You searched for subject:(Epidemiology 0766 ).
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University of Toronto
1.
Lega, Iliana Carolina.
The Association between Metformin Therapy and Mortality Following Breast Cancer: A Population-based Study.
Degree: 2013, University of Toronto
URL: http://hdl.handle.net/1807/35637 
► Metformin has been associated with a reduction in breast cancer incidence, however its effect on mortality following cancer has not been adequately examined. The purpose…
(more)
▼ Metformin has been associated with a reduction in breast cancer incidence, however its effect on mortality following cancer has not been adequately examined. The purpose of this study was to evaluate the impact of metformin therapy on mortality in women with breast cancer. Using Ontario health databases, this retrospective cohort examined the impact of metformin on mortality among women aged 66 years or older with diabetes and breast cancer. After a mean follow-up of 4.5 years, there was no association between cumulative metformin use and either all-cause or breast cancer-specific mortality (HR 0.97, 95% CI 0.92-1.07; HR 0.91, 95% CI 0.81-1.03 respectively per additional year of cumulative metformin use). Though metformin was not associated with a reduction in mortality in our study of older women with breast cancer, there is still a need to examine whether metformin has an effect on mortality in other breast cancer populations.
MAST
Advisors/Committee Members: Rochon, Paula A., Health Policy, Management and Evaluation.
Subjects/Keywords: General 0566; Epidemiology 0766
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APA (6th Edition):
Lega, I. C. (2013). The Association between Metformin Therapy and Mortality Following Breast Cancer: A Population-based Study. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/35637
Chicago Manual of Style (16th Edition):
Lega, Iliana Carolina. “The Association between Metformin Therapy and Mortality Following Breast Cancer: A Population-based Study.” 2013. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/35637.
MLA Handbook (7th Edition):
Lega, Iliana Carolina. “The Association between Metformin Therapy and Mortality Following Breast Cancer: A Population-based Study.” 2013. Web. 05 Mar 2021.
Vancouver:
Lega IC. The Association between Metformin Therapy and Mortality Following Breast Cancer: A Population-based Study. [Internet] [Masters thesis]. University of Toronto; 2013. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/35637.
Council of Science Editors:
Lega IC. The Association between Metformin Therapy and Mortality Following Breast Cancer: A Population-based Study. [Masters Thesis]. University of Toronto; 2013. Available from: http://hdl.handle.net/1807/35637
University of Toronto
2.
Valentini, Adriana Alicia Rodriguez de.
The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation.
Degree: 2013, University of Toronto
URL: http://hdl.handle.net/1807/43314
► Background: Young BRCA mutation carries with a history of breast cancer often inquire about the impact of pregnancy upon their risks of cancer recurrence and…
(more)
▼ Background: Young BRCA mutation carries with a history of breast cancer often inquire about the impact of pregnancy upon their risks of cancer recurrence and survival.
Methods: We identified 128 BRCA carriers who were diagnosed with breast cancer while pregnant or who became pregnant after breast cancer diagnosis. Women were matched to 269 controls. Women were followed from the date of breast cancer diagnosis until the date of death. The Kaplan-Meier method and a left-truncated Cox proportional hazard model were used to estimate 15-year survival rates.
Results: The adjusted hazard ratio associated with 15-year survival for women diagnosed with breast cancer who were or became pregnant after breast cancer diagnosis, compared to women who did not become pregnant was 0.76 (95% CI 0.31 to 1.91 p = 0.56).
Conclusion: Pregnancy concurrent with or after a diagnosis of breast cancer does not appear to adversely affect survival among BRCA1/2 mutation carriers.
MAST
Advisors/Committee Members: Narod, Steven, Medical Science.
Subjects/Keywords: Epidemiology; Survival; Oncology; Pregnancy; 0766
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APA (6th Edition):
Valentini, A. A. R. d. (2013). The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/43314
Chicago Manual of Style (16th Edition):
Valentini, Adriana Alicia Rodriguez de. “The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation.” 2013. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/43314.
MLA Handbook (7th Edition):
Valentini, Adriana Alicia Rodriguez de. “The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation.” 2013. Web. 05 Mar 2021.
Vancouver:
Valentini AARd. The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation. [Internet] [Masters thesis]. University of Toronto; 2013. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/43314.
Council of Science Editors:
Valentini AARd. The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation. [Masters Thesis]. University of Toronto; 2013. Available from: http://hdl.handle.net/1807/43314
University of Toronto
3.
Bassil, Katherine.
The Relationship Between Temperature and 911 Medical Dispatch Data for Heat-Related Illness in Toronto, 2002-2005: An Application of Syndromic Surveillance.
Degree: 2008, University of Toronto
URL: http://hdl.handle.net/1807/17296
► Heat-related illness (HRI) is of growing public health importance, particularly with climate change and an anticipated increased frequency of heat waves. A syndromic surveillance system…
(more)
▼ Heat-related illness (HRI) is of growing public health importance, particularly with climate change and an anticipated increased frequency of heat waves. A syndromic surveillance system for HRI could provide new information on the population impact of excessive heat and thus be of value for public health planning. This study describes the association between 911 medical dispatch calls for HRI and temperature in Toronto, Ontario during the summers of 2002-2005.
A combination of methodological approaches was used to understand both the temporal trend and spatial pattern in the relationship between 911 medical dispatch data and temperature. A case definition for HRI was developed using clinical and empirical assessments. Generalized Additive Models (GAM) and Zero inflated Poisson regression (ZIP) were used to determine the association between 911 calls and mean and maximum temperature. The validity of the HRI case definition was investigated by making comparisons with emergency department visits for HRI. Descriptive, aberration detection, and cross-correlation methods were applied to explore the timing and volume of HRI calls in relation to these visits, and the declaration of heat alerts. Finally, the existence of neighbourhood level spatial variation in 911 calls for HRI was analyzed using geospatial methods.
This is the first study to demonstrate an association between daily 911 medical dispatch calls specifically for HRI and temperature. On average, 911 calls for HRI increased up to a maximum of 36% (p<.0001) (median 29%) for each 1°C increase in temperature. The temporal trend of 911 calls for HRI was similar to emergency department visits for HRI and heat alerts, improving confidence in the validity of this data source. Heterogeneity in the spatial pattern of calls across neighbourhoods was also apparent, with recreational areas near the waterfront demonstrating the highest percentage increase in calls.
Monitoring 911 medical dispatch data for HRI could assist public health units carrying out both temporal and geospatial surveillance, particularly in areas where synoptic based mortality prediction algorithms are not being utilized. This previously untapped data source should be further explored for its applications in understanding the relationship between heat and human health and more appropriately targeting public health interventions.
PhD
Advisors/Committee Members: Cole, Donald, Dalla Lana School of Public Health.
Subjects/Keywords: Epidemiology; 0766
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APA (6th Edition):
Bassil, K. (2008). The Relationship Between Temperature and 911 Medical Dispatch Data for Heat-Related Illness in Toronto, 2002-2005: An Application of Syndromic Surveillance. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/17296
Chicago Manual of Style (16th Edition):
Bassil, Katherine. “The Relationship Between Temperature and 911 Medical Dispatch Data for Heat-Related Illness in Toronto, 2002-2005: An Application of Syndromic Surveillance.” 2008. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/17296.
MLA Handbook (7th Edition):
Bassil, Katherine. “The Relationship Between Temperature and 911 Medical Dispatch Data for Heat-Related Illness in Toronto, 2002-2005: An Application of Syndromic Surveillance.” 2008. Web. 05 Mar 2021.
Vancouver:
Bassil K. The Relationship Between Temperature and 911 Medical Dispatch Data for Heat-Related Illness in Toronto, 2002-2005: An Application of Syndromic Surveillance. [Internet] [Doctoral dissertation]. University of Toronto; 2008. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/17296.
Council of Science Editors:
Bassil K. The Relationship Between Temperature and 911 Medical Dispatch Data for Heat-Related Illness in Toronto, 2002-2005: An Application of Syndromic Surveillance. [Doctoral Dissertation]. University of Toronto; 2008. Available from: http://hdl.handle.net/1807/17296
University of Toronto
4.
Fergenbaum, Jennifer.
Vascular and Metabolic Risk Factors, Carotid Atherosclerosis and Vascular Cognitive Impairment in a First Nations Population.
Degree: 2009, University of Toronto
URL: http://hdl.handle.net/1807/19267
► The objectives of the thesis were to examine the associations between vascular and metabolic risk factors, carotid atherosclerosis and cognitive function in a Canadian First…
(more)
▼ The objectives of the thesis were to examine the associations between vascular and metabolic risk factors, carotid atherosclerosis and cognitive function in a Canadian First Nations population. Eligible individuals were ≥18 years and with First Nations status who had undergone cognitive function assessment by the Clock Drawing Test (CDT) and the Trail Making Test Parts A and B. Parts A and B were combined into an executive function score (TMT-exec). Anthropometric, vascular and metabolic risk factors were assessed by interview, clinical examinations and blood tests. Doppler ultrasonography assessed carotid atherosclerosis (carotid stenosis, plaque volume). For the 190 individuals with TMT-exec scores, obese individuals were at a 4-fold increased risk for lowered cognitive performance compared to those who were not obese (odds ratio [OR]: 3.77, 95% confidence interval [CI]: 1.46-9.72). Those having an increased waist circumference also had 5 times the risk compared to those without an increased waist circumference (OR: 5.41, 95% CI: 1.83-15.99). Individuals having the metabolic syndrome were at a 4-fold increased risk compared to those without the metabolic syndrome (OR: 3.67, 95% CI: 1.34-10.07). No other cardiovascular risk factors were associated and no associations were shown for the CDT. For TMT-exec only, individuals with elevated levels of left (LCS) and total carotid stenosis (TCS) were less likely to demonstrate lowered cognitive performance (LCS, OR: 0.47, 95% CI: 0.24-0.96; TCS, OR: 0.40, 95% CI: 0.20-0.80). In structural equation modeling, for every 1-unit change in the anthropometric factor in kg/m2, there was a 0.86-fold decrease in the percent of TCS (p<0.05). The etiology of VCI is vascular and is affected by non-traditional risk factors such as obesity. The health effects of obesity beyond traditional disease endpoints warrants further study. Mild-moderate levels of carotid stenosis are not detrimental to cognitive functioning and may additionally include acting as a mediator.
PhD
Advisors/Committee Members: Young, Kue, Dalla Lana School of Public Health.
Subjects/Keywords: Epidemiology; 0766
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APA (6th Edition):
Fergenbaum, J. (2009). Vascular and Metabolic Risk Factors, Carotid Atherosclerosis and Vascular Cognitive Impairment in a First Nations Population. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/19267
Chicago Manual of Style (16th Edition):
Fergenbaum, Jennifer. “Vascular and Metabolic Risk Factors, Carotid Atherosclerosis and Vascular Cognitive Impairment in a First Nations Population.” 2009. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/19267.
MLA Handbook (7th Edition):
Fergenbaum, Jennifer. “Vascular and Metabolic Risk Factors, Carotid Atherosclerosis and Vascular Cognitive Impairment in a First Nations Population.” 2009. Web. 05 Mar 2021.
Vancouver:
Fergenbaum J. Vascular and Metabolic Risk Factors, Carotid Atherosclerosis and Vascular Cognitive Impairment in a First Nations Population. [Internet] [Doctoral dissertation]. University of Toronto; 2009. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/19267.
Council of Science Editors:
Fergenbaum J. Vascular and Metabolic Risk Factors, Carotid Atherosclerosis and Vascular Cognitive Impairment in a First Nations Population. [Doctoral Dissertation]. University of Toronto; 2009. Available from: http://hdl.handle.net/1807/19267
University of Toronto
5.
Rachlis, Beth Stephanie.
Losses to Follow-up from an Antiretroviral Therapy (ART) Program in the Zomba District of Malawi.
