Research Symposium

The uOttawa Global Health Conference is dedicated to raising awareness and disseminating knowledge about local and global health issues through stimulating conversation with diverse and thought-provoking keynote speakers and workshops.

Continuing in the spirit of last year, we are again implementing a research symposium which aims to provide an opportunity for innovative students (undergraduate, graduate, postdoctoral) to present their work.

 

THEME 1: WOMEN & NEONATAL HEALTH
Presenters Poster Titles & Authors Abstract
1. Dieula Cazeau Assessing the availability of abortion services in Quebec hospitals: A mystery client study

Cazeau D., LaRoche K.J., Foster A.M

Background: In Canada, provincial and territorial health insurance schemes cover hospital-based abortion care. However, a 2006 study found that nationally only one in six hospitals provided abortion services but nearly one in four hospitals in Quebec provided abortion care.

Objectives: We aimed to assess the current availability of this medically necessary service in Quebec. We also explored what hospital representatives tell women who call seeking abortion care.

Methods: From January to April 2017, we conducted a mystery client study in French with 93 non-specialized Quebec hospitals. We used a predetermined character profile to mimic a real world interaction. We analyzed our data with descriptive statistics and assessed the tone and tenor of the encounters.

Results: Twenty-eight percent (n=26) of Quebec hospitals informed the caller that they provided abortion services. Aspiration abortion remains the most common type of procedure, although medication abortion is available. Hospitals providing medication abortion with methotrexate/misoprostol are concentrated in urban areas; at the time of the study no hospitals provided mifepristone/misoprostol. Most hospital representatives reported that the patient was required to book an appointment with a social worker prior to the procedure. Many representatives also referred us to Centres locaux de services communautaires (CLSC).

Conclusion: Hospital-based abortion in care in Quebec has remained steady over the last decade. Our findings suggest that Quebec hospitals approach the abortion process from social-psychological framework and integrate social workers. This research also provides a baseline by which to assess the incorporation of mifepristone/misoprostol into Quebec hospitals.

2. Elyse Fortier Exploring “Rapid Repeat Pregnancy” in Adolescent Mothers Living in Ottawa, Canada.

Elyse Fortier, MSc(c) and Angel M. Foster, DPhil, MD, AM

Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada

Introduction: Rapid repeat pregnancy, which is common among young mothers, is the onset of pregnancy within 24 months of a previous pregnancy outcome. Teenage motherhood is associated with many economic, social, and health challenges. These challenges often become more serious and more difficult to manage after a subsequent delivery. The circumstances surrounding “rapid repeat pregnancy” among teenage mothers living in Ottawa remain unclear.

Objectives: Through this project we aimed to understand the dynamics that shape young mothers’ initial and subsequent pregnancies and to identify the services that young mother access in Ottawa and how they may be improved.

Methods: We conducted in-depth semi-structured interviews with 10 young mothers and 10 key informants in Ottawa. We transcribed the interviews and analyzed them using inductive and deductive techniques and used Atlas.ti software to manage our data.

Results: Our findings suggest that young mothers often do not use post-partum contraception, actively and passively plan their pregnancies, experience violence, and have mental health and substance abuse issues. Many young mothers expressed that trying to access mental health support services can be a long and difficult process. Key informants expressed the need for more sex-positive, youth-friendly sexual and reproductive health education.

Conclusions: There is a need to identify and further develop youth-friendly services that young mothers feel comfortable accessing. Supporting efforts to increase adolescent mothers’ and service providers’ awareness of existing services appears warranted.

3. Mariame Ouedraogo Utilization of key malaria and pregnancy complications control measures among women in Jimma Zone, Ethiopia

Mariame Ouedraogo1, Jaameeta Kurji1, Lakew Abebe2, Ronald Labonté1, Sudhakar Morankar2, Kunuz Haji Bedru3, Gebeyehu Bulcha3, Muluemebet Abera2, Marie-Hélène Roy-Gagnon1, Manisha Kulkarni1.

1School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Canada
2Department of Health Education and Behavioural Sciences, Jimma University, Ethiopia
3Jimma Zonal Health Office, Ethiopia

Antenatal care (ANC) provides an entry point for women to access insecticide-treated nets (ITNs) and messaging on malaria prevention and treatment. In Ethiopia, minimal research has been investigating variations in the coverage of ITN in relation to ANC attendance and identifying their respective determinants.

