Medicine and Health Sciences Commons^™

Sleep, Sleepiness, And Driving Performance In Healthcare Shiftworkers, Melissa Knott

Electronic Thesis and Dissertation Repository

Almost half of Canadian healthcare workers are employed in rotating day/night shifts to provide essential 24-hour services. However, poor sleep quantity and quality are pervasive in shiftwork and may negatively impact cognitive functions required for driving. Furthermore, healthcare shiftworkers (HCSW) are under-represented in research examining shiftworkers’ sleep and driving performance. Thus, this dissertation examined sleep, sleepiness and driving performance in HCSW via three aims. First, chapter 2 aimed to quantify and describe HCSWs’ sleep-related driving experiences and advance the understanding of occupational adaptations used by HCSWs to meet driving demands. Second, chapter 3 aimed to quantify differences in sleep, sleepiness, …

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 …

A Picture Of Spirituality In Youth Living With Bipolar Disorder, Michelle S. Solomon

Electronic Thesis and Dissertation Repository

There is a paucity of literature concerning how youth living with bipolar disorder understand and experience spirituality. The management of bipolar disorder through psychosocial interventions such as spirituality is critical due to the chronic and complex nature of the illness and the fact that pharmacotherapy has not been found to fully restore mood and quality of life (Michalak et al., 2016; Miller et al., 2014; Sanchez-Moreno et al., 2009; Stroppa & Moreira-Almeida, 2013). Spirituality has been defined as being concerned with the ultimate questions in life; the meaning in life that a person gains in relation to something bigger than …

Regulation Of Health Ai Chatbots In Ontario, Mingi Chu

Electronic Thesis and Dissertation Repository

Artificial Intelligence (AI) has made remarkable strides in healthcare, from revolutionizing medical imaging, patient support, research insight, and health education. However, a recent shift from query-based to interactive and regenerative AI presents a question of properly facilitating its development. Upon close inspection, regulations and policy adaptations lag behind the rapidly advancing field of medical AI which raises concerns over governance and societal implications. This paper explains some of the technical and ethical considerations surrounding the use of health AI applications with chatbots as a specific example. It evaluates the existing policies and regulations in Ontario, Canada, that govern the production …

The Population-Centered Medical Model: A Theory Of Practice For Public Health And Preventive Medicine, Sudit Ranade

Electronic Thesis and Dissertation Repository

Introduction

Public health physicians occupy a unique place in the fields of both medicine and public health. Trained in each field, and often holding positions of authority in public health systems, public health physicians are sometimes challenged to identify their roles in either field of practice. Public health physicians work to achieve population health, but there has been limited theoretical development in this field of practice.

Objectives

The objective of this research was to develop an empirical theory of practice for public health physicians.

Methods

A literature review of current practice models applicable to public health physicians was performed. A …

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 …

Lbnp Reduces Cerebral Perfusion But Does Not Impact Executive Function, James Van Riesen

Electronic Thesis and Dissertation Repository

A growing body of literature has demonstrated that a single bout of aerobic exercise and/or hypercapnic manipulations increase cerebral blood flow (CBF) and are linked to a transient (i.e.,min) post-intervention executive function (EF) benefit. However, there are no direct studies examining whether a transient decrease in CBF elicits a post-intervention EF decrement. Accordingly, my thesis employed 10-min single bout manipulations of -30 mmHg and -50 mmHg lower-body negative pressure (LBNP) to determine whether a transient reduction in CBF impacts EF. LBNP was applied as it renders sub-atmospheric pressure to the lower limbs and redistributes blood from the upper to lower …

Jumping Ship And Going To The Other Side: Experiences Of Nurses Who Retrain As Doctors, Anne Robinson

Electronic Thesis and Dissertation Repository

Aim: To gain an understanding of the experience of medical training for nurses who retrain as doctors.