Degree: 2013, University of Toronto
URL: http://hdl.handle.net/1807/68903
► Losses to Follow-Up from Antiretroviral Therapy (ART) programs remain a challenge in Malawi. The objectives of this doctoral project were to explore factors that influence…
(more)
▼ Losses to Follow-Up from Antiretroviral Therapy (ART) programs remain a challenge in Malawi. The objectives of this doctoral project were to explore factors that influence loss to follow-up, to describe patterns of follow-up, to identify a definition of lost to follow-up (LTFU) that predicts whether a patient will return to care and to determine the predictors of becoming and remaining LTFU, among patients receiving ART through Dignitas International (DI) in Zomba, Malawi. DI has been working with the Malawi Ministry of Health since 2004 to deliver comprehensive HIV/AIDS care. In collaboration with DI, this project used a mixed-methods approach to explore losses to follow-up from ART. New data collection in the form of concept mapping with Malawian stakeholders was first used to determine why patients on ART become LTFU. Descriptive analyses involving Generalized Estimating Equations (GEE) was used to describe patterns of follow-up among patients who initiated ART from 1 January 2007 to 1 July 2010. Survival functions were plotted to identify the cut-off that can be used to define LTFU. GEE logistic regression was used to model the predictors of becoming and remaining LTFU at each FU visit. In concept mapping, 90 participants consisting of ART patients, ART providers, Health Surveillance Assistants and Zomba District Health Office team members participated. A nine-cluster concept map solution was generated. In the descriptive analyses, n =7,815 patients with n =76,417 follow-up visits were included. Patients did not show a consistent pattern of follow-up over time (e.g., not always late). Plotted survival functions indicated that a LTFU cut-off of ≥9 weeks late was relevant in this context. Based on the GEE models, 5 factors that were explored were consistent in predicting both LTFU risk and a return to care within 12 months of an expected visit (transferring in, duration on ART, World Health Organization stage at ART initiation, duration on ART and being in centralized care). Five variables demonstrated statistical differences across models (female gender, being married, cumulative proportion of non-adherent visits, a ≥10% weight gain and reporting side effects, and being in centralized care). This dissertation points to the dynamic complexities which individuals face during the course of their treatment that affect their ability to return to the clinic for scheduled follow-up. There is a need for a variety of program strategies to adequately address the diverse challenges faced by patients.
PhD
Advisors/Committee Members: Cole, Donald, Dalla Lana School of Public Health.
Subjects/Keywords: Epidemiology; Global Health; 0766
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APA (6th Edition):
Rachlis, B. S. (2013). Losses to Follow-up from an Antiretroviral Therapy (ART) Program in the Zomba District of Malawi. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/68903
Chicago Manual of Style (16th Edition):
Rachlis, Beth Stephanie. “Losses to Follow-up from an Antiretroviral Therapy (ART) Program in the Zomba District of Malawi.” 2013. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/68903.
MLA Handbook (7th Edition):
Rachlis, Beth Stephanie. “Losses to Follow-up from an Antiretroviral Therapy (ART) Program in the Zomba District of Malawi.” 2013. Web. 05 Mar 2021.
Vancouver:
Rachlis BS. Losses to Follow-up from an Antiretroviral Therapy (ART) Program in the Zomba District of Malawi. [Internet] [Doctoral dissertation]. University of Toronto; 2013. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/68903.
Council of Science Editors:
Rachlis BS. Losses to Follow-up from an Antiretroviral Therapy (ART) Program in the Zomba District of Malawi. [Doctoral Dissertation]. University of Toronto; 2013. Available from: http://hdl.handle.net/1807/68903
University of Toronto
6.
Hill, Andrea.
Access to Trauma Centre Care in Canada - A National Comparison.
Degree: 2013, University of Toronto
URL: http://hdl.handle.net/1807/68943
► Objectives: (1) To examine the association of transfer from a non-trauma hospital to a trauma centre, compared to direct transport to a trauma centre, on…
(more)
▼ Objectives: (1) To examine the association of transfer from a non-trauma hospital to a trauma centre, compared to direct transport to a trauma centre, on patient outcomes; (2) to describe temporal trends and provincial variations in major trauma hospitalization and outcomes; (3) to describe trends in the receipt of trauma centre care for severely injured patients; and (4) to identify factors associated with the receipt of trauma centre care.
Methods: To address the first objective a systematic review and meta-analysis of published observational studies was performed. The remaining objectives were addressed as part of a population-based retrospective cohort study using the National Trauma Registry Minimum Dataset. Age-standardized hospitalization and death rates were calculated using the direct method. Multi-level logistic regression analyses were used to explore factors associated with receipt of trauma centre care.
Results: The meta-analysis revealed no difference in mortality between direct and indirect admissions to a trauma centre (pooled odds ratio (OR), 1.06; 95% confidence interval (CI): 0.90 - 1.25). The population based study identified increasing hospitalization rates for major trauma among older Canadian patients (≥ 65 years) over the eight-year period (estimated annual percent increase of 3.3%;95% CI: 2.8% - 3.8%). Case fatality rates declined modestly. Overall, 41% of major trauma patients did not receive care in a trauma centre, ranging from 28% to 76% across the provinces. A disproportionately greater proportion of older Canadians did not receive care in a trauma centre. The odds of receiving care in a trauma centre were 64% lower among older compared to young patients. Compared to men, the odds of receiving care in a trauma centre were 21% lower amongst women (adjusted OR 0.79; 95% CI: 0.76, 0.82). These findings were consistent across the provinces.
Conclusion: Major trauma hospitalization rates increased over the study interval. Moreover, decreased likelihood of trauma centre care was demonstrated for elderly patients and women. These findings highlight important opportunities for injury prevention and strategies to improve access to trauma centre care for patients. Further studies examining the underlying reasons for the gender and age disparity in access to trauma centre care are warranted.
PhD
Advisors/Committee Members: Fowler, Robert, Health Policy, Management and Evaluation.
Subjects/Keywords: Injury; Trauma Centers; Epidemiology; Access; 0766
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APA (6th Edition):
Hill, A. (2013). Access to Trauma Centre Care in Canada - A National Comparison. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/68943
Chicago Manual of Style (16th Edition):
Hill, Andrea. “Access to Trauma Centre Care in Canada - A National Comparison.” 2013. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/68943.
MLA Handbook (7th Edition):
Hill, Andrea. “Access to Trauma Centre Care in Canada - A National Comparison.” 2013. Web. 05 Mar 2021.
Vancouver:
Hill A. Access to Trauma Centre Care in Canada - A National Comparison. [Internet] [Doctoral dissertation]. University of Toronto; 2013. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/68943.
Council of Science Editors:
Hill A. Access to Trauma Centre Care in Canada - A National Comparison. [Doctoral Dissertation]. University of Toronto; 2013. Available from: http://hdl.handle.net/1807/68943
University of Toronto
7.
Mason, Stephanie.
A population-based evaluation of long-term outcomes following major burn injury.
Degree: PhD, 2018, University of Toronto
URL: http://hdl.handle.net/1807/95637
► Introduction: Advances in critical care and the regionalization of burn care have resulted in a significant decrease in mortality after burn injury such that most…
(more)
▼ Introduction: Advances in critical care and the regionalization of burn care have resulted in a significant decrease in mortality after burn injury such that most burn-injured patients are expected to survive. This thesis aimed to evaluate and characterize long-term outcomes following major burn injury.
Methods: Using linked health administrative data, we identified adults who sustained major burn injury during 2003-2014. First, we evaluated temporal changes in the incidence and in-hospital mortality of burn injury. We then estimated five-year risk-adjusted rates and principal causes of emergency department visits and readmissions. A self-matched longitudinal cohort study was performed to compare rates of mental illness-related healthcare utilization in the 3 years before and after burn. Finally, a matched cohort study was performed to estimate 5-year mortality after burn.
Results: The incidence of burn injury remained stable over time, and significant reductions in the overall in-hospital mortality rate occurred; the odds of death in 2010-2013 were significantly lower than 2003-2006 (odds ratio (OR) 0.39, 95% CI 0.25-0.61). In the five years after discharge from the index burn admission, 70% of patients had >1 emergency department (ED) visit, and 30% had an unplanned readmission. The principal cause of healthcare utilization was unintentional injury, followed by mental illness and respiratory disease. Patients who received burn center care had significantly lower rates of ED visits (rate ratio 0.64, 95% CI 0.56-0.73) and readmissions (hazard ratio 0.77, 95% CI 0.65-0.92). Burn injury was not associated with a higher rate of mental health visits compared to the pre-injury period (RR 0.97, 95% CI 0.78-1.20), but was associated with a two-fold increase in self-harm (RR 1.95 (95% CI 1.15-3.33). Five-year mortality after burn injury was 11%, compared to 4% among matched controls. The hazard ratio was greatest during the first year after discharge (HR 4.15, 95% CI 3.17-5.42).
Conclusions: Burn injury confers a physical and psychological impact up to five years after discharge, associated with high rates of healthcare utilization and increased late mortality compared to matched controls. Further development of consolidated and focused burn care, and improved mental healthcare, offer an opportunity to improve outcomes after burn injury.
2019-07-10 00:00:00
Advisors/Committee Members: Nathens, Avery B, Jeschke, Marc G, Health Policy, Management and Evaluation.
Subjects/Keywords: burns; epidemiology; health services research; outcomes; 0766
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APA (6th Edition):
Mason, S. (2018). A population-based evaluation of long-term outcomes following major burn injury. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/95637
Chicago Manual of Style (16th Edition):
Mason, Stephanie. “A population-based evaluation of long-term outcomes following major burn injury.” 2018. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/95637.
MLA Handbook (7th Edition):
Mason, Stephanie. “A population-based evaluation of long-term outcomes following major burn injury.” 2018. Web. 05 Mar 2021.
Vancouver:
Mason S. A population-based evaluation of long-term outcomes following major burn injury. [Internet] [Doctoral dissertation]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/95637.
Council of Science Editors:
Mason S. A population-based evaluation of long-term outcomes following major burn injury. [Doctoral Dissertation]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/95637
University of Toronto
8.
Sritharan, Jeavana.
Investigating the occupational etiology of prostate cancer in Canadian men.
Degree: PhD, 2018, University of Toronto
URL: http://hdl.handle.net/1807/89820
► Prostate cancer is one of the most commonly diagnosed cancers worldwide and the etiology of prostate cancer is poorly understood. Aside from non-modifiable factors, there…
(more)
▼ Prostate cancer is one of the most commonly diagnosed cancers worldwide and the etiology of prostate cancer is poorly understood. Aside from non-modifiable factors, there is limited understanding of modifiable risk factors for prostate cancer, including occupation. In epidemiological studies, job titles are generally classified into occupational or more broadly industry groupings. Previous studies have reported inconsistent findings between occupation, industry, and prostate cancer, with weak associations for farming and agriculture, rubber manufacturing, and transportation. In Canada, there have been very few large population studies that include a range of occupation and industry groups, prostate cancer outcomes, and information on non-occupational factors. The purpose of this thesis was to further investigate the occupational etiology of prostate cancer in Canadian men. By identifying occupations and industries using multiple large Canadian population based datasets, we aimed to identify consistent patterns of the multi-faceted prostate cancer – job-industry relationships. Three population based studies and one meta-analysis were conducted. Significant associations between natural resource based (agriculture, forestry, logging, wood, paper), administrative, protective services (firefighters, police, and armed forces), construction, transportation, and prostate cancer risk were observed in the three population studies. Consistent evidence for increased prostate cancer incidence and mortality among firefighting and police work was observed in the meta-analysis. Non-occupational factors including lifestyle factors and screening behaviours were also potential confounders in the relationship between occupation and prostate cancer. Overall, the results of this work provide strong evidence associating specific occupations to prostate cancer risk. Specific occupational exposures to be considered in the future are pesticides, diesel exhaust, whole body vibrations, wood dust, wood preservative chemicals, among other factors of shift work, stress, sedentary behaviour, screening patterns. These findings indicate the need for more focused studies with better exposure assessment methods and improved understanding of related non-occupational factors. Examining these factors together will inform prevention strategies for job-specific exposure and prostate cancer risk reduction. The evidence from this thesis and proposed future directions will improve knowledge on occupational risk factors related to the etiology of prostate cancer, ultimately informing policies and programs for reduction in prostate cancer risk.
