, and perceived social support.

Methods: Propensity scores and inverse probability of treatment weights were used …

Substance Use Patterns Among Women Living With Hiv Compared With The General Female Population Of Canada, Mostafa Shokoohi, Greta R Bauer, Angela Kaida, Ashley Lacombe-Duncan, Mina Kazemi, Brenda Gagnier, Alexandra De Pokomandy, Mona Loutfy

Epidemiology and Biostatistics Publications

BACKGROUND: HIV infection and substance use synergistically impact health outcomes of people with HIV. In this study, we assessed the prevalence of substance use among women living with HIV (WLWH) and compared them with expected values from general data.

METHODS: Cigarette smoking, frequency of alcohol consumption, last-month non-prescribed cannabis use (vs. last-year use), and last 3 months regular (≥once/week) and occasional (

RESULTS: Compared to expected estimates from general population women, a higher proportion of WLWH reported daily cigarette smoking (SPD: 26.8% [95% CI: 23.9, 29.7]), smoking ≥20 cigarettes/day (SPD: 11.6% [9.8, 13.6]), regular non-prescribed cannabis use (SPD: 8.0% [4.1, …

Family Physician Remuneration Schemes And Specialist Referrals: Quasi-Experimental Evidence From Ontario, Canada., Sisira Sarma, Nirav Mehta, Rose Anne Devlin, Koffi Ahoto Kpelitse, Lihua Li

Epidemiology and Biostatistics Publications

Understanding how family physicians respond to incentives from remuneration schemes is a central theme in the literature. One understudied aspect is referrals to specialists. Although the theoretical literature has suggested that capitation increases referrals to specialists, the empirical evidence is mixed. We push forward the empirical research on this question by studying family physicians who switched from blended fee-for-service to blended capitation in Ontario, Canada. Using several health administrative databases from 2005 to 2013, we rely on inverse probability weighting with fixed-effects regression models to account for observed and unobserved differences between the switchers and nonswitchers. Switching from blended fee-for-service …

Wait Times, Resource Use And Patient-Reported Outcomes For Patients Referred For Total Knee Replacement Surgery, Kate Lebedeva

Electronic Thesis and Dissertation Repository

This prospective cohort study evaluated the usual care pathway for patients referred to total knee arthroplasty (TKA). We measured healthcare resource use, costs and health-related quality of life (HRQoL) over the continuum of care. We also determined the proportion of inappropriate referrals and estimated wait times for initial surgical consultation and TKA. We found that two in five patients referred to specialty care were deemed inappropriate surgical candidates. Prior to referral, few conservative treatment options were tried, and many imaging tests ordered by referring providers were unjustified. Overall, the greatest proportion of costs were borne by the patient or private …

Effectiveness Of 4-Aminopyridine For The Management Of Spasticity In Spinal Cord Injury: A Systematic Review, Joshua Weiner, Jane Hsieh, Amanda Mcintyre, Robert Teasell

Epidemiology and Biostatistics Publications

Background: Spasticity is a common secondary complication of spinal cord injury (SCI), which can severely impact functional independence and quality of life. 4-Aminopyridine (4-AP) is a potassium channel blocker that has been studied as an intervention for spasticity in individuals with SCI. Objective: To conduct a systematic review of the available evidence regarding the effectiveness of 4-AP for the management of spasticity in individuals with SCI. Methods: A comprehensive literature search was conducted on five electronic databases for articles published in English up to January 2017. Studies were included if (1) the sample size was three or more subjects, (2) …

Exploring Unmet Healthcare Needs, Healthcare Access, And The Use Of Complementary And Alternative Medicine By Chronic Pain Sufferers- An Analysis Of The National Population Health Survey, Jessica Lachance

Electronic Thesis and Dissertation Repository

Background: Chronic pain is a condition nurses encounter in their practice often; estimated to affect 1 in 5 Canadian adults, resulting in significant disability, a deleterious impact on health and quality of life, and a large financial and operational burden on the health care system. It is a complex and multifactorial phenomenon that despite research efforts remains poorly understood. Consequently, the focus of chronic pain treatment targets the managementof pain to improve quality of life and reduce suffering as much as possible, rather than a curative approach. Chronic pain has been recognized as one of the most pervasive and …

The Effects Of Child Restraint System Use And Motor Vehicle Collision Severity On Injury Patterns And Severity In Children 8 Years Old And Younger., Peyton A. Schroeder

