Public Health Commons^™

Sedentary Behaviour: Theory-Based Interventions And Measurement Considerations In High-Risk Populations, Kirsten Dillon

Electronic Thesis and Dissertation Repository

High amounts of total and prolonged sedentary behaviour (SB) are detrimental to both short and long-term health. SB describes any waking behaviour performed in a seated, lying, or reclining posture at a low energy expenditure. While the average Canadian spends over 9.5 hours sedentary per day, high-risk populations such as university students and office workers report up to 14 hours per day. Interventions targeting these at-risk populations are needed. This dissertation aimed to build and contribute to the knowledge surrounding theory-based interventions and measurement amongst these high-risk populations. First, in a randomized controlled trial (study 1), we evaluated the effectiveness …

The Coping Strategies Of Older Adults With Age Related Vision Loss (Arvl) – A Narrative Account, Zakara J. Stampp

Electronic Thesis and Dissertation Repository

The goal of this study was to share the stories of older adults with age-related vision loss (ARVL) and how they have coped to maintain meaningful occupational engagement. Grounded in a constructivist paradigm, data collection and analysis were guided by the narrative inquiry methodology. The participants consisted of six older adults aged 60 or older, diagnosed with one of the following ARVL conditions: macular degeneration, diabetic retinopathy, and/or glaucoma. Participants were recruited from vision loss non-profit organizations such as the Canadian National Institute for the Blind (CNIB) and the Alliance for Equity of Blind Canadians (AEBC). One older adult was …

The Quality Of Life Of Patients With Eye Diseases, Brian Edward Yu

Electronic Thesis and Dissertation Repository

Background: Health-related Quality of Life (HRQoL) values determined using direct elicitation methods and generic preference-based measures are important for economic evaluations of healthcare interventions. The ophthalmology clientele is vulnerable to psychological stressors in the context of the coronavirus disease 2019 (COVID-19) pandemic.

Objectives: To systematically identify and summarize the quality of life (QoL) of eye disease patients in general in North America and seniors with eye diseases during the COVID-19 pandemic.

Methods: A systematic review identified North American studies that quantified HRQoL of eye disease patients. A cross-sectional study was conducted among seniors with eye diseases and backwards stepwise regression …

Effectiveness Of Machine Learning Classifiers For Cataract Screening, Ronald Cheung

Electronic Thesis and Dissertation Repository

Cataract is the leading cause of blindness and vision loss globally. The implementation of artificial intelligence (AI) in the healthcare industry has been on the rise in the past few decades and machine learning (ML) classifiers have shown to be able to diagnose patients with cataracts. A systematic review and meta-analysis were conducted to assess the diagnostic accuracy of these ML classifiers for cataracts currently published in the literature. Retrieved from nine articles, the pooled sensitivity was 94.8% and the specificity was 96.0% for adult cataracts. Additionally, an economic analysis was conducted to explore the cost-effectiveness of implementing ML to …

Evaluation Of Healthcare Facilities And Services Provided For Tuberculosis And Zoonotic Tuberculosis In Kajiado County, Kenya, Joel Zhang

Electronic Thesis and Dissertation Repository

There are key challenges people face due to the burden of tuberculosis (TB), caused by Mycobacterium tuberculosis, and zoonotic tuberculosis (ZTB), caused by Mycobacterium bovis, in Kenyan Maasai rural communities. Thus, the objective of this study was to describe current capacities/infrastructure for diagnosis/treatment of TB/ZTB, and knowledge, attitudes, and practices among healthcare workers in rural Kajiado, Kenya.

Developing Artificial Intelligence And Machine Learning To Support Primary Care Research And Practice, Jacqueline K. Kueper

Electronic Thesis and Dissertation Repository

This thesis was motivated by the potential to use "everyday data", especially that collected in electronic health records (EHRs) as part of healthcare delivery, to improve primary care for clients facing complex clinical and/or social situations. Artificial intelligence (AI) techniques can identify patterns or make predictions with these data, producing information to learn about and inform care delivery. Our first objective was to understand and critique the body of literature on AI and primary care. This was achieved through a scoping review wherein we found the field was at an early stage of maturity, primarily focused on clinical decision support …

An Intersectional Analysis Of Intimate Partner Violence In Canada, Isabella V. Aversa

Electronic Thesis and Dissertation Repository

Background: Intimate partner violence (IPV) is a recognized public health issue that can lead to poor mental and physical health outcomes. It is critical to take an intersectional approach to understanding the ways that social and interpersonal power impact IPV.

