Medicine and Health Sciences Commons^™

Exploring The Quality Performance Of Ethno-Specific And Mainstream Not-For-Profit Long-Term Care Homes In Ontario, Lanei Amein

Electronic Thesis and Dissertation Repository

The purpose of this retrospective study was to determine how ethno-specific not-for-profit long-term care (LTC) homes in Ontario perform in comparison to mainstream not-for-profit LTC homes using nine RAI-MDS 2.0 quality indicators. Publicly available data from three sources: the Canadian Institute for Health Information "Your Health System: In Depth" database from the Continuing Care Reporting System, data on Ontario ethno-specific not-for-profit LTC homes from the Home and Community Care Support Services, and data on home and ownership records from the Ministry of Long-Term Care “Public Reporting” website, between 2017-2022, were retrieved and analyzed. Descriptive analysis suggests that for all quality …

Oral Health Inequalities In Adolescents And Young Adults In Ontario, Maria Rahman

Electronic Thesis and Dissertation Repository

Oral health is consistently linked to physiological, psychological, and social aspects of well-being in adolescents and young adults. In this thesis, I aimed to examine the social determinants of oral health and dental care utilization. First, I conducted a scoping review of the literature, demonstrated the multifaceted nature of oral health and its connections to broader social and economic factors. Then, I conducted a cross-sectional analysis of the Canadian Community Health Survey which showed a social gradient in oral health and dental care utilization among adolescents and young adults in Ontario. When stratified by age, there was a protective association …

Systemic, Institutional, And Teaching Factors In The Delivery Of Interprofessional Education Curriculum In Canada, Mohammad B. Azzam

Electronic Thesis and Dissertation Repository

The Canadian federal and several provincial governments are currently collaborating to establish ‘team-based’ primary healthcare—or interprofessional collaborative practice (IPCP), which can be effectively accomplished when interprofessional education (IPE) is sustainably delivered by health and social care (HASC) professional education programs. Indeed, achieving the intended patient/client-oriented outcomes of IPE and subsequent IPCP requires deliberate and purposeful considerations of several systemic, institutional, and teaching factors. Regrettably, the analyses of the extent to which these factors have influenced effective IPCP is currently under-researched. In this integrated-article dissertation, we took a purposeful and systematic approach to explore the extent to which these multi-tiered factors …

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

Electronic Thesis and Dissertation Repository

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 …

Fertility Preservation Discussions With Transgender People In Canada Prior To Beginning Medical Gender Affirmation, Emily K. Sanders

Electronic Thesis and Dissertation Repository

Background. Prevalence of fertility preservation discussions and procedures, participant characteristics associated with discussions, and prevalence of desire to parent are described.

Methods. Describes, for a clinical sample of < 16-year-olds: medical chart-recorded discussion and procedure prevalence, and desire to parent longitudinally. Describes self-reported discussion prevalence for a community sample of 14- to 39-year-olds. Bivariate and multivariable modified Poisson analyses were conducted for this sample.

Results. Discussion prevalence was confirmed for approximately 80% of the clinical sample, with approximately 20% unconfirmed. Self-reported discussion prevalence was 45% in the community sample. Non-binary gender with female sex at birth, greater family religiosity, and diagnosed mental health condition excluding depression or anxiety were crudely associated with less discussions. Multivariable analyses revealed no statistically significant predictors. Desire to parent was fairly consistent over time.

Conclusion. Discussions should be standard practice for …

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 …

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 Discursive Construction Of Substance Use And Harm Reduction In Canadian Health Policy, Sibel Kusdemir

Electronic Thesis and Dissertation Repository

Harm reduction as a philosophy has been widely recognized by healthcare professionals in Canada, yet the topic remains controversial in both political and public discourses. Understanding these discourses will allow health care providers to better respond to political and public concerns, as well as ensuring that services are aligned well with public health needs. This study explored the discursive use of the term “harm reduction” in Canadian health care and nursing policy documents’ contexts by using a Foucauldian framework and Bacchi’s ‘what’s the problem represented to be?’ approach. I propose three discursive themes: self-responsible citizen, evidenced-based practice, and what nurses …

Interplay Between Shift Work, Psychological Distress, Sleep Quality, And Cognitive Performance, Rea Therese Alonzo

