Risk Stratification For Treatment Decisions In People At Ultra-High Risk For Psychosis: A Cost-Effectiveness Analysis, Olajumoke Marissa Ologundudu

Electronic Thesis and Dissertation Repository

People with psychotic disorders have long-term negative health outcomes and contribute large health system costs. Intervening among those at ultra-high risk (UHR) for psychosis may prevent or mitigate risk for psychotic disorder; however, it is unclear if we should treat all UHR individuals or only those above a certain risk threshold. The objectives were to systematically review the literature on the cost-effectiveness of UHR programs, and to conduct an economic evaluation of a risk stratification strategy, where treatment decisions are based on the probability of transitioning to psychotic disorder. Our systematic review found that UHR programs are potentially cost-effective. The …

Intersectional Social Inequalities And Cognitive Functioning Among Community-Dwelling Older Adults In England: A Decomposition Analysis Of The Mediating Role Of Loneliness, Chantel Walwyn

Electronic Thesis and Dissertation Repository

Normative cognitive decline is an emerging public health issue for older adult populations. It is necessary that we take an intersectional approach to examining heterogeneity in cognitive health outcomes. Using complex longitudinal survey data from the English Longitudinal Study of Ageing (ELSA), multiple linear regression models were used to examine the relationship between intersectional group membership based on age, education, and sex, and change in cognitive functioning domains (memory function, and executive function) over an 8-year period. Three-way decomposition analysis was also used to examine the mediating effect of loneliness on the association between intersectional group membership and the change …

Population-Based Studies On Medications And Fall-Related Injury In Older Adults, Yu Ming

Electronic Thesis and Dissertation Repository

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one …

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 …

Trends And Factors Associated With Suicide Deaths In Older Adults, Eada Novilla-Surette

Electronic Thesis and Dissertation Repository

Suicide in older adults is a significant overlooked problem worldwide; particularly in Canada where a national suicide prevention strategy has not yet been established. This population-level study utilized and analyzed linked administrative health care databases (from 2011-2015) that were available at ICES (provincial health care administrative data steward), to build a better understanding of suicide (rate; trends; risks/preventive factors) in older adults living in Ontario, Canada. The findings suggest that suicide remains a persistent cause of death in older adults (with an average annual suicide rate of 0.1 per 1000 people over 5 years; the risks include being male, living …

Uganda As A Role Model For Pandemic Containment In Africa, Ahmed M. Sarki, Alex Ezeh, Saverio Stranges

Epidemiology and Biostatistics Publications

No abstract provided.

Participatory Video As A Novel Recovery-Oriented Intervention In Early Psychosis: A Pilot Study., Arlene G Macdougall, Sahana Kukan, Elizabeth Price, Sarah Glen, Richelle Bird, Laura Powe, Joshua C. Wiener, Paul H Lysaker, Kelly K Anderson, Ross Mg Norman

Epidemiology and Biostatistics Publications

BACKGROUND: Personal narrative plays an important role in the process of recovery from psychotic illnesses. Participatory video is a novel, active intervention that can be used as a tool for fostering narrative development among people with psychosis.

AIM: To assess the feasibility, acceptability and potential clinical utility of participatory video as an innovative tool for promoting recovery in early psychosis.

METHODS: Ten outpatients of an early psychosis intervention programme were recruited to participate in 13 biweekly workshops to plan, film and produce documentary-style videos of their experiences. Feasibility was measured through recruitment and retention. Acceptability was measured through workshop attendance …

The Impact Of The Diabetes Management Incentive On Diabetes-Related Services: Evidence From Ontario, Canada., Thaksha Thavam, Rose Anne Devlin, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician …

Understanding Physical Activity Behaviour In Ontario, Canada: A Cross-Sectional Cohort Analysis Of Carrot Rewards App Users, David D. Mchugh

Electronic Thesis and Dissertation Repository

Little device-measured data are available to describe the physical activity (PA) of rural-dwelling individuals living with chronic disease. PURPOSE: From accelerometer data collected using a smartphone app (‘Carrot Rewards’), we sought to provide mean daily step counts for app users in general and by age and gender for those living in rural/urban areas and those self-reporting a chronic disease or not. METHODS: This cross-sectional cohort study used device-assessed data from Ontario app users (i.e., PA data collected over a 7-day period for each user) who completed an in-app chronic disease survey from December 2018 to April 2019. A …

Stirring The Pot: Switching From Blended Fee-For-Service To Blended Capitation Models Of Physician Remuneration., Nibene H Somé, Rose Anne Devlin, Nirav Mehta, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

