Is Sabr Cost-Effective In Oligometastatic Cancer? An Economic Analysis Of Sabr-Comet Randomized Trial, Yujie Chen

Electronic Thesis and Dissertation Repository

The phase II randomized study SABR-COMET demonstrated that in cancer patients with 1-5 oligometastatic lesions, stereotactic ablative radiotherapy (SABR) was associated with an improvement in both progression-free survival and overall survival compared to standard of care (SoC). SABR, however, is associated with higher costs and treatment-related toxicity. The objective of this study was to assess the cost-effectiveness of SABR versus SoC in patients with oligometastatic disease.

A time-dependent Markov model with five health states was constructed from the Canadian health care system perspective. Utility values and transition probabilities were derived from the SABR-COMET trial. Costs were obtained from the published …

Production Of Physician Services Under Fee-For-Service And Blended Fee-For-Service: Evidence From Ontario, Canada., Nibene H Somé, Rose Anne Devlin, Nirav Mehta, Greg Zaric, Lihua Li, Salimah Shariff, Bachir Belhadji, Amardeep Thind, Amit Garg, Sisira Sarma

Epidemiology and Biostatistics Publications

We examine family physicians' responses to financial incentives for medical services in Ontario, Canada. We use administrative data covering 2003-2008, a period during which family physicians could choose between the traditional fee for service (FFS) and blended FFS known as the Family Health Group (FHG) model. Under FHG, FFS physicians are incentivized to provide comprehensive care and after-hours services. A two-stage estimation strategy teases out the impact of switching from FFS to FHG on service production. We account for the selection into FHG using a propensity score matching model, and then we use panel-data regression models to account for observed …

Healthcare Utilization Costs Of Emerging Adults With Mood And Anxiety Disorders In An Early Intervention Treatment Program Compared To A Matched Cohort, Ava A. John-Baptiste, Lihua Li, Wanrudee Isaranuwatchai, Elizabeth Osuch, Kelly K. Anderson

Epidemiology and Biostatistics Publications

AIM: The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care.

METHODS: We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and …

Trends In Asthma Prevalence In Canadians, Asthma Course Trajectories In Children, And The Effect Of Maternal Gestational Diabetes Mellitus On The Risk Of Asthma In The Offspring, Sharifa Nasreen

Electronic Thesis and Dissertation Repository

Asthma causes substantial public health burden. An enhanced understanding of asthma burden, asthma course and identification of intervenable risk factor is warranted.

The objectives of this research were to: 1) examine the age, period and cohort effects on asthma prevalence among Canadian adults during 1994–2011 (manuscript one); 2) identify the trajectories of asthma exacerbation and their predictors in children with incident asthma (manuscript two); and 3) examine the effect of maternal gestational diabetes mellitus on the risk of asthma in offspring (manuscript three).

Longitudinal data from 13,616 individuals in the National Population Health Survey, household component were used to address …

Construction Of Prediction Models For The Health Utility Index Mark 3 In Ontario And Its Application, Yue Niu

Electronic Thesis and Dissertation Repository

The government of Ontario initiated primary care reform in the early 2000s, leading to a shift away from the traditional fee-for-service (FFS) physician remuneration to incentive-based blended remuneration models. Research on the association between change in physician remuneration and patients' health status is unknown. The objectives of this thesis are to (i) construct a statistical model to predict the Health Utility Index 3 (HUI3) values for all non-institutionalized Ontario residents, and (ii) study the association between the change in physician remuneration models and patients' health status measured by HUI3. The data came from the Canadian Community Health Survey (CCHS) 2000-2001 …

Development And Application Of A Teen-Informed Tool For Measuring The Power Of Food-Related Advertisements In Canadian Environments, Drew Bowman

Electronic Thesis and Dissertation Repository

Food environments are influential in shaping dietary behaviours of adolescents. Exposure to food and beverage marketing is known to impact food knowledge, behaviours, and health outcomes, yet food environment research largely overlooks advertisements. Given that marketers tend to advertise less healthy foods to teens and teens predominantly purchase low-nutrient foods, it is crucial to study the information environment in the context of secondary school environments. This thesis uses a sequential mixed-methods approach, including environmental audits and teen consultations, to develop and apply a teen-informed tool to measure the power of advertisements surrounding secondary schools. Results indicate that exposure to and …

Differences In Duration Of Untreated Psychosis For Racial And Ethnic Minority Groups With First-Episode Psychosis: An Updated Systematic Review And Meta-Analysis., Nicole Schoer, Chen Wei Huang, Kelly K. Anderson

Epidemiology and Biostatistics Publications

PURPOSE: Ethnic minority groups with early psychosis may have longer treatment delays, potentially leading to poorer outcomes. We updated a previous systematic review of the literature on racial and ethnic differences in duration of untreated psychosis (DUP) among people with first-episode psychosis.

