Public Health Commons^™

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 …

A Novel Spatio-Temporal Examination Of Children's Accessibility, Exposure, And Engagement To Parks And Recreation Spaces In Middlesex-London, Ontario, Malcolm K. Little

Electronic Thesis and Dissertation Repository

Children are spending more free time engaged in activities indoors, rather than in outdoor environments such as parks and recreation spaces. Parks and recreation spaces provide amenities that promote physical, cognitive, and social health among children. As it relates to the complexities of children’s living situations, properly measuring children’s levels of interactions with these spaces is poorly understood in geography research.

By examining various attributes of children, this thesis improves on the measurement of children’s levels of interactions with parks and recreation spaces. Research herein utilized household survey data, a high-resolution GIS dataset of environmental factors, and GPS logs from …

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 …

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 …

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 …

Breakfast Consumption And Diet Quality Of Teens In Southwestern Ontario, Nicolas Woods

Electronic Thesis and Dissertation Repository

BACKGROUND: Breakfast skipping has previously been associated with worse diet quality among adolescents, although research from Canada is relatively sparse. Additionally, many studies do not consider diet quality as a function of calories, which is problematic as skippers tend to consume less energy than consumers.

PURPOSE: This study investigated breakfast skipping habits and Healthy Eating Index-2015 scores among teens in Southwestern Ontario.

METHODS: Cross-sectional, baseline data were used from the SmartAPPetite project, which is currently ongoing. 24-hour dietary recalls and sociodemographic information were obtained from participants and parents (n=512).

RESULTS: Breakfast skippers had significantly lower diet quality, even when calories …

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 …

Cost-Effectiveness Analysis Of Pharmacogenomics (Pgx) Based Warfarin, Apixaban And Rivaroxaban Compared To Standard Warfarin For Atrial Fibrillation Patients In Canada, Aneeka Hafeez

Electronic Thesis and Dissertation Repository

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based warfarin, apixaban and rivaroxaban compared to standard warfarin therapy for atrial fibrillation (AF) patients in Canada. A decision-analytic Markov model was developed to compare lifetime costs and quality-adjusted life years (QALYs) from the public healthcare payer perspective. The parameters applied in the model were derived from published literature and some costs from the IC/ES databases. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard warfarin, PGx-based warfarin care had an ICER of 17,727/QALY and apixaban had an ICER of $64,853/QALY gained. Apixaban dominated rivaroxaban. The probabilistic sensitivity …

Investigating Children's Experiences And Participation In A Free Community-Based Physical Activity Program: The Grade 5 Act-I-Pass, Emma E. Ostermeier

Electronic Thesis and Dissertation Repository

Physical activity is an important component of children’s health and development; however, a majority of Canadian children are not meeting the physical activity recommendations. This thesis aimed to identify the factors that influenced children’s enrollment and participation in a free community-based physical activity program, the Grade 5 ACT-i-Pass (G5AP). This thesis consisted of two individual, but interrelated studies. First, focus groups with G5AP participants were used to explore the factors that influenced children’s perceived physical activity levels and participation in the program. Second, a spatially-targeted promotional campaign was developed and implemented to help evaluate the impact of promotions on program …

The Provision Of Foods And Beverages To Children From Non-Parental Sources: An Exploratory Study, Emilia B. Klassen

Electronic Thesis and Dissertation Repository

This study explored: (1) the overall frequency of food/beverage provision to children from non-parental sources; (2) frequency based on location/setting, source, type of food/beverage, and special event/occasion; (3) parental attitudes and awareness related to this provision; and (4) parent perceptions of children’s eating patterns during the COVID-19 pandemic. Parents (n =30) and children (n = 44) completed an online survey. Most participants reported that children were provided with foods/beverages from non-parental sources an average of 1-3 times per week. Children reported that provision was most likely to: (a) occur in other people’s homes, during …

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 …

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 …

Evaluating The Implementation Of A Chronic Obstructive Pulmonary Disease Management Program Using The Consolidated Framework For Implementation Research: A Case Study, Stefan Paciocco

Electronic Thesis and Dissertation Repository

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage. Interprofessional teams are effective at providing chronic disease management and care that meets the needs of patients. As part of an ongoing spread, an interprofessional primary care COPD management program was implemented at a family health team in Ontario. A qualitative case study was performed to determine the supporting or hindering factors to the implementation of the program. Data collected was deductively analyzed using the Consolidated Framework for Implementation Research. Eleven constructs were determined to meaningfully affect implementation. Cosmopolitanism, networks and communication, engaging, design …

Intimate Partner Violence (Ipv): Clinical And Societal Perspectives, Marudan Sivagurunathan

Electronic Thesis and Dissertation Repository

Intimate Partner Violence (IPV) can have a lasting impact on survivors’ emotional, physical, and psychological wellbeing. IPV is multifaceted and can influence survivors’ interactions across various institutions, including healthcare settings. This PhD project consists of both qualitative and quantitative studies aimed at exploring the clinical and societal perspectives around IPV.

