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

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Thinking outside the brain: Testing predictors of drug addiction anticipated by dislocation theory

Date created: 
2014-04-10
Abstract: 

Considerable financial, technological, and human resources are currently spent on the expansion of a brain-disease model of drug addiction in humans. This model conceptualizes addiction as a disease arising from the combined effects of drug interactions with susceptible brain physiology. Psychosocial models of addiction provide an important complement to brain-disease models by addressing social, cultural, and environmental determinants of addiction. The present work describes an emergent, systematized model known as the dislocation theory of addiction, and draws on data from the Vancouver At Home trial on homelessness and mental illness to test a hypothesized relationship between psychosocial integration and drug addiction. Results from multivariate logistic regression analysis indicate that both included dimensions of psychosocial integration (physical and psychological) remain associated with addiction to drugs other than alcohol and cannabis after controlling for a variety of lifestyle and demographic factors. Increased physical integration scores were found to predict reduced odds of daily drug use, while increased psychological integration scores predicted increased odds. Findings are reconciled with existing dislocation theory literature and further opportunities for evaluating the dislocation theory are discussed.

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

The rise and fall of the Occupational Health and Safety Agency for Healthcare (OHSAH) in British Columbia, 1999 – 2010

Date created: 
2013-11-21
Abstract: 

This thesis analyzes the conditions giving rise to the Occupational Health and Safety Agency for Healthcare (OHSAH), its mandate, what it accomplished, why it was dismantled, and how its legacy can be preserved. Policy decisions contributing to the agency’s establishment and closure are explored from the perspective of stakeholders/key informants. A quantitative analysis compares injury and lost work time rates among healthcare workers with other industrial sectors and considers the costs associated with time loss from work as the result of slips, trips, falls, musculoskeletal and other injuries, and injury-related insurance claims. The competing interests and unequal distribution of power among healthcare employers and healthcare workers are described. OHSAH’s limited success in mobilizing supporters is discussed. Fundamental misperceptions and missteps are identified that contributed to OHSAH’s inability to secure champions to ensure the agency’s continued operation in the face of limited financial resources. Finally, this paper makes recommendations to further OHSAH’s legacy.

Document type: 
Thesis
File(s): 
Senior supervisor: 
John Calvert
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.P.H.

Persistent organic pollutants and type 2 diabetes mellitus

Author: 
Date created: 
2013-11-29
Abstract: 

This study quantified the associations between plasma concentrations of persistent organic pollutants (POP) and type 2 diabetes (T2D) in cycle 1 (2007-2009) of the Canadian Health Measures Survey, a cross-sectional sample representative of 96% of Canadians. The sample included 1,612 participants aged 20 to 79. The analyses include nineteen POPs detectable in at least 60% of plasma samples. After adjusting for obesity, body mass index, daily leisure energy expenditure and age, a significant (p<0.05) association was observed with polychlorinated biphenyl (PCB) congeners 153, 170, 180, and with organochlorine pesticides including β-hexachlorocyclohexane, and hexachlorobenzene. The summed measures of non-dioxin-like PCBs, and PCB 1260 (Aroclor) were also significantly associated with T2D. The summed plasma levels did not interact with the association of obesity and T2D. Exposure to these POPs should be considered when assessing risk factors for and policies to reduce, T2D and potentially other chronic diseases.

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

Practical and Ethical Issues in Conducting Health Research with Refugees

Date created: 
2013-09-18
Abstract: 

Research is needed in Canada to understand refugees’ health challenges and barriers to accessing health services. There are practical and ethical challenges for engaging refugees as participants. This study observed five recruitment methods and three informed consent strategies for four Government Assisted Refugee (GAR) language groups (Somali, Arabic, Karen and Farsi/Dari) in British Columbia. Demographic, attitudes and knowledge questionnaires were administered and language concordant focus groups explored participant perspectives on practical and ethical research issues. Participants’ knowledge and experience with research was generally low particularly for groups with low formal education. Recruitment success was influenced by participants’ familiarity with the research team. Twenty-three variables impacting participants’ willingness to participate in research were identified. There were high rates of consent form signing which were even higher with implied consent options. Participants’ identified challenges and strategies for the informed consent process. This research provides guidance for involving Canadian refugees in health research.

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

Something to think about: informing Canadians about ethical concerns in medical tourism

Date created: 
2013-07-25
Abstract: 

Medical tourists, persons traveling across international borders with the intention of accessing medical care, are often unaware of safety and ethical concerns related to the practice of medical tourism. Accessing medical care as a medical tourist may result in risks to the health of the patient, as well as negative impacts to both destination and departure country health care systems and global health equity. These ethical considerations are not provided in sources of information commonly accessed by Canadian medical tourists. This interview-based study affirms the usefulness of an iterative process for designing an information sheet for Canadians considering engaging in medical tourism and for communicating ethical considerations to consumers of other services. Perceptions from former Canadian medical tourists indicate that this information sheet is useful in raising awareness of the ethical concerns of medical tourism, which may impact medical tourists’ decision-making given adequate additional sources of information and support.

Document type: 
Thesis
File(s): 
Senior supervisor: 
Jeremy Snyder
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.P.H.

