Publications by authors named "Lofters A"

Article Synopsis
  • Cervical cancer screening, particularly through the Pap test, is not equally accessible for marginalized groups like sex workers and ex-prisoners in Ontario, prompting a study on the viability of HPV self-sampling as an alternative.
  • Involving 84 participants aged 25-69, the study found that most had limited knowledge about cervical cancer, but 88% chose to use HPV self-sampling, with a significant portion testing positive for high-risk HPV types.
  • The study highlights the need for community-based sexual health education and support for HPV self-sampling, emphasizing its acceptability among participants who often experience healthcare discrimination and lack primary care access.
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Objective: The COVID-19 pandemic highlighted and exacerbated health inequities worldwide. While several studies have examined the impact of individual social factors on COVID infection, our objective was to examine how interactions of social factors were associated with the risk of testing positive for SARS-CoV-2 during the first two years of the pandemic.

Study Design And Setting: We conducted an observational cohort study using linked health administrative data for Ontarians tested for SARS-CoV-2 between January 1st, 2020, and December 31st, 2021.

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Purpose: Childhood cancer survivors are at increased lifetime risk of morbidity and mortality, but adherence to periodic surveillance is suboptimal. One of the reasons that adult survivors of childhood cancer do not complete the recommended surveillance is that their parents may not have disclosed their cancer history to them. We sought to identify key barriers and enablers to talking to children about their cancer history.

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Cervical cancer is largely preventable through screening and treatment of cervical lesions. In the province of Ontario, South Asian women have some of the lowest rates of screening. The roles of service providers-those in healthcare and community services-and their interactions with screen-eligible people can greatly impact the uptake of screening.

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Purpose: Primary care access is a key health system metric, but little research has compared models to provide primary care access when one's regular physician is not available. We compared health system use after a visit with a patient's own family physician group (ie, within-group physician who was not the patient's primary physician) vs a visit with a walk-in clinic physician who was not part of the patient's family physician group.

Methods: We conducted a population-based, retrospective cohort study using administrative data from Ontario, Canada, including all individuals formally enrolled with a family physician, from April 1, 2019 to March 31, 2020.

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Background: Racism has been shown to impact the health of Black persons through its influence on health care, including its expression through implicit biases in provider training, attitudes, and behaviours. Less is known about the experiences of racism in contexts outside of the USA, and how race and racism interact with other social locations and systems of discrimination to shape Black patients' experiences of racism in health care encounters. To help address this gap, this study examined diverse Black individuals' perceived experiences of, and attitudes towards, anti-Black racism and racial discrimination in Canadian health care, specifically in Montreal, Quebec.

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Background: HPV test-based primary cervical screening is replacing cytology in Canada. In other countries, women's unpreparedness and concerns hindered the transition and post-implementation screening uptake. We investigated psychosocial correlates of intentions of screening in eligible individuals to participate in HPV-based primary cervical screening.

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Background: Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia).

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Article Synopsis
  • In Canada, racialized and immigrant women face barriers to cancer screening due to a lack of awareness, language issues, and socio-economic factors, which has led to under-screening for breast and cervical cancer.
  • To combat these challenges, a team implemented virtual educational and screening events specifically for Black women, partnering with community organizations and creating a resource hub for breast cancer awareness.
  • The events were well-attended, with over 450 participants per session and high satisfaction rates, leading to increased screening intentions among attendees, suggesting that culturally tailored initiatives may help reduce stigma and improve cancer knowledge in these communities.
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Article Synopsis
  • Osteoarthritis is more common and severe in women, especially among racialized immigrant women, who often struggle to access early diagnosis and treatment options.
  • The study aimed to evaluate the quality and cultural safety of online materials about osteoarthritis for affected individuals and healthcare professionals, utilizing a rigorous content analysis process.
  • Out of 176 items screened, 47 relevant materials were assessed, revealing that many had moderate to low quality and cultural safety, highlighting the need for improved resources tailored to diverse populations.
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Article Synopsis
  • The study aimed to compare family physicians working in walk-in clinics with those providing long-term care in Ontario, focusing on their characteristics and patient demographics.
  • The research linked a 2019 physician survey with health care data, revealing differences such as a higher percentage of male physicians and a diverse language background among walk-in clinic practitioners.
  • Results showed that walk-in clinic physicians typically served younger, less frequently seeking patients, many of whom were from diverse backgrounds and often attached to other family physicians.
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Background: Lung cancer is one of the most common cancers and causes of cancer death in Canada. Some previous literature suggests that socioeconomic inequalities in lung cancer screening, treatment and survival may exist. The objective of this study was to compare overall survival for immigrants versus long-term residents of Ontario, Canada among patients diagnosed with lung cancer.

