Medicine and Health Sciences Commons^™

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 …

Social Capital Associates With Better Cognitive Health, Oral Health And Epigenetic Age Deceleration: Findings From The Canadian Longitudinal Study On Aging., Aileen Liang, Noha Gomaa

Department of Medicine Publications

Background: Social exposures are linked to an array of health outcomes, especially around aging. In this study, we examined the association of social capital, defined as social relationships and networks, with clinical and biological outcomes including cognitive health, oral inflammation, and epigenetic aging. Methods: We used data from the Canadian Longitudinal Study on Aging (CLSA) (n =1,479; aged 45–85 years), categorizing social capital as structural and cognitive capital. Oral inflammation was determined as the presence of gum bleeding. Epigenetic aging was computed as the difference between chronological age and DNA methylation age. We constructed multivariable regression models adjusted for covariates …

Students' Attitudes, Beliefs And Perceptions Surrounding 2slgbtqia + Health Education And Inclusiveness In Canadian Physiotherapy Programs, Codie A Primeau, Holly T Philpott, Kyle Vader, Janelle Unger, Christina Y Le, Trevor B Birmingham, Joy C Macdermid

Physical Therapy Publications

BACKGROUND: Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons.

METHODS: We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours …

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 …

Knowledge, Behaviours, And Training Related To 2slgbtqia+ Health Education Amongst Entry-Level Physiotherapy Students In Canada: Results Of A Nationwide, Cross-Sectional Survey, Codie A Primeau, Holly T Philpott, Kyle Vader, Janelle Unger, Christina Y Le, Trevor B Birmingham, Joy C Macdermid

Physical Therapy Publications

BACKGROUND: Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada.

METHODS: We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August …

Exploring Quality Improvement For Diabetes Care In First Nations Communities In Canada: A Multiple Case Study., Meghan Fournie, Shannon L. Sibbald, Stewart B. Harris

Health Studies Publications

BACKGROUND: Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams' quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada.

METHODS: This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda Lee Terry, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B. Brown, Erin Christian, Thomas R. Freeman, Paul S. Gill, Shannon L. Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda L. Terry Dr., Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B Brown, Erin Christian, Thomas R Freeman, Paul S Gill, Shannon L Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

The Roles Of Family Physicians During A Pandemic., Maria Mathews, Leslie Meredith, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily G Marshall, Richard Buote, Lauren Moritz, Sarah Spencer, Shabnam Asghari, Judith B Brown, Thomas R Freeman, Paul S Gill, Rita K Mccracken, Madeleine Mckay, Bridget Ryan, Shannon L Sibbald, Stephen Wetmore, Eric Wong

Health Studies Publications

Family physicians play important roles throughout all stages of a pandemic response; however, actionable descriptions outlining these roles are absent from current pandemic plans. Using a multiple case study design, we conducted a document analysis and interviewed 68 family physicians in four Canadian regions. We identified roles performed by family physicians in five distinct stages of pandemic response: pre-pandemic, phased closure and re-opening, acute care crisis, vaccination, and pandemic recovery. In addition to adopting public health guidance to ensure continued access to primary care services, family physicians were often expected to operationalize public health roles (eg, staffing assessment centres), modulate …

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 …

Examining The Barriers, Facilitators And Attitudes Towards Covid-19 Vaccine And Public Health Measures For Black Communities In Canada: A Qualitative Study Protocol., Obidimma Ezezika, Bethelehem Girmay, Toluwalope Adedugbe, Isaac Jonas, Yanaminah Thullah, Chris Thompson

Health Studies Publications

INTRODUCTION: Black communities claim the highest number of cases and deaths due to COVID-19 in Canada. Generating culturally/contextually appropriate public health measures and strategies for vaccine uptake in black communities within Canada can better support the disproportionate impact of this pandemic. This study explores the barriers and enablers to public health measures limited to mask-wearing, disinfection, sanitation, social distancing and handwashing, as well as the barriers and attitudes towards COVID-19 vaccines among the black community.