Recognizing that poor ITN coverage can negatively impact maternal and child health, we aim to assess ITN access and use as well as ANC attendance in three districts of Jimma Zone, Ethiopia. A total of 3784 women who gave birth in the preceding year participated in a cross-sectional survey. Information was collected on socio-demographics and various attitudes and practices associated with safe motherhood. Adjusted logistic regression analyses were performed to explore the association of interests.

Women tended to be married (97%), housewives (77%), and uneducated (55%). An ITN possession proportion of 52% was estimated. Of the women who owned a net during their last pregnancy, 55% reported to have always slept under it. We estimated overall ANC attendance to 85% and that first ANC visit mostly occurred in the second trimester (83%). Women who attended at least one ANC visit were more likely to have owned an ITN (OR: 1.97[1.54-2.51]) and always used it (OR: 1.62[1.23-2.13]).

Our findings suggest that promoting ITN ownership and use as part of ANC services should be emphasized. Subsequently identifying the determinants of ITN uptake and ANC attendance will also be essential for countries like Ethiopia to reach their goals of eradicating malaria and improving maternal and child health.

THEME 2: INFECTIOUS DISEASE
Presenters  Poster Title & Authors  Abstract
4. Ashley Cerqueira Continuing Surveillance of Haemophilus influenzae in Northwestern Ontario and the emergence of serotype a as a significant cause of invasive disease

Ashley Cerqueira, MSc1; Jessica Gencarelli, BSc2, Raymond S.W. Tsang, MMedSc PhD3; Frances B. Jamieson, MD4,5; and Marina Ulanova, MD/PhD6

1Faculty of Medicine, University of Ottawa, Ottawa, Ontario

2Faculty of Medicine, Northern Ontario School of Medicine, Thunder Bay, Ontario

3Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba

4Public Health Laboratories, Public Health Ontario, Toronto, Ontario

5Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto

6Division of Medical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario

Prior to the introduction of a pediatric conjugate vaccine in the early 1990s, Haemophilus influenzae serotype b (Hib) was a major cause of infant mortality globally. Inclusion of the Hib vaccine into the Canadian routine pediatric immunization schedule eliminated Hib disease almost entirely; however, an increased incidence of H. influenzae serotype a disease is now reported worldwide with a disproportionate burden of disease in Canadian First Nation, Inuit, and Alaskan Indigenous populations. Previous studies by our group found an increased incidence of invasive disease caused by H. influenzae serotype a (Hia), f (Hif), and non-typeable H. influenzae in Northwestern Ontario (50 cases between January 2002 to July 2011). Here we reviewed the clinical presentations and bacterial characteristics of 20 invasive Haemophilus influenzae isolates recovered in Thunder Bay, Ontario, over a 6-year period (August 2011 – March 2017). Among them were two cases of Hib, nine cases of non-typeable H. influenzae, and nine cases of Hia. Furthermore, four cases resulted in pneumonia, 3 resulted in respiratory failure, one resulted in necrotising fasciitis, and two Hia cases presented as epiglottitis, a life-threatening condition associated with invasive Hib disease historically, but rarely reported in Hia infections. Moreover, of the three pediatric cases under 1 year of age, two required urgent transfer to a tertiary care centre for further treatment. Our results stress the importance of continued surveillance of H. influenzae in the post Hib-vaccine era, and further support the significance of developing a Hia vaccine to prevent severe invasive disease.
5. Jonathan Dench When 1 + 1 6= 2 : When a single canonical resistance determining loci confers no resistance

Jonathan Dench1†, Stéphane Aris-Brosou†, ‡ and Rees Kassen†

†Department of Biology, University of Ottawa, Ottawa, ON, Canada

‡Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada

Drug therapy choices would improve with knowledge of pairs of correlated mutations linked to microbial antibiotic resistance. However, both traditional wet lab techniques and existing computational approaches do not scale well to the analysis of whole genomes or a large number of strains. Using a novel in house computational method, we have identified numerous pairs of correlated mutations from the whole coding genome of Pseudomonas aeruginosa. For the most significant pair, the canonical fluoroquinolone resistance determining mutations in gyrA and parC, we have constructed single and double mutants and tested the mutations’ effect on both fitness and level of resistance. We found that alone, the parC mutation confers no resistance to ciprofloxacin yet has strong positive epistatic interaction with the gyrA mutation.
6. Andreea Slatculescu The spatial distribution of Lyme disease and infected ticks in the city of Ottawa

