Medicine and Health Sciences Commons^™

Voice: Exploring The Experiences Of University Students Who Have Experienced Gender-Based Violence, Rabani Nagra

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Introduction: The occurrence and severity of gender-based violence (GBV) on Canadian higher education campuses has been a concern for decades. In September 2021, there were multiple reports of GBV at several Canadian universities with Western University being an exceptional case. The goal of this study was to explore: (1) the experiences of students who have experienced GBV during their enrollment at Western University; (2) the impact of GBV on students’ academics; and (3) student knowledge and experience with GBV resources.

Methods: This cross-sectional, qualitative study used an interpretive description framework and dialogue maps, underpinned by intersectionality. Seventeen undergraduate students were …

Sociodemographic Determinants Of Potentially Avoidable Hospitalizations Due To Ambulatory Care Sensitive Conditions Among Hospitalized Patients In The United States, Munira Kashem

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Social determinants of health play a crucial role in explaining the variation of potentially avoidable hospitalizations (PAH) due to Ambulatory Care Sensitive Conditions (ACSCs). Utilizing data from the National Inpatient Sample from 2018 to 2020 in the United States, this study conducted retrospective cohort analyses to explore the relationships between sociodemographic factors, specifically income, race, geography, age, and sex and PAH. Our approach used multilevel logistic regression models to adjust for potential confounders and account for clustering of admissions within hospitals. Of the 17,629,891 hospital admissions examined in this study, 1,868,609 (10.6%) were attributable to ACSCs. Our results indicate that …

Physiotherapists Description Of Patient-Centered Care, And Barriers And Facilitators Experienced To Implementation, Maclean Jordan

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Patient-centered care (PCC) is a growing standard for healthcare delivery due to the benefits to patient autonomy. Lacking a cohesive definition in the physiotherapy literature, it is also lacking in implementation. Employing interpretive description with semi-structured interviews, the goal was to understand how physiotherapists drawn from private for-profit clinics in Canada describe PCC, and barriers and facilitators to providing it. Results included requiring person-centered communication in PCC, seeing Health holistically, centering the patient in care, and being a skill that becomes clearer with practice experience. Barriers included: lack of practitioner reflexivity, patient not desiring self-directed care, and limited access to …

Sex And Gender Differences In Arthritis Health Information, Tania Al-Jilawi

Electronic Thesis and Dissertation Repository

Arthritis is a common disorder that may result in pain and inflammation, making it challenging to move or continue being active. Arthritis comes in a variety of forms. The two studies of this thesis aimed to identify the influence of intersectionality, especially sex and gender, in arthritis. The first study, a structured review, evaluated the inclusion of sex/gender and intersectional identities in patient resources of three arthritis societies: the Canadian Arthritis Society, the American Arthritis Foundation, and the National Rheumatoid Arthritis Society. The appraisal tool, the Sex/Gender and Intersectional Considerations in Patient/Consumer Health Information Appraisal Tool was used to evaluate …

The Predictors Of Multimorbidity (Defined As Diabetes + Hypertension) Amongst Males Aged 15-54 In India: An Analysis Of The Nfhs-5, Vikramjit Brar

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Research Question: “What are the predictors of multimorbidity (defined as having diabetes + hypertension) amongst males aged 15-54 in India?”

Methods: Using mixed-effect multi-level binary logistic regression models, data from the 2019-2021 India NFHS-5 were analyzed. Separate multivariable analyses were conducted for males from urban and rural areas so the association between common predictors of interest (sociodemographic & lifestyle), and multimorbidity could be determined.

Results: Various predictors (listed below) were found to have a statistically significant association to multimorbidity with some variation across urban and rural areas:

Urban areas: Age, region of residence, wealth, religion, occupation, and …

The Role Of Patient And Rehabilitation Factors In The Recovery Of Home And Family Work Roles Following Distal Radius Fracture, Sheena Saju Philip Ms.