Methods: Using a Constructivist Grounded Theory design, semi-structured interviews were conducted with thirteen medical students and residents who had completed nursing training prior to entering medical school. Interviews were audiotaped and professionally transcribed. Transcripts were coded and analysis in an inductive manner to construct central themes.

Findings: Many left nursing due to negative effects of a hierarchal system. As preclinical medical students they felt both advantaged and burdened by their advanced clinical knowledge. During clinical placements, they experienced social distress and role confusion …

The Significance Of Injuries And Anatomical Patterns Of Trauma In Pedestrian And Cyclist Fatalities And Their Association With Motor Vehicle Collision Dynamics And Post-Collision Kinematics, Moheem M. Halari

Electronic Thesis and Dissertation Repository

Deaths from motor vehicle collisions (MVCs) are a major global health concern, with over 1.35 million fatalities reported annually by the United Nations. More than half involve pedestrians, cyclists, and motorcyclists. Post-mortem examinations by pathologists determine the cause of death and mechanisms of injury and play a significant role in the investigation of the deaths of vulnerable road users.

The purpose of this study was to understand the injury patterns sustained by pedestrians and cyclists fatally injured in motor vehicle impacts.

This study reviews the development of injury patterns described in the medical literature and identifies their limitations in the …

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

Electronic Thesis and Dissertation Repository

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 …

Interaction Of Circularrna And Microrna-9-5p In The Mediation Of Cardiac Fibrosis In Diabetic Cardiomyopathy, Honglin Wang

Electronic Thesis and Dissertation Repository

Diabetic cardiomyopathy (DCM) is a chronic diabetic complication affecting the heart. It is a significant and independent contributor to heart failure and characterized by cardiac fibrosis and left ventricular hypertrophy. Endothelial cells are the first cells to be damaged by hyperglycemia, leading to epigenetic modifications and subsequent signaling and transcription derangements that lead to endothelial dysfunction and therefore cardiac fibrosis. The role of the two noncoding RNA microRNA-9-5p and circRNA_012164 are investigated using in vivo and in vitro models of hyperglycemia. CircRNA_012164 is upregulated in the hearts of diabetic mice and in cells exposed to high glucose. This results in …

Multi-Arm Randomized Control Trials In Inflammatory Bowel Disease: A Literature Review And An Illustration Of Methods For Analysis, Sahiba Saini

Electronic Thesis and Dissertation Repository

This thesis aimed to review the literature on multiple-arm randomized control trials in inflammatory bowel disease (IBD) and to illustrate how to analyze these trials, focusing on appropriately controlling the type 1 error rates. The literature review found 247 trials published from the inception of each database to April 2014, of which 122 (49%) trials were multiple-arm trials and of those, 59 (48%) trials were on ulcerative colitis and 63 (52%) on Crohn’s disease. A published assessment tool was adopted to assess whether controlling of Type I error rates was needed. Despite the common use of this trial design 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.

Electronic Thesis and Dissertation Repository

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 …

Exploring Level Ii Nicu Case Study Research Challenges: Embracing The Proposal Journey, Engaging In Retrospective Pragmatic Reflection On Challenges, And Enhancing Research Within Graduate Education And The Profession Of Massage Therapy, Amanda R. Winter

Electronic Thesis and Dissertation Repository

Background

Infants born preterm and low birth weight face health risks; studies demonstrate massage therapy (MT) promotes weight gain and earlier hospital discharge. A gap remains in understanding the role of massage in preterm care within Canada.

Research Methods and Theoretical Orientation – Part A

Case study methodology is proposed to examine the nature of MT as a healthcare intervention within an Ontario Level II Neonatal Intensive Care Unit. Constrained by a Master’s program’s two-year time limit and contextual challenges, the project could not secure support.