RESULTS: Six of 17 studies described significant differences across aggregated racial groups; however, the pooled estimates did not show differences across groups. Additional data from this update allowed for disaggregated analyses, finding that Black-African groups have a shorter DUP, whereas Black-Caribbean groups have longer DUP, relative to White groups.

CONCLUSIONS: These findings highlight the importance of in-depth research …

Sleep Quality, Shift Work And Its Effects On Stroop Task Errors In University Student Nurses: A Feasibility Study, Michael Gaspar

Electronic Thesis and Dissertation Repository

It is estimated that as many as 98,000 people die due to medical errors that occur in hospitals worldwide any given year. Studies suggest there is a deterioration in nurses’ sleep quality as a result of rotational shift work and this impairs nursing work performance. The present study determined the feasibility of using nursing students to study the impact of shift work on their sleep quality, fatigue and executive function.Results suggested a future study would be feasible after changing certain aspects of the methodology. Most importantly is a need to employ a large enough sample to include a representative array …

Routines To Enhance Active Lifestyles (Real) Projects: A Pilot Program To Promote Incidental Physical Activity, Hieu Ly

Electronic Thesis and Dissertation Repository

Engaging in different types of incidental physical activity of daily living (e.g., walking to school or stair climbing) could contribute to individuals leading more active lifestyles by improving their total physical activity levels and reducing rates of inactivity. Particularly, post-secondary students are highly inactive and innovative strategies are needed to encourage them to be more active. The overall purpose of this research program was to explore the use of evidence-informed and tailor-made point-of-choice prompts to promote active transportation and staircase use among university students. Study 1 employed focus groups to determine the most suitable health messages and designs to create …

Timely Access To Maternal, Neonatal And Child Healthcare For Rural Communities In Rwanda: The Role Of Community Health Workers, Jean Bosco Bigirimana

Electronic Thesis and Dissertation Repository

Abstract

Introduction: In Rwanda, although there has been some progress in health care delivery as expressed in the reduction in maternal and child mortality, rates are still high and geographically variable. Improving equitable access to quality healthcare services for maternal, neonatal and child healthcare (MNCH), community-based maternal, neonatal and child healthcare (CBMNCH) depends upon using “community health workers” (CHWs). Yet CHWs program faces difficulties that upset delivery of the quality of the comprehensive package of services. Unfortunately, little is known about CHWs` performance and job satisfaction in the provision of CBMNCH.

Goal: The study aimed to provide insight into …

Exploring Healthcare Consumer Involvement In Clinical Practice Guideline Development, Adam Jordan

Electronic Thesis and Dissertation Repository

Involving healthcare consumers (HCCs) in clinical practice guideline (CPG) development can lead to identification of topics that guidelines should consider. To evaluate the strategies being used to involve HCCs in CPG development, a description of these strategies is needed. This study utilized qualitative description to analyze CPGs and related documents. Professionals involved in CPG development were also interviewed. Patients, family members, and informal caregivers have been involved in the formulation of recommendations, CPG reviewing and editing, and through use of patient resources. According to the results, involving HCCs is done to incorporate patient preferences and values into CPGs, and to …

Using The Re-Aim Framework To Evaluate The Feasibility Of A Parent-Focused Pilot Intervention Targeting Childhood Obesity, Daniel Briatico

Electronic Thesis and Dissertation Repository

Background: Childhood obesity is a major public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviours and outcomes, but require effective evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a parent-focused pilot intervention (“C.H.A.M.P. Families”) targeting childhood obesity using the RE-AIM framework, an evaluation tool for community-based health interventions.

