Health Sciences - Theses, Dissertations, and other Required Graduate Degree Essays

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Mentoring and the Public Health Workforce: A Scoping Review

Date created: 
2015-07-02
Abstract: 

This study sought to better understand mentoring in the training of the public health workforce, and to identify key issues in the conceptualization and application of mentoring and its potential relevance to public health. Methods entailed a scoping review of literature in Medline, CINAHL, and Web of Science databases following guidelines in the PRISMA standards. A total of 1809 references between 2000 and June 2014 were identified, of which 27 met inclusion criteria. Very little research on the topic has been published. The main thematic areas were the models used in mentoring, the value of mentoring, mentors' and mentees' perceptions and needs, attributes of successful mentoring relationships, elements for the design and evaluation of mentoring programs, and authors’ recommendations. The main conclusion is that mentoring is a growing interest in relation to developing the public health workforce. To improve mentoring models and practices, further research should be conducted.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Kitty Corbett
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

Engagement in care among adolescents and young adults living with HIV in Canada

Date created: 
2015-09-22
Abstract: 

Background: More than thirty years after the beginning of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, HIV continues to be a problem among adolescents and young adults (AYA).. The benefits of combination antiretroviral therapy (cART), including lower morbidity and improved survival, are realized through timely uptake of treatment, virological suppression, and retention in care; however, compared with their adult counterparts, AYA living with HIV tend to have poorer treatment and clinical outcomes. In the current context of UNAIDS’ ambitious 90-90-90 campaign, there is a push to expand cART to all those in need in order to reduce morbidity/mortality and to curb transmission of HIV. We will not achieve the 90-90-90 goals without addressing HIV treatment and outcomes among AYA; however this population remains under-researched; to date there is very little research describing AYA living with HIV in Canada. The overall aim of this dissertation is to examine key cART treatment outcomes among Canadian AYA (ages 18-29 years) living with HIV and compare outcomes with those of older adults (30 years and older). Methods: The quantitative studies in this dissertation utilize clinical and laboratory data from the Canadian Observational Cohort Collaboration (CANOC), Canada’s largest HIV cohort study, which includes data from the year 2000 onward on a total of 10,044 people living in three of Canada’s largest provinces—British Columbia, Ontario, and Quebec. All participants in CANOC are HIV-positive and were cART-naive prior to initiating antiretroviral treatment on or after January 1, 2000. Findings: There are 1168 (13.7%) AYA (ages 18-29 years) in CANOC. Significant differences in treatment outcomes were found between AYA and older adults. AYA were more likely than older adults to initiate cART before their CD4 counts were <200 cells/mm3 and/or they had an AIDS-defining illness (ADI) (51.7% vs 40.2% p<0.001). When looking at virological suppression, fewer AYA experienced virological suppression than older adults (86% vs. 91%, p<0.001) and of these, only 73% (compared with 80% of older adults) suppressed within the first year of cART inititation (p<0.001). Additionally, a greater proportion of AYA who achieved virological suppression experienced viral rebound than older adults (26% vs. 22%, p=0.009). Discussion: When comparing AYA with older adults, AYA are more likely to initiate treatment when recommended but once on treatment, they are less likely to virologically suppress and remain suppressed. The importance of supporting AYA to achieve optimal health is a long-term investment with benefits over the life course. In order to meet ambitious public health goals such as those that the UNIADS 90-90-90 campaign has set, AYA will require tailored health care services and programming to assist them to access and remain in care.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Robert, Hogg
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.

Global-Fundization: HIV/AIDS funding mechanisms and programming in Sierra Leone

Date created: 
2015-05-08
Abstract: 

This thesis explores how the Global Fund’s standardized funding stipulations and expectations impact HIV/AIDS programs in Sierra Leone. Situating funding mechanisms within the current trajectory of international healthcare delivery and financing, I argue that the Global Fund’s business-oriented financing approach has shaped Sierra Leonean program targets towards data production and digitization, allowing the Global Fund to make decisions ‘from a distance.’ Drawing on three months of ethnographic fieldwork in Freetown, Sierra Leone, I demonstrate how: 1) contradictions between weak infrastructure and Global Fund expectations impact HIV program practices; 2) the Global Fund’s data requirements and timeframes create asymmetries and disconnects in-country; and 3) audit and accountability technologies in HIV programs can become practices unrelated to health outcomes.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Susan L. Erikson
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