Andreea M. Slatculescu and Manisha A. Kulkarni

Background: Lyme disease (LD) is a tick-borne bacterial infection caused by Borrelia burgdorferi. It constitutes a present and increasing health risk for Canadians because of the significant rise in annual incidence. In the Ottawa region, the number of reported human LD cases increased steadily from 2010-2016 and is mirrored by the expansion of Borrelia burgdorferi infected and non-infected ticks in this area over the last half decade. By the end of 2017 nearly double the amount of tick submissions are expected from passive and active surveillance compared to previous years.

Objectives: Populations at risk for LD are defined by the geographic distribution of the tick vector, which is dependent on a variety of environmental and climatic factors. The objective of this study was to characterize spatial and temporal clusters of infected black-legged ticks and LD cases at a fine geographic scale within the City of Ottawa.

Methods: Data was acquired from active and passive tick surveillance activities from 2016-2017 and from the Integrated Public Health Information System (iPHIS) dataset containing human case data between 2011-2016. The geographic distribution of ticks and LD cases were visualized using ArcGIS. Retrospective spatial-temporal clusters were identified using SaTScan models scanning for high-rate areas.

Results: Three LD case clusters and three infected tick clusters were identified in the Ottawa area, although the cluster sizes were too small to reach statistical significance. Overlap was detected between one LD case cluster and one infected tick cluster in the western region of the Greenbelt Pathway. The observed LD case clusters differed by patient age and temporal occurrence suggesting that multiple risk factors are associated with Borrelia burgdorferi infection. Tick infection was 14% in this study, which is slightly lower than previously identified. However, this proportion may increase with continuing passive and active surveillance in the fall.

Conclusion: This study provides an update on the emergence of LD in the City of Ottawa based on a fine scale spatial analysis of LD cases and infected ticks. It may help inform public health officials and healthcare practitioners of the current risk of infection in the Ottawa region.

7. Shabana Jaman Can lice be transmitted by bathing in the river?: A study of prevalence and beliefs in rural Honduras

Shabana Jamani1, Dr. Ana Sanchez1, Dr. Maria Mercedes Rueda2, Garbriela Matamoros2, Dr. Maritza Canales2, Carol Rodriguez2

1Brock University, St. Catharines, ON

2National Autonomous University of Honduras

Background and Introduction: Along with other ectoparasites, P.capitis infestations are normally overlooked by primary health care providers, falling into the category of Neglected Tropical Diseases. However, persistent head lice infestations can lead to severe itching, sleep disturbances, disturbances in concentration, pruritus, anemia, secondary infections, impetigo and cervical lymphadenopathy. Further, pathogens such as B. quintana (responsible for Trench fever), has been identified in populations of p.capitis along with Acinetobacter baumannii, Staphlococcus aureus and streptococci. P.capitis has also been demonstrated to lead to social stigma, anxiety and isolation among children in a school and community setting, leaving lasting effects on their mental health.
Vulnerable populations are commonly affected by endemics and epidemics of head lice. These populations include school children, those who are homeless, refugees and those located in resource-poor communities. Compared to countries in Africa, Europe and Asia, the Americas have the highest recorded prevalence of up to 61.4%, with a greater distribution documented in South American countries such as Brazil, Peru and Argentina. Researcher Shabana Jamani witnessed this problem while working among the urban, low-resource communities in the outskirts of Lima, Peru.
Little research has been conducted on head lice infestations in Honduras. However, in working alongside rural communities surrounding Olanchito, Honduras, community members voiced their concerns about head lice infestations to researcher Dr. Ana Sanchez and her team while conducting research on helminth infections. To explore these concerns, the current study aimed to determine the prevalence and intensity of human head lice infestations in rural communities of La Hicaca and Los Lomitas, Honduras, and investigate beliefs and perceptions of head lice in the community as well as barriers and factors that propagate the head lice infestations.