Advisors/Committee Members: Demers, Paul A, Medical Science.
Subjects/Keywords: Canada; Epidemiology; Occupation; Prostate cancer; 0766
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APA (6th Edition):
Sritharan, J. (2018). Investigating the occupational etiology of prostate cancer in Canadian men. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/89820
Chicago Manual of Style (16th Edition):
Sritharan, Jeavana. “Investigating the occupational etiology of prostate cancer in Canadian men.” 2018. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/89820.
MLA Handbook (7th Edition):
Sritharan, Jeavana. “Investigating the occupational etiology of prostate cancer in Canadian men.” 2018. Web. 05 Mar 2021.
Vancouver:
Sritharan J. Investigating the occupational etiology of prostate cancer in Canadian men. [Internet] [Doctoral dissertation]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/89820.
Council of Science Editors:
Sritharan J. Investigating the occupational etiology of prostate cancer in Canadian men. [Doctoral Dissertation]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/89820
University of Toronto
9.
Alali, Abdulaziz.
Process of Care and Outcome of Critically Ill Patients with Traumatic Brain Injury.
Degree: PhD, 2014, University of Toronto
URL: http://hdl.handle.net/1807/68347
► This thesis used clinical epidemiology methods to examine the relationship between process of care and outcome of critically ill patients with traumatic brain injury (TBI).…
(more)
▼ This thesis used clinical
epidemiology methods to examine the relationship between process of care and outcome of critically ill patients with traumatic brain injury (TBI). First, I evaluated the association between intracranial pressure (ICP) monitoring use and mortality after severe TBI at the patient-level and at the hospital-level. ICP monitoring use was associated with lower mortality at the patient-level [adjusted odds ratio (OR) was 0.44; 95% confidence interval (CI): 0.31-0.63] and at the hospital-level (adjusted OR for death in the quartile of hospitals with highest use compared to the lowest was 0.52; 95% CI: 0.35-0.78). The main implication is that wider utilization of ICP monitoring in managing severe TBI appears warranted pending further studies. Second, I evaluated whether decompressive craniectomy or barbiturate coma provides better value, in terms of health effects and costs, for the management of refractory intracranial hypertension following TBI. Decompressive craniectomy resulted in greater quality-adjusted life expectancy relative to barbiturate coma [average gain was 1.5 quality-adjusted life years (QALYs)] but at higher costs (incremental cost-effectiveness ratio was $9,565/QALY gained). The main implication is that decompressive craniectomy, for this indication, is a more attractive strategy relative to barbiturate coma at commonly accepted willingness-to-pay thresholds. Third, I examined the relationship between tracheostomy timing and outcomes of TBI patients. Early tracheostomy (
Advisors/Committee Members: Nathens, B. Avery, Health Policy, Management and Evaluation.
Subjects/Keywords: Critical Care; Epidemiology; Traumatic Brain Injury; 0766
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APA (6th Edition):
Alali, A. (2014). Process of Care and Outcome of Critically Ill Patients with Traumatic Brain Injury. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/68347
Chicago Manual of Style (16th Edition):
Alali, Abdulaziz. “Process of Care and Outcome of Critically Ill Patients with Traumatic Brain Injury.” 2014. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/68347.
MLA Handbook (7th Edition):
Alali, Abdulaziz. “Process of Care and Outcome of Critically Ill Patients with Traumatic Brain Injury.” 2014. Web. 05 Mar 2021.
Vancouver:
Alali A. Process of Care and Outcome of Critically Ill Patients with Traumatic Brain Injury. [Internet] [Doctoral dissertation]. University of Toronto; 2014. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/68347.
Council of Science Editors:
Alali A. Process of Care and Outcome of Critically Ill Patients with Traumatic Brain Injury. [Doctoral Dissertation]. University of Toronto; 2014. Available from: http://hdl.handle.net/1807/68347
University of Toronto
10.
Wanigaratne, Susitha.
Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective.
Degree: PhD, 2015, University of Toronto
URL: http://hdl.handle.net/1807/69490
► Refugee women and their newborns are suspected to experience greater risk of adverse maternal and perinatal health outcomes. However, little systematic refugee-specific research has been…
(more)
▼ Refugee women and their newborns are suspected to experience greater risk of adverse maternal and perinatal health outcomes. However, little systematic refugee-specific research has been done. This dissertation poses the research question - "are refugee immigrant women and their newborns at higher risk of adverse maternal and perinatal outcomes compared to 1) non-refugee immigrant and 2) non-immigrant women?" Large population-based immigration (1985-2010) and hospitalizations databases (2002-2010) from Ontario, Canada were used (all women eligible for health insurance).
The first manuscript examined severe maternal morbidity (SMM) and SMM subtypes among refugee immigrants compared to both non-refugee immigrants and non-immigrants. The rate of any SMM was elevated among refugees (n=30,420) compared to non-refugee immigrants (n=235,540) (adjusted rate ratios (ARR)=1.22, 95% confidence interval: 1.09-1.36) and non-immigrants (n=878,709) (ARR=1.34 (1.23-1.47)). HIV (SMM subtype) among refugees was 8 and 17 times that of non-refugee immigrants and non-immigrants, respectively. The SMM rate among refugees was no longer elevated when deliveries with HIV were excluded.
The second manuscript examined the risk of severe neonatal morbidity (SNM) among neonates born to refugees compared to those of non-refugee immigrants and non-immigrants. SNM risk among non-sponsored refugees (i.e., asylum seekers) was also compared to that of sponsored refugees (i.e., government, privately sponsored). The risk of severe neonatal morbidity was significantly higher among newborns of refugee compared to non-refugee immigrants (ARR=1.10 (1.03-1.17)) but lower in comparison to non-immigrants (ARR=0.94 (0.89-0.99)). There was no difference by sponsorship status.
The objective of the third manuscript was to determine if the relationship between refugee status and risk of preterm birth (PTB) was modified by secondary (migration to another country prior to Canada) or primary (direct to Canada) migration. A secondary objective was to examine whether this relationship varied by maternal region of birth. Secondary refugees and primary refugees experienced a significantly higher cumulative probability of PTB (22-31, 32-36, ≥37 weeks) compared to their secondary and primary non-refugee counterparts (adjusted cumulative odds ratio (ACOR) =1.59 (1.25-2.01) and ACOR=1.12 (1.02-1.23)), respectively. These associations were also significant for Asian immigrants.
This dissertation makes a substantial contribution towards understanding the health and the determinants of health of refugee immigrant mothers and their infants in Canada.
Advisors/Committee Members: Urquia, Marcelo, Cole, Donald, Dalla Lana School of Public Health.
Subjects/Keywords: perintal epidemiology; refugee health; social disparities; 0766
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APA (6th Edition):
Wanigaratne, S. (2015). Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/69490
Chicago Manual of Style (16th Edition):
Wanigaratne, Susitha. “Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective.” 2015. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/69490.
MLA Handbook (7th Edition):
Wanigaratne, Susitha. “Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective.” 2015. Web. 05 Mar 2021.
Vancouver:
Wanigaratne S. Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective. [Internet] [Doctoral dissertation]. University of Toronto; 2015. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/69490.
Council of Science Editors:
Wanigaratne S. Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective. [Doctoral Dissertation]. University of Toronto; 2015. Available from: http://hdl.handle.net/1807/69490
University of Toronto
11.
Varadi, Gabriel Robert.
Beta-blocker Use and Morbidity from Chronic Lung Disease in Patients Undertaking Pulmonary Rehabilitation.
Degree: 2014, University of Toronto
URL: http://hdl.handle.net/1807/67888
► Cardiovascular diseases are common in patients with chronic lung diseases. Beta-blockers reduce their morbidity, but are underutilized because of concerns over pulmonary side effects. In…
(more)
▼ Cardiovascular diseases are common in patients with chronic lung diseases. Beta-blockers reduce their morbidity, but are underutilized because of concerns over pulmonary side effects. In this retrospective cohort study, we evaluated the association of beta-blocker use with survival in elderly patients enrolled in pulmonary rehabilitation between 1996-2008. Patient characteristics were abstracted from hospital charts and linked to administrative health databases. Primary outcome was time to death or first hospitalization. Matching on propensity score was used to account for potential confounding. No significant increase was seen in the hazard of death or hospitalization in beta-blocker users. In patients with obstructive lung disease, survival was non-significantly longer among beta-blocker users. Residual imbalance in important confounders remained despite repeated refinement of the propensity-score.Survival to death or hospitalization was not significantly associated with beta-blocker use. Beta-blockers should not be withheld from patients with lung disease who have clinical indications for them.
M.Sc.
Advisors/Committee Members: Stanbrook, B Matthew, Health Policy, Management and Evaluation.
Subjects/Keywords: beta-blockers; clinical epidemiology; lung diseases; propensity score; 0766
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APA (6th Edition):
Varadi, G. R. (2014). Beta-blocker Use and Morbidity from Chronic Lung Disease in Patients Undertaking Pulmonary Rehabilitation. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/67888
Chicago Manual of Style (16th Edition):
Varadi, Gabriel Robert. “Beta-blocker Use and Morbidity from Chronic Lung Disease in Patients Undertaking Pulmonary Rehabilitation.” 2014. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/67888.
MLA Handbook (7th Edition):
Varadi, Gabriel Robert. “Beta-blocker Use and Morbidity from Chronic Lung Disease in Patients Undertaking Pulmonary Rehabilitation.” 2014. Web. 05 Mar 2021.
Vancouver:
Varadi GR. Beta-blocker Use and Morbidity from Chronic Lung Disease in Patients Undertaking Pulmonary Rehabilitation. [Internet] [Masters thesis]. University of Toronto; 2014. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/67888.
Council of Science Editors:
Varadi GR. Beta-blocker Use and Morbidity from Chronic Lung Disease in Patients Undertaking Pulmonary Rehabilitation. [Masters Thesis]. University of Toronto; 2014. Available from: http://hdl.handle.net/1807/67888
University of Toronto
12.
Roifman, Idan.
Non-invasive Cardiac Diagnostic Tests in Ontario: Temporal Trends in Utilization and Association with Obstructive Coronary Artery Disease.
Degree: 2016, University of Toronto
URL: http://hdl.handle.net/1807/71698
► Contemporary temporal trends in utilization of graded exercise stress test (GXT), myocardial perfusion scanning (MPI), stress echocardiography (stress echo), and cardiac computed tomography angiography (CCTA)…
(more)
▼ Contemporary temporal trends in utilization of graded exercise stress test (GXT), myocardial perfusion scanning (MPI), stress echocardiography (stress echo), and cardiac computed tomography angiography (CCTA) are unknown. The optimal initial testing strategy to evaluate stable coronary artery disease (CAD) is also unknown. We conducted a repeated cross sectional study of the adult population of Ontario in order to assess the temporal trends in utilization of these modalities and a retrospective inception cohort study in order to compare the relationship between differing initial testing strategies and the presence of obstructive CAD on downstream angiography. Our results indicate stable utilization patterns for GXT and MPI. We had insufficient data to make definitive conclusions regarding the temporal trends for CCTA and stress echo. An initial diagnostic strategy consisting of CCTA, MPI or stress echo was not significantly different than an initial strategy with a GXT in detecting obstructive CAD on downstream angiography.
M.Sc.