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Background: Distal radius fracture (DRF) is a common upper extremity fracture that causes significant impairment and leads to difficulties in fulfilling important life roles such as indoor and outdoor cleaning, meal preparation, grocery shopping, caring for others, and earning and managing family income. However, clinicians do not routinely address home and family life roles after a DRF. Patient and rehabilitation factors are crucial in addressing home and family work roles (HFWRs). The HFWR questionnaire consists of tasks that are typically performed at home.

Objective: The overarching objective of this thesis is to explore the role of patient and rehabilitation …

"We Are The Living Dead": The Gendered Impacts Of Open-Pit Mining In The Dominican Republic, Klaire Gain

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Despite a rhetorical commitment to enhancing community well-being, Canadian mining corporations have a history marked by ecological degradation and human rights violations, with women experience disproportionately negative impacts. While Latin America and the Caribbean (LAC) is a desired topography for open-pit mining, the geographical area of the Dominican Republic has been largely absent from the literature. As such, this dissertation, rooted in decolonial ecofeminism, enacted a critical narrative inquiry with 7 women from the Dominican Republic to explore the gendered impacts of open-pit mining on their health and well-being.

This thesis is composed of six chapters, with chapter one introducing …

Intimate Partner Violence, Mental Health Services And The Covid-19 Pandemic In Ontario: What Are The Differences, If Any, In Mental Health Service Accessibility And Service Satisfaction During Covid-19 Between Women In Abusive Relationships And Women In Non-Abusive Relationships?, Nokuzola Ncube

Electronic Thesis and Dissertation Repository

Introduction: Intimate partner violence (IPV) increased during the COVID-19 pandemic in Canada as a result of increased economic pressures and social isolation brought on by stay-at home orders. During the COVID-19 pandemic, women experiencing IPV experienced declines in mental health conditions and unique difficulties in accessing mental health services amid closures, shifts in service delivery, and inconsistent availabilities.

Methods: An online survey was administered to 44 women living in Ontario (23 who had not experienced IPV and 16 who had not) to explore their satisfaction and access to mental health services during the COVID-19 pandemic. Descriptive statistics were used to …

Developing An Online Questionnaire To Investigate The Covid-19 Pandemic’S Impacts On Social Isolation And Health In Older Adults Living With Multimorbidity: A Pilot Study, Patricia Nistor

Electronic Thesis and Dissertation Repository

Introduction. Social restrictions preventing the spread of COVID-19 possibly increased social isolation and loneliness. The validity and reliability of a questionnaire assessing the COVID-19 pandemic’s impact on social isolation and loneliness in community dwelling older adults with multimorbidity was investigated.

Methods. A conceptual framework was developed to guide questionnaire construction. Participants were recruited through professional networks, comprising a convenience sample. Feedback interviews assessed usability and face validity. Content validity was assessed using a Content Validity Matrix, and construct validity through tests of association. Reliability of validated scales was assessed using Cronbach’s ⍺. Descriptive statistics and logistic regression were computed. …

Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

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Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

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This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

The Impact Of Access To Oral Health Care On Inadequate Oral Health And Multimorbidity, Luis Limo

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The connection between oral health and other non-communicable chronic conditions—commonly referred in the dental literature as the oral-systemic health connection—emphasizes the role of oral health care on both oral diseases and chronic conditions, particularly in vulnerable populations like the elderly. This thesis comprises 2 studies: the first is a systematic review on the impact of oral health care interventions, as an indicator of access to oral health care, on chronic conditions of which their co-existence would result in multimorbidity; the second study is a cross-sectional investigation of the associations between oral health, access to oral health care, and multimorbidity among …

Exploring The Experience Of Sexuality And Gender During The Healthcare Transition Of The Youth With Cerebral Palsy, Umma Salma

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Background: Transition from the pediatric to adult health care system is an important phase of healthcare for youth with cerebral palsy (CP). Sexuality and gender are two very important components of health that are mostly ignored in the healthcare transition process. It is possible that health care providers only see a client’s disability, and therefore, key aspects of sexuality and gender diversity may be ignored, or deemed irrelevant as a result of their disability status. Therefore, the purpose of our study is to explore how gender and sexuality may influence the experience of health care transition for youth with cerebral …