Description of Project: This study aimed to approach P.capitis infestations using a holistic perspective to understand the beliefs, stigma, knowledge, prevalence and intensity of p.capitis infestations in rural Honduras among school-aged children. A cross-sectional pilot study was conducted in the La Hicaca and Las Lomitas communities, inviting community members from surrounding villages to the study. 52 children aged 2-14 were visually inspected for head lice prevalence and intensity using a V-comb and the quadrant method. Depending on the diagnosis, children were then given a ‘care package’ including 2 treatments of Resultz pediculicide, instructions in Spanish and information on head lice in Spanish for both children and adults. Children with severe secondary infections were referred to the VCU medical brigade in La Hicaca. Both children and parents participated in structured questionnaires to collect sociodemographic characteristics and beliefs surrounding infestations. The questionnaires were qualitatively analyzed through a theme-based approach. Prevalence was stratified according to sociodemographic features such as gender, community, number of people per household, number of children under the age of 15 per household and education level of the child.
Among the 52 children inspected, 86.7% of children head head lice infestations, significantly higher than the prevalence found in the only other prevalence study in Honduras (to the researchers knowledge). However, in the present study, the high prevalence was due to a sampling method of self selection, a large limitation. Further, due to the treatment incentive, the majority of volunteers already suspected they had infestations, significantly overestimated the prevalence. Of interest, the prevalence of head lice infestations was also 12.1% higher than the self-reported prevalence, indicating an underestimation of infestations when compared to beliefs of members. High intensity infestations were found in 20.9% of children with infestations and secondary infections were found in 4.65%. Agreeable with the literature, girls had a higher prevalence than boys (p=0.003).
Unheard of before, P.capitis was suggested to be transmitted through the slow-flowing river, in the La Hicaca community through the bathing-washing cycle. Analysis of the scientific literature revealed that this is a plausible method of transmission as head lice have been found to survive in a stasis position for up to 36 hours. Further, the river provided an ideal orientation for free-floating head lice to latch onto hair. Further research must be conducted in the community to analyze this mechanism of transmission.
Children struggled with identifying modes of transmission and reservoirs. These gaps in knowledge can also have severe consequences on the prevalence of head lice among children. The present study also found that teachers blamed head lice infestations on a lack of cleanliness and personal hygiene and took on a passive role, where more than half of teachers do nothing with an infested child in class. This misconception results in shaming the child and propagating false conceptions in the community. This inactivity can be explained by the the belief that pediculosis is a normal part of life, feelings of helplessness, or the belief that it is only the parent’s responsibility. With a lack of knowledge capacity being built and transferred in a school setting, it is unsurprising that a stigma surrounding pediculosis capitis infestations is still perpetuated in La Hicaca. Greater than half of children and adults confirmed that children were teased and isolated by their school peers.
Treatment methods included Piojex shampoo and, due to the acceptance of homemade remedies, a paste created out of the carbosulfan insecticide and extracted vegetable oils. Toxicity symptoms include malaise, muscle weakness, dizziness, diarrhea, CNS depression, and pulmonary edema. This carbamate pesticide is poisonous by inhalation and therefore poses a direct risk for both the caregiver applying the paste as well as the child’s health. Oral invermectin is suggested by the researchers as a safe, alternative method of treatment, simulatneously combatting polyparatism with soil-transmitted helminths.

Goals of the Project: 1. Establish the point prevalence and intensity of head lice infestations among primary aged school children aged 2<=14. 2. Investigate the beliefs, perceptions and social impact surrounding the infestations among community members. 3. Identify existing factors that contribute to the spread of infestations and barriers to treatment.