In Canada's most populous province, Ontario, family physicians may choose between the blended fee-for-service (Family Health Group [FHG]) and blended capitation (Family Health Organization [FHO] payment models). Both models incentivize physicians to provide after-hours (AH) and comprehensive care, but FHO physicians receive a capitation payment per enrolled patient adjusted for age and sex, plus a reduced fee-for-service while FHG physicians are paid by fee-for-service. We develop a theoretical model of physician labor supply with multitasking to predict their behavior under FHG and FHO, and estimable equations are derived to test the predictions empirically. Using health administrative data from 2006 to …

Mood And Anxiety Disorders, Measurement, And Migrant Groups In Ontario, Jordan Edwards

Electronic Thesis and Dissertation Repository

Our objectives were to: (1) evaluate the current literature on the epidemiology of mood or anxiety disorders among migrant groups; (2) assess how current tools for measuring mood or anxiety disorders at the population level influence our understanding of the epidemiology by a) analyzing the concordance between two commonly used population measures, and b) using a Bayesian analysis to create a combined estimate using both measures; (3) estimate the prevalence and effects of potential risk factors on the prevalence of mood or anxiety disorders among first-generation migrant groups compared to the general population in Ontario. We conducted a systematic review …

Understanding The Determinants Of The Cost Of Coronary Artery Bypass Graft Surgery, Hun Lee

Electronic Thesis and Dissertation Repository

Introduction: The relationship between patient demographics, clinical factors, and cost of coronary artery bypass graft (CABG) is complex. Investigation of these relationships is important to aid clinical practice and inform reimbursement models. This thesis analyzes multiple different domains in order to understand the significant factors that impact the cost of CABG at the London Health Sciences Centre (LHSC).

Methods: Model selection, construction of nested descriptive models, exploration of mediation analysis of the impact of peri-operative factors and cost through length of stay, and construction of estimative models were performed.

Results: Several baseline characteristics, socio-demographics, peri-operative variables, and post-operative variables were …

An 8-Year Longitudinal Assessment Of Health-Related Quality Of Life In Children With Epilepsy, Emily Chemnitz

Electronic Thesis and Dissertation Repository

This study estimated the course of health-related quality of life (HRQL) over 8 years among children newly diagnosed with epilepsy. Levels of HRQL in children newly diagnosed with epilepsy were assessed over 8 years and compared to levels reported for peers in the general population. Data came from the Health-Related Quality of Life in Children with Epilepsy Study, a multi-center prospective study of children in Canada with epilepsy. Parents of children with epilepsy reported their children were comparable to (or better than) their counterparts in the general population on the majority of individual health concepts 8 years post diagnosis. On …

Call To Action: Sars-Cov-2 And Cerebrovascular Disorders (Cascade), Shahram Abootalebi, Benjamin M. Aertker, Mohammad Sobhan Andalibi, Negar Asdaghi, Ozlem Aykac, M. Reza Azarpazhooh, M. Cecilia Bahit, Kristian Barlinn, Hamidon Basri, Reza Bavarsad Shahripour, Anna Bersano, Jose Biller, Afshin Borhani-Haghighi, Robert D. Brown, Bruce Cv Campbell, Salvador Cruz-Flores, Deidre Anne De Silva, Mario Di Napoli, Afshin A. Divani, Randall C. Edgell, Johanna T. Fifi, Abdoreza Ghoreishi, Teruyuki Hirano, Keun Sik Hong, Chung Y. Hsu, Josephine F. Huang, Manabu Inoue, Amanda L. Jagolino, Moira Kapral, Hoo Fan Kee, Zafer Keser, Rakesh Khatri

Epidemiology and Biostatistics Publications

Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. Methods: This is an international, multicenter, hospital-based …

The Prevalence Of Multimorbidity Among People With Non-Affective Psychotic Disorders 10-Years After First Diagnosis, Myanca D. Rodrigues

Electronic Thesis and Dissertation Repository

Prior research suggests that people with psychotic disorders have an excess risk of individual chronic conditions, however less is known about their risk of co-occurring multiple chronic health conditions; that is, multimorbidity. The overall objective of this thesis was to examine the association between psychotic disorders and multimorbidity using two complementary studies. First, our systematic review and meta-analysis of fourteen studies found that people with psychotic disorders had an increased risk of 2+ chronic conditions relative to those without psychosis (RR=1.69, 95%CI=1.37,2.08). Second, our retrospective matched cohort study found that people with psychotic disorders treated by an early psychosis intervention …

Examining The Simultaneous Influence Of Individual And Neighborhood Determinants On Cardiovascular Health: A Multilevel Study In Canadian Adults, Sarah Singh

Electronic Thesis and Dissertation Repository

Introduction: Previous studies have found that the cardiovascular health of individuals may be influenced not only by their personal characteristics, but also independently by their social relationships and the neighborhoods in which they reside. Still, it is unclear how these determinants act together to influence cardiovascular health and whether these determinants account for differences in cardiovascular health among Canadian adults.