(In)Dependence, Socio-Sexual Relationships, And Sexual Health Among Adults With Mild Intellectual Disability (Mid): A Critical, Qualitative Exploration, Vanessa L.E. Cox Ms

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The purpose of this critical, qualitative study was to explore how adults with mild intellectual disability navigate independent socio-sexual relationships in settings where they are highly dependent upon caregivers and family members who exert significant control over most aspects of their lives. Data were gathered during one-on-one interviews conducted with adults with MID (n=15), and parental caregivers (n=6). Theoretical insights from critical disability studies and sexual citizenship were used to analyze the findings, which are presented thematically by study population. Participants with MID faced challenges to establishing and maintaining meaningful relationships, including a lack of choice about where and how …

The Changing Landscape Of Orthopaedic Surgery In Ontario: Where We Are, Where We Have Been, And Where We Are Going., Silvio Ndoja

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Orthopedic surgery is a field which has often been talked about with regards to surgeon underemployment. This is particularly important given the paradoxical increasing demand for orthopedic care. There has not been well studied literature understanding the state of orthopedic surgery training in Ontario, Canada. Using a combination of various databases and surveying surgeons trained in Ontario we sought to provide some insight.

We demonstrated multiple important findings. More recent graduates are feeling less ready to enter practice and almost all graduates do at least 1 fellowship, with equal amount of 1 versus 2 fellowships. We showed an effect of …

Examining Individualized Participatory Approaches To Care For Individuals With Intellectual And Developmental Disabilities, Megann Yen Dong

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Person-centred plans have been identified as an upstream approach to addressing the inequities experienced by individuals with intellectual and developmental disabilities. However, little evidence on implemented approaches exists. This integrated thesis consists of two studies exploring individualized participatory approaches to care within community-care services, guided by an integrated knowledge translation approach. The first study is a scoping review aimed to identify individualized participatory approaches to care in the literature. The second study is a qualitative descriptive study utilizing semi-structured interviews with community-care staff (n=11) to understand an operationalized person-centred planning approach. The scoping review provides insight into the variability of …

Sleep And Multimorbidity In The Canadian Longitudinal Study On Aging, Shreni Patel

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Sleep health is a latent construct comprising various sleep measures such as duration, quality, initiation, maintenance, and daytime sleepiness. This thesis compared the association of two measures of sleep health, a conventional summary score and a pooled index, with incident multimorbidity over a 3-year follow-up in 30,097 middle- to older-aged adults from the Canadian Longitudinal Study on Aging. At baseline, approximately 26% and 29% of participants with multimorbidity displayed poor sleep patterns according to additive and pooled indexing methods. Longitudinal analysis indicated that those with additive scores of 4 to 5 at baseline had a 1.54 (95% CI: 1.18, 2.03) …

Primary Care Physician Engagement In Health System Transformation: A Case Study, Atharv Joshi

Electronic Thesis and Dissertation Repository

Primary care physician engagement is essential in enhancing organizational performance, system efficacy, and provider collaboration; yet limited literature exists within health systems research. This thesis explored physician engagement throughout the development of an organization known as the London Middlesex Primary Care Alliance (LMPCA). This thesis used a qualitative case study approach guided by a constructivist paradigm. The findings revealed six themes which contributed to the development of the LMPCA and provided insight into how physicians were engaged within health systems work. Unique to this study were two facilitators for engagement: the role of a transformation lead and the use of …

Ontario Adults' Mental Health, Wellbeing, And Prosocial Behaviour During The First 16 Months Of The Covid-19 Pandemic: A Longitudinal Study, Katie J. Shillington

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The overall purpose of this dissertation was to provide a detailed assessment of the mental health, wellbeing, and prosocial behaviour of Ontario adults aged 30–59 (those at highest risk for losing years of healthy life due to chronic disease) during the first 16 months of the COVID-19 pandemic (April 2020–August 2021). To address this dissertation’s purpose specifically, four distinct yet thematically connected articles were written. Article 1 provides the starting point of this program of research via an overview of Ontario adults’ inter-related health behaviours (i.e., physical activity, sedentary behaviours, and dietary intake) and outcomes including, mental health, and wellbeing …