Study #1 sought to explore the discourses around male IPV drawn from a social networking site (Reddit.com). While some areas related to IPV are well researched, studies on male intimate partner violence survivors are limited. The results from study #1 show that male IPV disclosure is a complex process. While …

Evaluating The Implementation Of The Centrally Procured School Food Program (Cpsfp) In Southwestern Ontario Elementary Schools, Mariam R. Ismail

Electronic Thesis and Dissertation Repository

School food programs can improve children’s health and well-being, while also creating economic opportunities for local food systems. Program evaluations of such interventions have always been done, but from the perspectives of their effectiveness. Yet, few have thoroughly examined the process or implementation practices of these interventions. The aim of this dissertation was to evaluate the implementation of the Centrally Procured School Food Program (CPSFP), a procurement and delivery-based school food program in Southwestern Ontario, that aims to improve elementary school-aged children’s intake of fruit and vegetables (FVs). Canada remains one of the few industrialized nations without a national school …

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 …

Visual Analytics Of Electronic Health Records With A Focus On Acute Kidney Injury, Sheikh S. Abdullah

Electronic Thesis and Dissertation Repository

The increasing use of electronic platforms in healthcare has resulted in the generation of unprecedented amounts of data in recent years. The amount of data available to clinical researchers, physicians, and healthcare administrators continues to grow, which creates an untapped resource with the ability to improve the healthcare system drastically. Despite the enthusiasm for adopting electronic health records (EHRs), some recent studies have shown that EHR-based systems hardly improve the ability of healthcare providers to make better decisions. One reason for this inefficacy is that these systems do not allow for human-data interaction in a manner that fits and supports …

The Experiences Of Female Adolescents Who Have Sustained A Concussion Through Sport Participation: A Consideration Of An Occupational Perspective During Recovery, Annalise Michelle Tichenoff

Electronic Thesis and Dissertation Repository

Adolescence is a time of rapid and tumultuous development in the physical, cognitive and psychosocial domains. Sustaining a concussion during this time period may complicate this development, particularly when symptoms are prolonged. Of particular importance is the study of adolescent females, as this population has been under-evaluated within the literature. This is especially troubling due to the number of concussions that occur among adolescent females, as concussions within this population reportedly occur at twice the frequency of adolescent males. This dissertation presents a qualitative case study investigation that explores the recovery experiences of adolescent female athletes who have sustained a …

Pregnancy In Peril: The Impact Of Conflict On Antenatal Care And Skilled Birth Attendant Utilization In The Democratic Republic Of The Congo And Burundi, Bianca R. Ziegler

Electronic Thesis and Dissertation Repository

As of 2019, over two billion people globally reside in conflict-affected areas, and as a result, face negative health implications. Burundi and the Democratic Republic of the Congo are among those countries classified as fragile and conflict-affected situations, resulting in disproportionally high maternal mortality rates. Grounded in Andersen’s Model of Healthcare Utilization, this thesis employed multivariate binary logistic regressions to examine factors which influence antenatal care and skilled birth attendant usage in these two countries. Findings indicate that women living in high conflict regions were significantly less likely than those in low conflict regions to have their first antenatal care …

Investigating Elementary School Food Programs: Impacts On Child Knowledge And Dietary Behaviours, Paige Colley

Electronic Thesis and Dissertation Repository

Good nutrition is an important part of maintaining a healthy lifestyle. A balanced diet can promote positive health outcomes, protecting against health problems caused by nutritional deficiencies. Canada has reported poor diet quality and high rates of overweight and obesity among children. Obesity has been linked to several non-communicable diseases including type 2 diabetes, heart disease, and some forms of cancer. Efforts to improve lifelong, healthy eating behaviours must be implemented.

This dissertation investigated the impacts of school food programming on child nutrition. A Centrally Procured School Food Program (CPSFP) was implemented at 30 elementary schools in Southwestern Ontario, Canada. …

Environmental Changes Following The Implementation Of The Childcare Physical Activity (Play) Policy, Victoria Tran

Electronic Thesis and Dissertation Repository

Environmental factors such as the infrastructure and equipment in childcare centres can influence the physical activity levels of young children. This study explored if implementing the Childcare PhysicaL ActivitY (PLAY) policy resulted in unintended environmental changes that were conducive to physical activity in childcare. Childcare centres were randomized to an experimental (n = 5) or control (n = 4) condition. Three Environment and Policy Assessment and Observation Self-Report (EPAO-SR) tools were used to measure 12 best practice items in relation to the childcare environment and early childhood educators’ (ECEs) practices. Descriptive statistics and mixed-effects logistics regression models were …

Implementation Adherence And Perspectives Of The Physical Activity (Play) Policy Study: A Process Evaluation, Monika B. Szpunar

Electronic Thesis and Dissertation Repository

This study entailed a process evaluation of the Childcare PhysicaL ActivitY (PLAY) Policy. Early childhood educators (ECEs) in childcare centres (n = 5) delivered the policy (which included 8 recommendations) and documented adherence (i.e., dose) in daily implementation logs. Program evaluation surveys (n = 21) and interviews (n = 10) were completed post-intervention to assess barriers/facilitators, feasibility, enjoyment, and likelihood of future implementation. Descriptive statistics and thematic analysis were conducted. Adherence was highest for delivery of child-directed play (85.9%) and lowest for delivery of frequent outdoor periods (16.5%). Participants reported they were likely to continue policy implementation, …

The Effects Of Exercise On Cognition, Mobility, And Neuroimaging Outcomes In Older Adults Without Dementia, Narlon Cassio Boa Sorte Silva

Electronic Thesis and Dissertation Repository

Cognitive decline is increasing with the aging population and, at present, there is no effective pharmacologic treatment available. Exercise interventions may impart protection against cognitive decline. A novel exercise approach is multiple-modality exercise (MME; aerobic, resistance, and balance exercise) with mind-motor training. Mind-motor training is a promising intervention in the study of cognitive function. Combining MME with mind-motor training may improve or maintain cognition and provide prevention of dementia early in the course of cognitive decline. Individuals with subjective cognitive complaints (SCC) comprise an at-risk group early in the spectrum of cognitive decline that could be targeted for prevention. The …

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 …

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 …