Electronic Thesis and Dissertation Repository

Shift work schedules are designed to maintain a continuous operation of goods and services. However, engaging in shift work may impact cognitive functioning. This thesis assessed the relationship between shift work and cognitive performance. Using cross-sectional data from the Canadian Longitudinal Study on Aging, multiple linear regression models were used to investigate the association between shift work and cognitive performance, as well as the moderating effects of psychological distress and sleep quality. Differences by sex and retirement status were also investigated. Shift work was significantly associated with poor performance for executive functioning but not for declarative memory. Poorer cognitive performance …

Correlates Of Preventable Emergency Department Visits In Canada: Evidence From The Literature And The Canadian Community Health Survey, Tammy Lau

Electronic Thesis and Dissertation Repository

Emergency department (ED) visits for primary healthcare-treatable conditions are preventable and indicate barriers to primary healthcare. The goal of this thesis was to explore the prevalence and key correlates of preventable ED visits among adults in Canada. Our systematic review found that the prevalence of these visits ranged from 4.3% to 59.1% and were associated with younger age, low education, low income, rural residence, and worse self-rated health. Our analysis of data from the 2015-2016 Canadian Community Health Survey found that 39.9% of adults with a regular healthcare provider considered their last ED visit to be preventable. In addition to …

The Impact Of School Nutrition Policy On Diet Quality Of Children And Youth In Canada, Victoria Gaudin

Electronic Thesis and Dissertation Repository

Improving diet quality is an important public policy initiative targeted to enhance population health worldwide. In this regard, school nutrition policy is an important means to promote healthy diet among children and youth. In Canada, six provinces implemented mandatory school nutrition policies at different times between 2005 and 2011. We investigated the impact of mandatory school nutrition policy on diet quality of Canadian children and youth using a quasi- experimental study design. Using 24-hour dietary recall data from the 2004 Canadian Community Health Survey (CCHS) Cycle 2.2 and 2015 CCHS-Nutrition, we constructed the Diet Quality Index (DQI). We used multivariable …

Utilization Of Healthcare By Immigrants In Canada: A Cross-Sectional Analysis Of The Canadian Community Health Survey, Nisanthini Ravichandiran

Electronic Thesis and Dissertation Repository

Immigrants to Canada face unique barriers to health care, which leads to inequities in the utilization of health care. Lower utilization of health care by immigrants to Canada is associated with the deteriorating health of individual immigrants as well as costs to the health care system. The existing literature suggests that time since immigration is an important predictor for utilization of healthcare for Canadian immigrants. This thesis uses Andersen and Newman’s Framework of Health Service Utilization and data from the 2015-2016 Canadian Community Health Survey to examine health care utilization among immigrants in Canada. The objectives were: (1) To examine …

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 …

Exploring The Mental Health Care Experiences Of Youth Transitioning From Paediatric To Adult Psychiatric Services Using The Photovoice Method: A Participatory Analysis Of The Photostream Project, Brianna Jackson

Electronic Thesis and Dissertation Repository

The transition from adolescence to adulthood brings with it many new challenges and stressors that may negatively impact psychosocial wellbeing. Unfortunately, the disjointed progression from paediatric to adult psychiatric services leaves transitional-aged youth (TAY) vulnerable to its deleterious sequelae, including social isolation, self-harm, substance use, and suicidal ideation. As devised, the Canadian mental health sector is ill-equipped to meet the care demands of emerging adults, resulting in undue suffering. Current evidence validates the need for clinical practice reform and policy revision to address this issue, yet the perspectives of young people are consistently underrepresented in conversations regarding youth-oriented psychiatric program …

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 …

The Effects Of Child Restraint System Use And Motor Vehicle Collision Severity On Injury Patterns And Severity In Children 8 Years Old And Younger., Peyton A. Schroeder

Electronic Thesis and Dissertation Repository

Motor vehicle collisions (MVCs) are a leading cause of injury and death for children under the age of 14 years in North America. Children, eight years old or younger, are required to use a child restraint system (CRS) when travelling in a vehicle in Canada. In the present study, the hypothesis that head injury severity of children in this age group, seated in rear rows of vehicles in MVCs, will be influenced by the types of restraint systems used was not supported by the data; however, other secondary aspects of collision data were explored. There were injury patterns that involved …

A National Perspective On Childhood Obesity Medical Education: Do Medical Students In Canada Perceive That They Are Prepared To Treat Children With Obesity?, Dr. Dalia Hasan