The Influences Of The Mindfulness Ambassador Program On Graduate Students, Varsha Vasudevan

Electronic Thesis and Dissertation Repository

The two-fold primary purpose of this pilot study was to: (1) explore, qualitatively, the influence of the Mindfulness Ambassador Program (MAP) on graduate students’ experiences of stress and their relationship with themselves and meaningful others; and (2) investigate, quantitatively, if participation in the MAP elicited changes in graduate students’ levels of stress, self-awareness, interpersonal skills, and/or social connectedness. The secondary purpose of this study was to gain an understanding of graduate students’ satisfaction with the MAP. This one-group mixed-method study utilized a brief demographic questionnaire, open-ended questions, semi-structured interviews, two MAP-specific program questionnaires, the Perceived Stress Scale, the Situational Self-Awareness …

Sociodemographic Factors And The Risk Of Paediatric Out-Of-Hospital Cardiac Arrest, Samina Idrees

Electronic Thesis and Dissertation Repository

Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. This thesis aims to explore the relationship between sociodemographic factors and POHCA. The findings from our systematic review indicate that there are racial disparities in POHCA risk and in the provision of bystander cardiopulmonary resuscitation. There was little evidence of sociodemographic disparities in bystander defibrillation, survival and neurological outcome, particularly across adjusted analyses. The findings from our case-control study in Ontario, Canada, indicate that children living in marginalized areas have an elevated risk of experiencing POHCA. We also found that children living in northern urban or …

Exploring The Experience Of Disclosing In The Workplace, Jillian Auger

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An alarming rate of workplace violence/harassment is observed each year, with negative outcomes that affect the organization (i.e., financial loss) and those directly involved (i.e., job loss, financial strain, fear of being blamed, being labeled a ‘troublemaker’). The literature indicates that, for many victim-survivors, there is little hope for positive outcomes following a disclosure of workplace violence/harassment. In fact, some studies show that negative reactions to disclosure can compound and intensify the impact of violence/harassment on psychological functioning. However, minimal research has been devoted to the experiences of victim-survivors regarding the outcomes of a disclosure. Utilizing virtual semi-structured interviews, the …

Regulatory Implications Of Inadequately Designed Pimavanserin Drug Trials Published With Risk Of Bias On Expedited Regulatory Approval Processes, Benson Law

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The objective of this retrospective critical appraisal study was to determine if the trials submitted to the Food and Drug Administration for the expedited approval of pimavanserin was of sufficient methodological quality to ascertain its safety and efficacy. After the general metrics of the trials were assessed, the Risk of Bias 2 tool and the PRagmatic Explanatory Continuum Indicator Summary tool were employed to evaluate the risk of bias and the design suitability of the trials. This study suggests that the decision to approve pimavanserin for the treatment of Parkinson’s Disease Psychosis failed to meet the threshold of evidence normally …

The Resilience And Socioeconomic Status Of Caregivers And School-Aged Children In The Context Of The Covid-19 Pandemic, Julia Yates

Electronic Thesis and Dissertation Repository

Introduction: The COVID-19 pandemic has challenged caregivers’ and school-aged children’s ability to adapt. Their adaptability may be due to their resilience, which socioeconomic status (SES) may impact.

Methods: Surveys were administered to 22 caregivers and 27 school-aged children (7-10 years) living in Ontario to measure their resilience and SES in the context of COVID-19. Correlations were employed to explore relationships between: (1) caregiver and child resilience; and (2) resilience and SES.