Methods: A single-centre, single-group, non-randomized, repeated measure feasibility study was conducted over the course of 10 months. Participants (n = 16 parents/caregivers representing 11 children with obesity) completed a 13-week parent-focused education intervention. …

Investigating Haemoglobin Thresholds For Red Blood Cell Transfusion In Patients With Acute Upper Gi Bleeding, Natalie May Nightingale

Electronic Thesis and Dissertation Repository

Red blood cell transfusion is frequently used to treat the harmful effects of anemia in patients with acute upper gastrointestinal bleeding. However, there is no clear consensus on when red blood cell transfusion is warranted. No studies thus far have defined the optimal threshold for transfusion, and none have looked at whether volume of blood transfused is associated with clinical outcome. This thesis attempts to addresses these gaps by analyzing hemoglobin and volume of blood transfused as predictors of patient outcomes using multivariable logistic regression models. Main results showed a statistically significant interaction between initial hemoglobin and whether a patient …

Patterns Of Problem Behaviours Among A Representative Sample Of Youth In Ontario, Chantal Williams

Electronic Thesis and Dissertation Repository

Behavioural addictions among adolescents are becoming a growing public health concern. It is well established that problem behaviours, particularly substance use behaviours, tend to cluster together. Some research indicates that gambling is associated with substance use, aligning with Problem Behaviour Theory, which suggests that problem behaviours stem from an underlying disposition toward deviance. This study sought to assess whether a) behavioural addictions, including gambling, video gaming and technology use, cluster together and with substance use and b) profiles of problem behaviours are associated with age, race, socioeconomic status, grade achievement, school connectedness, and antisocial behaviour in the total sample and …

Using The Health Action Process Approach (Hapa) To Understand And Change Sedentary Behaviour In Office Workers: Effects On Motivation, Behaviour, And Health Outcomes, Andrew Scott Rollo

Electronic Thesis and Dissertation Repository

Sedentary behaviour (SB) is positively associated with all-cause mortality, as well as numerous chronic diseases, including fatal and non-fatal cardiovascular disease, type 2 diabetes, certain types of cancer, and metabolic syndrome. Interventions targeting reductions in sedentary time among office workers who are an at-risk population for high levels of SB are needed. The main objective of this dissertation was to contribute to the body of knowledge surrounding theory-based behavioural interventions targeting SB among office working adults. First, a systematic review of the literature (study 1, chapter 2) was conducted that highlighted important cognitive and motivational factors associated with SB, which …

The Application Of Community-Based Participatory Research (Cbpr), Riley Kennedy

2019 Cohort

Community-based participatory research is a contemporary research methodology used largely in health research. Community-based participatory research works to balance power and control in research. Indigenous people around the world have had an continue to have an uncomfortable research. Community-based participatory research is viewed as a way to do ethical research with Indigenous people. This project seeks to understand factors that influence community-based participatory research on Indigenous health using a narrative literature review approach.

The Application Of Community-Based Participatory Research (Cbpr), Riley Kennedy

Head and Heart Posters 2019

Community-based participatory research is a contemporary research methodology used largely in health research. Community-based participatory research works to balance power and control in research. Indigenous people around the world have had an continue to have an uncomfortable research. Community-based participatory research is viewed as a way to do ethical research with Indigenous people. This project seeks to understand factors that influence community-based participatory research on Indigenous health using a narrative literature review approach.

The Application Of Community-Based Participatory Research (Cbpr), Riley Kennedy

Learning with your Head & Heart

Community-based participatory research is a contemporary research methodology used largely in health research. Community-based participatory research works to balance power and control in research. Indigenous people around the world have had an continue to have an uncomfortable research. Community-based participatory research is viewed as a way to do ethical research with Indigenous people. This project seeks to understand factors that influence community-based participatory research on Indigenous health using a narrative literature review approach.

Sharing Of Injection Drug Preparation Equipment Is Associated With Hiv Infection: A Cross-Sectional Study, Laura J. Ball, Klajdi Puka, Mark Speechley, Ryan Wong, Brian Hallam, Joshua C. Weiner, Sharon Koivu, Michael S. Silverman

Epidemiology and Biostatistics Publications

Background: Sharing needles/syringes and sexual transmission are widely appreciated as means of HIV transmission among persons who inject drugs (PWIDs). London, Canada, is experiencing an outbreak of HIV among PWIDs, despite a large needle/syringe distribution program and low rates of needle/syringe sharing.