Research Methods and Theoretical Orientation – Part B

Introducing a retrospective pragmatic reflective approach, …

The Lived Experience Of Persons With Parkinson's Disease In Non-Contact Boxing Programs, Laura Mulder

Electronic Thesis and Dissertation Repository

We conducted a scoping review to identify articles examining non-contact boxing programs for persons with Parkinson’s disease (PwP). Results suggested that gait, mobility, balance, and quality-of-life were the most-studied outcomes. Many qualitative articles explored the experience within in-person boxing programs, but no articles explored experiences within virtual boxing programs. We followed this review with an interpretative phenomenological analysis aimed at addressing this research gap and interviewed six PwP who had engaged with both virtual and in-person Rock Steady Boxing programming. Results suggested that although the virtual setting improved elements of the individual experience, the physical and social aspects were better …

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

Electronic Thesis and Dissertation Repository

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 …

The Development, Refinement, Implementation, And Impact Of A Nurse-Led Health Coaching Self-Care Management Intervention For Heart Failure, Maureen Leyser

Electronic Thesis and Dissertation Repository

Background: Heart Failure (HF) hospitalizations and readmissions remain unacceptably high despite medical advances and, in spite of the education provided to HF patients regarding the signs of fluid accumulation, HF exacerbations persist. There is a gap between patients recognizing the signs of fluid accumulation and performing timely self-management activities to control it. Currently, there is no standardized approach for nurse-led health coaching to assist patients in HF symptom management oriented to self-care activities within a primary healthcare (PHC) setting. There is a need to better understand how self-care interventions can be delivered within a PHC practice, which health outcomes …

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. …

Assessing Copd Care Quality In A Rural Ontario Primary Care Clinic: A Retrospective Chart Review, Daniel Henke

Electronic Thesis and Dissertation Repository

Background: Primary chronic obstructive pulmonary disease (COPD) care may be worse in rural versus more urban environments.

Purpose: To evaluate the quality of COPD care in a rural Ontario primary care clinic.

Methods: A 12-month retrospective chart review study was conducted between June 2022 and January 2023 at a Goderich, Ontario primary care clinic. Electronic medical records (EMRs) were randomly selected for inclusion. Baseline sociodemographic (e.g., occupation) and health (e.g., smoking status) characteristics were extracted as well as information regarding COPD care received (i.e., Health Quality Ontario [HQO] Quality Standard [QS] indicators; n=33. The primary study outcome was overall proportion …

The Process Of Art Creation Among Mothers From Ontario Who Have Experienced Gender-Based Violence, Madison L. Broadbent

Electronic Thesis and Dissertation Repository

Mothers who have experienced gender-based violence (GBV) face physical, mental, and social health implications. Participating in artmaking has the potential to reduce these consequences. An arts-based study including in-depth interviews was conducted with 13 mothers with histories of GBV. The creative processes involved in artmaking amongst mothers with histories of GBV were explored. Mothers demonstrated using symbols, thoughtful colour selection, and choice of artistic medium when creating their artforms. Moreover, mothers’ experiences of storytelling experiences of GBV through art were examined. Mothers described using art as a means of communication, emotional processing and healing through art, and the process of …

Fracture Prediction And Prevention In Individuals With Chronic Kidney Disease, Andrea C.J. Cowan

Electronic Thesis and Dissertation Repository

Patients with chronic kidney disease (CKD) face increased fracture risk yet our understanding and management of this risk remains poor. We conducted three studies using retrospective cohort analysis in Ontario, Canada. We developed a 3-year fracture prediction model for patients receiving dialysis. Secondly, we contrasted fracture rates among patients on SGLT2i or DPP4i medications, stratified by kidney function. Lastly, we examined hypocalcemia incidence post-denosumab prescription, stratified by kidney function.

