Predicting the Risk of Lung Cancer in Never-smokers

Despite being considered a disease of smokers, approximately 10-15% of lung cancer cases occur in never-smokers. Lung cancer risk prediction models have demonstrated excellent ability to discriminate cases from non-cases, and have been shown to be more efficient at selecting individuals for future screening than current criteria. Existing models have primarily been developed in populations of smokers, thus there was a need to develop an accurate model in never-smokers. This study focused on developing and validating a model using never-smokers from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cox regression analysis, with six-year follow-up, was used for model building. Predictors included: age, body mass index, education level, personal history of cancer, family history of lung cancer, previous chest X-ray, and secondhand smoke exposure. This model achieved fair discrimination (optimism corrected c-statistic = 0.6645) and good calibration. This represents an improvement on existing neversmoker models, but is not suitable for individual-level risk prediction.

The National Hockey League (NHL) Entry Draft: An Examination of the Impact of Brand Associations Attached to the Russian Hockey Players

This research was conducted to investigate whether negative brand associations attached to Russian hockey players impact their draft rankings during the National Hockey League (NHL) Entry Draft. A quantitative analysis based on various regression model specifications was used to test whether Russian players were drafted relatively equally to their counterparts in the NHL Entry Draft. The data consisted of the NHL draft picks between 1993 and 2013 and their performance statistics and physical characteristics. The results suggested that Russian players were drafted relatively equal to their counterparts from other countries. Meanwhile, Russian players who played in the CHL before the draft are actually drafted better than Canadians who played in the same league. Hence, the negative brand associations attached to Russians were unlikely to impact their draft rankings. This study redefined the so-called “Russian Factor” from a notion that allegedly damages Russian players’ rankings to one that enhances their rankings.

Identification of Network-Based Risk Factors Associated with Gonorrhea

The evolving antimicrobial resistance coupled with a recent increase in incidence highlights the importance of reducing gonococcal transmission. Establishing novel risk factors associated with gonorrhea facilitates the development of appropriate prevention and disease control strategies. Sexual Network Analysis (NA), a novel research technique used to further understand sexually transmitted infections, was used to identify network-based risk factors in a defined region in Ontario, Canada experiencing an increase in the incidence of gonorrhea. Linear network structures were identified as important reservoirs of gonococcal transmission. Additionally, a significant association between a central network position and gonorrhea was observed. The central participants were more likely to be younger, report a greater number of risk factors, engage in anonymous sex, have multiple sex partners in the past six months and have sex with the same sex. The network-based risk factors identified through sexual NA, serving as a method of analyzing local surveillance data, support the development of strategies aimed at reducing gonococcal spread.

Factors Associated with Small Aggressive Non-Small Cell Lung Carcinomas

Small aggressive non-small cell lung carcinomas (SA-NSCLC) are characterized by spread to distant lymph nodes and metastases, even while the primary tumour remains small in size, as opposed to tumours that are relatively large before cancer progression. These small aggressive cancers present a challenge for clinical diagnosis and screening, carry grave prognosis, and may benefit from using a targeted approach to identify high-risk individuals. The objectives of this thesis were to identify factors associated with SA-NSCLC, and compare survivorship of stage IV SA-NSCLC to large stage IV NSCLC. Logistic and Cox regression analysis were performed using data from the National Lung Screening Trial (NLST). Model building was guided by knowledge of lung carcinogenesis and lung cancer prognostic factors. Previous diagnosis of emphysema and positive family history of lung cancer in females were associated with increased risk of SA-NSCLC among adenocarcinomas. Despite overall poor prognosis, SA-NSCLC have a better prognosis compared to large stage IV NSCLC.

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.

The perceptions of commune health workers about an education strategy received for counselling fathers about infant and breastfeeding involvement

Objective To evaluate the perceptions of healthcare workers in Vietnam about the efficacy of a continuing education strategy about father involvement and breastfeeding counselling. Design One group, post-test only, quasi-experimental design Method A questionnaire based on Social Cognitive Theory (SCT; Bandura, 2004) was disseminated to participants (N=28). This questionnaire measured self-efficacy, outcome expectations, socio-structural factors, goal setting and behaviour. Multiple regressions were analyzed predicting participants’ practice of client focused father involvement consulting. Results Bivariate correlations demonstrated the anticipated patterns of association between SCT-based constructs. Multiple regression analysis indicated that outcome expectations and barriers were significant predictors of client focused father involvement consulting. Conclusions Participants reported that the education increased their self-efficacy, outcome expectations and client focused father involvement consulting behaviour. Future education should be accessible, increase counselling confidence and address beliefs about the outcomes and challenges of father involvement consulting.