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Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups-South Asian service users and service providers-to identify and prioritize points of intervention to encourage the uptake of cervical screening.

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Introduction: The Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care (BETTER) programme trains allied health professionals working in primary care settings to develop personalised chronic disease 'prevention prescriptions' with patients. However, maintenance of health behaviour changes is difficult without ongoing support. Sustainable options to enhance the BETTER programme and ensure accessibility to underserved populations are needed.

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Background: The original 'BETTER' (Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care) approach consisted of a prevention-focused visit between participants aged 40-65 years and a "Prevention Practitioner" (PP), who empowered the participant to set achievable prevention and screening goals for cancers and chronic diseases. BETTER was successfully adapted for economically deprived communities (BETTER HEALTH) in Canada. Our objective was to conduct a review of guidelines in preparation for adapting the 'BETTER HEALTH' approach for younger adults aged 18-39 years living with lower income, a group known to have earlier mortality due to a higher prevalence of preventable chronic diseases than their peers with higher income.

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Risk-stratified breast screening has been proposed as a strategy to overcome the limitations of age-based screening. A prospective cohort study was undertaken within the PERSPECTIVE I&I project, which will generate the first Canadian evidence on multifactorial breast cancer risk assessment in the population setting to inform the implementation of risk-stratified screening. Recruited females aged 40-69 unaffected by breast cancer, with a previous mammogram, underwent multifactorial breast cancer risk assessment.

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Background: Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care.

Methods: We conducted an online, bilingual survey of adults in Canada in fall 2022.

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Purpose: The time from breast cancer surgery to chemotherapy has been shown to affect survival outcomes; however, the effect of time from first breast cancer-related healthcare contact to first cancer specialist consultation, or the time from first breast cancer-related healthcare contact to adjuvant chemotherapy on survival has not been well explored. We aimed to determine whether various wait times along the breast cancer treatment pathway (contact-to-consultation, contact-to-chemotherapy, surgery-to-chemotherapy) were associated with overall survival in women within the Canadian province of Ontario.

Methods: We performed a population-based retrospective cohort study of women diagnosed with stage I-III breast cancer in Ontario between 2007 and 2011 who received surgery and adjuvant chemotherapy.

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Background: Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations.

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Background: Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists' roles in practice, which are particularly prevalent in primary care teams.

Objectives: This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams.

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Background: Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access OA care, particularly racialized women. One way to reduce inequities is through policies that can influence healthcare services. We examined how OA-relevant policies in Canada address equitable, person-centred OA care for women.

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Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening.

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Article Synopsis
  • The BETTER WISE study aimed to evaluate a cancer and chronic disease prevention program's effectiveness by comparing outcomes between participants facing financial difficulties versus those who did not.
  • The study analyzed data from a cluster-randomized trial involving 596 participants from 59 physicians across 13 clinics, comparing a 1-hour intervention visit to usual care.
  • Results indicated that participants without financial difficulties in the intervention group had a higher completion rate of eligible preventive actions (29%) compared to the control group (23%), while there was no significant difference in those with financial difficulties.
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