Methods: Random Forest was used to aid in social group selection when forming intersections. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was used to estimate the prevalence of IPV across intersections. Descriptive statistics were used to explore the context in which IPV occurred.

Results: The prevalence of IPV was greatest for cisgender women, transgender, and non-binary individuals, aged …

Development Of A Multi-Factorial Data Quality Score For Primary Care Electronic Medical Records, Kathryn Stirling

Electronic Thesis and Dissertation Repository

As healthcare providers transitioned from paper-based records to electronic medical records (EMRs), researchers gained access to more patient and care data, with greater detail. Current research regarding Canadian primary care EMR data suggests the quality of data is variable. For researchers who wish to use EMR data, it is important to have a method of evaluating data quality that is applicable to multiple EMR datasets so research quality can be assured. There is currently no unified scoring system for primary care EMR data. This thesis built on previous EMR data quality research by developing and testing a composite measure of …

Spin And Distortion In Surgical Trials, Andrea Mataruga

Electronic Thesis and Dissertation Repository

Research problem: Randomized controlled trials (RCTs) are essential; however, their validity can be threatened through distortion or spin. This study quantifies publication bias and distorted outcome reporting.

Methodology: All surgical RCTs registered on ClinicalTrials.gov from 1997-2017 were identified and a sample was obtained through random and intentional selection. Failure to publish (proportion of studies that remain unpublished), outcome distortion (changing intended outcomes), and spin (distorted presentation) were explored. Comparisons were made for positive versus negative studies and for high-income (HICs) versus low-middle income countries (LMICs).

Results: In total, 13,761 RCTs were registered (median enrollment size = 96, 94% from …

Does The Way We Pay Primary Care Providers Influence Emergency Department Use During After-Hours?, Michael Hong

Electronic Thesis and Dissertation Repository

In the early 2000s, Ontario introduced extensive primary care reforms to increase around-the-clock access to comprehensive primary care in response to inadequate access to primary care, including the way Ontario primary care physicians were paid. This thesis investigates the extent to which changes in physician payment could affect emergency department visits. First, a review evaluating the impact of access to primary care on primary care and emergency department utilization was conducted. Secondly, the impact of Ontario’s after-hours premium on emergency department visits was investigated, first within Ontario, then compared to four control provinces. Finally, rates of primary care services and …

Cost-Effectiveness Analysis Of Tpmt Genotype-Guided Azathioprine Treatment Compared To Standard Treatment For Patients With Moderate/Severe Ulcerative Colitis, Ali Unsal

Electronic Thesis and Dissertation Repository

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based azathioprine (AZA) compared to standard AZA therapy for ulcerative colitis (UC) patients in Canada. A patient-level Microsimulation model was developed to compare the lifetime costs and quality-adjusted life years (QALYs) gained by a hypothetical cohort of UC patients with age and sex characteristics. The parameters used in the model were derived from the published literature and costs from the Ontario Schedules of Payments and published sources. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard AZA, PGx-based AZA care was the dominant strategy with 0.17 incremental QALYs …

Examining The Impact Of Financial Incentive Removal On Physical Activity: A Quasi-Experimental Study Of 584,760 Mobile Health Application Users, Sean Kevin Spilsbury

Electronic Thesis and Dissertation Repository

BACKGROUND: Government interest in using financial incentives (FIs) to stimulate physical activity (PA) is increasing. The cost of longer-term incentive interventions may be prohibitive, however. PURPOSE: To examine the impact of FI withdrawal on PA. METHODS: A 25-week retrospective pre-post quasi-experimental study was conducted with users of a FI-based mHealth app. Users from three Canadian provinces were included. Daily FI were removed in Ontario (ON; intervention) but not British Columbia (BC) and Newfoundland and Labrador (NL; control). Simple linear regression models were used to examine weekly mean daily step count after FI withdrawal. RESULTS: The total sample included 584,760 users …

Fate Of Registered Studies From London, Ontario, Alex Bi

Electronic Thesis and Dissertation Repository

Introduction: Lack of study publication leads to bias in the scientific literature. It is important to better understand this phenomenon and find methods for mitigation.

