Objective. To conduct a preliminary exploration of psychological outcomes and health behaviour in individuals undergoing testing for genetic mutations associated with thrombophilia. Methods. Subjects were 57 carriers and 54 non-carriers identified through an existing pilot study. Part I analyzed perceived risk and psychological data collected at baseline, 1 week and 12 months post-test. Part II used a cross-sectional survey to collect data regarding: test implications, perceived causes and control, and behaviour change post-test. Results. Accuracy of risk perception improved post-test due to decreased risk perception among non-carriers. No major psychological harms were identified, but a subgroup of carriers may experience distress. Participants had a high sense of control over their risk of venous thromboembolism and had a good understanding of risk factors. Many tried to change their behaviours post-test, but did not report doing this specifically to reduce their risk of a blood clot. Conclusions. This exploratory study suggests no major psychological harm arising from genetic testing, but its findings need replication with larger samples.

Stroke is a common illness with significant morbidity and mortality. Thrombolysis is the only approved therapy for ischemic stroke. Current protocols utilize a three hour time window from symptom onset for treatment eligibility. Public education campaigns regarding the symptoms of stroke have been advocated as a means to increase the treatment rates. A Markov model was constructed to simulate the experience of a population at risk for stroke. The probabilities of clinical events and health state utilities were extracted from the literature or estimated. Systematic reviews of community interventions in stroke and chest pain were performed. Base case analysis suggests that community intervention is the preferred strategy. The preference was robust in the face of multiple sensitivity analyses. A small incremental gain of 56 minutes was noted in life expectancy with a gain of 69 minutes in quality-adjusted life expectancy and 56 minutes in discounted quality-adjusted life expectancy.

Introduction. Little is known about patient safety issues in the emergency department (ED). The goal of this study was to determine the proportion of patients with adverse events in high acuity areas of the ED. Methods. This was a prospective cohort study in two Ottawa EDs. All consenting consecutive patients had a telephone interview at 14 days if discharged or chart review if admitted. Three emergency physicians assessed flagged outcomes (such as death, return ED visits) for adverse events. An adverse event was a flagged outcome associated with health care management. Descriptive statistics and multiple logistic regression analysed the adverse events. Results. Over 4 months, 518 patients were enrolled. Seventy-three percent were discharged and 27% admitted. Of 135 flagged outcomes, 43(8.5%) patients had adverse events. None of the variables examined were statistically associated with adverse events. Conclusion. This study suggests that adverse events are important considerations in the ED.

Objectives The overall goal of this research was to study continuity of care in the context of team based care delivery to support adolescent women's mental health issues, specifically Anorexia or Bulimia. I used the three concepts of continuity of care described by Haggerty et al. (2003): relational, managerial and informational continuity, to develop an exploratory model of continuity of care for women's mental health. To research question was how are health care professionals providing continuity of care and collaborative patient centred care in the case of adolescent/women's mental health as represented by the eating disorders, anorexia and bulimia. Methods Data collection took place in the eating disorder program in a tertiary care paediatric hospital. The study included 36 participants including: psychiatrists, family physicians, psychologists, nurses, dietician, child and youth counsellors, medical and psychological interns and residents, and art therapist. Data sources included non participant observation of team meetings (approximately 20 hours) of inpatient, day hospital and outpatient clinics as well as 10 semi-structured interviews with health care professionals. Constructivist Grounded theory method was used to analyze the data. Results In terms of the continuity of care and how it unfolds, the three types work in a cyclical process. It starts with informational continuity, with the team learning with and from the patient. Once all the information is put together managerial continuity begins to form, as does relational continuity. When the patient is close to discharge informational continuity increases within the team, as well as between the family and different actors in the community. From the constructivist grounded theory analysis, fives themes emerged as dimensions that impact continuity of care: political, clinical, social, financial, and geographical. Conclusion The professionals can better understand the process of continuity within their team. There is now empirical evidence on the interaction of the types of continuity. At the policy level, the types of remuneration played a role in the process of continuity. Next steps include clarifying the patient perspective.