Advisors/Committee Members: Tu, Jack V, Dalla Lana School of Public Health.
Subjects/Keywords: Cardiac imaging; Cardiology; Comparative effectiveness; Epidemiology; Resource utilization; Temporal trends; 0766
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APA (6th Edition):
Roifman, I. (2016). Non-invasive Cardiac Diagnostic Tests in Ontario: Temporal Trends in Utilization and Association with Obstructive Coronary Artery Disease. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/71698
Chicago Manual of Style (16th Edition):
Roifman, Idan. “Non-invasive Cardiac Diagnostic Tests in Ontario: Temporal Trends in Utilization and Association with Obstructive Coronary Artery Disease.” 2016. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/71698.
MLA Handbook (7th Edition):
Roifman, Idan. “Non-invasive Cardiac Diagnostic Tests in Ontario: Temporal Trends in Utilization and Association with Obstructive Coronary Artery Disease.” 2016. Web. 05 Mar 2021.
Vancouver:
Roifman I. Non-invasive Cardiac Diagnostic Tests in Ontario: Temporal Trends in Utilization and Association with Obstructive Coronary Artery Disease. [Internet] [Masters thesis]. University of Toronto; 2016. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/71698.
Council of Science Editors:
Roifman I. Non-invasive Cardiac Diagnostic Tests in Ontario: Temporal Trends in Utilization and Association with Obstructive Coronary Artery Disease. [Masters Thesis]. University of Toronto; 2016. Available from: http://hdl.handle.net/1807/71698
University of Toronto
13.
Johnston, Barbara.
Epidemiology of Nosocomial Pneumonia in Adults Hospitalized in Canadian Acute Care Facilities.
Degree: 2011, University of Toronto
URL: http://hdl.handle.net/1807/30643
► Background: Nosocomial pneumonia (NP) is a significant cause of morbidity and mortality in hospitalized patients. Objective: The objectives of this study were to describe the…
(more)
▼ Background: Nosocomial pneumonia (NP) is a significant cause of morbidity and mortality in hospitalized patients.
Objective: The objectives of this study were to describe the epidemiology of NP in adult patients hospitalized in Canadian acute care facilities and identify prognostic indicators for death.
Methods: A retrospective cohort study was conducted in 114 patients with NP admitted to
hospitals that participated in a 2002 Canadian point prevalence survey.
Results: A high proportion of NP patients had a rapidly or ultimately fatal underlying illness. NP in non-intensive care unit (ICU) patients accounted for the larger proportion of these infections.There was no mortality difference between patients with and without ventilator-associated NP, or with and without ICU-acquired NP. Delayed initiation of appropriate antimicrobial therapy was
associated with a poorer outcome.
Discussion: Strategies that result in the timely administration of appropriate antimicrobial therapy should be investigated in an effort to reduce NP-associated mortality.
MAST
Advisors/Committee Members: McGeer, Allison, Dalla Lana School of Public Health.
Subjects/Keywords: epidemiology; nosocomial pneumonia; nosocomial infections; outcomes; 0766; 0564
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APA (6th Edition):
Johnston, B. (2011). Epidemiology of Nosocomial Pneumonia in Adults Hospitalized in Canadian Acute Care Facilities. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/30643
Chicago Manual of Style (16th Edition):
Johnston, Barbara. “Epidemiology of Nosocomial Pneumonia in Adults Hospitalized in Canadian Acute Care Facilities.” 2011. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/30643.
MLA Handbook (7th Edition):
Johnston, Barbara. “Epidemiology of Nosocomial Pneumonia in Adults Hospitalized in Canadian Acute Care Facilities.” 2011. Web. 05 Mar 2021.
Vancouver:
Johnston B. Epidemiology of Nosocomial Pneumonia in Adults Hospitalized in Canadian Acute Care Facilities. [Internet] [Masters thesis]. University of Toronto; 2011. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/30643.
Council of Science Editors:
Johnston B. Epidemiology of Nosocomial Pneumonia in Adults Hospitalized in Canadian Acute Care Facilities. [Masters Thesis]. University of Toronto; 2011. Available from: http://hdl.handle.net/1807/30643
University of Toronto
14.
Grewal, Keerat.
Continuity of Care and Oncological Expertise for Patients with Active Cancer who require Emergency Department Care: A Population-Based Assessment.
Degree: 2018, University of Toronto
URL: http://hdl.handle.net/1807/95617
► Patients with cancer have complex care requirements that may result in an emergency department (ED) visit. In this retrospective cohort study, Ontario health databases were…
(more)
▼ Patients with cancer have complex care requirements that may result in an emergency department (ED) visit. In this retrospective cohort study, Ontario health databases were used to identify 42,820 qualifying patients who received chemotherapy or radiation in the 30-days prior to a cancer-related ED visit. Using multivariable models and propensity score matching, odds of hospitalization were lower in patients treated at alternative EDs compared to original EDs, but there was no difference in mortality, return ED visits or CT imaging. For patients seen at an alternative general hospital, the adjusted odds of hospitalization were again lower when compared to patients seen at original hospitals/cancer centres, but 30-day mortality and return ED visits were higher and CT imaging was lower. The results of this study suggest that the cancer expertise of an institution, rather than continuity of care, may be an important predictor of outcomes following emergency treatment of cancer patients.
M.Sc.
2019-07-10 00:00:00
Advisors/Committee Members: Atzema, Clare L, Dalla Lana School of Public Health.
Subjects/Keywords: Administrative Data; Emergency Medicine; Epidemiology; Health Services; Oncology; 0766
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APA (6th Edition):
Grewal, K. (2018). Continuity of Care and Oncological Expertise for Patients with Active Cancer who require Emergency Department Care: A Population-Based Assessment. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/95617
Chicago Manual of Style (16th Edition):
Grewal, Keerat. “Continuity of Care and Oncological Expertise for Patients with Active Cancer who require Emergency Department Care: A Population-Based Assessment.” 2018. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/95617.
MLA Handbook (7th Edition):
Grewal, Keerat. “Continuity of Care and Oncological Expertise for Patients with Active Cancer who require Emergency Department Care: A Population-Based Assessment.” 2018. Web. 05 Mar 2021.
Vancouver:
Grewal K. Continuity of Care and Oncological Expertise for Patients with Active Cancer who require Emergency Department Care: A Population-Based Assessment. [Internet] [Masters thesis]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/95617.
Council of Science Editors:
Grewal K. Continuity of Care and Oncological Expertise for Patients with Active Cancer who require Emergency Department Care: A Population-Based Assessment. [Masters Thesis]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/95617
University of Toronto
15.
Urquia, Marcelo L.
Birth Outcomes of Immigrants to Urban Ontario. A Population-based Study.
Degree: 2009, University of Toronto
URL: http://hdl.handle.net/1807/19303
► The total number of births among immigrants is on the rise and currently exceeds one fifth of live births within industrialized countries. The relation between…
(more)
▼ The total number of births among immigrants is on the rise and currently exceeds one fifth of live births within industrialized countries. The relation between adverse birth outcomes and migration remains unclear.
The objectives of this thesis are to undertake a literature review to clarify the relation between migration and adverse birth outcomes, and to examine the interplay between duration of residence, maternal country of origin, and the residential environment using data on immigrants to Ontario Census Metropolitan Areas. The findings indicate that:
a) Analyzing disparities in birth outcomes by migrant status with migrants defined as a single category is not informative. Rather, ethnicity and country of origin are important predictors of birth outcomes among immigrants.
b) Duration of residence is linearly associated with low infant birth weight and preterm birth, mainly driven by decreases in gestational age with prolonged stay in Canada.
c) The detrimental effects of long duration of residence on preterm birth are modestly attenuated, but not prevented, among immigrants living in urban neighbourhoods characterized by low material deprivation.
d) Neighbourhood material deprivation has little, if any, influence on birth outcomes of recent immigrants, and only becomes influential after 15 years of stay in Canada. Maternal world region of origin constitutes a stronger predictor of adverse birth outcomes among recent immigrants.
These findings stress the importance of the maternal country of birth and duration of residence as key predictors of immigrants’ health. They also support further research aimed at clarifying the nature of the association between time spent in Canada after migration and decreases in gestational age at delivery, and the identification of immigrant groups at high risk of adverse birth outcomes, based on these two key predictors.
PhD
Advisors/Committee Members: Frank, John W., Dalla Lana School of Public Health.
Subjects/Keywords: epidemiology; immigrants; Ontario; perinatal; 0766
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APA (6th Edition):
Urquia, M. L. (2009). Birth Outcomes of Immigrants to Urban Ontario. A Population-based Study. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/19303
Chicago Manual of Style (16th Edition):
Urquia, Marcelo L. “Birth Outcomes of Immigrants to Urban Ontario. A Population-based Study.” 2009. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/19303.
MLA Handbook (7th Edition):
Urquia, Marcelo L. “Birth Outcomes of Immigrants to Urban Ontario. A Population-based Study.” 2009. Web. 05 Mar 2021.
Vancouver:
Urquia ML. Birth Outcomes of Immigrants to Urban Ontario. A Population-based Study. [Internet] [Doctoral dissertation]. University of Toronto; 2009. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/19303.
Council of Science Editors:
Urquia ML. Birth Outcomes of Immigrants to Urban Ontario. A Population-based Study. [Doctoral Dissertation]. University of Toronto; 2009. Available from: http://hdl.handle.net/1807/19303
University of Toronto
16.
Buchan, Sarah.
Using Laboratory-Confirmed Outcomes to Study Pediatric Influenza and Influenza Vaccine Epidemiology in Ontario.
Degree: PhD, 2018, University of Toronto
URL: http://hdl.handle.net/1807/95641
► Annual epidemics of seasonal influenza continue to cause substantial morbidity in young children. Influenza is among several respiratory viruses that cause illness in children, in…
(more)
▼ Annual epidemics of seasonal influenza continue to cause substantial morbidity in young children. Influenza is among several respiratory viruses that cause illness in children, in addition to a large burden on the healthcare system and society, but is the only one for which a vaccine is available. In this dissertation, I present three studies regarding the epidemiology of influenza in children under the age of five years using a novel approach of linking laboratory and health administrative data in Ontario.
In a systematic review and meta-analysis of children presenting to healthcare who are tested for influenza, I found that 20% (95%CI 15%-25%) have laboratory-confirmed influenza, with variation across subgroups. I found that influenza represents a large overall burden of disease and a substantial proportion of healthcare encounters for respiratory illnesses.
In a retrospective cohort study, I compared the characteristics, outcomes, and relative severity of illness of children who were hospitalized and tested for influenza A, influenza B, and respiratory syncytial virus (RSV) and were positive for only a single virus. I found that in-hospital outcomes and post-discharge healthcare utilization in children with no identified comorbidities were similar by virus type, but post-discharge healthcare utilization was higher for those with influenza in those with underlying comorbidities. I observed similar severity of illness, based on in-hospital outcomes, and cost of hospitalization between viruses.
In a test-negative study, I estimated vaccine effectiveness (VE) against laboratory-confirmed influenza hospitalizations in children aged 6-59 months for the 2010-11 to 2013-14 seasons. I found that overall, VE was 51% (95%CI 38%-61%) for any vaccination, with variation by vaccination status (full vs. partial), season, age group, and subtype. These results indicate that large numbers of pediatric hospitalizations resulting from influenza infection could be prevented by promoting seasonal influenza vaccination each year.
Overall, these results contribute to our understanding of pediatric respiratory viruses in Ontario, with each individual chapter adding to our knowledge regarding burden, severity, and prevention of influenza infection. These results can inform families, clinicians, public health practitioners, and policy makers in order to help reduce the impact of annual influenza infection in young children.
2019-07-10 00:00:00
Advisors/Committee Members: Kwong, Jeffrey C, Dalla Lana School of Public Health.