Electronic Thesis and Dissertation Repository

Motor vehicle collisions (MVCs) are a leading cause of injury and death for children under the age of 14 years in North America. Children, eight years old or younger, are required to use a child restraint system (CRS) when travelling in a vehicle in Canada. In the present study, the hypothesis that head injury severity of children in this age group, seated in rear rows of vehicles in MVCs, will be influenced by the types of restraint systems used was not supported by the data; however, other secondary aspects of collision data were explored. There were injury patterns that involved …

Viral Etiology Of Rheumatoid Arthritis, Fatima Kudaeva

Electronic Thesis and Dissertation Repository

Viruses can trigger rheumatoid arthritis (RA) or inflammatory arthritis (IA). Our study provides insight into etiology of RA/IA. We analyzed the evidence relating to the risk of RA after viral infections; estimated the distribution of IA onsets over time; quantified the effect of influenza on the risk of IA.

Results of systematic review and meta-analysis showed that the risk of RA/IA is increased after parvovirus B19 and chikungunya virus. There seems to be a risk of RA after chronic hepatitis C (HCV), but whether it is a true RA or HCV-associated arthritis is not clear.

We estimated the distribution of …

The Transitioning Nutrition Status Of Countries In Sub-Saharan Africa, Jason Mulimba Were

Electronic Thesis and Dissertation Repository

Countries in Sub-Saharan Africa (SSA) are experiencing the double burden of malnutrition (under- and over-nutrition) due to an on-going nutrition transition. Little research exists that explores the underlying causes of this double burden phenomenon within and across countries in SSA. This study examined potential causes among women in 34 countries, with an objective of identifying malnutrition groups and determining the key drivers of women nutritional status. Cross country analyses showed that fertility rate and gross domestic product were key drivers of nutrition transition. Within country analyses showed that age, wealth and parity were key drivers of women’s nutritional status. Parity …

Active And Safe Routes To School: Evaluating School Travel Planning To Support Children's Active Travel, Adrian Nicholas Buttazzoni

Electronic Thesis and Dissertation Repository

Most Canadian children are not achieving their daily recommended physical activity (PA) levels despite the many emotional, psychological, and physical benefits of PA. Walking or wheeling to/from school, or active school travel (AST), is a viable method for improving children’s daily participation in PA. In Canada, the Active and Safe Routes to School initiative promotes AST through its comprehensive School Travel Planning (STP) program. Utilizing a mixed-methods approach, broadly, this thesis investigates the i) implementation and ii) effectiveness of a regional, two-year STP program supporting AST. This thesis includes a systematic review of AST intervention models implemented in North America, …

An Exploratory Case Study Of A High-Performing Interprofessional Primary Lung Health Team, Karen R. Schouten

Electronic Thesis and Dissertation Repository

Interprofessional team-based care is essential to primary healthcare in Ontario, but care provided by teams is often disjointed. A Lung Health Team working within Family Health Teams (FHTs) in Ontario developed a successful team model and Lung Health Program that improved patients’ quality of life and reduces healthcare utilization.

A qualitative exploratory case study was conducted to explore components of the team and program that contribute to improved performance, facilitators and barriers to success, the perceived benefit to patients and providers, and the team’s and program’s sustainability and spread. Focus groups and interviews with the team and their patients, environmental …

Risk Perceptions Of Smoking In China, Imran Syed

Electronic Thesis and Dissertation Repository

Approximately one million smokers die in China every year. Risk perceptions of smoking have been theorized as being important in explaining behaviour change and have been found to be associated with initiating and quitting smoking. This study examined the extent to which smokers in China perceive risks associated with smoking (i.e., perceived likelihood of getting a smoking-related disease) and the roles of socio-demographic factors (i.e., gender, age, ethnicity, income and education) and knowledge of the consequences of smoking in explaining risk perceptions of smoking. Participants included 4861 smokers from six cities in China. The prevalence of perceived risk for smoking …

Examining Geographic Variation In Children's Perceived Barriers To Physical Activity And The Implications On Behaviour, Leah Gabrielle Taylor

Electronic Thesis and Dissertation Repository

Low levels of physical activity among Canadian children has become a national public health issue. Recent research has suggested that children’s physical activity levels are associated with their perceptions of their everyday environments. A better understanding of the formation of these perceptions within different contexts is needed to explain the extent of the relationship. Using a multi-tool quantitative protocol, this thesis examines geographic variation in socio-ecological factors influencing children’s perceptions of barriers to PA, and the extent to which perceptions mediate the relationship of the environment and PA. Results indicate that perceptions form within contexts, and have an influence on …