Protein-protein interactions mediating hypoxia-inducible factor 1 complex function

Author: 
Date created: 
2012-04-11
Abstract: 

The hypoxia-inducible factor 1 (HIF1) complex, comprised of a HIF1α and aryl hydrocarbon receptor translocator (ARNT/HIF1β) heterodimer, regulates the transcription of genes promoting tumour progression under hypoxia. Preliminary data suggests that the retinoblastoma protein (RB) attenuates HIF1-mediated transcription directly through interaction with the co-activator thyroid hormone receptor/retinoblastoma interacting protein 230 (TRIP230) to inhibit invasiveness of MCF7 human breast cancer cells. The objective of this study was to further characterize the invasive phenotype in MCF7 cells following loss of RB. Loss of RB resulted in a hypoxic-dependent increase in expression of HIF1 target genes involved in tumour progression. Protein-protein interaction analysis demonstrated that RB exists in complex with ARNT and TRIP230. Moreover, this complex dissociated in the presence of an ARNT-interacting peptide. Lastly, the C-terminal region of the TRIP230 RB-interaction domain has been identified as the minimal interaction domain. Altogether, these results further establish RB as an attenuator of HIF1-mediated transcription.

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

Emergency department utilization among formerly homeless adults with mental disorders after 1-year of housing first: a randomized controlled trial

Date created: 
2013-04-23
Abstract: 

Homeless individuals represent a disadvantaged and marginalized group who experience increased rates of physical illness, mental and substance use disorders. Compared to housed individuals, homeless adults use emergency departments (ED) and other acute healthcare services at a higher frequency. Housing First (HF) has been identified as an effective means of facilitating acute health service reductions among homeless populations. The present analysis is based on (n=297) participants enrolled in the Vancouver At Home Study (VAH) randomized to one of three intervention arms: HF in a congregate setting (CONG), HF in scattered site apartments (SS), or to treatment as usual (TAU), and incorporates linked data from a regional database representing six urban ED’s. Compared to TAU, significantly lower ED utilization was observed during the post-randomization period in the SS arm. Our results suggest that HF, particularly the SS model, produces significantly lower ED visits among homeless adults with a mental disorder.

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

Assessing needs for systematic non-communicable disease prevention efforts in urban Mongolia

Date created: 
2012-12-04
Abstract: 

Noncommunicable diseases (NCDs) are an emerging health problem and result in considerable economic burdens at national, regional, and global levels. Mongolia, as is the case in many other developing and developed countries, has experienced a shift in the burden of disease from infectious to NCDs. The prevention and management of NCDs are now an essential responsibility of the health care system in Mongolia. Improved and a better performing primary health care system is one of the important aspects of NCD prevention and management in Mongolia. The goals of the study were to: 1) measure the relationship between the characteristics of the physicians and the residential populations they serve, and the NCD prevention practices (i.e. risk factor assessment, behaviour modification recommendation, treatment plan, and follow-up practice) of health care providers; 2) explore the reasons/underlying the determinants of current NCD prevention practices; and 3) identify areas for possible improvement of NCD prevention practices at the primary health care level through the collection and analysis of both quantitative and qualitative data from the six main urban districts of Ulaanbaatar. 200 surveys were completed by family doctors and 21 key informant interviews, 4 focus group discussions, and 6 participant observation sessions were conducted. The results showed that physicians’ medical specialties, experiences working in primary care, year of graduation from university, number of family doctors working in a family clinic, and the relative poverty level of the community were predictive of elements of NCD prevention practice among family doctors. Doctors specialized in family medicine, who worked with four or five colleagues, and had more experience in primary health care offer better prevention activities. Several significant barriers (e.g. doctors’ inadequate practice skills, workload at family clinics, and poor health-seeking behavior of patients) and facilitators (e.g. prevention activity and policy toward NCD prevention) of NCD prevention practices were identified at physician, family clinic, population, and policy/health system levels. Improvements to organizational activities, and resources and services such as increasing funding and reorienting primary health care, were recommended to develop the practice of NCD prevention and management at the primary health care level in urban areas of Mongolia.

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

Great expectations: women’s experiences of pregnancy when HIV-positive and on antiretroviral therapy in Uganda

Date created: 
2012-11-22
Abstract: 

In Ugandan, the social expectation that women should bear children competes with HIV clinic expectation that HIV-positive women should bear few or none. This contradiction undergirds this thesis, which examines how access to ART, social expectations and clinical expectations all combine to influence how HIV-positive women approach pregnancy in southwestern Uganda. From August to December 2011, ethnographic fieldwork was conducted in Mbarara, Uganda. Semi-structured interviews were conducted with 25 pregnant HIV-positive women accessing ART. The main themes that emerged were that: 1) HIV-positive women reported new optimism about pregnancy since being on ART, 2) adherence to ART and family support helped women manage social expectations placed upon them, and 3) clinic counselling about pregnancy beyond adherence to ART was not common. Thus, ART is an important link between managing social and clinical expectations for HIV-positive women since it improves women’s health and decreases risks of childbearing.

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

Improving trauma care in British Columbia using early activation of helicopter emergency medical services

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Utilizing helicopter emergency medical services (HEMS) to minimize the time from injury to definitive trauma care is increasingly popular in North America. Through a combination of improved access, expeditious transport, and superior preclinical therapy, multiple studies have demonstrated that direct transfer by HEMS from the emergency scene to a level-1 trauma center significantly reduces mortality. Early activation of HEMS, or Autolaunch, to emergency scenes prior to the arrival of ground ambulances based on information provided by 9-1-1 callers is an innovative way of reducing response times further. Information extracted from these callers enables the dispatcher to simultaneously send HEMS and ground-EMS directly to the scene. This work presents a study that examined the changes in response times to major trauma patients in southwestern British Columbia since the Autolaunch strategy came into effect in 2004. This study highlights significant reductions in response times when Autolaunch is used.

Document type: 
Thesis
File(s): 
Senior supervisor: 
T
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)