THEME 3: GLOBAL MEDICAL SERVICES
Presenters Poster Title & Authors Abstract
8. Dalia Karol, Shirley Shuster, and Itai Malkin Saving Children’s Hearts: A Global Challenge

Dalia Karol, Shirley Shuster, and Itai Malkin

Faculty of Medicine, University of Ottawa

Introduction: Save a Child’s Heart (SACH) is a UN-sponsored Israeli non-profit organization that provides free life-saving cardiac treatment to children from developing. Many global health initiatives work by providing short-term solutions for individual patients, neglecting the need for long-term sustainability. Instead, strengthening communities’ fundamental healthcare system must be achieved to address this population-level need. SACH was established in 1996 and follows a model that is unique from other approaches, as it uses a tertiary site of excellence as a cornerstone to their continuum of care. Its unique global health model is exemplary and a leader in its potential for sustainability due to its use of four pillars: its use of a tertiary care centre in Israel, a site of excellence for pediatric heart care; international screening missions, with reliable NGOs, to developing countries that diagnose and triage over 200 kids per mission; outreach through training local HCPs at the Israeli tertiary centre and establishment of local care facilities in partner countries; finally, volunteers who perpetuate the cycle by providing service, learning humanitarian work, and acting as local ambassadors.

Methods: We acquired data through collaboration with Save a Child’s Heart coordinators and scholars, and utilized our personal experience as medical interns with the organization in Israel.

Results: From 1996 until today, 50% of children treated to date by SACH are Palestinian from the West Bank and Gaza (2080 of 4293). The remaining children come from 53 other countries, and 14 out of 17 countries that have Health Care Professionals (HCPs) trained by SACH are part of the 53 countries. To date, SACH has trained 133 HCPs, most commonly Anesthesiology (26), Surgery (25), Nursing (22), Cardiology (20) and Intensive Care (19). SACH has also established independent surgical centres in 4 of the 14 countries (Romania, Moldova, Tanzania, China), and is currently establishing centres in Ethiopia and Ramallah. To date, SACH sent 73 missions to 13 countries. SACH has hosted around 800 volunteers and interns from 24 countries, most of which are developed countries, and the organization’s funding for SACH comes from worldwide affiliates including USAID, EU Partnership for Peace, Palestine MOH, Israel MOH, and Israeli Ministry of International Cooperation, and other private donors.

Discussion: SACH has a comprehensive and unique model which has the ability to create long-term improvement in cardiac care in 3rd world countries. As physicians, it is our obligation to treat patients regardless of their country of origin, race, sex, religion, socioeconomic background and political beliefs, which applies to treating children in developing countries as well as treating Palestinian children (50% of SACH children) from the West Bank and Gaza. The model of SACH is not only applicable to cardiac surgery. This model can serve for other tertiary surgical endeavors such as craniofacial reconstruction, neurosurgery, complex spine surgeries and other conditions that have a high level of burden in developing countries. Such endeavors can adopt the unique SACH global health model, a tertiary-care site of excellence with locally-trained doctors capable of recognizing the benefits of tertiary care, and simultaneously skilled enough to deliver local care.

9. Julia Boucher & Meryl Hodge SOARing to Morocco: A Sustainability Analysis of a New International Elective

Julia Boucher & Meryl Hodge

Faculty of Medicine, University of Ottawa

Objective: To evaluate the sustainability of a new international elective for University of Ottawa medical students.

Methods: Using a SOAR analysis framework (strengths, opportunities, aspirations, results) we evaluated the sustainability of a new international elective for University of Ottawa medical students. The evaluators were two medical students who travelled to Tangier, Morocco to participate in this elective after completing their first year of medicine. Upon reflecting back on a daily task log kept during the elective, we conducted a SOAR analysis. Sustainability analysis was required because other medical students had decided to also pursue this elective upon the original students’ return.

Results: Strengths: This elective comprised numerous strengths for the medical students from safety and affordability to the large variation of medical specialties observed. Opportunities: This elective promises the ability to be tailored to the interest of any medical student. Aspirations: Through appropriate promotion of this elective, more medical students will have the opportunity to participate in an elective that promotes the development of culturally and socially competent physicians. Results: Medical students return having performed tasks appropriate to their abilities and having learned about Moroccan culture and social issues.

Conclusions: This international elective is sustainable and culturally appropriate and should therefore continue to be pursued in the future by medical students.

