The prevalence of disabling musculoskeletal conditions in children underscores the importance of measuring function. The objectives for the current study were: (1) to develop an evaluative measure assessing function in adolescents with lower extremity orthopedic conditions and; (2) to provide a preliminary assessment of the validity, reliability and measurement properties of the newly developed scale. The Lower Extremity Activity Limitations Scale (LEALS) incorporates a 17-item self-report questionnaire and a 10-item functional performance test. Excessive internal consistency was established for both subscales of the LEALS. The construct validity of the LEALS was supported by its convergent validity with other measures of the same construct. Lastly, the LEALS self report scale was found to be more sensitive to change then the Activities Scale for Kids. Preliminary assessments suggest that the LEALS is a valid, reliable and responsive outcome measure assessing lower-extremity function in adolescents.

This multilevel study examined the influence of neighbourhood socioeconomic context on individual health as measured by self-rated health status and the Health Utilities Index (HUI) in urban neighbourhoods of the City of Ottawa and the combined cities of Ottawa and Gatineau. The samples were drawn from the respondents to the Canadian Community Health Survey 2000--2001 which included individuals 12 years of age and older. There were 1441 respondents within the 37 Ottawa neighbourhoods and 711 respondents within the 14 Gatineau neighbourhoods. The neighbourhood characteristics were derived from the 2001 Census. In Ottawa there was significant variation in health at the neighbourhood level. In age-adjusted models the neighbourhood low income rate and the neighbourhood low education rate were significantly associated with self-rated health (OR=1.35, 95% CI 1.01--1.81; OR=1.03, 95% CI 1.00--1.06, respectively) and a HUI score <0.973 (OR=1.31, 95% CI 1.10--1.56; OR=1.27, 95% CI 1.07--1.52, respectively). However, adjustment for individual level factors reduced the influence of the neighbourhood level variables such that they were no longer statistically significant. Similar results were found for the analysis of the combined cities. This study suggests that the differences in health between neighbourhoods of Ottawa and Ottawa-Gatineau can be attributed primarily to the compositional impact of the characteristics of individuals within the neighbourhoods.

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.

Major depressive disorder (MDD) constitutes the most commonly diagnosed mental illness affecting 16% of the population. Reduction in serotonergic tone is the most widely accepted etiological hypothesis for MDD and antidepressant treatments enhance serotonin (5-hydroxytryptamine, 5-HT) neurotransmission. Negative regulation of serotonergic raphe neurons is mediated by somatodendritic 5-HT1A autoreceptors, which are increased in depressed suicides and become down-regulated before antidepressants take effect. I hypothesized that genetic variations in regulatory regions of this receptor that dictate its expression, could contribute to predisposition to depression and treatment responsiveness. I initially addressed the basal mechanisms of human 5-HT1A receptor gene regulation using transient transfections with luciferase reporter constructs of 5' flanking sequences. A region between -1624 and -1550 by displayed strong repressor activity and contained at least three repressor elements: a consensus RE-1 and two copies of a novel dual repressor element (DRE). By yeast one-hybrid screening we identified a novel calcium-regulated repressor (Freud-1) that binds to DRE to reduce basal 5-HT1A receptor expression in neurons. Using an inhibitor of histone deacetylase (HDAC), we have demonstrated that Freud-1 mediates HDAC-independent repression in neuronal 5-HT1A positive cells, while REST or other DRE binding proteins recruit HDAC-dependant mechanisms to silence the receptor in non-neuronal 5-HT1A-negative cells. I also searched for sequence variations in 5-HT1A regulatory regions that may associate with depression. Further downstream from this region, we have identified a functional C(-1019)G polymorphism in the human 5-HT1A promoter that associates with major depression and completed suicide. The occurrence of the G allele at -1019 by prevents binding and repression by specific transcription factors NUDR and Hes5, identified by yeast one hybrid approach, and results in de-repression of the 5-HT1A receptor gene and hence, may contribute to the predisposition to depression. In conclusion, I have identified important transcriptional regulatory elements and proteins of the 5-HT1A gene implicated in serotonin neurotransmission, and characterized the mechanism of a new functional 5-HT1A promoter polymorphism involved in both suicide and MDD. This study may provide an improved marker for diagnosis and treatment of depression and provide a model for correlation between polymorphisms, gene expression and mental illnesses.

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.