Subjects/Keywords: epidemiology; influenza; pediatric; respiratory viruses; vaccine effectiveness; 0766
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APA (6th Edition):
Buchan, S. (2018). Using Laboratory-Confirmed Outcomes to Study Pediatric Influenza and Influenza Vaccine Epidemiology in Ontario. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/95641
Chicago Manual of Style (16th Edition):
Buchan, Sarah. “Using Laboratory-Confirmed Outcomes to Study Pediatric Influenza and Influenza Vaccine Epidemiology in Ontario.” 2018. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/95641.
MLA Handbook (7th Edition):
Buchan, Sarah. “Using Laboratory-Confirmed Outcomes to Study Pediatric Influenza and Influenza Vaccine Epidemiology in Ontario.” 2018. Web. 05 Mar 2021.
Vancouver:
Buchan S. Using Laboratory-Confirmed Outcomes to Study Pediatric Influenza and Influenza Vaccine Epidemiology in Ontario. [Internet] [Doctoral dissertation]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/95641.
Council of Science Editors:
Buchan S. Using Laboratory-Confirmed Outcomes to Study Pediatric Influenza and Influenza Vaccine Epidemiology in Ontario. [Doctoral Dissertation]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/95641
University of Toronto
17.
Abdel-Qadir, Husam.
The Spectrum, Impact, and Management of Cardiovascular Disease in Ontario Women with Early Stage Breast Cancer.
Degree: PhD, 2018, University of Toronto
URL: http://hdl.handle.net/1807/89745
► Background: There are limited data about the epidemiology of cardiovascular disease after early stage breast cancer. Methods: We conducted four cohort studies utilizing data from…
(more)
▼ Background: There are limited data about the
epidemiology of cardiovascular disease after early stage breast cancer.
Methods: We conducted four cohort studies utilizing data from Ontario women diagnosed with early stage breast cancer between 1998 and 2015. The first study describes causes of death after breast cancer, with a focus on patient strata where death from cardiovascular causes may exceed that from breast cancer. The second study examines hospital presentations for different categories of cardiovascular disease, and their temporal relationship to heart failure, comparing early stage breast cancer cases to age-matched women without cancer. The third study develops a score for predicting cardiovascular risk after early stage breast cancer. The final study examines 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitor (also known as statins) use after early stage breast cancer as a marker of cardiovascular preventative therapy, with comparison to cancer-free women of similar cardiovascular risk.
Results: Breast cancer was the most common cause of death. Among patients with prior cardiovascular disease, the risks of death from breast cancer and cardiovascular disease were equivalent for the first five years, after which death from cardiovascular causes was more frequent. For women aged ≥66 years who survived ≥5 years after diagnosis, cardiovascular disease exceeded breast cancer as the leading cause of death at ten years post-diagnosis.
The 10-year cumulative incidence of cardiovascular hospitalization was 11.7% after early stage breast cancer and 10.6% in controls. The ratio of cardiovascular disease rates between the cohorts increased with time. 76% of cardiovascular hospitalizations were for diagnoses other than heart failure. 36% of first heart failure presentations were preceded by hospital presentation with another cardiovascular disease.
We developed a score to predict the risk of death or hospitalization from cardiovascular disease. Model calibration and discrimination were good. The c-index in the validation cohort was 81.3% at 5 years. Finally, we observed that women with early stage breast cancer were less likely to dispense statins compared to cancer-free women, though the differences were small.
Relevance: These data provide useful insights into the importance of cardiovascular disease and how its management can be improved in women with early stage breast cancer.
Advisors/Committee Members: Anderson, Geoffrey M, Health Policy, Management and Evaluation.
Subjects/Keywords: breast cancer; cardiovascular disease; clinical epidemiology; competing risks; 0766
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APA (6th Edition):
Abdel-Qadir, H. (2018). The Spectrum, Impact, and Management of Cardiovascular Disease in Ontario Women with Early Stage Breast Cancer. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/89745
Chicago Manual of Style (16th Edition):
Abdel-Qadir, Husam. “The Spectrum, Impact, and Management of Cardiovascular Disease in Ontario Women with Early Stage Breast Cancer.” 2018. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/89745.
MLA Handbook (7th Edition):
Abdel-Qadir, Husam. “The Spectrum, Impact, and Management of Cardiovascular Disease in Ontario Women with Early Stage Breast Cancer.” 2018. Web. 05 Mar 2021.
Vancouver:
Abdel-Qadir H. The Spectrum, Impact, and Management of Cardiovascular Disease in Ontario Women with Early Stage Breast Cancer. [Internet] [Doctoral dissertation]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/89745.
Council of Science Editors:
Abdel-Qadir H. The Spectrum, Impact, and Management of Cardiovascular Disease in Ontario Women with Early Stage Breast Cancer. [Doctoral Dissertation]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/89745
University of Toronto
18.
Fazli, Ghazal Sanam.
Ethnic Variation in Prediabetes Incidence and Outcomes among Immigrants and Long-Term Residents.
Degree: PhD, 2018, University of Toronto
URL: http://hdl.handle.net/1807/89859
► Type 2 diabetes is rapidly increasing worldwide, particularly in low and middle-income countries. In Canada, the estimated prevalence of diabetes is projected to increase from…
(more)
▼ Type 2 diabetes is rapidly increasing worldwide, particularly in low and middle-income countries. In Canada, the estimated prevalence of diabetes is projected to increase from 9.3% to 12.1% by 2025. Previous studies have shown that some ethnoracial populations of non-European descent have a higher risk of developing diabetes, however, evidence on the onset of prediabetes across different ethnoracial groups in Canada is not available. Although, 5-10% of people with prediabetes convert to diabetes, there is no knowledge on the risk of conversion to diabetes among immigrants of different ethnic origins in Canada. Therefore, the purpose of this thesis was to investigate the
epidemiology of prediabetes within an immigrant cohort across different ethnicities, compared with long-term Canadian residents to inform future research and policy.
The main findings from this thesis conclude that:
1) Ethnicity is an important risk factor for the development of prediabetes and its progression to diabetes
2) Non-European populations, especially, people of South Asian, Sub-Saharan African and Caribbean, and South-East Asians at young ages have an elevated risk of developing prediabetes, in comparison to Western Europeans
3) Generally, South Asians, Sub-Saharan African and Caribbeans, and West Asian and Arabs, have a nearly twofold risk of converting to diabetes relative to Western Europeans
4) Relative to Western Europeans, the incidence of prediabetes and its conversion to diabetes was elevated for both women and men of non-European descents
5) Neighbourhood walkability amplified the effects of ethnicity such that non-European populations living in low walkability neighbourhoods had an increased risk of prediabetes, but those living in high walkability neighbourhoods did not. This was
particularly evident among West Asian and Arabs, and Latin Americans.
These findings highlight the need for population health interventions that will address the rapidly rising rates of prediabetes and conversion to diabetes among immigrant populations of different ethnicities. Future research and policy steps may involve establishing age/ethnic specific cut offs for diabetes screening and monitoring prediabetes risk within health care settings; designing diabetes prevention programs tailored to high risk groups and tackling upstream determinants such as neighbourhood designs that promote healthier lifestyles and support the prevention of diabetes.
Advisors/Committee Members: Booth, Gillian L, Dalla Lana School of Public Health.
Subjects/Keywords: diabetes; epidemiology; ethnicity; immigrant; prediabetes; social determinants of health; 0766
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APA (6th Edition):
Fazli, G. S. (2018). Ethnic Variation in Prediabetes Incidence and Outcomes among Immigrants and Long-Term Residents. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/89859
Chicago Manual of Style (16th Edition):
Fazli, Ghazal Sanam. “Ethnic Variation in Prediabetes Incidence and Outcomes among Immigrants and Long-Term Residents.” 2018. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/89859.
MLA Handbook (7th Edition):
Fazli, Ghazal Sanam. “Ethnic Variation in Prediabetes Incidence and Outcomes among Immigrants and Long-Term Residents.” 2018. Web. 05 Mar 2021.
Vancouver:
Fazli GS. Ethnic Variation in Prediabetes Incidence and Outcomes among Immigrants and Long-Term Residents. [Internet] [Doctoral dissertation]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/89859.
Council of Science Editors:
Fazli GS. Ethnic Variation in Prediabetes Incidence and Outcomes among Immigrants and Long-Term Residents. [Doctoral Dissertation]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/89859
19.
Brenner, Darren.
The Role of Chronic Inflammation in the Development of Lung Cancer.
Degree: 2012, University of Toronto
URL: http://hdl.handle.net/1807/33939
► Inflammation is believed to play a pivotal role in the development of cancer and in particular lung cancer through both intrinsic and extrinsic pathways. This…
(more)
▼ Inflammation is believed to play a pivotal role in the development of cancer and in particular
lung cancer through both intrinsic and extrinsic pathways. This thesis aimed through 4
manuscripts to determine the role of lung-specific inflammation-related exposures as well as
genetic variants (Single Nucleotide Polymorphism (SNPs)) in genes related to inflammation
pathways in lung cancer risk. Risk factors of particular interest were lung diseases including
emphysema, chronic bronchitis, pneumonia and tuberculosis. Data were collected from a
Toronto-based case-control study and combined with data from the International Lung Cancer
Consortium (17 studies for the non-genetic analyses and 6 studies for the genetic analyses). For
non-genetic data, methods included, but were not limited to, unconditional logistic regression
within single studies, Cox proportional hazards regression, meta-analytic techniques and pooled
analyses techniques. For genetic data, additive models of association across 7,650 SNPs
(selected based on role in inflammation) were pooled across studies and hierarchical modeling
iv
(HM) was used to incorporate prior functional information from various sources concerning the
SNPs of interest. Within the Toronto study (manuscript 1) associations with increased lung
cancer risk were observed for occupational exposures, previous lung diseases and a family
history of cancer. The meta-analysis (manuscript 2) and pooled analysis (manuscript 3) showed
relatively consistent associations between previous lung diseases and lung cancer risk across
histology, gender and smoking categories. Results persisted when examining lung disease
diagnoses made >10 or >20 years before cancer diagnosis. Our pathway-based analysis of
inflammation-related variants and lung cancer risk using HM (manuscript 4) showed that HM is
applicable to SNP analysis using pooled designs where heterogeneity can be incorporated into
SNP priors. After HM a previously observed variant (rs2736100) and novel variant (rs2741354)
were observed to be associated with lung cancer risk at corrected levels and replicated in an
independent population. Taken together these results provide further evidence of both intrinsic
and extrinsic factors affecting risk of lung cancer through inflammation.
PhD
Advisors/Committee Members: Hung, Rayjean, Dalla Lana School of Public Health.
Subjects/Keywords: Epidemiology; Lung Cancer; 0766
…5.5 Implications to Epidemiology and Human Health… …Literature Review
2.1. Epidemiology of Lung Cancer
2.1.1 Anatomy
Carcinoma of the lung arises in… …Descriptive Epidemiology
Lung cancer is the leading cause of cancer related mortality in Canada1 as… …Epidemiology of Lung Cancer among Never Smokers
Incidence rates of lung cancer among never smokers…
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APA (6th Edition):
Brenner, D. (2012). The Role of Chronic Inflammation in the Development of Lung Cancer. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/33939
Chicago Manual of Style (16th Edition):
Brenner, Darren. “The Role of Chronic Inflammation in the Development of Lung Cancer.” 2012. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/33939.
MLA Handbook (7th Edition):
Brenner, Darren. “The Role of Chronic Inflammation in the Development of Lung Cancer.” 2012. Web. 05 Mar 2021.
Vancouver:
Brenner D. The Role of Chronic Inflammation in the Development of Lung Cancer. [Internet] [Doctoral dissertation]. University of Toronto; 2012. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/33939.
Council of Science Editors:
Brenner D. The Role of Chronic Inflammation in the Development of Lung Cancer. [Doctoral Dissertation]. University of Toronto; 2012. Available from: http://hdl.handle.net/1807/33939
University of Toronto
20.