10. Pinkal Patel Innovate Global Plastic and Reconstructive Surgery (iGPRS): Cleft Lip and Palate Non-Governmental Organization (NGO) Database

Pinkal Patel, BSc1, Karen Chung, BHSc, MD2, Leila Kasrai, MD, FRCSC, MPC3

1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

2Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

3Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Background: There is an emerging interest in global surgery. The Lancet Commission on Global Surgery recognizes the important role that non-governmental organizations (NGOs) play in the delivery of cleft lip and/or palate (CLP) surgical care. To better address the unmet burden of surgical disease, the commissioners propose the use of a centralized registry to maximize coordination of global surgical volunteerism efforts. This study aims to create a comprehensive database of CLP organizations providing surgical and non-surgical care, as this is not currently provided in the literature.

Methods: A systematic search of the following resources were conducted: The Plastic Surgery Foundation, Smile Train, Wikipedia, Google, and published lists of surgical non-government organizations (NGOs) (Ng-Kamstra et al., 2016; Wyszynski, D. F., 2002). A secondary review of each organization’s website was performed to verify inclusion criteria and to extract data.

Results: 31 organizations providing CLP care were reviewed, with 30 that met inclusion criteria. 33% of these organizations use a diagonal approach of international outreach and the remainder, vertical (27%) and horizontal models (40%). Their offices are distributed across North America (43%), Asia (27%), Europe (23%), and Australia (7%). 43% of the organizations provide CLP surgeries or services in more than one country; 93% do so with a multidisciplinary team. A majority of the organizations established collaborations with host institutions (80%).

Conclusion: To our best knowledge, this database includes the largest collection of CLP organizations. This list will be made publicly available to promote collaboration between organizations, national health systems, and global health policymakers.

11. Ashley Cerqueira The Utility of Photovoice Journaling in teaching Critical Reflection Skills following Global Health Post-Electives in Canadian Undergraduate Medical Education

Ashley M. Cerqueira1, Desiree Miller-McCaughey2 & Dr. Anne McCarthy1,3

1Faculty of Medicine, University of Ottawa, Ottawa ON, Canada

2Office of Internationalization, University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada

3Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

Background: Global Health Electives (GHE) benefit medical practice and have risks, including safety, occupational health, and ethical challenges. Reflection ensures wellbeing and integration back into medical training. UOttawa is a national leader in preparing medical trainees through mandatory pre-departure training; however, what is needed is an effective post-GHE debriefing program. Last year we undertook a scoping review related to GHE debriefing and used these results, with faculty and national guidelines, to develop a novel debriefing program for GHE. Here we review the results after two years of implementation.

Methods: Post-GHE, trainees completed reflective essays and surveys pertaining to their elective and preceptor experience. They submitted photo narratives from their GHE for a Photovoice project (PV). Before debriefing, trainees received a list of reflective questions, incorporating the CanMEDS competency framework, to be used as a guide during a semi-structured group reflection period and examination of the PV.

Results: 58 trainees completed reflections and surveys; 51 made submissions for the PVs, and 42 trainees attended debrief sessions. Group reflection topics covered safety, poverty, language barriers, and ethical challenges related to limited resources and death. The PVs (487 photos) had themes ranging from culture (47%), clinical experiences (29%), networking (26%), food (14%), and inequities (3%), among others. Trainees rated the Post-GHE debrief session and group reflection as valuable, stimulating and helpful to their reflective practice.

Conclusion: Our project reinforces the significance teaching reflection in medical education, the importance of post-GHE debriefing, and the value of creative PV platforms.

THEME 4: DIVERSITY & BARRIERS IN GLOBAL HEALTH
Presenters Poster Title & Authors Abstract
12. Jessica Bui, Glara Rhee, Lisa Xuan, and Hsin Yun Yang Influences behind Gender Disparity in Academic Physical Medicine and Rehabilitation in North America

Hsin Yun Yang1, Gaeun Rhee2, Jessica Bui3, Lisa Xuan4, Sabeena Jalalkhan2, Faisal Khosa2

1Faculty of Medicine, University of Ottawa

2Emergency & Trauma Radiology, Department of Radiology, Vancouver General Hospital

Background and Objectives: Gender disparity in the field of physical medicine and rehabilitation (PM&R) is an ongoing concern in North America. Although several papers have studied gender differences amongst practicing physicians, none have yet explored them in the academic setting of residency programs. Our objectives were to (1) establish the extent of gender disparity in academic PM&R faculties across USA and Canada, and (2) evaluate associations between gender, leadership position, and research throughput.