The research undertaken in this thesis was aimed at exploring the awareness and attitudes of both the Canadian public and health professionals regarding drug safety and their use of the various sources of drug risk information available in Canada. This information provides a deeper understanding of the strengths and weaknesses of the risk communication tools used by Health Canada, and serves as a starting point for improvements in the communication process. The results obtained in this research provide a baseline against which future improvements to the risk communication system can be compared, thereby allowing Health Canada to guide policy changes and program improvements based on empirical evidence. A series of case studies were examined in order to assess the impact that dear health professional letters issued in Canada had on the prescribing practice of physicians. Several studies of this nature have been conducted in the U.S., with most concluding that dear doctor letters do not have a significant impact on physician prescribing practice. The present examination of the impact that dear health professional letters have on prescribing practice in Canada is the first of its kind, and was needed in order to confirm or refute the findings of similar studies conducted elsewhere. This research is important from a population health perspective since any changes to Health Canada's risk communication policy that results in increased awareness, increased use, or increased confidence in the risk information provided by Health Canada will, in turn, result in more appropriate prescribing practice and improved patient safety. Given that the risks posed by drugs are known to be a significant cause of morbidity and mortality in developed countries and that Canadians consume a large number of drugs, it follows that interventions which successfully improve drug risk communication have the potential to improve individual patient safety as well as the overall health of Canadians. (Abstract shortened by UMI.)

This qualitative study explores the discursive constructions of health, the narratives about the body and appearance as well as the meanings of fitness among Canadian youth from English- and French-language high schools as well as from the Portuguese-Canadian community in Ottawa, Canada. Small group discussions and a "write and draw" schedule were used to gather qualitative materials among 63 youth aged between 13-15 years. Qualitative materials were submitted first to thematic analysis followed by a discourse analysis method informed by feminist postructuralist theory. In the first instance, participants were found to construct health mostly as a corporeal notion and as something under their responsibility: health was discursively constructed as "being physically active," "not being too fat or too skinny," "eating well" and "avoiding bad habits." Although no major linguistic or ethnic differences were observed between participants in how they discursively constructed health, gender differences were noticed in discussions of body weight. Furthermore, it was revealed that most participants adopted subject positions within dominant bodily discourses, including the discourses of obesity and personal responsibility for health. Another area explored in this study was the participants' narratives of the body and appearance. It was found that these young people discuss their body and appearance in a way that is very much tied up with larger discourses of beauty and the so-called "obesity epidemic." In addition, the results highlight how most of the participants want something they do not have, which is a different body. Major gender differences were observed, as male participants wanted to be taller and more muscular, while female participants wanted to lose weight. Although gender differences were observed, no major ethnic or linguistic differences were noted in their narratives about the body and appearance. The last area explored in this study was the participants' meanings of fitness. Four major themes emerged from the participants' narratives. Regardless of language or ethnic background, for these youth, fitness meant "being physically active," "a way to stay healthy," "a way to look good" and/or "a disease prevention strategy." Meanings of fitness were gendered with female participants resisting the conventional ideas associated with fitness and male participants appropriating them. While conveying their meanings of fitness, participants generally located themselves at the intersection of complementary dominant discourses (of healthism, beauty, and obesity) and constructed normative gender subjectivities.

Public discourse on genetically modified (GM) foods tends to focus on those aspects of recombinant DNA (rDNA) technology that heighten concerns about the potential risks of GM foods. Despite this focus of concern, a wide range of GM foods exist, including those that are modified by conventional approaches, the safety of which has not been assessed in detail. Also in contention is the likelihood of unintended effects with adverse health consequences in foods derived from crops genetically modified by more modern techniques such as rDNA, compared to those derived from crops modified by conventional techniques. Divergent views exist regarding the methods by which unintended effects should be detected and monitored. With advances in genomic technology, boundaries between conventional and modern approaches to genetic modification may become blurred. There is the need for a reliable method to efficiently differentiate GM foods that require more extensive testing and regulatory oversight from those that do not, regardless of the method of modification. I propose a risk-based classification scheme (RBCS) to differentiate foods derived from GM crops based on levels of concern reflecting their potential to produce human health risks. Two categories of health effects are included in the scheme: (1) the potential for toxic/antinutritional effects, and (2) the potential for allergenic effects. To differentiate the sources of uncertainty about GM food risks, intended and unintended changes are classified separately with respect to potential toxic/antinutritional effects. Factors that may affect the level of risk are identified for each category of adverse health effects. Criteria for differentiating potential health risks are developed for each factor. The extent to which each factor satisfies the applicable criteria is rated separately. A concern level for each category of health effects is then determined by aggregating the ratings for the respective factors. This thesis describes the factors, criteria, and aggregation rules used in determining concern levels in the proposed RBCS and the process used in its development. An exploratory evaluation of selected functional aspects of the scheme is provided. The implications of the classification scheme for the graded testing of GM foods are also discussed.