Objective: To determine whether sharing of injection drug preparation equipment (IDPE) is associated with HIV infection.

Methods: Between August 2016 and June 2017, individuals with a history of injection drug use and residence in London were recruited to complete a comprehensive questionnaire and HIV testing.

Results: A total of 127 participants were recruited; 8 were excluded because of …

Effectiveness Of High-Intensity Interval Training For Fitness And Mobility Post Stroke: A Systematic Review., Joshua C. Wiener, Amanda Mcintyre, Scott Janssen, Jeffrey Ty Chow, Cristina Batey, Robert Teasell

Epidemiology and Biostatistics Publications

OBJECTIVE: To evaluate the evidence on the effectiveness of high-intensity interval training (HIIT) in improving fitness and mobility post stroke. TYPE: Systematic review.

LITERATURE SURVEY: Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for articles published in English up to January 2018.

METHODOLOGY: Studies were included if the sample was adult human participants with stroke, the sample size was ≥3, and participants received >1 session of HIIT. Study and participant characteristics, treatment protocols, and results were extracted.

SYNTHESIS: Six studies with a total of 140 participants met inclusion criteria: three randomized controlled trials and three pre-post studies. HIIT protocols ranged …

Uptake Of Colorectal Cancer Screening Tests By Ontario Physicians., Owen Litwin

Electronic Thesis and Dissertation Repository

This population-based study used administrative healthcare data to examine the uptake of tests recommended for colorectal cancer screening by eligible Ontario physicians and non-physicians, and to examine if testing of primary care physicians is associated with greater testing in their patients. Physicians (n=11,434) were matched 1:4 to non-physicians (n=45,736) on age, sex, and geographic location as of April 21, 2016. Uptake of colorectal tests was similar in physicians (67.9%, 95% CI, 67.0–68.7%) and non-physicians (66.6%, 95% CI, 66.2–67.1%). Physicians were more likely than non-physicians to undergo colonoscopy and less likely to undergo fecal occult blood testing. Uptake of colorectal tests …

Academic Center Tiered Operating Room Strategy (Action): Comparing A High Efficiency Or To The Conventional Or, Moaz Bin Yunus Chohan

Electronic Thesis and Dissertation Repository

Canadian healthcare system is under immense economic pressure. In an attempt to resolve the problem, outpatient surgical services were offered to patients presenting with orthopaedic surgical complaints. An observational cohort study was carried out, comparing the conventional surgical setup to the newly designed high-efficiency setup that provided similar care, with a significantly lower operating cost. A total of 200 patients were enrolled in the study. Standardized and unstandardized questionnaires were used to evaluate pre-operative and post-operative patient data that reflected quality of life outcomes. Data was collected at enrolment and during post-operative follow-ups of up to 6 months. Results indicate …

Resedent Study- Reducing Sedentary Behaviour May Slow Cognitive Decline In Older Adults With Mild Cognitive Impairment: A Pilot Study, Kirsten B. Dillon

Electronic Thesis and Dissertation Repository

Physical activity (PA) has been shown to slow down dementia. Unfortunately, older adults spend most of their day in sedentary behaviours (SB). Breaking up prolonged bouts of sitting with intermittent bouts of light intensity PA may reduce glycemic variability in the brain; potentially mitigating cognitive decline. This study investigated how interrupting SB with 10 min bouts of light intensity PA 3x a day would affect mild to moderate cognitive impairment progression (primary outcome) in older adults residing in an assisted living facility. Participants (n=25) were assigned in clusters into a two arm 10-week single site pilot randomized controlled trial. Secondary …

Health Policy And Social Change: Women’S Advocacy Groups And Narrative Mobilization, Jill Moffatt

Electronic Thesis and Dissertation Repository

The goal of this study is to systematically investigate the mobilization of co-created (storyteller and story-gatherer) narratives for policy and social change. A case study format investigated the mobilization of narratives by a women’s health organization in London, Ontario. Semi-structured interviews resulted in transcripts from key actors. These transcripts were thematically coded and analyzed. All interview participants emphasized that from their perspective the organization did influence health policy or social change through their narrative use. Specific policy change examples were provided by participants, and social change was subjectively recognized as realized through the creation of awareness and affirmed through audience …

