Medicine and Health Sciences Commons^™

Family Physician Access Among Trans People In Ontario: A Cross-Sectional Analysis Of Social Determinants Of Health And Inequality Issues., Xuchen Zong

Electronic Thesis and Dissertation Repository

For trans Ontarians with access to publicly insured health care, this study aimed to determine predictors of not having a family physician, as well as to identify factors that influence a trans patient’s comfort discussing trans status or trans-related health needs with their physician. Previously collected demographic and family physician access related data (n=433) were used. Multiple logistic predictive model showed that age, marital status, education, employment, income-to-needs ratio, and social support independently predicted not having a family physician. Marital status, negative trans-specific experience with family physicians, and perception of family physician's knowledge about trans health needs were identified as …

The Cost-Effectiveness Of Combination Treatment Consisting Of Either Cetuximab Or Panitumumab Plus Folfiri Versus Treatment With Bevacizumab Plus Folfiri As First-Line Treatment For Kras Wild-Type Metastatic Colorectal Cancer Patients In Ontario, Emmanuel M.G. Ewara

Electronic Thesis and Dissertation Repository

I conducted a cost-effectiveness analysis of combination cetuximbab or panitumumab plus FOLFIRI as first-line treatment for patients with metastatic colorectal cancer (MCRC) from the perspective of the Ontario healthcare payer. I developed a Markov decision analytical model to simulate the lifetime costs and benefits of each treatment option. The model was parameterized using data collected from administrative databases in the province of Ontario and from published clinical trials. In the base case scenario, treatment consisting of bevacizumab plus FOLFIRI was found to dominate other treatment options. The ICER values were found to be sensitive to the efficacy of first-line treatment, …

Obesity And Health Care Utilization Trends In Canada During The Period 1996-7 To 2009-10, Michael Lebenbaum

Electronic Thesis and Dissertation Repository

In Canada, there have been large improvements in the management of chronic diseases attributed to obesity such as diabetes, hypertension and high cholesterol since the 1990s. How this trend has impacted the health care utilization patterns of obese individuals relative to normal weight individuals is unknown in Canada. This study examined health care utilization across categories of body mass index in Canada during the time period 1996 to 2010 using the 1996-7 National Population Health Survey and the 2000-1 and 2009-10 Canadian Community Health Surveys. I found that there were significant declines in the intensity of utilization of general practitioner/family …

Social Support As A Determinant Of Health Related Quality Of Life In Breast Cancer Survivors In California, Faiza Rab

Electronic Thesis and Dissertation Repository

Objective:

To evaluate the relationship between perceived social support and HRQOL (physical and emotional) in low SES breast cancer survivors.

Methods:

A cross-sectional study design was used to measure perceived social support at 18 months and HRQOL at 3 years after breast cancer diagnosis using MOS SS and MOS SF-36, respectively. Multiple regression analyses were used to evaluate the relationship.

Results:

Menopause at the time of diagnosis, adjunct chemotherapy, adjunct radiation therapy, co-morbidities, treatment side effects and depression were negatively associated with PCS scores (p < 0.01). Treatment side effects, anxiety and depression were negatively associated with MCS scores (p < 0.01).

Conclusions:

Perceived social support was not associated with HRQOL in low SES breast cancer survivors …

Functional Recovery And Caregiver Support Of Stroke Patients Admitted For Rehabilitation In Singapore Community Hospitals (1996 To 2005), Gerald Koh

Electronic Thesis and Dissertation Repository

Post-acute rehabilitation is the active process where disabled persons realize their optimal recovery potential through therapy after discharge from acute hospital admissions. Community hospitals which are mainly run by family physicians in Singapore provide post-acute rehabilitation, and are similar to US inpatient rehabilitation facilities and Canada’s specialty rehabilitation facilities. This thesis is based on a national dataset of all admissions into community hospitals in Singapore from 1996 to 2005 (ten years) manually extracted from medical records of four sites by the PhD candidate. Four chapters are presented: (1) a systematic review of the rehabilitation indices from published studies and their …

The Symptom Of Fatigue In Primary Care: A Comparative Study Of Health Care Utilization Patterns Using Electronic Medical Records, Kathryn A. Nicholson

Electronic Thesis and Dissertation Repository

The experience of fatigue has been a common problem among community populations for decades. The symptom of fatigue is also a frequent health complaint in primary care practices. Fatigue patients have been shown to be significantly high users of health care resources, particularly when compared to non-fatigued patient populations. To date, an understanding of the presence and the impact of the symptom of fatigue within the context of the Canadian health care system has been understudied.