Tuite, Ashleigh.
Using Mathematical Models to Inform Syphilis Control Strategies in Men Who Have Sex with Men.
Degree: PhD, 2015, University of Toronto
URL: http://hdl.handle.net/1807/71350
► Syphilis is resurgent in many high-income countries, disproportionately affecting urban men who have sex with men (MSM). Frequent screening of at-risk individuals remains the best…
(more)
▼ Syphilis is resurgent in many high-income countries, disproportionately affecting urban men who have sex with men (MSM). Frequent screening of at-risk individuals remains the best available tool for syphilis control, but current public health efforts are not resulting in reduced disease burden. The aim of this thesis was to use mathematical modeling to understand the effect of different approaches to syphilis screening on epidemic dynamics and the health of MSM.
An agent-based model of syphilis transmission in a core group of sexually active MSM was parameterized with data on the
epidemiology of the current epidemic to evaluate plausible screening strategies that might be employed for epidemic control. Of the strategies evaluated, more frequent screening of at-risk MSM already accessing screening, rather than expanding outreach to provide screening to unscreened individuals, was found to be the most effective means of reducing syphilis incidence over a 10-year intervention period.
A state-transition microsimulation model of syphilis natural history and medical care was developed to determine the cost-effectiveness of incorporating routine syphilis testing into the blood-work of MSM under care for HIV. When rates of syphilis acquisition were high, opt-out syphilis screening in HIV-infected MSM was projected to be a highly cost-effective intervention.
A risk-structured deterministic compartmental mathematical model of syphilis transmission in MSM was used to examine the impact of sustained syphilis screening at varying levels of population coverage. Increasing screening in a population with initially low levels of coverage was shown to lead to increases in infection incidence. Although screening has the potential to control syphilis outbreaks, suboptimal screening coverage may result in the establishment of higher equilibrium infection incidence than that observed in the absence of the intervention, possibly contributing to outbreak persistence.
The results of this research suggest that current control efforts are not expected to reduce syphilis incidence, with more effective screening programs required to reduce syphilis burden in MSM. The work presented in this thesis provides some insight into factors that may lead to screening programs that both improve the health of individuals and reduce the overall population burden, ultimately resulting in improved epidemic control.
Advisors/Committee Members: Fisman, David N, Medical Science.
Subjects/Keywords: Communicable diseases; Epidemiology; Mathematical modeling; Screening; Sexually transmitted infections; Syphilis; 0766
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APA (6th Edition):
Tuite, A. (2015). Using Mathematical Models to Inform Syphilis Control Strategies in Men Who Have Sex with Men. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/71350
Chicago Manual of Style (16th Edition):
Tuite, Ashleigh. “Using Mathematical Models to Inform Syphilis Control Strategies in Men Who Have Sex with Men.” 2015. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/71350.
MLA Handbook (7th Edition):
Tuite, Ashleigh. “Using Mathematical Models to Inform Syphilis Control Strategies in Men Who Have Sex with Men.” 2015. Web. 05 Mar 2021.
Vancouver:
Tuite A. Using Mathematical Models to Inform Syphilis Control Strategies in Men Who Have Sex with Men. [Internet] [Doctoral dissertation]. University of Toronto; 2015. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/71350.
Council of Science Editors:
Tuite A. Using Mathematical Models to Inform Syphilis Control Strategies in Men Who Have Sex with Men. [Doctoral Dissertation]. University of Toronto; 2015. Available from: http://hdl.handle.net/1807/71350
University of Toronto
21.
Dennis, Jessica Kiri.
Genetic and Epigenetic Determinants of Tissue Factor Pathway Inhibitor Plasma Levels.
Degree: PhD, 2016, University of Toronto
URL: http://hdl.handle.net/1807/72974
► Tissue factor pathway inhibitor (TFPI) regulates the intravascular formation of blood clots, and low TFPI plasma levels increase the risk of both arterial and venous…
(more)
▼ Tissue factor pathway inhibitor (TFPI) regulates the intravascular formation of blood clots, and low TFPI plasma levels increase the risk of both arterial and venous thrombosis. TFPI plasma levels are also heritable, but few genes have been implicated. The objectives of my thesis were to identify genetic variants associated with TFPI plasma levels, and to integrate epigenetic data to better understand the molecular mechanisms by which these variants affect TFPI plasma levels.
I started with a Human Genome
Epidemiology (HuGE) review of genetic variants associated with TFPI plasma levels (manuscript 1). I meta-analyzed associations between four TFPI variants and TFPI plasma levels, and confirmed an association with rs5940 and rs7586970.
I next conducted a linkage analysis of TFPI plasma levels in 251 individuals from the F5L Family Study (manuscript 2) and replicated a linkage region on chromosome 2q identified in the only genome-wide study of TFPI plasma levels reported to date. I meta-analyzed SNPs in the region across three European ancestry study samples, and implicated rs62187992 in the chromosome 2q linkage result, and in the risk of venous thromboembolism in the INVENT Collaboration dataset. Public genomic resources supported three-dimensional looping of the rs62187992 region to the promoter of IKZF2, whereas nearby whole blood DNA methylation did not mediate the association between rs62187992 and TFPI plasma levels in either the F5L Family or MARTHA studies.
I last conducted a genome-wide association scan (GWAS) of TFPI plasma levels in the F5L Family Study (manuscript 3). I found that TFPI plasma level-associated SNPs were enriched in promoters and enhancers in vascular endothelial cells, a cell type that expresses TFPI, and I leveraged this enrichment in a prioritized GWAS via stratified false discovery rate control. While I did not identify novel SNPs, I nonetheless outlined a strategy for incorporating epigenetic data into prioritized GWAS.
This thesis is the most comprehensive assessment of genetic risk factors for TFPI plasma levels, and integrates epigenetic data to understand biological mechanisms - a first step towards new therapies that will reduce the public health burden of thrombosis.
Advisors/Committee Members: Gagnon, France, Dalla Lana School of Public Health.
Subjects/Keywords: coagulation; genetic epidemiology; population health; statistical genetics; thrombosis; 0766
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APA (6th Edition):
Dennis, J. K. (2016). Genetic and Epigenetic Determinants of Tissue Factor Pathway Inhibitor Plasma Levels. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/72974
Chicago Manual of Style (16th Edition):
Dennis, Jessica Kiri. “Genetic and Epigenetic Determinants of Tissue Factor Pathway Inhibitor Plasma Levels.” 2016. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/72974.
MLA Handbook (7th Edition):
Dennis, Jessica Kiri. “Genetic and Epigenetic Determinants of Tissue Factor Pathway Inhibitor Plasma Levels.” 2016. Web. 05 Mar 2021.
Vancouver:
Dennis JK. Genetic and Epigenetic Determinants of Tissue Factor Pathway Inhibitor Plasma Levels. [Internet] [Doctoral dissertation]. University of Toronto; 2016. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/72974.
Council of Science Editors:
Dennis JK. Genetic and Epigenetic Determinants of Tissue Factor Pathway Inhibitor Plasma Levels. [Doctoral Dissertation]. University of Toronto; 2016. Available from: http://hdl.handle.net/1807/72974
University of Toronto
22.
Behman, Ramy.
The Management of Adhesive Small Bowel Obstruction: A Population-based Analysis of Practices and Outcomes.
Degree: PhD, 2019, University of Toronto
URL: http://hdl.handle.net/1807/99901
► Background Adhesive small bowel obstruction (aSBO) is a common surgical illness that is characterized by its high likelihood for recurrence. We sought to compare different…
(more)
▼ Background
Adhesive small bowel obstruction (aSBO) is a common surgical illness that is characterized by its high likelihood for recurrence. We sought to compare different management strategies during the first admission for aSBO to characterize how early management strategies effect short- and long-term outcomes associated with aSBO.
Methods
We developed an algorithm to identify patients admitted to hospital for their first episode of aSBO using administrative data collected by the Ministry of Health and Long-Term Care of Ontario. We compared operative management to non-operative management with respect to the cumulative incidence of recurrence and overall survival; we also performed a cost-utility analysis comparing early operative management to a trial of non-operative management; finally, we evaluated the impact of laparoscopic surgery for aSBO on the incidence of bowel injury and peri-operative morbidity and mortality. A variety of quasi-experimental methods were used to estimate causal effects while accounting for potential confounding by indication.
Results
We identified 40,800 patients admitted for their first episode of aSBO over 2005-2014. Patients managed operatively had a lower risk of recurrence of aSBO [21.1% vs 13.0%, p
2020-03-21 00:00:00
Advisors/Committee Members: Nathens, Avery B, Karanicolas, Paul J, Health Policy, Management and Evaluation.
Subjects/Keywords: Adhesions; Clinical Epidemiology; Health Care Research; Small Bowel Obstruction; 0766
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APA (6th Edition):
Behman, R. (2019). The Management of Adhesive Small Bowel Obstruction: A Population-based Analysis of Practices and Outcomes. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/99901
Chicago Manual of Style (16th Edition):
Behman, Ramy. “The Management of Adhesive Small Bowel Obstruction: A Population-based Analysis of Practices and Outcomes.” 2019. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/99901.
MLA Handbook (7th Edition):
Behman, Ramy. “The Management of Adhesive Small Bowel Obstruction: A Population-based Analysis of Practices and Outcomes.” 2019. Web. 05 Mar 2021.
Vancouver:
Behman R. The Management of Adhesive Small Bowel Obstruction: A Population-based Analysis of Practices and Outcomes. [Internet] [Doctoral dissertation]. University of Toronto; 2019. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/99901.
Council of Science Editors:
Behman R. The Management of Adhesive Small Bowel Obstruction: A Population-based Analysis of Practices and Outcomes. [Doctoral Dissertation]. University of Toronto; 2019. Available from: http://hdl.handle.net/1807/99901
University of Toronto
23.
Wang, Zhengnan (Windy).
The association of urinary vitamin D binding protein with kidney dysfunction and hypovitaminosis D in patients at risk for type 2 diabetes.
Degree: 2018, University of Toronto
URL: http://hdl.handle.net/1807/91342
► One possible explanation for hypovitaminosis D in type 2 diabetes (T2DM) is that vitamin D metabolites may still be bound to the vitamin D binding…
(more)
▼ One possible explanation for hypovitaminosis D in type 2 diabetes (T2DM) is that vitamin D metabolites may still be bound to the vitamin D binding protein (VDBP) as the protein is lost in urine. Given that VDBP may be linked to both kidney dysfunction and hypovitaminosis D, the objective is to investigate longitudinal associations of urinary VDBP on measures of kidney health and vitamin D status. Data from a cohort of adults at risk for T2DM was used (n=729). Albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were measures of kidney function while 25-hydroxyvitamin D (25(OH)D) indicated vitamin D status. Adjusted generalized estimating equation models showed that uVDBP was associated with higher ACR over time, but was not associated with changes in eGFR or 25(OH)D. These results emphasize that although mild VDBP loss is not linked with hypovitaminosis D, urinary VDBP may be a useful biomarker for tubular damage.
M.Sc.
Advisors/Committee Members: Hanley, Anthony JG, Nutritional Sciences.
Subjects/Keywords: Albuminuria; Diabetes; Epidemiology; Kidney diease; Vitamin D; Vitamin D binding protein; 0766
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APA (6th Edition):
Wang, Z. (. (2018). The association of urinary vitamin D binding protein with kidney dysfunction and hypovitaminosis D in patients at risk for type 2 diabetes. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/91342
Chicago Manual of Style (16th Edition):
Wang, Zhengnan (Windy). “The association of urinary vitamin D binding protein with kidney dysfunction and hypovitaminosis D in patients at risk for type 2 diabetes.” 2018. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/91342.