Methods: PM&R programs enlisted in Fellowship and Residency Electronic Interactive Database (FREIDA) (n=72) and Canadian Resident Matching Service (CaRMS) (n=9) were searched for academic faculty listings to generate our database of gender and academic profiles. Bibliometric data were collected using Elsevier’s SCOPUS and analyzed by Stata version 14.2.

Results: Of the 1045 faculty members meeting our inclusion criteria, 653 (62.49%) were men and 392 (37.51%) were women. Men were found in greater numbers across all academic ranks, with professors as the most conspicuous (79.14%), and held the majority (85.54%) of leadership positions. Furthermore, our prediction model assessed the relationship between faculty gender, academic rank, and leadership roles and found the odds of men having higher h-index as 0.78 (p≤0.001), indicating that women did not have a significant difference in academic productivity.

Conclusion: A significantly greater number of men make up PM&R faculties in all academic ranks and leadership positions across North America. H-index is not significantly different between men and women, suggesting that more complex and multifactorial issues are likely influencing the existing gender disparity.

Keywords: Physical Medicine and Rehabilitation (PM&R), academic faculties, gender disparity, academic ranks, leadership positions, h-index

13. Norah Ahmad  Considering Impact on Health Equity Using Evidence to Decision Framework on ECDC Migrant Guidelines

Nora Ahmad, B.ASc, MD Canda,c, Kevin Pottie, MD, MClSa,b,c, Vivian Welch, MDc,d, Ayesha Ratnayake, PhDc, and Peter Tugwell, MDc,e

aFaculty of Medicine, University of Ottawa, Ottawa, Ontario

bDepartment of Family Medicine, Ottawa, Ontario

cBruyere Research Institute, Ottawa, Ontario

dCentre for Global Health University of Ottawa, Ontario

eFaculty of Medicine University of Ottawa, Ottawa, Ontario

Introduction: Health inequity is defined as “differences in health, which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust”. Equity consideration is imperative in the process of health guideline development given the potential to inform public health and policy decisions.

Objective: To address health equity within the “Evidence-Based Guidance on Screening for Infectious Disease Among Migrants to the EU/EEA” project under the European Centre for Disease Prevention and Control (ECDC). Equity facilitation was utilized to engaged disease review teams to include equity considerations when developing GRADE evidence to decision framework.

Methods: Developed a systematic process to identify equity considerations by asking key questions to group leads in each of the 6 disease review teams: HIV, TB, intestinal parasites, Hepatitis B, Hepatitis C, and childhood vaccines. Focused areas for equity considerations included children because those under 18 made up more than 50% of refugees in 2013. Women were also included as they are more likely to face barriers in accessing health care thereby creating discordant expectations between them and their providers.

Results: Each group formulated equity draft recommendations with positive feedback towards equity facilitation.

Discussion: Practice facilitation is a multifaceted approach involving skilled individuals who enable others to address challenges in implementing evidence-based guidelines within primary care settings. It has been shown to help practices make and maintain changes. Equity is rarely addressed in evidence-based guidelines and we hope facilitation can improve the process in addressing equity systematically.

14. Joanne Joseph Promoting Refugee Mental Wellbeing through the RHI Community Service Learning Program

Joanne Joseph, Rana Hassan, Jennifer Dcruz, Matt Driedger, Doug Gruner, Kevin Pottie

Refugee Health Initiative, Faculty of Medicine, University of Ottawa.

Mental wellbeing is essential for a healthy and content life. This fundamental necessity is disrupted due to multiple stressors involving the process of displacement and migration. In fact, Post-Traumatic Stress Disorder (PTSD) and depression among refugees in Canada is on the rise. The Refugee Health Initiative (RHI), a student run interest group at the University of Ottawa- Faculty of Medicine, through the Community Service Learning (CSL) program aims to facilitate the integration of refugees in to the Canadian society while paying attention to various barriers. This past academic year we payed special attention to mental health barriers and promoted various activities that focused on mental wellbeing. We trained medical students in Narrative Exposure Therapy (NET) in order to allow them to effectively counsel/ interview refugees with traumatic experiences. We also introduced Refugee Paint Night where medical students and refugee families alike took part in painting activities, crafts and a cultural pot luck. This event was well received by the refugee families as this allowed them to meet others refugee families and share their stories, while using art as a therapeutic outlet. In addition we also collaborated with the Ottawa Newcomer clinic to organise a mental health themed Refugee Health Fair, which promoted various mental health resources available for the refugees. Therefore, the past academic year RHI has aimed to promote positive view of mental health among refugees.
15. Alexandra Kobza Assessing whether the Ottawa-Shanghai Joint School of Medicine Diabetes Curriculum reflects the Chinese population that graduates will serve; Is there a match?