The Association Between Maternal Obesity And Fetal Size For Gestational Age In Singletons And Twins, Shohi Prajapati

Electronic Thesis and Dissertation Repository

Maternal obesity and multiple births have adverse effects on fetal growth; prevalence of both are increasing in Canada. We explored associations between maternal obesity and infant size for gestational age using data from a London perinatal database. Birthweight for gestational age was assessed using standards published by Robertson (2002) to classify Small for Gestational Age (SGA) and Large for Gestational Age (LGA) in 30396 singletons and 1346 twins. Associations were estimated using logistic regression for singletons and the GEE extension of logistic regression for twins. Increased maternal pre-pregnancy BMI was statistically significantly associated with decreased odds of SGA in singletons …

Social Determinants Of Health And Substance Use Among Women Living With Hiv In Canada: Inequalities And Impacts, Mostafa Shokoohi

Electronic Thesis and Dissertation Repository

The objective of this doctoral research was two-fold: 1) to estimate inequalities in social determinants of health (SDoH), health-related quality of life, and substance use among women living with HIV (WLWH) compared to the general population of women; and 2) to assess the impact of the SDoH clusters on illicit drug use and heavy alcohol drinking among WLWH. For the first objective, estimates were obtained from 1,422 WLWH aged 16+ in the 2013-2015 Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS, time-point 1), and then compared with their counterparts estimated in 46,831 general population women in the 2013-2014 …

Realist Evaluation Of Ldcp Funded Health Equity Indicators, Shamiram Zendo Ms

Western Research Forum

Background: The Health Equity Indicators were developed by a group of public health practitioners, and academics to assist Local Public Health Agencies (LPHAs), across Ontario, Canada, determine whether their public health programs and activities meet the equity standards required by the Ministry of Health and Long-term Care (MOHLTC). The Health Equity Indicators have been designed to assess organizational internal practice and determine whether programs meet equity standards.

Objective: A realist evaluation is currently underway to determine who these indicators work for and under what conditions, across the LPHAs in the province of Ontario.

Method: Realist methodology has been …

An Application Of The Modifiable Areal Unit Problem: Optimizing Cluster Method Parameters To Produce Predictive Data For Hiv Outbreaks, Connor J. Chato, Art Fy Poon

Western Research Forum

Background

A popular approach to study HIV outbreaks is to cluster cases based on genetic similarity. However, there is no widely-used statistical criterion which optimizes the parameters for sequence-based clustering methods. The relationship between a cluster-defining similarity threshold and it’s associated set of clusters can be analogized to the aggregation level in the Modifiable Areal Unit Problem (MAUP).

Hypothesis

Based on the selection of aggregation level for study partitions in MAUP, we present a statistical framework to optimize the similarity threshold for pairwise distance algorithm TN93 (http://github.com/veg/tn93). We hypothesize that defining this threshold includes case connections such that …

Working With Youth As Stakeholders In Mental Health System Transformation: An Institutional Ethnography Of A Service Organization In Access Open Minds, Eugenia Canas

Electronic Thesis and Dissertation Repository

As national system- and research-agendas invest heavily in the improvement of youth mental health services delivery, the discursive and policy impetus for the inclusion of youth as advisors has increased. However, we know little about the work of youth engagement (YE) in the everyday realities of a care-delivery organization. Does the engagement of youth advisors ultimately inform care?

This dissertation addresses the knowledge concerns of YE with a detailed account of the experiences of youth advisors, service providers, and an organization in the process of services reform. I used institutional ethnography to (1) reveal the day-to-day work of engaging young …

Optimizing The Carrot Rewards App: An Examination Of Team-Based Financial Incentives To Increase Walking, Emma Pearson

Electronic Thesis and Dissertation Repository

Mobile health applications (mHealth apps) targeting physical activity (PA) have increased in popularity, yet effectiveness is often limited by low engagement. This study examined the impact of adding a team-based feature, Step Together Challenges (STCs), to an existing incentive-based mHealth app (i.e., Carrot Rewards) on PA. A 24-week retrospective matched pairs study was conducted (n=61,170; pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used STCs (experimental group) were matched with those who did not (controls). STC users could earn team incentives for collaboratively reaching individual daily step goals 10 times in seven days. Controlling for pre-intervention mean daily step count, …