Results: Analyses found no significant relationship between caregiver and child resilience, nor resilience and SES in the context of COVID-19. Trends revealed caregivers with normal resilience had a higher …

Return To Play: Impact Of Urbanicity And Socioeconomic Status On Parents’ Attitudes Regarding Their Children's Play And Sport During The Covid-19 Pandemic, Kendall Saravanamuttoo

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The COVID-19 pandemic has had a profound impact on the daily routines of parents and children. The primary aim of this study was to explore the influence of socioeconomic status (SES) and urbanicity on parents’ attitudes toward their children’s active play opportunities 6 months and 1.5 years into COVID-19. The secondary objective was to explore how parents’ attitudes at 6 months related to the structured and unstructured play opportunities that children returned to 1 year later, while moderating the effects of SES and urbanicity. A sample of 239 Ontario parents of children (< 12) completed two online surveys (August – December 2020; 2021). In general, parents in communities with urban features (e.g., densely populated areas), single-parents, full-time employed parents, and parents of lower-income were more hesitant to return their children to active play during the pandemic. Findings from this work highlight SES and urbanicity disparities that continue to exist during COVID-19.

Understanding The Knowledge Translation Practices Of Environmental Health Officers In Canada: A Mixed Methods Study, Shawna Bourne-Shields

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Though important to Environmental Health Officer (EHO) practice, few research articles explore what evidence-informed practice looks like in environmental health or the factors that influence it. This study set out to understand the barriers to, and facilitators of, research utilization (RU) experienced by EHOs by asking: how do EHO practitioner perceptions of the barriers to RU change during an emergency; what factors influence evidence use during an emergency; and what can be done to ensure access to evidence and support effective and appropriate practice decision-making?

These questions were answered through three studies that used quantitative and qualitative methods. The Barriers …

Socioeconomic Patterning Of Physical Activity Among Middle-Aged To Older Adults, Jane Yuan

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Regular physical activity is a well-known protective factor against chronic disease and strongly correlated with healthy aging. However, as physical activity levels tend to decline with age, there is a need to identify barriers which prevent older adults from being physically active. This thesis investigated the relationship between socioeconomic status and meeting physical activity guidelines of 150 minutes or more of moderate- to vigorous- intensity physical activity among middle-aged to older adults in Canada. Using cross-sectional data from the baseline assessment of the Canadian Longitudinal Study on Aging, block-wise multivariable logistic regression was performed to assess the association between socioeconomic …

Social Determinants Of Health And Uptake Of Colorectal Cancer Screening In Canada, Seth F. Kadish

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Colorectal cancer (CRC) screening uptake may be associated with social determinants of health and could indicate potential barriers to health service access. The goal of this thesis was to evaluate the association of social determinants with CRC screening in screen-eligible adults. We used Andersen’s Behavioural Model of Health Service Utilization and the PROGRESS-Plus Framework to conceptualize potential social determinants. Our first study was a systematic review of peer-reviewed Canadian studies, and the second was a cross-sectional analysis of data from the Canadian Longitudinal Study on Aging (CLSA). The systematic review found lower uptake was associated with non-White ethno-racial identity, less …

How We Debrief: An Interpretive Description Of Social Service Community Workers' Experiences, Andrea C. Krywucky

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The aim of this research was to understand current practices of debriefing being used or not used in community social service organizations and the presumed frameworks or evidence justifying these practices in London, Ontario. The geographical area under concern has seen an increasing poverty gap, lack of affordable housing, toxic drug crisis, with mental health issues being exasperated by the pandemic. Social service agencies are overwhelmed with caseloads, creating an increase in need of care for frontline workers, as they are the first point of contact for many. This research utilized an interpretive description methodology to explore workers’ experiences and …

Rapid Rhino Vs. Merocel: A Retrospective Analysis Of Patients With Anterior Epistaxis Visiting Emergency Rooms In London, Ontario, Dhatri Shukla

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When patients present to an emergency room (ER) with a nosebleed, one technique that physicians employ is the application of nasal packing. Merocel is a common nasal pack utilized in ER because of their low cost. Rapid Rhino is a nasal packing that is more comfortable for patients but is more costly than Merocel. Costing for epistaxis treatment is more than initial treatment costs and needs to consider rebleed rates. Using a retrospective cohort study design with covariates adjusted by propensity scores, we compared the costs associated with Merocel, and Rapid Rhino from the hospital and provincial healthcare perspectives. Merocel …