METHODS AND ANALYSIS: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid our investigation. We will …

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 …

Parents’ Report Of Canadian Elementary School Children’S Physical Activity And Screen Time During The Covid-19 Pandemic: A Longitudinal Study, Emma Ostermeier, Patricia Tucker, Andrew Clark, Jamie A. Seabrook, Jason Gilliland

Paediatrics Publications

COVID-19 public health protocols have altered children’s daily routines, limiting their physical activity opportunities. The purpose of this study was to examine how the COVID-19 pandemic affected children’s (ages 10–12 years) physical activity and screen time, and to explore the impact of gender, socioeconomic status (SES), and public health constraints (i.e., facility use and social interaction) on the changes in children’s health behaviors. Online surveys were disseminated to parents at two time points: before COVID-19 (May 2019 to February 2020) and during COVID-19 (November to December 2020). Wilcoxon signed-rank tests were used to assess changes in physical activity and screen …

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 …

Are Family Medicine Residents Trained To Counsel Patients On Physical Activity? The Canadian Experience And A Call To Action., Jane Thornton, Karim Khan, Richard Weiler, Christopher Mackie, Robert Petrella

Family Medicine Publications

Physical inactivity is a leading risk factor for non-communicable diseases (NCDs) and early mortality. Family physicians have an important role in providing physical activity counselling to patients to help prevent and treat NCDs. Lack of training on physical activity counselling is a barrier in undergraduate medical education, yet little is known regarding physical activity teaching in postgraduate family medicine residency. We assessed the provision, content and future direction of physical activity teaching in Canadian postgraduate family medicine residency programs to address this data gap. Fewer than half of Canadian Family Medicine Residency Programme directors reported providing structured physical activity counselling …

The Good Food For Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol For A Two-Year Matched Control Pre-Post And Case Study, Rachel Engler-Stringer, Jennifer Black, Nazeem Muhajarine, Wanda Martin, Jason Gilliland, Janet Mcvittie, Sara Kirk, Hannah Wittman, Amin Mousavi, Sinikka Elliott, Brent Hills, Gordon Androsoff, Debbie Field, Brit Macdonald, Chelsea Belt, Hassan Vatanparast

Paediatrics Publications

Background: Good nutrition affects children's health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children's eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous …

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 …

Structural Distress: Experiences Of Moral Distress Related To Structural Stigma During The Covid-19 Pandemic, Javeed Sukhera, Chetana Kulkarni, Taryn Taylor

Obstetrics & Gynaecology Publications

INTRODUCTION: The COVID-19 pandemic has taken a significant toll on the health of structurally vulnerable patient populations as well as healthcare workers. The concepts of structural stigma and moral distress are important and interrelated, yet rarely explored or researched in medical education. Structural stigma refers to how discrimination towards certain groups is enacted through policy and practice. Moral distress describes the tension and conflict that health workers experience when they are unable to fulfil their duties due to circumstances outside of their control. In this study, the authors explored how resident physicians perceive moral distress in relation to structural stigma. …

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 Application Of Drones In Healthcare And Health-Related Services In North America: A Scoping Review, Bradley Hiebert, Elysée Nouvet, Vyshnave Jeyabalan, Lorie Donelle

Health Studies Publications

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Using drone aircraft to deliver healthcare and other health-related services is a relatively new application of this technology in North America. For health service providers, drones represent a feasible means to increase their efficiency and ability to provide services to individuals, especially those in difficult to reach locations. This paper presents the results of a scoping review of the research literature to determine how drones are used for healthcare and health-related services in North America, and how such applications account for human operating and machine design factors. Data were collected from …