Research Question: How many clinical trials registered on ClinicalTrials.gov in London, Ontario are started, completed, and published?

Methods: Data from all studies in the ClinicalTrials.gov registry associated with London, Ontario were collected, from registry conception until the end of 2017. We determined whether these registered studies were published by July 2020 and whether their first publication included their planned primary outcome at all. Main factors associated with non-publication were assessed using multivariable log-binomial regression. Multivariable …

Implementing Health Impact Assessment As A Required Component Of Government Policymaking: A Multi-Level Exploration Of The Determinants Of Healthy Public Policy, Stephanie A. Simpson

Electronic Thesis and Dissertation Repository

It is widely understood that the public policies of ‘non-health’ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level.

The …

Improving Developing Countries’ Health Information Systems Capacity For Infectious Disease Pandemic Responses: A Case Study Of The Ebola Virus Disease And The Coronavirus Disease Pandemics, Uche Ikenyei

Electronic Thesis and Dissertation Repository

There is increasing evidence to demonstrate that current information system theoretical models meant to assess the success of the health information systems (HIS) lack the applicable theoretical underpinning suitable for developing countries. This stems partly from a theory-evidence gap where theoretical models developed in the West are applied in developing country contexts but lack tailoring to localized, contextual realities. Therefore, this study addresses this gap by enhancing the DeLeon and McLean's information system success model with six contextual factors peculiar to the infectious disease HISs in a developing country context.

This study took place in two developing countries, Liberia and …

Falls Screening In Community- Dwelling Older Adults, Hadi Kooshiar

Electronic Thesis and Dissertation Repository

Falls screening can prevent falls and their consequences. The two studies of this thesis aimed to identify the accuracy of falls screening tools and explore patient preferences and empirical validity of the self-rated Falls Risk Questionnaire (FRQ). The first study, Systematic Literature Review, found the Toulouse-St. Louis University Mini Falls Assessment and the Activities-specific Balance Confidence scale Hindi version emerged as accurate tools for predicting falls in the target population. The second study determined most of respondents, 36%, had no preference between Activities Specific Balance Confidence 6 items (ABC-6) or FRQ. The Bland & Altman approach revealed a degree of …

The Development, Short-Term Efficacy, And Pilot Implementation Of An E-Learning Course In Physical Activity And Sedentary Behaviour For Pre-Service Early Childhood Educators, Brianne Bruijns

Electronic Thesis and Dissertation Repository

The overarching purpose of this dissertation was to develop an e-Learning course in physical activity and sedentary behaviour and test its short-term efficacy and implementation among pre- and in-service early childhood educators (ECEs). The Delphi approach was adopted for Study 1, wherein a panel of international experts in physical activity and sedentary behaviour suggested topics for the course and, together with a panel of ECE experts, rated their importance. Study 2 employed a pre-post design to explore the changes in pre- and in-service ECEs’ physical activity and sedentary behaviour-related knowledge, self-efficacy, behavioural intention, and perceived behavioural control following course completion. …

Reddit And Nursing During Covid-19: A Summative Content Analysis, Julia C. Savin

Electronic Thesis and Dissertation Repository

Purpose: The purpose of this thesis was to explore what self-identified nurses discussed on the nursing SubReddit during the Covid-19 pandemic between March 2020 to May 2020.

Methods: The Hsieh and Shannon (2005) summative content analysis with emergent categorical development was used to categorize the naturalistic data.

Findings: Through analysis, six content categories were identified from the nursing SubReddit: (a) employers’ approaches to the pandemic; (b) emergency preparedness in response to the pandemic; (c) shared experiences; (d) nursing students and new graduate nurses; (e) coping; and, (f) gratitude to nurses.