Findings: The fracture risk tool, incorporating demographic and lab data, performed well (AUC 0.72). SGLT2i did not elevate fracture risk vs. DPP4i (HR 0.95 [95% CI 0.79,1.13]). In those prescribed denosumab, …

Social Connectedness, Adolescent Mental Health And Well-Being At The Later Stages Of The Covid-19 Pandemic: A Mixed Methods Exploration, Sarah Abdunnabi

Electronic Thesis and Dissertation Repository

COVID-19 posed novel challenges by limiting in-person interactions and shifting interactions online. Effects of online and offline social connectedness on adolescent mental health and well-being, and the moderating role of the social determinants of health (SDoH) were explored. Canadian adolescents (n=1,586; M_age=15.3, range 13 to 18 years; surveyed summer 2022) reported their social connectedness, psychological distress, and mental well-being. An ordinal logistic regression was performed to examine the association between social connectedness (online and offline) and dual-factor mental health. Responses to two open-ended survey questions were analyzed. Social disconnection was associated with higher odds of being in a …

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

Electronic Thesis and Dissertation Repository

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

Electronic Thesis and Dissertation Repository

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

Electronic Thesis and Dissertation Repository

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 …

A Comparison Of The Thulium Fiber Laser Versus Holmium:Yag Laser Lithotripsy Of Upper Urinary Tract Calculi: Preliminary Results Of A Randomized Prospective Clinical Trial, Eduardo Gonzalez Cuenca

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The Holmium:yttrium-aluminium-garnet (Ho:YAG) laser has become an indispensable tool in Endourology since its introduction in 1995, due to its safe and efficient urinary stone fragmentation capabilities. The Thulium Fiber Laser (TFL), is the latest innovation with early clinical experience suggesting improvements over the Ho:YAG. This prospective, randomized controlled study aims to compare clinical outcomes of Ho:YAG versus TFL lithotripsy for upper urinary tract calculi. Patients undergoing ureteroscopy for renal stones (size 8-20mm, density >600 HU) from a single institution were prospectively recruited.

Thirty-eight patients have been recruited (Ho:YAG=20, TFL=18). The laser-on time (p=.330), total operative time (p …

Treatment Of Blunt Cerebrovascular Injury - A Systematic Review And Meta-Analysis, Multicenter Retrospective Review, And Protocol For A Feasibility Randomized Controlled Trial, Jovana Momic

Electronic Thesis and Dissertation Repository

Blunt cerebrovascular injury (BCVI) is an often-overlooked clinical problem that can result in stroke and cause devastating, potentially permanent, neurologic disabilities in young and otherwise healthy trauma patients. Early diagnosis and treatment of BCVI can reduce the risk of stroke and prevent disability, however, treatment also carries a risk of bleeding complications. More research is needed to understand the optimal management strategy to reduce the risk of stroke while minimizing bleeding complications.

The aim of this thesis is to review and critically appraise the literature to better understand the efficacy of various treatment strategies in preventing stroke following BCVI, evaluate …

Understanding The Information Needs Of Clients And Caregivers Regarding Early Psychosis: A Conventional Content Analysis, Tanvin K. Juneja

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A first episode of psychosis is defined by the first presentation of psychotic symptoms that have gone untreated, characterized by a loss of contact with reality and significant declines in functioning. Low psychosis literacy among clients and caregivers can result in a delay in receiving treatment. This study sought to understand the information needs of clients and caregivers regarding early psychosis. Using a conventional content analysis, we conducted a secondary analysis of 64 transcripts from clients, caregivers, family physicians, and early psychosis intervention clinicians. Clients and caregivers often described having difficulties recognizing symptoms of early psychosis until they became overt …

Islamic Ethical Considerations On Medical Decision-Making In Adolescence, Nuray Catic

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Medical decision-making in adolescence has not been studied in-depth from the Islamic bioethics perspective. The objective of this dissertation is to use the Islamic ethical position to explore the adolescent medical decision-making process in Canada so as to contribute to building frameworks for Islamic bioethics consumers such as patients, physicians and policymakers. A descriptive literature review is conducted to analyze data from related disciplines such as Islamic theology, developmental psychology, law and clinical ethics through principles of Islamic ethics such as objectives of Sharīʿa, legal maxims and operational maxims. The concepts of taklīf, ahliyya, bulūgh and rushd are focused on …