The goal of this research was to consolidate and expand on current knowledge about the use of objective and subjective measures to assess the health of Canadians. Specifically, this dissertation examined the relationship between self-report and direct measures of health to determine the extent of discrepancies between the two methods. This was accomplished through a series of five research papers, including three systematic reviews that examined the relationship between self-reported and directly measured estimates of height, weight and Body Mass Index (BMI), hypertension and smoking. An in-depth examination of the discrepancies in reported obesity followed. It included two additional papers, one examining the feasibility of establishing correction factors to increase the accuracy of reported estimates of obesity and a second examining the trends in the reporting bias over time and between two different population groups (Canada and the U.S.). Results clearly documented a bias in self-reported estimates of height, weight, BMI, hypertension and smoking; reported estimates of height were consistently overestimated while reported weight, BMI, hypertension and smoking were consistently underestimated in both men and women. Statistical adjustment of reported values generated estimates of height, weight and obesity that were more accurate than those generated by self-report alone. Historical analysis with Canadian and American datasets indicated that the bias in reported obesity is increasing, implying that the generalizability of the correction equations may be limited and that in Canada, monitoring trends in obesity based solely on self-reported height and weight may produce inaccurate estimates because of the diverging discrepancy between self-reported and measured data. This work has made an important contribution to understanding the bias in current surveillance practices that are grounded in the collection of self-reported data and presents a series of recommendations to improve population health surveillance in Canada.

To study how context influences health and well-being it is first necessary to measure the boundary of a person's geographical context. Rigorous description of context is difficult and existing studies have offered weak and mixed evidence about the importance of context to health. Either the characteristics of places have been inadequately conceptualized, or the spatial definition of place relies on inflexible administrative boundaries and a limited set of corresponding attribute data. Furthermore, the influence of context on health presumably depends a great deal on the amount of time spent in each space, and the potential for misclassifying context is greater for individuals whose routine activities are spatially diffuse. However, errors in spatial classification are usually not specified in studies linking context to health. This dissertation combines theories from geomatics and population health to argue that the time geography of human activities has an important role in delineating and describing contexts relevant to health. Specifically, the contextual impact on health status reflects not only the person's immediate neighbourhood, but also locations where other activities of daily life occur. The theoretical contribution of the thesis is to conceptualize context as a healthscape---a spatial notion that captures an array of contexts defined by individuals as they navigate through the spatial patterns of daily life. The empirical goal of the dissertation is to compare these healthscapes to contexts delineated by census tract geographies typically used in health and place research. Individual healthscapes are defined by developing a wearable global positioning system and data logger that records an individual's location and velocity at one-second intervals over a seven-day period. Data from 53 people are linked to responses from a health questionnaire. Several approaches drawn from ecology and spatial statistics are used to quantify the properties of each person's spatial activity patterns, or healthscape. These objectively measured contexts are compared statistically to the traditionally used census boundaries to examine differences in morphology, compositional and contextual characteristics. The results are broadly consistent with the theoretical justification proposed for healthscapes, and signal the need for place and health research to better represent the geography of human activities.

Power, how it is defined, embodied and expressed by individuals is central to how those individuals will behave in and perceive their relationships. This dissertation is based on a study focusing on the issues of power and positive sexual health outcomes within adolescent heterosexual relationships from a Population Health perspective that attends to selected social determinants of health. Specifically, this dissertation examines how power is conceptualized, understood and measured in the context of adolescent heterosexual relationships and how power influences the outcomes of these relationships. An explicit concentration is placed on positive outcomes while maintaining a consideration of negative outcomes as key factors in the achievement of sexual health for adolescents. Both qualitative interviews and a quantitative cross-sectional survey were used to explore these issues with a convenience sample of self-defined heterosexual youth between the ages of 14 and 20 who primarily self-identified as Caucasian. Results show that power is overwhelming conceptualized as negative, with some adolescents denying that they have or exercise power. The embodiment of power is perceived to be gendered. 'Powerful girls' are critiqued in a way that 'powerful guys' are not. Young men and women described expressing power in their relationships in generally positive fashions. A minority of young men described expressing power in dominant ways while a minority of young women described using their sexuality as a means of expressing power. The quantitative measurement of relationship power as measured by a modified version of the Sexual Relationship Power scale (Pulerwitz, Gortmaker, & Delong, 2000) revealed lower scores for young men as compared to young women. Regression analyses revealed that for both males and females and experience of physical or verbal violence from a partner in the past year was negatively associated with scores on the SRPS and communication within the most recent relationship was positively associated with scores on the SRPS. High rates of positive sexual health outcomes such as, sexual self-efficacy, satisfaction, sexual assertiveness and communication were seen. Findings, as well as limitations of this study, point to the need for more research on issues of power, equity, gender and positive sexual health outcomes.