Elucidating the consequences of HIV-1 immune escape from host CTL selection pressure

Author: 
Date created: 
2015-08-05
Abstract: 

This thesis focuses on HIV-1 adaptation to CTL immune response and presents original data on the consequences of 10 published HLA-B*13-associated CTL escape mutations in Gag, Pol and Nef on HIV-1 replication capacity (RC) and Nef-mediated CD4 and HLA class I downregulation. B*13-driven immune escape at Gag-I147L and -I437L incurred replicative costs of 5% and 17% on in vitro viral RC, which was rescued to wild-type (HIV-1NL4.3) levels by Gag-A146S/K436R and Gag-K436R, respectively. One major observation was that B*13-driven double mutation, NefE24Q/Q107R impaired this protein’s HLA class I downregulation ability by 40%, with no evidence of replicative or expression defects. Moreover, cells infected with double mutant virus were “visible” to HIV-specific T cells. Our results thus suggest that B*13-mediated protective effects on HIV-1 disease progression may be attributable, in part to a novel mechanism – namely, the selection of escape mutations in Nef that dampen one of HIV-1’s key immune evasion strategies.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Zabrina Brumme
Department: 
Health Sciences:
Thesis type: 
(Thesis) M.Sc.

Associations between biogeoclimatic zones, aquifer type, agricultural land and five gastrointestinal illnesses in British Columbia from 2000-2013 and potential implications under projected climate change

Author: 
Date created: 
2015-05-14
Abstract: 

Rates of five acute gastrointestinal illnesses (AGIs) were calculated across three environmental variables in British Columbia: biogeoclimatic zone, aquifer type and agricultural land. The three bacterial pathogens (campylobacteriosis, Verotoxin-producing Escherichia coli and salmonellosis) were strongly correlated with many temperature-related variables calculated at the biogeoclimatic zone level. Combined relative risk for the three bacterial AGIs was 1.11189 (p=0.006) for every degree Celsius increase in mean annual temperature. When amalgamated into two groups (bacteria and parasites) both groups had significantly higher proportions associated with unconsolidated aquifers than with bedrock aquifers. Verotoxin-producing Escherichia coli rates were significantly higher in watersheds with agricultural land than those with none. Conversely, rates of campylobacteriosis, salmonellosis and giardiasis were significantly lower in agricultural watersheds.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Tim Takaro
Diana Allen, Margot Parkes, Stephen Dery
Department: 
Health Sciences:
Thesis type: 
(Thesis) M.Sc.

Cervical Screening in Swaziland: an Ethnographic Case Study

Date created: 
2015-07-31
Abstract: 

This thesis examines and contextualizes women’s fears about cervical screening in Swaziland. I begin with a critique of the historical and epidemiological trend to blame screening avoidance among African women on cultural fears. Then, drawing on data from semi-structured interviews and participant observation, I find that fear of cervical screening is a product of the clinical, social and political contexts of screening, thus challenging assumptions about culture-based fear. The clinical encounter between women and nurses is laborious; complicated by fears of gossip, the pejorative judgment of women’s bodies and hospital politics. The complexities of this encounter collide with politically produced realities of cancer treatment scarcity, therapeutic failure and HIV’s dominance of local clinical space to further create and sustain fear. Ultimately, women’s fears of cervical screening are logical, and must be understood relative to the complex backdrop of clinical sociality, politics and scarcity that situates cervical cancer in Swaziland.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Susan Erikson
Department: 
Health Sciences:
Thesis type: 
(Thesis) M.Sc.

Relationship between air pollution exposure and systemic inflammation in Canada

Date created: 
2015-08-20
Abstract: 

Research has shown that plausible links between air pollution exposure and both atherosclerosis and diabetes may exist through systemic inflammation. This present study quantified the association between particulate matter less than 2.5 μm and nitrogen dioxide with four biomarkers of inflammation (CRP, fibrinogen, white blood cells, and platelets) in a cross-sectional sample representative of the Canadian population aged between 18 and 79 (N=6322) from cycle 1 and 2 (2007-2012) of the Canadian Health Measures Survey. After adjusting for race, household income and temperature, results showed that daily and annual NO2 was inversely associated with fibrinogen and the associations were slightly stronger among those taking statins, although not clinically significant. Although our results did not support our hypothesis, our findings raise new questions about other possible health effects behind the association between NO2 exposure and fibrinogen.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Scott Venners
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