Implications: (a) Leadership that is communication-focused will improve the quality …

Examining Public Health Risk Communication Via Social Media By Provincial And Local Health Authorities In Ontario During The Covid-19 Pandemic, Marc Resendes

Electronic Thesis and Dissertation Repository

Risk communication campaigns are essential during public health crises to inform the public about ways to mitigate, alleviate and manage potential risks. The purpose of this study was to describe risk communication on social media by Ontarian health authorities amid COVID-19, in addition to examining the strategies that guided their social media use. This was completed through (a) a narrative review of risk communication literature; (b) a qualitative content analysis of select health authority Twitter messaging following three major COVID-19 milestones; and (c) key informant interviews with those coordinating social media responses to COVID-19. Information giving and news updates were …

Community Health Workers And Trainers Perspectives On Education And Practice: A Qualitative Case Study In The Context Of Maternal And Child Health In Rwanda, Damilola Toki

Electronic Thesis and Dissertation Repository

Achieving global health-care goals hinges on a health workforce that is available, competent, and productive. Chronic health worker shortages impede the abilities of health systems to provide equitable services, especially in low-resource settings.

Global consensus on bridging health workforce gaps calls for alternatives such as using community health workers (CHWs) to achieve health-care aims. CHWs are laypeople who are closely connected with communities and provide frontline health services. Although CHWs are an integral part of workforces in many countries, with potential to inform global health systems, CHW programs continue to operate on the fringe and are fraught with challenges.

This …

Health Care Utilization By Immigrants With Multimorbidity: A Population Based Cross-Sectional Study Of The 2015-2016 Canadian Community Health Survey (Cchs), Chinmoy Talukder

Electronic Thesis and Dissertation Repository

Immigrants face unique healthcare barriers, which can negatively impact their health and health service use. Those with multimorbidity face a particular challenge as multimorbidity is associated with increased need for healthcare. The purpose of this study was to compare healthcare utilization, as measured by number of visits to family physicians and specialists, between immigrants and Canadian-born populations with multimorbidity, stratified by sex and for specific chronic diseases. A cross-sectional analysis using 2015-2016 Canadian Community Health Survey (CCHS) was conducted. After adjusting for relevant covariates, no statistically significant differences in visits to family physicians or specialists were observed between immigrants and …

The Impact Of Interruptions In Gender-Affirming Medical Care During Covid-19 On Anxiety And Depression Among Trans And Non-Binary People In Canada: A Longitudinal Study, Sara Todorovic

Electronic Thesis and Dissertation Repository

Background. Transgender and non-binary (TGNB) populations experience disproportionally high levels of anxiety and depression; it is imperative we investigate how the COVID-19 pandemic may have impacted the mental health of TGNB communities. Methods. Among a Canadian sample of TGNB persons aged >=15 years, we used multiple linear regression to examine whether interruptions in gender-affirming care were associated with anxiety and depression, and whether that effect was modified by pre-pandemic mental health. Results. Anxiety and depression levels were high both pre-pandemic and during the pandemic. Approximately a quarter of TGNB persons experienced interruptions in hormonal care. After adjusting for confounders, there …

The Role And Importance Of Social Support During Recovery Following Distal Radius Fracture, Ogheneruona Mi Idoghor Ikpen

Electronic Thesis and Dissertation Repository

This thesis explored how social support changes with time and differs across genders within 1-year post distal radius fracture (DRF). It also examines the effect of social support on the patient-rated wrist evaluation (PRWE) score and health-related quality of life (HRQoL) of DRF patients at 3 months post-fracture. In this cohort study, patient-reported social support (emotional/informational, tangible, affectionate and positive social interaction) was measured using the Medical Outcomes Study (MOS) social support survey, and HRQoL was measured using the 36-Item Short-Form Survey (SF-36). Social support significantly decreased at 3 months in comparison to baseline, 6 months and 1 year (with …

An Epidemic Amidst A Pandemic: A Critical Policy Analysis Of Supervised Consumption Sites, Vanisa Ezukuse

Electronic Thesis and Dissertation Repository

This study's primary purpose is to critically appraise current federal and provincial policies regarding supervised consumption sites (SCS), noting intended and unintended consequences; and how these policies could impact SCS users. This study's secondary goal is to compare current policies related to SCS in Alberta, British Columbia, Ontario, and Quebec to provide critical insight and suggestions for ongoing policy development. Carol Bacchi’s (2009) “What is the Problem Represented to Be?” framework was applied to the Canadian policy document with a focus on SCS. Four themes are proposed: Public Health versus Criminality, Presumptions versus Assumptions, Policy Unaccountability, and Policy Duality. It …