MLA Handbook (7th Edition):
Wang, Zhengnan (Windy). “The association of urinary vitamin D binding protein with kidney dysfunction and hypovitaminosis D in patients at risk for type 2 diabetes.” 2018. Web. 05 Mar 2021.
Vancouver:
Wang Z(. The association of urinary vitamin D binding protein with kidney dysfunction and hypovitaminosis D in patients at risk for type 2 diabetes. [Internet] [Masters thesis]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/91342.
Council of Science Editors:
Wang Z(. The association of urinary vitamin D binding protein with kidney dysfunction and hypovitaminosis D in patients at risk for type 2 diabetes. [Masters Thesis]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/91342
24.
Coleman, Brenda Lee.
The Role of Drinking Water as a Source of Transmission of Antimicrobial Resistant Escherichia coli.
Degree: 2008, University of Toronto
URL: http://hdl.handle.net/1807/17297
► Antimicrobial resistance is a serious threat to the treatment of infectious diseases and a leading public health concern of the 21st century. Antimicrobial resistant E.…
(more)
▼ Antimicrobial resistance is a serious threat to the treatment of infectious diseases and a leading public health concern of the 21st century. Antimicrobial resistant E. coli has been detected in many places including domestic livestock, humans, food items, surface water, and drinking water. Although the use of antibiotics is a major contributor to the emergence of resistance, the ingestion of water contaminated with antimicrobial resistant bacteria may contribute to the prevalence of antimicrobial resistance in humans. Purpose: The objectives of the research were to determine the prevalence of human faecal carriage of antimicrobial resistant E. coli in people residing in southern Ontario who used private water sources and to determine whether the use of water contaminated with antimicrobial resistant E. coli was associated with human carriage of same. Method: The study population consisted of people living in Ontario households that submitted water samples from private water sources for bacteriological testing between May 2005 and September 2006. Respondents completed a questionnaire and submitted a self-collected rectal swab. Results: Antimicrobial resistant E. coli were detected in the swabs of 41% of the 699 respondents, with 28% resistant to ampicillin, 25% to tetracycline, and 24% to sulfisoxazole, and 29% that were multi-drug resistant. Subjects from households using untreated water contaminated with antimicrobial resistant E. coli were 40% more likely to carry antimicrobial resistant E. coli in their gastrointestinal system than people from households using uncontaminated water, even after adjusting for the effect of other variables. Implications: The association between the consumption of water contaminated with antimicrobial resistant E. coli and human carriage of resistant E. coli highlights the ongoing risks associated with water contamination and antimicrobial resistance in Ontario. The high rates of resistant E. coli in healthy non-institutional persons provides further rationale for public health programs to reduce antibiotic use in medicine and agriculture.
PhD
Advisors/Committee Members: McGeer, Allison, Dalla Lana School of Public Health.
Subjects/Keywords: epidemiology; public health science; 0766
…in E. coli
1.2.1 The Descriptive Epidemiology of E. coli
Escherichia coli are Gram-negative… …E. coli and the use of water contaminated
with same.
1.2.2 Epidemiology of Antimicrobial…
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APA (6th Edition):
Coleman, B. L. (2008). The Role of Drinking Water as a Source of Transmission of Antimicrobial Resistant Escherichia coli. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/17297
Chicago Manual of Style (16th Edition):
Coleman, Brenda Lee. “The Role of Drinking Water as a Source of Transmission of Antimicrobial Resistant Escherichia coli.” 2008. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/17297.
MLA Handbook (7th Edition):
Coleman, Brenda Lee. “The Role of Drinking Water as a Source of Transmission of Antimicrobial Resistant Escherichia coli.” 2008. Web. 05 Mar 2021.
Vancouver:
Coleman BL. The Role of Drinking Water as a Source of Transmission of Antimicrobial Resistant Escherichia coli. [Internet] [Doctoral dissertation]. University of Toronto; 2008. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/17297.
Council of Science Editors:
Coleman BL. The Role of Drinking Water as a Source of Transmission of Antimicrobial Resistant Escherichia coli. [Doctoral Dissertation]. University of Toronto; 2008. Available from: http://hdl.handle.net/1807/17297
University of Toronto
25.
Tait, Christopher.
Dietary Patterns, Food Insecurity, and Type 2 Diabetes Risk: A Novel Platform for Population-Based Nutrition Research Using Linked Survey and Health Administrative Data in Ontario.
Degree: PhD, 2018, University of Toronto
URL: http://hdl.handle.net/1807/92178
► The burden of type 2 diabetes has consistently grown in Canada over the past several decades. As current prevention efforts have been unsuccessful in curbing…
(more)
▼ The burden of type 2 diabetes has consistently grown in Canada over the past several decades. As current prevention efforts have been unsuccessful in curbing the diabetes epidemic, there is a need to advance our understanding of the pathways between modifiable risk factors and diabetes incidence at the population-level.
Unhealthy diet has been characterized as a leading risk factor for morbidity and mortality in Canada and across peer nations over the last 20 years. Despite this observation, the majority of research considering the relationship between diet and type 2 diabetes has focused on the influence of individual nutrients as opposed to real-world patterns of dietary intake, and in the absence of considering the broader social determinants that influence these dietary patterns, such as food insecurity. At the same time, research on food insecurity rarely considers this construct beyond a descriptive marker of economic deprivation, resulting in a dearth of literature examining the diet-related chronic disease effects that stem from food insecurity.
Throughout this dissertation, four studies were conducted to rigorously examine the poorly understood pathways by which modifiable dietary exposures and upstream nutrition-related social factors relate to the incidence of type 2 diabetes in the Canadian population. In doing so, a breadth of methodological approaches were applied to a unique platform for population-based nutrition research that was established through linked survey and administrative data in Ontario.
The first manuscript synthesizes the published literature on dietary patterns and type 2 diabetes, as a means to understand how different methodologies can be used to comprehensively study the relationship between diet and diabetes. I found that the literature is heterogeneous with respect to viable measurement approaches for conceptualizing dietary patterns, but also gained a perspective on which approaches were the most meaningful for the Canadian context. The second manuscript investigates the prospective relationship between dietary patterns and type 2 diabetes risk for the first time in the Canadian population, improving upon many of the methodological limitations identified in studies captured in the systematic review. I found that dietary patterns most congruent with Canadian dietary recommendations were not associated with a decreased risk of type 2 diabetes, challenging findings that have persisted in the extant literature. The third study moves beyond considering the proximal relationships between diet and disease to consider the influence of food insecurity as an upstream nutrition-related social determinant of diabetes risk. I found that food insecurity is associated with a greater than 2-fold risk of type 2 diabetes over 12 years of follow-up. The fourth study extends this work to gain insight into the mechanisms by which food insecurity increases the risk of type 2 diabetes in the Canadian population. In this final study, I found that nearly 45% of the association observed in study 3 may be…
Advisors/Committee Members: Rosella, Laura C, Dalla Lana School of Public Health.
Subjects/Keywords: causal mediation; dietary patterns; food insecurity; nutritional epidemiology; type 2 diabetes; 0766
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APA (6th Edition):
Tait, C. (2018). Dietary Patterns, Food Insecurity, and Type 2 Diabetes Risk: A Novel Platform for Population-Based Nutrition Research Using Linked Survey and Health Administrative Data in Ontario. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/92178
Chicago Manual of Style (16th Edition):
Tait, Christopher. “Dietary Patterns, Food Insecurity, and Type 2 Diabetes Risk: A Novel Platform for Population-Based Nutrition Research Using Linked Survey and Health Administrative Data in Ontario.” 2018. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/92178.
MLA Handbook (7th Edition):
Tait, Christopher. “Dietary Patterns, Food Insecurity, and Type 2 Diabetes Risk: A Novel Platform for Population-Based Nutrition Research Using Linked Survey and Health Administrative Data in Ontario.” 2018. Web. 05 Mar 2021.
Vancouver:
Tait C. Dietary Patterns, Food Insecurity, and Type 2 Diabetes Risk: A Novel Platform for Population-Based Nutrition Research Using Linked Survey and Health Administrative Data in Ontario. [Internet] [Doctoral dissertation]. University of Toronto; 2018. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/92178.
Council of Science Editors:
Tait C. Dietary Patterns, Food Insecurity, and Type 2 Diabetes Risk: A Novel Platform for Population-Based Nutrition Research Using Linked Survey and Health Administrative Data in Ontario. [Doctoral Dissertation]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/92178
University of Toronto
26.
Foty, Richard George.
Measuring the Short-Term Effect of Ambient Air Pollution on Acute Health Service Use in Ontarians Living with Chronic Obstructive Pulmonary Disease.
Degree: PhD, 2017, University of Toronto
URL: http://hdl.handle.net/1807/80803
► Short-term air pollution exposure has been associated with increased morbidity, especially amongst vulnerable populations like those with Chronic Obstructive Pulmonary Disease (COPD). The Air Quality…
(more)
▼ Short-term air pollution exposure has been associated with increased morbidity, especially amongst vulnerable populations like those with Chronic Obstructive Pulmonary Disease (COPD). The Air Quality Health Index (AQHI) is an aggregate measure of overall ambient air pollution. It was designed to communicate to the public in an understandable way air quality levels, associated health risks, and strategies to reduce exposure. Its formulation was based on relative mortality and little is known about the association between the AQHI and morbidity amongst individuals with COPD. The objective of my dissertation is to determine the association between ambient air pollution and acute health service use (HSU - hospitalization and emergency department [ED] visits) amongst individuals with COPD. My first original research study determined the perception and knowledge of individuals with COPD, regarding air pollution health risks, assessment, and exposure reduction strategies. The second quantified the association between the AQHI and acute HSU, and the final study examined whether temperature modifies this association. While Canadians with COPD believed that air pollution affects health, their level of knowledge regarding air quality assessment, health risks, and strategies to reduce exposure was lacking. The AQHI was associated with increased risk of acute HSU for non-accidental, COPD and cardiovascular (CVD) causes. A statistically significant association between the AQHI and CVD hospitalization was observed at all temperatures, whereas the association with COPD hospitalization was only significant at higher temperatures. Results also suggested individuals with prior history of hospitalization for COPD, lower respiratory tract infection, or acute myocardial infarction may be more vulnerable. These findings provide important insights for policy and public health strategy. Reducing the negative health effects of air pollution amongst individuals with COPD requires patient and health care provider education, real-time dissemination of air quality levels regardless of temperature, and specific recommendations on how to reduce exposure.
Advisors/Committee Members: To, Teresa, Medical Science.
Subjects/Keywords: Air Pollution; Chronic Obstructive Pulmonary Disease; Epidemiology; Health Effects; Public Health; Respiratory Health; 0766
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APA (6th Edition):
Foty, R. G. (2017). Measuring the Short-Term Effect of Ambient Air Pollution on Acute Health Service Use in Ontarians Living with Chronic Obstructive Pulmonary Disease. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/80803
Chicago Manual of Style (16th Edition):
Foty, Richard George. “Measuring the Short-Term Effect of Ambient Air Pollution on Acute Health Service Use in Ontarians Living with Chronic Obstructive Pulmonary Disease.” 2017. Doctoral Dissertation, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/80803.
MLA Handbook (7th Edition):
Foty, Richard George. “Measuring the Short-Term Effect of Ambient Air Pollution on Acute Health Service Use in Ontarians Living with Chronic Obstructive Pulmonary Disease.” 2017. Web. 05 Mar 2021.
Vancouver:
Foty RG. Measuring the Short-Term Effect of Ambient Air Pollution on Acute Health Service Use in Ontarians Living with Chronic Obstructive Pulmonary Disease. [Internet] [Doctoral dissertation]. University of Toronto; 2017. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/80803.
Council of Science Editors:
Foty RG. Measuring the Short-Term Effect of Ambient Air Pollution on Acute Health Service Use in Ontarians Living with Chronic Obstructive Pulmonary Disease. [Doctoral Dissertation]. University of Toronto; 2017. Available from: http://hdl.handle.net/1807/80803
27.