The objective of this research was to determine the number of patients who were suffering from the symptom of fatigue within a primary care …

Preliminary Economic Evaluation Of Brentuximab Vedotin In Relapsed And Refractory Hodgkin Lymphoma: An "Early Look" Model Based On Phase Ii Results, Vusal Babashov

Electronic Thesis and Dissertation Repository

We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin Lymphoma (HL) from health care system perspective in Canada. We developed a Markov decision analytical model to simulate lifetime costs and benefits and parameterized the model using brentuximab phase II clinical trial and cd-link data which is a linked datasets of cancer registry with administrative databases of Ontario, Canada. In the base case scenario, brentuximab treatment led to an increase of 0.352 Quality Adjusted Life Years (QALYs) per person and $108,500 per person, which resulted in incremental cost effectiveness ratio (ICER) of $308,532 per …

Being An Austrian Mother With Rheumatoid Arthritis: An Institutional Ethnography About The Social Organization Of Everyday Life, Birgit Prodinger

Electronic Thesis and Dissertation Repository

This institutional ethnography research explored how women with rheumatoid arthritis, who are mothers, and of employable age, go about their daily lives given their social context. The social context for this research was Austria, which is characterized by social policies based on familialism and an emphasis on employment. This context may open up various resources and possibilities about what women can do and actually do in their daily lives, and thus, directs attention to the situated nature of human occupation.

In institutional ethnography particular attention is given to the social, which suggests that daily life becomes accomplished through coordinated activities …

A Measurement Of Readiness For Tennessee Hospitals To Implement “Meaningful Use” Criteria Resulting From The American Recovery And Reinvestment Act, 2009, Kathryn Wallin Wilhoit

Electronic Theses and Dissertations

In 2009, the American Recovery and Reinvestment Act was signed into law. This legislation provided for monetary rewards for those acute-care hospitals that meet "meaningful use" computerization and reporting criteria.

The study used a descriptive, nonexperimental design to answer three research questions (1) What is the level of readiness to meet "meaningful use" criteria in the Tennessee Hospital Association (THA) member hospitals; (2) What is the level of readiness to meet "meaningful use" criteria in the rural THA member hospitals; and (3) Is there a difference in the readiness to meet "meaningful use" criteria between rural and urban THA member …

Organizational Cultural Competence Assessment Of Health-Related Academic Units, Alviony Febrina Pangloli

Masters Theses

The US is increasingly becoming more diverse; however, racial and ethnic minorities are more likely to experience health disparities and poor health outcomes. To better respond to the needs of diverse populations, cultural competence training for future health professionals is needed. Important to the cultural competence of individuals is organizational cultural competence. Models and recommendations have been developed to apply cultural competence education and training formally in government agencies, health care organizations, and academia. An example of such a model in academia is the Dotson Organizational Cultural Competence Model for Health-Related Academic Units, which consists of 4 domains (organizational accountability, …

A Monitoring And Evaluation Plan For The Core Competencies Of Skilled Birth Attendants In Nepal, Roberta Goldstein

Capstone Collection

The purpose of this capstone is to present a Monitoring and Evaluation (M&E) plan of the core competencies, for Skilled Birth Attendants (SBA) of Nepal. The World Health Organization has laid out 10 specific skills that assess a SBAs competency. Nepal presently lacks any formal process for monitoring quality assurance of its SBAs and therefore has no measurement of their effectiveness. This Capstone proposes a simple M&E plan to begin the process of quality measurement, using a recent follow-up study done by the Nepali government, other articles and the experiences of the author. The tools included in this Capstone are …

Somatechnologies Of Body Size Modification: Posthuman Embodiment And Discourses Of Health, Meghan Griffin

Electronic Theses and Dissertations

This project focuses on persistent gaps in philosophies of the body: the enduring mindbody divide in accounts of phenomenology, the unfulfilled promises of representing and inhabiting the body in online and virtual spaces, and the difference between health as quantified in medical discourse versus health as lived experience. These tensions are brought to light through the electronic food journal genre where the difficulty in capturing pre-noetic, outsideconsciousness aspects of experience and embodied health are thrown into relief against circulating cultural discourses surrounding health, body size, self-surveillance, and self-care. The electronic food journal genre serves as a space for users to …

An Examination Of Factors Affecting Non-Urgent Use Of Emergency Department Services By Patients With "Universal" Healthcare, Gregory Smith Feltenberger

Health Services Research Dissertations

The purpose of this research is to examine the factors affecting non-urgent utilization of emergency department (ED) services by individuals with "universal" healthcare using the Behavioral Model of Health Services Use. Since Air Force Medical Service beneficiaries have free and unlimited use of the full-range of healthcare services, they are ideally suited for this study. The findings of this research may also apply to other populations with free or low-cost access to healthcare (i.e., universal or single-payer healthcare). Using secondary data extracted from the Air Force Medical Service's electronic health record system at several military hospitals, this study will present …

Risk Factors For Homelessness Among Community Mental Health Patients With Severe Mental Illness, Rupert Talmage Van Wormer

Dissertations and Theses

The purpose of this study was to identify risk factors associated with homelessness, assess the relationship between housing status and consumption of costly publicly funded resources, to identify characteristics associated with service retention, and to evaluate whether length of treatment is associated with better outcomes. The target population was homeless and formerly homeless adults with SMI enrolled in community mental health services at the Downtown Emergency Service Center SAGE mental health program located in Seattle. The sample consisted of 380 SAGE patients who had continuous enrollment in 2005. These patients formed the cohort for the study. Agency records for these …