Exploring Experiences Of Parents Of A Child With Medical Complexity: A Case Study Approach, Vanessa Rocchese

Electronic Thesis and Dissertation Repository

Parents of children with medical complexity (CMC) have the unique experience of also being their child’s health care provider (HCP). This cross-sectional, qualitative single-case study sought to 1) examine experiences of parental caregivers of CMC whilst navigating healthcare and social systems; and 2) examine influences of urban/rural settings on parental caregiver experiences. An online demographic survey and semi-structured telephone interviews were utilized with two families, one urban (n=1) and one rural (n=2). A thematic analysis was undertaken using both intersectionality and the Conceptual Model of Health-Related Quality of Life-(HRQoL) as frameworks to explore findings. This study revealed that challenges in …

Quantifying Timely Access To Surgery: A Global Modelling Study, Joo-Hyun Jeong

Electronic Thesis and Dissertation Repository

The Lancet Commission on Global Surgery proposed six core indicators to track access to safe, timely, and affordable surgery. We identified published data for countries reporting Indicator 1 (Access to timely essential surgery), defined as a country’s proportion of population living within two hours from the nearest surgery-capable facility, and conducted geospatial analyses to estimate this metric in other countries. In the primary analysis using this data, linear regression models were run to project this indicator for all countries globally according to their Human Development Index; followed by secondary analyses using broader definitions for surgical access, then by sensitivity analyses …

The Impact Of A Dedicated Pediatric Ambulance On Interfacility Transport Dispatch Times: Findings From The Canadian Pediatric Transport Network Database, Tiffany Liu

Electronic Thesis and Dissertation Repository

Introduction: This retrospective cohort study evaluates the impact of a dedicated ambulance on dispatch times of pediatric transports to the London Health Sciences Centre using the Canadian Pediatric Transport Network (CPTN) database.

Methods: After assessing the data quality of the CPTN database, we used multiple linear regressions to examine differences in dispatch times before and after June 2019, when a dedicated ambulance was introduced.

Results: We found that additional measures are needed to improve data quality in the CPTN database. A dedicated ambulance improved ambulance return times but not dispatch times.

Conclusion: Ongoing quality assessment is necessary to improve the …

Residential Greenness And Substance Use, Evan R. Wiley

Electronic Thesis and Dissertation Repository

INTRODUCTION: Research has identified positive associations between green space and health and green space and mental health. Substance use outcomes, however, have received considerably less attention.

OBJECTIVE: The purpose of this study was to investigate associations between residential greenness and patterns of substance use among transitional aged youth (age 15-25) in Canada.

METHODS: This study utilized three waves (2016-2018) of the Canadian Community Health Survey (CCHS) as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multivariable regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 …

Increasing Access To Essential Surgery In Resource Restricted Settings: An Economic Analysis, Anne Zhao

Electronic Thesis and Dissertation Repository

Globally, 5 billion people lack access to safe, timely, and affordable surgical, obstetric, and anaesthetic care. Increasing access to surgery saves lives, promotes economic growth, and drives equitable global development. Essential surgery includes caesarean section, laparotomy, and open fracture treatment, otherwise known as the Bellwether procedures. Thesis objectives included conducting a systematic review examining cost-effectiveness of undergoing or increasing access to Bellwether procedures in resource restricted settings and performing an economic evaluation of increasing access to caesarean section for obstructed labour compared to existing care in the South African Development Community region. Our systematic review found that Bellwether procedures were …

The Contribution Of Memorial University Medical Graduates To The Family Physician Workforce In Newfoundland And Labrador, Emily M. Volpe

Electronic Thesis and Dissertation Repository

Recruiting and retaining family physicians (FP) in rural communities has been an ongoing issue in Canada and other developed nations. The objective of this thesis was to analyze the long-term contribution that Memorial University medical graduate FP make to the physician workforce in Newfoundland and Labrador (NL). We found that 47% of our sample ever worked in NL, 15% ever worked in rural NL and 58% who ever worked in NL stayed for at least 10 years. Being from NL was a predictor of working in NL for at least 5 years and 10 years, respectively. Doing at least some …