Objective: The main objectives were: 1) to examine the status of cardiovascular health in Canadian adults and, 2) to describe how individual and neighborhood determinants can: a) act together to influence cardiovascular health and, b) account for differences …

Risk Of New Bloodstream Infections And Mortality Among People Who Inject Drugs With Infective Endocarditis., Charlie Tan, Esfandiar Shojaei, Joshua C. Wiener, Meera Shah, Sharon Koivu, Michael Silverman

Epidemiology and Biostatistics Publications

IMPORTANCE: People who inject drugs (PWID) who are being treated for infective endocarditis remain at risk of new bloodstream infections (BSIs) due to ongoing intravenous drug use (IVDU).

OBJECTIVES: To characterize new BSIs in PWID receiving treatment for infective endocarditis, to determine the clinical factors associated with their development, and to determine whether new BSIs and treatment setting are associated with mortality.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was performed at 3 tertiary care hospitals in London, Ontario, Canada, from April 1, 2007, to March 31, 2018. Participants included a consecutive sample of all PWID 18 years or …

The Impact Of Improved Access To After-Hours Primary Care On Emergency Department And Primary Care Utilization: A Systematic Review., Michael Hong, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

Access to after-hours primary care is problematic in many developed countries, leading patients to instead visit the emergency department for non-urgent conditions. However, emergency department utilization for conditions treatable in primary care settings may contribute to emergency department overcrowding and increased health system costs. This systematic review examines the impact of various initiatives by developed countries to improve access to after-hours primary care on emergency department and primary care utilization. We performed a systematic review on the impact of improved access to after-hours primary and searched CINAHL, EMBASE, MEDLINE, and Scopus. We identified 20 studies that examined the impact of …

Epidemiology Of Upper Urinary Tract Stones And Stone Management In Autosomal Dominant Polycystic Kidney Disease, Vinusha Kalatharan

Electronic Thesis and Dissertation Repository

Upper urinary tract stones are a major determinant of pain and is suggested to accelerate disease progression in patients with autosomal dominant polycystic kidney disease (ADPKD). For these reasons, stones should be optimally managed in patients with ADPKD. However, the kidney distortions may make managing stones challenging in patients with ADPKD. Understanding of the epidemiology of upper urinary tract stones and stone intervention and the outcomes of stone interventions is limited. The aim of this thesis is to understand the epidemiology of upper urinary tract stones and stone interventions and consequences of stone management in patients with ADPKD.

To address …

Excess Mortality From Covid-19: A Commentary On The Italian Experience, Paolo Pasquariello, Saverio Stranges

Epidemiology and Biostatistics Publications

No abstract provided.

Age At Migration And The Risk Of Psychotic Disorders: A Systematic Review And Meta-Analysis., Kelly K. Anderson, Jordan Edwards

Epidemiology and Biostatistics Publications

OBJECTIVE: To conduct a systematic review and meta-analysis of the existing evidence on the association between age at migration and the risk of psychotic disorders.

METHODS: Observational studies were eligible for inclusion if they presented data on the association between age at migration and the risk of psychotic disorders among first-generation migrant groups. We used two random effects meta-analyses to pool effect estimates for each stratum of age at migration relative to (i) a native-born reference category and (ii) the youngest age stratum (0 to 2 years).

RESULTS: Ten studies met inclusion criteria, and five were included in the meta-analysis. …

Evaluating Quantitative Methods For Intercategorical-Intersectionality Research: A Simulation Study, Mayuri Mahendran

Electronic Thesis and Dissertation Repository

This study evaluated eight quantitative methods for their predictive accuracy for intersectionally-defined subgroups, via a simulation study. The methods included two forms of single-level regression with interaction terms, cross-classification, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA), and four decision tree methods: classification and regression trees (CART), conditional inference trees, chi-square automatic interaction detector, and random forest. The simulated datasets varied by outcome variable type, input variable types, sample size, and size and direction of the effects. Predictive accuracy improved with increasing sample size for all methods except CART. At small sample sizes, random forest and MAIHDA generally created …

Concordance Between Health Administrative Data And Survey-Derived Diagnoses For Mood And Anxiety Disorders, J. Edwards, A. Thind, S. Stranges, M. Chiu, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Objective: To assess whether estimates of survey structured interview diagnoses of mood and anxiety disorders were concordant with diagnoses of these disorders obtained from health administrative data.