Electronic Thesis and Dissertation Repository

The purposes of this survey-based, mixed-methods study were to investigate medical students’ perceptions of: (1) the overall level of medical school training acquired in relation to childhood obesity treatment; (2) the medical school training acquired in relation to specific competencies associated with the treatment of children with obesity and their caregiver(s); and (3) additional training needed. Results showed that of the 507 students who provided complete data, approximately 60% (n = 303) disagreed or strongly disagreed that their medical training related to childhood obesity was adequate. With regard to specific competencies and additional training needed, quantitative and qualitative data revealed …

Social Connectedness, Social Support And The Health Of Older Adults: A Comparison Of Immigrant And Native-Born Canadians, Natalie Iciaszczyk

Electronic Thesis and Dissertation Repository

Considerable research exists on the influence of social relationships for health in old age. However, few studies have compared the associations of social connectedness and social support with the health of older adults. Using data from the CCHS-Healthy Aging, this study examines how these constructs are related to the self-reported health status of immigrant and native-born adults aged 65+. Results show that social connectedness and social support are differently associated with health in later life; whereas connectedness is linked to better health, social support is negatively related with health once levels of social connectedness are considered. Furthermore, these associations hold …

Uprootedness And Health Of Women Temporary Agricultural Workers: A Critical Ethnography, Kathryn Ann Edmunds

Electronic Thesis and Dissertation Repository

In recent years, increased global mobility for work, gendered approaches to migration, and the vulnerabilities of women in temporary and precarious work have received increased attention. However, there is limited evidence regarding the health of women temporary foreign workers in Canadian agriculture. The purposes of this critical ethnography using feminist and intersectional perspectives were to: 1) explore and describe women temporary agricultural workers’ experiences and meanings of health in the context of prolonged and repeated uprootedness from their homes and families, 2) to critically examine how the intersections of current gendered, global, political and economic conditions shaped their everyday lives …

The Experiences Of Black Men Living With Hypertension In Ontario, Canada: A Critical Narrative Study, Rob Haile

Electronic Thesis and Dissertation Repository

To date, most Black hypertension literature centers on the risk factors predictive of hypertension, and the treatment of this condition within this population. The purpose of this critical narrative inquiry is to better understand how Black men make sense of their hypertension diagnosis, and how they negotiate this condition into their everyday lives. Eight individual in-depth interviews were utilized to elicit stories from four Black men living in Ontario, Canada. Additionally, a critical stance was used in this study to illuminate how racism and power dynamics embedded within social, historical, and political contexts affected participants’ experiences of living with hypertension. …

The Impact Of Obesity On Employment Participation And Earnings Among Working-Age Women In Canada: Evidence From The Nphs Longitudinal Data, Samantha L. Larose

Electronic Thesis and Dissertation Repository

Background: The direct medical care costs attributable to obesity are well-known, but little is known about the indirect costs of obesity. In particular, less is known about the impact of obesity on employment participation and earnings, especially among women in Canada.

Objectives: The objectives of this study are to examine the association between obesity and employment participation and earnings, if employed, among Canadian women.

Methods: Data were taken from the last six cycles of the National Population Health Survey from 2000/01-2010/11 longitudinal cohort data from women aged 18-53 years. The association between obesity and labour market participation was analyzed using …

Exploring The Iranian-Canadian Family Experience Of Dementia Caregiving: A Phenomenological Study, Sevil Deljavan

Electronic Thesis and Dissertation Repository

Presently in Canada, there are approximately 500,000 individuals living with dementia, which is expected to increase to over one million by 2038. With Canada’s minority elderly population growing, the number of Iranian-Canadian older adults living with dementia is expected to rise as well. Family caregivers are a significant source of help among Iranian-Canadians and the provision of informal care by adult children for parents with dementia in the Iranian culture is an expression of love and dedication.

This study explored the meaning of the experience of Iranian adult children in Canada caring for a parent with Alzheimer’s disease, the values …

Sexual Trafficking In The Canadian Context: Exploring The Political Landscape, Examining Discourse, And Identifying Health Issues Among Women With Lived Experience, Hoda Malakouti-Nejad

Electronic Thesis and Dissertation Repository

Although human trafficking has a long history, it has more recently become a topic of profound interest in popular culture, in political debates on sex work and immigration, and among law enforcement and social service providers. However, the widespread interest in human trafficking has not translated into a clear or consistent understanding of the phenomenon or the experiences of those who have been trafficked. This study sought to explore the perspectives of women who have been trafficked for sexual exploitation and the professionals who work with them. Specifically, the study examined three key issues in sexual trafficking: the political and …

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 …