Medicine and Health Sciences Commons^™

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 …

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 …

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 …

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 …

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 …

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, …

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 …

Transition From Paediatric To Adult Healthcare: Readiness And Experiences Of Canadian Adolescents And Young Adults Diagnosed With Epilepsy In Childhood, Alison S.B. Dasiewicz

Electronic Thesis and Dissertation Repository

Documenting the transition from paediatric to adult healthcare is important to guide the delivery of developmentally appropriate healthcare. The objectives of this research were to quantify the transition readiness of adolescents and young adults (AYAs) diagnosed with epilepsy in childhood, explore its association with individual and familial factors, and describe transfer/transition experiences for AYAs and parents. Families and physicians were followed for ten years as part of the Health-Related Quality of Life in Children with Epilepsy Study and provided report using questionnaires.

The distribution of transition readiness indicates much room for improvement. Age was the only factor significantly associated with …

Communicating Through A Brain-Computer Interface: Towards The Assessment Of Quality Of Life In Minimally Conscious And Covertly Aware Vegetative State Patients, Jasmine Tung

Electronic Thesis and Dissertation Repository

Neuroimaging has been utilized to establish communication, using a brain-computer interface, with select patients with severe brain injuries and profound communication impairments. Due to the severe injuries sustained by these patients, traditional techniques used to develop quality of life instruments cannot be used. The Aware Study used a novel approach to establish the key dimensions for assessing the quality of life of patients who can only communicate using this sophisticated technology. Consensus methodology was employed, with the assistance of a multidisciplinary panel of experts, to collectively decide which dimensions are essential for the inclusion in a quality of life instrument …