Methods: All Ontario respondents to the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) were linked to health administrative databases at ICES (formerly known as the Institute for Clinical Evaluative Sciences). Survey structured interview diagnoses were compared with health administrative data diagnoses obtained using a standardized algorithm. We used modified Poisson regression analyses to assess whether socio-demographic factors were associated with concordance between the two measures.

Results: Of the 4157 Ontarians included in our …

Social Connectedness And Self-Perceived Mental Health In Canadian Transitional Aged Youth, Romaisa Pervez

Electronic Thesis and Dissertation Repository

Introduction:Transitional aged youth (TAY; ages 15-24) is a vulnerable age group that face several life changes which contribute to many forms of distress in their lives.

Objective:To assess the impact social connectedness has on self-perceived mental health in Canadian TAY.

Methods:The dataset provided by the Canadian Community Health Survey 2016 cycle was used. Listwise deletion was used to handle missing data. The final sample size for the study was 5,378 youth between the ages of 15-24. Linear and ordinal logistic regressions were conducted for the statistical analysis of the dataset.

Results:With every point decrease in social …

Proportion Of Canadian Adults With Unreported Type 2 Diabetes Who Experience A Related Hospitalization: Results From Canadian Community Health Survey And Discharge Abstract Database Linkage, Aini Khan

Electronic Thesis and Dissertation Repository

Abstract

Background: People with type 2 diabetes (T2D) may go undiagnosed and subsequently be hospitalized with T2D.

Objective: Determine the percentage of Canadians, with unreported T2D, who experience a T2D hospitalization

Methods: Using linked dataset, respondents who reported no diabetes in the Canadian Community Health Survey, were followed in the Discharge Abstract Database for T2D hospitalization event.

Results: 0.56% of men and 0.44% of women, who reported no diabetes, were hospitalized with T2D. Older Age, higher BMI and worse self-reported health increased T2D hospitalization in both men and women. In women, drinking alcohol, smoking tobacco and lower physical activity were …

Diversification Of Research Methodological Approach During Model Enhancements In Health Information System Research, Uche Ikenyei

Africa Western Collaborations Day 2020 Abstracts

No abstract provided.

The Epidemiology Of Overweight And Obesity In Ghana: Examination Of Predictors And Risk Groups Among Women Of Childbearing Age, Jason Mulimba Were, Emmanuel Kojo Kyeremeh, Bridget Annor, Saverio Stranges

Africa Western Collaborations Day 2020 Abstracts

No abstract provided.

Epilepsy Risk Among Survivors Of Intensive Care Unit Hospitalization For Sepsis, Tresah C. Antaya, Britney N. Allen, Lucie Richard, Salimah Z. Shariff, Gustavo Saposnik, Jorge Burneo

Neuroepidemiology Research Unit Project Summaries

Research Summary: Key Findings

• 407 (0.28%) patients developed epilepsy within 2 years of their ICU discharge, 103 (25.3%) of whom were exposed to sepsis.
• Sepsis survivors were significantly more likely to develop epilepsy, relative to non-septic ICU survivors.
• Among sepsis survivors, epilepsy risk increased with age and was higher among those with chronic kidney disease.

After-Hours Incentives And Emergency Department Visits: Evidence From Ontario Forthcoming At Canadian Public Policy, Rose Anne Devlin, Koffi Ahoto Kpelitse, Lihua Li, Nirav Mehta, Sisira Sarma

Epidemiology and Biostatistics Publications

No abstract provided.

Evaluating The Effectiveness Of Aquatic Therapy On Mobility, Balance, And Level Of Functional Independence In Stroke Rehabilitation: A Systematic Review And Meta-Analysis., Alice Mary Iliescu, Amanda Mcintyre, Joshua C. Wiener, Jerome Iruthayarajah, Andrea Lee, Sarah Caughlin, Robert Teasell

Epidemiology and Biostatistics Publications

OBJECTIVE: To meta-analyze and systematically review the effectiveness of aquatic therapy in improving mobility, balance, and functional independence after stroke.

DATA SOURCES: Articles published in Medline, Embase, CINAHL, PsycINFO, and Scopus up to 20 August 2019.

STUDY SELECTION: Studies met the following inclusion criteria: (1) English, (2) adult stroke population, (3) randomized or non-randomized prospectively controlled trial (RCT or PCT, respectively) study design, (4) the experimental group received >1 session of aquatic therapy, and (5) included a clinical outcome measure of mobility, balance, or functional independence.

DATA EXTRACTION: Participant characteristics, treatment protocols, between-group outcomes, point measures, and measures of variability …