Improving Prediction Of Systemic Statin Exposure Using Concomitant Medications, Non-Linear Modelling And Novel Snp Discovery, Rhiannon Rose

Electronic Thesis and Dissertation Repository

Introduction: Statin drugs are a highly efficacious treatment for hypercholesterolemia and adherent treatment with statins reduces the risk of cardiovascular disease. Although statins are generally well tolerated, myalgia (muscle pain) is a common side effect and can lead to non-compliance with treatment. Increased systemic exposure may contribute to the development of myalgia. Drug-drug interactions inhibiting statin metabolism and impaired drug transporter function may lead to decreased statin clearance. Establishing accurate predictive models is an important step towards preventing adverse drug events by titrating statin dosing to limit systemic exposure.

Objectives: 1) To develop an algorithm to select concomitant medications for …

Exploring The Influence Of Childcare Type On Physical Activity And Sedentary Time Of A Nationally Representative Sample Of Canadian Preschoolers, Julie Statler

Electronic Thesis and Dissertation Repository

A large number of Canadian children are enrolled in childcare, and they spend substantial time there. Capturing a national picture of the relationship between childcare type and physical activity (PA; i.e., light, moderate- to-vigorous, and total) and sedentary time (ST) in young children is needed. Using a nationally representative sample of preschoolers (aged 3-5 years), this cross-sectional study used cycles 3 and 4 of the Canadian Health Measures Survey. Childcare type (e.g., centre-, home-based childcare, home with parent, kindergarten) was reported by parents. Preschoolers wore an accelerometer for 7 consecutive days. Device and population-specific cut-points were applied to delineate PA …

Exploring The Physical Activity And Screen Viewing-Related Knowledge, Training, And Self-Efficacy Of Early Childhood Education Candidates, Brianne Bruijns

Electronic Thesis and Dissertation Repository

Early childhood educators (ECEs) greatly influence young children’s physical activity (PA) and screen viewing (SV) behaviours. This study explored the PA and SV-related knowledge (i.e., of important PA/SV concepts), training (i.e., PA/SV courses/content received), and self-efficacy (i.e., to facilitate PA and limit SV in childcare) of early childhood education students. A sample of 1,292 students from 61 Canadian colleges/universities completed the online survey. In general, students exhibited the least amount of knowledge regarding the link between SV and health. Further, 67.8% and 73.3% of students had not completed PA or SV courses during their post-secondary training, respectively, and students who …

The Indigenous Determinants Of Health As Predictors For Diabetes And Unmet Health Needs Among Urban Indigenous People: A Respondent-Driven Sampling Study In Toronto, Ontario, Stephanie Rachael Mcconkey

Electronic Thesis and Dissertation Repository

National statistics commonly present Indigenous peoples as a falsely homogenous group of people experiencing disproportionate ill health when compared to non-Indigenous peoples. There are significant gaps in statistical information regarding the health services access barriers experienced by Indigenous people that disrupts the quality of care they receive or prevents them from accessing care altogether. Our Health Counts Toronto is a community-based study that employed respondent-driven sampling (RDS) methodologies to sample 917 urban Indigenous adults. Prevalence estimates and prevalence ratios were calculated using RDS-II weights and adjusting for clustering by shared recruiter in SAS 9.4 and SAS-callable SUDAAN 11.0 software. This …

A Mapping Review Of Randomized Controlled Trials In The Spinal Cord Injury Research Literature, Amanda Mcintyre, Brooke Benton, Shannon Janzen, Jerome Iruthayarajah, Joshua Weiner, Janice J. Eng, Robert Teasell, Spinal Cord Injury Research Evidence Team

Epidemiology and Biostatistics Publications

Study design

Mapping Review.

Objective

The objective of this study was to map out and characterize the quantity and quality of all published spinal cord injury (SCI) randomized controlled trials (RCTs) with respect to number, sample size, and methodological quality between January 1970 and December 2016.

Setting

Not applicable.

Methods

A literature search of multiple research databases was conducted. Studies adhering to the following criteria were included: the research design was an RCT; written in English; participants were >18 years; and the sample was >50% SCI. Data were extracted pertaining to author(s), year of publication, country of origin, initial and …