Infection of the human urinary tract is one of the commonest bacterial infections, with uropathogenic E.coli (UPEC) being responsible for 90% of the diagnosed cases, with significant morbidity and mortality. The urinary bladder is a remarkable autonomic musculomembranous organ under conscious control. Its two main functions are, storage and voiding of urine. Any disturbance to normal urination leads to various clinical conditions, such as urinary incontinence, bladder retention, overactive bladder syndrome, prostatitis in men and urinary tract infections (UTI). Determining the predisposition of an individual to UTI by discovering a biomarker would allow for a more rational selection of patients who might best benefit from either antibiotic prophylaxis or preemptive surgical intervention. The purpose of this study was to examine the epigenetic effects of UPEC infection directly, or indirectly in the bladder. The study also identified potential gene candidates, such as TLR4 and CTCF, for development of DNA methylation biomarker targets.

Master of Arts / Department of Economics / Dong Li / Comprehensive worksite wellness programs were first introduced in the United States in the late 1970s and early 1980s, with the goals of improving health, reducing health care expenditures, and demonstrating senior management’s commitment to the health and well-being of workers (Ozminkowski et al, 2002). As the annual cost of employer-sponsored family health coverage increased four percent between 2012 and 2013 (Kaiser Family Foundation, 2013), many companies are turning to worksite wellness programs. Wellness programs have shown not only to reduce health care costs, but also decrease absenteeism and increase employee satisfaction. The studies on the benefits of wellness programs are not conclusive; there seems to be a general lack of good data collection and analysis. This report discusses what determines an employer’s likelihood of offering a wellness program, what determines an employee’s participation in a wellness program, and a benefits analysis of wellness programs.

Master of Science / Industrial & Manufacturing Systems Engineering / David H. Ben-Arieh / Telemental health systems, a form of telemedicine, use electronic communication media to provide patients in remote locations access to psychological and psychiatric specialists. The structure of telemental health systems has a major impact on their performance. Discrete-event simulations offer useful results concerning capacities and utilization of specific resources. Simulation, however, cannot provide theoretical properties of analyzed systems. Petri net representations of systems can overcome this shortfall, offering a wide range of easily-analyzed and useful properties. Their ability to model resource conflict, parallel activities, and failure modes fits nicely with the reality of telemental health systems. Analysis of behavioral properties of Petri nets can provide meaningful information for system analysts. The most useful properties include net boundedness, liveness, and non-reachability of certain undesirable states. The thesis discusses methods to find all these properties. Specifically, it provides property-preserving net reductions to facilitate analysis of boundedness and liveness and describes an integer programming model to solve reachability and coverability problems. Moreover, this thesis outlines a simulation analysis of synchronous and asynchronous telemental health systems. The paper then describes a Petri net model of a generic telemental health delivery system. The paper subjects the model to an integer programming model and net reduction. The integer programming model indicated that the number of resources in the system remains static, full utilization of resources at a given time is possible, conflict over resources is possible, and improper work prioritization is possible within the model. Net reduction and analysis with open-source software showed that the model is bounded and live. These results can aid telemedicine system architects in diagnosing potential process issues. Additionally, the methods described in the paper provide an excellent tool for further, more granular analysis of telemedicine systems.

Background: This thesis is composed of three studies testing the effect of the Colon Cancer Check (CCC) program, the organized screening program for colorectal cancer in Ontario, on screening participation. In the first paper, we described the trends of participation to Fecal Occult Blood Test (FOBT) and endoscopy, and the trend of ‘up-to-date’ consistent with guidelines, overall and stratified by demographic characteristics between 2005 and 2011. In the second paper, we tested the effect of physician’s recommendation on FOBT participation and disparities in participation. In the third paper, we measured the effect of the CCC program on FOBT participation using an interrupted time series. Methods: We identified six annual cohorts of individuals eligible for CRC screening in Ontario between 2005 and 2011 by linking the Registered Persons Database to Ontario Health Insurance Plan and 2006 Census from Statistics Canada. We used descriptive statistics to describe the trends of participation. The effect of physician’s recommendation on screening participation was tested using multiple logistic regression analysis. The effect of the CCC program on FOBT participation was tested using segmented regression analysis. Results: An increasing trend in FOBT participation and ‘up-to-date’ status was observed across all demographic characteristics. The disparity gaps persisted over time by gender, income, recent registrant and age. The rural/urban gap was removed. Physician’s recommendation tripled the likelihood of FOBT participation (prevalence rate ratio=3.23, CI= 3.22-3.24) and mitigated disparities. The CCC led to a temporary increase in level (8.2‰ person-month) in FOBT participation followed by a decline in trend and then a plateau. The increase in level was significant across all population sub-groups. Conclusions: We found that CRC screening has increased in Ontario across all subgroups of the population but remained suboptimal. Disparities in screening participation were identified. Proposed strategies to improve performance include interventions to increase the rate of physician’s recommendation at the practice level, tailored interventions to motivate under-users and public media campaigns.

Background: This thesis is composed of three studies testing the effect of the Colon Cancer Check (CCC) program, the organized screening program for colorectal cancer in Ontario, on screening participation. In the first paper, we described the trends of participation to Fecal Occult Blood Test (FOBT) and endoscopy, and the trend of ‘up-to-date’ consistent with guidelines, overall and stratified by demographic characteristics between 2005 and 2011. In the second paper, we tested the effect of physician’s recommendation on FOBT participation and disparities in participation. In the third paper, we measured the effect of the CCC program on FOBT participation using an interrupted time series. Methods: We identified six annual cohorts of individuals eligible for CRC screening in Ontario between 2005 and 2011 by linking the Registered Persons Database to Ontario Health Insurance Plan and 2006 Census from Statistics Canada. We used descriptive statistics to describe the trends of participation. The effect of physician’s recommendation on screening participation was tested using multiple logistic regression analysis. The effect of the CCC program on FOBT participation was tested using segmented regression analysis. Results: An increasing trend in FOBT participation and ‘up-to-date’ status was observed across all demographic characteristics. The disparity gaps persisted over time by gender, income, recent registrant and age. The rural/urban gap was removed. Physician’s recommendation tripled the likelihood of FOBT participation (prevalence rate ratio=3.23, CI= 3.22-3.24) and mitigated disparities. The CCC led to a temporary increase in level (8.2‰ person-month) in FOBT participation followed by a decline in trend and then a plateau. The increase in level was significant across all population sub-groups. Conclusions: We found that CRC screening has increased in Ontario across all subgroups of the population but remained suboptimal. Disparities in screening participation were identified. Proposed strategies to improve performance include interventions to increase the rate of physician’s recommendation at the practice level, tailored interventions to motivate under-users and public media campaigns.

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.