Amachawadi, Raghavendra G.
Selection and
co-selection of antimicrobial resistance in gut enterococci of
swine and cattle fed diets supplemented with copper, tylosin, and
chlortetracycline.
Degree: PhD, Department of Diagnostic
Medicine/Pathobiology, 2014, Kansas State University
URL: http://hdl.handle.net/2097/19765
► Copper, as copper sulfate, is often used as an alternative to in-feed antibiotics for growth promotion in both swine and cattle diets. Gut bacteria exposed…
(more)
▼ Copper, as copper sulfate, is often used as an
alternative to in-feed antibiotics for growth promotion in both
swine and cattle diets. Gut bacteria exposed to copper can acquire
resistance, which among enterococci is conferred by a plasmid-borne
transferable copper resistance gene (tcrB). The plasmid also
carries tetracycline [tet(M)] and macrolide [erm(B)] resistance
genes. Because of the genetic link between acquired copper (tcrB)
and antibiotic resistance in Enterococcus spp., we hypothesized
that copper supplementation may exert selection pressure for
enterococci to become resistant to macrolides and tetracyclines,
and possibly to other antibiotics. We conducted studies in cattle
and swine to investigate the relationship between copper
supplementation and the fecal prevalence of tcrB-positive
enterococci, as well as its potential co-selection for macrolide
and tetracycline resistance. The prevalence was higher in animals
fed diets supplemented with elevated level of copper compared to
normal level (P < 0.05). The tcrB-positive isolates belonged to
either E. faecium or E. faecalis; the majority was E. faecium. All
tcrB-positive isolates also contained both erm(B) and tet(M) genes;
however, none of them harbored the vanA gene. Median minimum
inhibitory concentrations (MIC) of copper for tcrB-positive and
tcrB-negative enterococci were 22 mM and 4 mM, respectively (P <
0.0001). The overall prevalence of erm(B) and tet(M) genes among
enterococcal isolates of cattle were 46.8 % and 57.5%,
respectively; in contrast,100% of the swine isolates were positive
for both erm(B) and tet(M) genes. The transferability of the tcrB
gene was demonstrated by filter mating assay. Multi-locus variable
number tandem repeat analysis revealed a genetically diverse
population of enterococci. The finding of a strong association
between the copper resistance gene and other antibiotic
(tetracycline and tylosin) resistance determinants is
significant
because enterococci are potential pathogens and have the propensity
to transfer resistance genes to other bacteria in the gut. The
occurrence of vancomycin resistant enterococci in swine in the US
is very rare. Strains of E. faecium positive for vanA, that confers
resistance to vancomycin, were isolated and characterized from
swine feces. The swine strains belonged to clonal complex 17, a
well-adapted hospital clone throughout the world.
Advisors/Committee Members: H. Morgan Scott.
Subjects/Keywords: Antimicrobial resistance;
Cattle;
Copper;
Enterococcus spp.;
Swine;
Antibiotics; Epidemiology (0766); Microbiology (0410)
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APA (6th Edition):
Amachawadi, R. G. (2014). Selection and
co-selection of antimicrobial resistance in gut enterococci of
swine and cattle fed diets supplemented with copper, tylosin, and
chlortetracycline. (Doctoral Dissertation). Kansas State University. Retrieved from http://hdl.handle.net/2097/19765
Chicago Manual of Style (16th Edition):
Amachawadi, Raghavendra G. “Selection and
co-selection of antimicrobial resistance in gut enterococci of
swine and cattle fed diets supplemented with copper, tylosin, and
chlortetracycline.” 2014. Doctoral Dissertation, Kansas State University. Accessed March 05, 2021.
http://hdl.handle.net/2097/19765.
MLA Handbook (7th Edition):
Amachawadi, Raghavendra G. “Selection and
co-selection of antimicrobial resistance in gut enterococci of
swine and cattle fed diets supplemented with copper, tylosin, and
chlortetracycline.” 2014. Web. 05 Mar 2021.
Vancouver:
Amachawadi RG. Selection and
co-selection of antimicrobial resistance in gut enterococci of
swine and cattle fed diets supplemented with copper, tylosin, and
chlortetracycline. [Internet] [Doctoral dissertation]. Kansas State University; 2014. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/2097/19765.
Council of Science Editors:
Amachawadi RG. Selection and
co-selection of antimicrobial resistance in gut enterococci of
swine and cattle fed diets supplemented with copper, tylosin, and
chlortetracycline. [Doctoral Dissertation]. Kansas State University; 2014. Available from: http://hdl.handle.net/2097/19765
28.
Srigley, Jocelyn Andyss.
The Hawthorne Effect in Hand Hygiene Compliance Monitoring.
Degree: 2014, University of Toronto
URL: http://hdl.handle.net/1807/65606
► Introduction: The Hawthorne effect, or behaviour change due to awareness of being observed, is believed to inflate directly observed hand hygiene compliance rates, but evidence…
(more)
▼ Introduction: The Hawthorne effect, or behaviour change due to awareness of being observed, is believed to inflate directly observed hand hygiene compliance rates, but evidence is limited.
Methods: A real-time location system tracked hospital hand hygiene auditors and recorded alcohol-based hand rub and soap dispenses. Rates of hand hygiene events per dispenser per hour within sight of auditors were compared to dispensers not exposed to auditors.
Results: The event rate in dispensers visible to auditors (3.75/dispenser/hour) was significantly higher than unexposed dispensers at the same time (1.48) and in prior weeks (1.07). The rate increased significantly when auditors were present compared to five minutes prior to arrival. There were no significant changes inside patient rooms.
Conclusions: Hand hygiene event rates increase in hallways when auditors are visible and the increase occurs after the auditors’ arrival, consistent with the existence of a Hawthorne effect localized to areas where auditors are visible.
MAST
Advisors/Committee Members: Baker, G. Ross, Health Policy, Management and Evaluation.
Subjects/Keywords: Hand hygiene; Hawthorne effect; Hospital epidemiology; 0766
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APA (6th Edition):
Srigley, J. A. (2014). The Hawthorne Effect in Hand Hygiene Compliance Monitoring. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/65606
Chicago Manual of Style (16th Edition):
Srigley, Jocelyn Andyss. “The Hawthorne Effect in Hand Hygiene Compliance Monitoring.” 2014. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/65606.
MLA Handbook (7th Edition):
Srigley, Jocelyn Andyss. “The Hawthorne Effect in Hand Hygiene Compliance Monitoring.” 2014. Web. 05 Mar 2021.
Vancouver:
Srigley JA. The Hawthorne Effect in Hand Hygiene Compliance Monitoring. [Internet] [Masters thesis]. University of Toronto; 2014. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/65606.
Council of Science Editors:
Srigley JA. The Hawthorne Effect in Hand Hygiene Compliance Monitoring. [Masters Thesis]. University of Toronto; 2014. Available from: http://hdl.handle.net/1807/65606
University of Toronto
29.
Murthy, Sanjay K.
Impact of Clostriduim difficile colitis on Five Year Health Outcomes of Ulcerative Colitis Patients.
Degree: 2012, University of Toronto
URL: http://hdl.handle.net/1807/33469
► Clostridium difficile colitis (CDC) is associated with a higher risk of acute death among hospitalized ulcerative colitis (UC) patients. However, the risk of colectomy with…
(more)
▼ Clostridium difficile colitis (CDC) is associated with a higher risk of acute death among hospitalized ulcerative colitis (UC) patients. However, the risk of colectomy with CDC in these patients has varied across studies. No study has assessed the long-term health impact of CDC in UC patients. Therefore, the present study evaluated the impact of CDC on five-year health outcomes of hospitalized UC patients based on Ontario health administrative data.
No overall association was observed between CDC and five-year risks of colectomy or death in overall cohort. However, patients who were discharged from hospital without undergoing colectomy demonstrated marginally higher five-year risks of colectomy and hospital re-admission. Mortality risk and length of stay during index hospitalization were also higher in patients with CDC. Analysis of a parallel cohort of UC patients derived using a published case definition corroborated most of these results, but demonstrated a higher five-year mortality risk with CDC.
MAST
Advisors/Committee Members: Steinhart, A. Hillary, Health Policy, Management and Evaluation.
Subjects/Keywords: Inflammatory bowel disease; Ulcerative colitis; Clostridium difficile; Colectomy; Mortality; Hospitalization; Prognosis; Population-based study; Health Outcomes; Epidemiology; 0564; 0766; 0573
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APA (6th Edition):
Murthy, S. K. (2012). Impact of Clostriduim difficile colitis on Five Year Health Outcomes of Ulcerative Colitis Patients. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/33469
Chicago Manual of Style (16th Edition):
Murthy, Sanjay K. “Impact of Clostriduim difficile colitis on Five Year Health Outcomes of Ulcerative Colitis Patients.” 2012. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/33469.
MLA Handbook (7th Edition):
Murthy, Sanjay K. “Impact of Clostriduim difficile colitis on Five Year Health Outcomes of Ulcerative Colitis Patients.” 2012. Web. 05 Mar 2021.
Vancouver:
Murthy SK. Impact of Clostriduim difficile colitis on Five Year Health Outcomes of Ulcerative Colitis Patients. [Internet] [Masters thesis]. University of Toronto; 2012. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/33469.
Council of Science Editors:
Murthy SK. Impact of Clostriduim difficile colitis on Five Year Health Outcomes of Ulcerative Colitis Patients. [Masters Thesis]. University of Toronto; 2012. Available from: http://hdl.handle.net/1807/33469
30.
Li, Debbie.
A Population-based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management.
Degree: 2015, University of Toronto
URL: http://hdl.handle.net/1807/69098
► Evidence has accrued to support change in the management of colonic diverticulitis. Advances in imaging and medical management suggest more patients may be managed non-operatively;…
(more)
▼ Evidence has accrued to support change in the management of colonic diverticulitis. Advances in imaging and medical management suggest more patients may be managed non-operatively; while various new operative approaches have been proposed as an alternative to Hartmann's procedure when urgent surgery is necessary. Furthermore, published reports suggest the clinical course of the disease may be characteristically benign; suggesting interval elective colectomy may be unnecessary for the majority of patients, even those with known risk factors. Reports to date consist predominantly of institutional cohort studies with high loss to follow-up and failure to account for competing risks. To address the gaps in knowledge, we performed a population-based retrospective cohort study. The objectives of this study were to (a) evaluate temporal trends in the management of diverticulitis, and (b) characterize the clinical course of the disease following initial non-operative management. Results from this study will help to inform best practice recommendations.
M.Sc.
Advisors/Committee Members: Nathens, Avery B, Health Policy, Management and Evaluation.
Subjects/Keywords: Colectomy; Diverticular disease; Diverticulitis; Epidemiology; Surgery; 0766
…remain
unclear.
2
1.2
Epidemiology of diverticular disease
The true prevalence of colonic…
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APA ·
Chicago ·
MLA ·
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Manager
APA (6th Edition):
Li, D. (2015). A Population-based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/69098
Chicago Manual of Style (16th Edition):
Li, Debbie. “A Population-based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management.” 2015. Masters Thesis, University of Toronto. Accessed March 05, 2021.
http://hdl.handle.net/1807/69098.
MLA Handbook (7th Edition):
Li, Debbie. “A Population-based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management.” 2015. Web. 05 Mar 2021.
Vancouver:
Li D. A Population-based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management. [Internet] [Masters thesis]. University of Toronto; 2015. [cited 2021 Mar 05].
Available from: http://hdl.handle.net/1807/69098.
Council of Science Editors:
Li D. A Population-based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management. [Masters Thesis]. University of Toronto; 2015. Available from: http://hdl.handle.net/1807/69098
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Open Access Theses and Dissertations