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 …

Screening And Treatment Outcomes In Adults And Children With Type 1 Diabetes And Asymptomatic Celiac Disease: The Cd-Diet Study., Farid H Mahmud, Antoine B M Clarke, Kariym C Joachim, Esther Assor, Charlotte Mcdonald, Fred Saibil, Heather A Lochnan, Zubin Punthakee, Amish Parikh, Andrew Advani, Baiju R Shah, Bruce A Perkins, Caroline S Zuijdwijk, David R Mack, Dror Koltin, Emilia N De Melo, Eugene Hsieh, Geetha Mukerji, Jeremy Gilbert, Kevin Bax, Margaret L Lawson, Maria Cino, Melanie D Beaton, Navaaz A Saloojee, Olivia Lou, Patricia H Gallego, Premysl Bercik, Robyn L Houlden, Ronnie Aronson, Susan E Kirsch, William G Paterson, Margaret A Marcon

Paediatrics Publications

OBJECTIVE: To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.

RESEARCH DESIGN AND METHODS: Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA

RESULTS: Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%,

CONCLUSIONS: CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.

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 …

Multi-Dose Oral Ondansetron For Pediatric Gastroenteritis: Study Protocol For The Multi-Dose Oral Ondansetron For Pediatric Acute Gastroenteritis (Dose-Age) Pragmatic Randomized Controlled Trial, Stephen B Freedman, Sarah Williamson-Urquhart, Anna Heath, Petros Pechlivanoglou, Gareth Hopkin, Serge Gouin, Amy C Plint, Andrew Dixon, Darcy Beer, Gary Joubert, Christopher Mccabe, Yaron Finkelstein, Terry P Klassen

Paediatrics Publications

BACKGROUND: There are limited treatment options that clinicians can provide to children presenting to emergency departments with vomiting secondary to acute gastroenteritis. Based on evidence of effectiveness and safety, clinicians now routinely administer ondansetron in the emergency department to promote oral rehydration therapy success. However, clinicians are also increasingly providing multiple doses of ondansetron for home use, creating unquantified cost and health system resource use implications without any evidence to support this expanding practice.

METHODS/DESIGN: DOSE-AGE is a randomized, placebo-controlled, double-blinded, six-center, pragmatic clinical trial being conducted in six Canadian pediatric emergency departments (EDs). In September 2019 the study began …

Demographic And Socioeconomic Characteristics Of Canadian Medical Students: A Cross-Sectional Study., Rishad Khan, Tavis Apramian, Joel Hosung Kang, Jeffrey Gustafson, Shannon Sibbald

Health Studies Publications

BACKGROUND: While the importance of medical students' demographic characteristics in influencing the scope and location of their future practice is recognized, these data are not systematically collected in Canada. This study aimed to characterize and compare the demographics of Canadian medical students with the Canadian population.

METHODS: Through an online survey, delivered in 2018, medical students at 14 English-speaking Canadian medical schools provided their age, sex, gender identity, ethnicity, educational background, and rurality of the area they grew up in. Respondents also provided information on parental income, occupation, and education as markers of socioeconomic status. Data were compared to the …

Covid-19 Hospital Response In Canada And Kenya: A Comparative Study Of Practices At Aga Khan University Hospital Nairobi, Sunnybrook Health Sciences Centre, And University Hospital Network, Betty Wang

Africa Western Collaborations Day 2020 Abstracts

No abstract provided.

Perseverance, Faith And Stoicism: A Qualitative Study Of Medical Student Perspectives On Managing Fatigue, Taryn S Taylor, Alexandra L Raynard, Lorelei Lingard

Obstetrics & Gynaecology Publications

CONTEXT: Fatigue risk management (FRM) strategies offer a potential solution to the widespread problem of fatigued trainees in the clinical workplace. These strategies assume a shared perception that fatigue is hazardous. Despite the growing body of evidence suggesting that fatigue leads to burnout and medical errors, previous research suggests that residents perceive fatigue as a personal, surmountable burden rather than an occupational hazard. Before we can implement FRM, we need a better understanding of when and how such problematic notions of fatigue are adopted by medical trainees. Thus, we sought to explore how third-year medical students understand and manage the …

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 …