Attempts to visualize lymphocytes latently infected with Marek’s Disease Virus in situ

Date created: 
2015-08-19
Abstract: 

Marek’s Disease (MD) is an avian lymphoma disease caused by an alphaherpesvirus, Marek’s Disease Virus (MDV). Live attenuated vaccines can protect birds from the disease but do not inhibit MDV infection. The co-infection of vaccine virus and virulent MDV perhaps contributed to the emergence of MDV strains that caused vaccine breaks. MDV establishes lytic and latent states of infection but it is during latency that cells can be transformed. This thesis strived to create a tool to visualize latently infected cells that would help reveal the transformation process and underlying mechanisms of the vaccine effect. Toward the goal, I constructed two recombinant MDVs that were designed to express a fluorescent protein during latency. The recombinant MDVs were able to replicate successfully in vitro and in vivo comparatively to parental MDV. They also expressed the fluorescent protein in the infected cells in vitro. However, the expression of the fluorescent protein was not confirmed in vivo and these recombinant MDVs did not cause lymphomas in infected birds.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Masahiro Niikura
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.

The climate change, water, and health nexus: an interdisciplinary inquiry

Date created: 
2015-07-08
Abstract: 

Climate change is an issue of unprecedented complexity and a major threat to ecosystem function, water resources, and human health. Although important knowledge gaps exist at the interface of climate change, water, and health, it is increasingly clear that water is a primary medium through which climate change affects health and that knowledge integration and collaboration are needed to understand and address climate change.This dissertation explores the links among climate change, water, and health drawing on interdisciplinary and ecohealth approaches and presents three individual research papers. The first two papers use eleven-years of acute gastro-intestinal illness (AGI) data to generate knowledge about the potential impacts of climate change on waterborne AGI in British Colombia (BC). Using a Geographic Information System and a suite of descriptive methods, the seasonality of AGI is characterized across BC’s major drinking water sources (surface water, groundwater, and mixed water) and hydroclimatic regimes (snowmelt-dominated and rainfall-dominated). Associations between hydroclimatic variables and AGI are assessed using times-series regression analysis. The results show that AGI exhibits seasonality and that hydroclimatic variables play a role in driving the occurrence and variability of AGI. Moreover, the relationships between hydroclimatic variables and AGI differ in the context of the two major hydroclimatic regimes in BC. These results suggest that future climate change will likely lead to a higher burden of AGI in BC, with impacts mediated by context and ecological factors. The third paper is oriented towards climate change policy and action and uses qualitative data and the method of frame analysis to describe the ways in which climate change is framed in public health and water resource management texts. Results show that climate change is framed in numerous ways both within and across these sectors. The notion of frames and the process of frame-reflection may be useful tools to promote integration and collaboration and an opportunity to foster enabling conditions for climate change policy and action.Finally, through a critical reflection on the research findings and the research process, implications for interdisciplinary research and collaborative action are synthesized and presented.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Tim Takaro
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.

Nursing Praxis, Racialization, and ‘Othering’: An Ethnography of Breastfeeding Promotion in Urban, Western Canada

Date created: 
2015-08-10
Abstract: 

This thesis examines how public health nurses (PHNs) racialize and ‘other’ mothers during the postpartum period. This study was conducted over seven months in urban, western Canada. Ethnographic methods included participant-observation, semi-structured interviews, and gray literature analyses. They helped to uncover the multifaceted ways public health nursing praxis reproduces and reifies racialized notions of ‘Chinese’ mothers in breastfeeding promotion contexts. I find that the historical professionalization of nursing, the medicalization of breastfeeding, and health promotion protocols shape how PHNs ascribe ‘race’ to women in relation to infant feeding. Further, racialized stereotypes and acts of ‘othering’ are concretized in nursing praxes. Even as nurses sometimes actively resist and regret these stereotypes, they nevertheless create contexts of exclusion that reinforce boundaries of citizenship and belonging for postpartum mothers and their infants. Most significantly, clinical practices pervasively mired in raced ideas of ‘others’ lead to differential care for mothers and their infants.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Susan Erikson
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.