Alexandra Kobza1, Ying Dong2, Amel Arnaout1

1The University of Ottawa, Ottawa, ON

2Shanghai Jiao Tong University, Shanghai, China

Background and Objective: The Ottawa Shanghai Joint School of Medicine (OSJSM) is a campus of the University of Ottawa Medical School in Shanghai, China. The school mirrors the University of Ottawa curriculum to teach Chinese students. This collaboration allowed us to study whether the Canadian curriculum is suitable for the Chinese population. The aim of this study is to evaluate 1) The Diabetes Curriculum of the OSJSM 2) The relevancy of the content for the Chinese population.

Methods: A curriculum comparison between the University of Ottawa, OSJSM and the Shanghai Jiao Tong School of Medicine evaluated the diabetes curriculum content. A literature search was performed to compare the diabetes populations in Canada and China. Surveys were used to determine how learners and physicians manage diabetes, and whether patients adhere to recommended guidelines.

Results: The diabetes curriculum at the OSJSM is identical to that of the University of Ottawa. Canada and China have a similar diabetes prevalence, diagnostic criteria and management. No data could be found on the rates of diabetes complications in China. Although both countries utilize the same guidelines for the screening of diabetes complications, diabetic patients in Canada are more likely to adhere to these recommendations.

Conclusion: This study suggests that the diabetes content of the University of Ottawa UGME curriculum remains relevant to educate future physicians in China. A greater emphasis on the importance of screening for disease complications in the curriculum may facilitate making this a priority for patients and health care providers in China.

 THEME 5: SYSTEMIC ISSUES
Presenters Poster Title & Authors Abstract
16. Niharika Shahi The use of urine drug screening by primary care providers in rural Northern Ontario for detecting and managing misuse amongst patients being prescribed opioids for chronic non-cancer pain

Niharika Shahi1 & Ryan Patchett-Marble, MD2

1Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON

2Marathon Family Health Team, Marathon, ON

The prevalence of opioid abuse has reached an epidemic level. National guidelines recommend safer opioid prescribing practices, including monitoring of patients with urine drug screening
(UDS). There is little evidence supporting or refuting the use of UDS in the context of chronic non-cancer pain (CNCP) patients. The Marathon Family Health Team (MFHT) has implemented a randomized UDS program, aimed at making opioid prescription safer. This research project evaluated the efficacy of randomized UDS to detect and manage opioid misuse amongst patients with CNCP. Data collected from patient chart reviews was analyzed using SPSS software. Of the 77 patients prescribed opioids and stratified as low-risk, 71.4% completed at least one UDS during the study period. Of these, 80% completed at least one random, and 20% completed only scheduled UDS. Overall, 66.4% of patients had expected, 29.7% unexpected, and 3.9% equivocal UDS results. The physicians at MFHT took action for 63.3% of unexpected results and 25% of equivocal results. Of the 77 patients, 8 were tapered, discontinued on opioids, or switched to a suboxone or methadone program for addiction directly as a result of UDS. The results of this study show that the UDS program implemented by MFHT is effective in detecting and managing misuse amongst patients being prescribed opioids for CNCP. Although the results of this study are based on data collected from a small clinic, this UDS program can be replicated by other primary care providers to reduce substance misuse among patients in rural and remote communities of Northern Ontario.
17. Chelsea Noel Pilot study examining the effects of an adjunct treatment for cognitive deficits related to schizophrenia.

Chelsea Noel

University of Ottawa

Schizophrenia (SZ) is a chronic psychiatric disorder characterized by cognitive deficits, receiving little benefit from antipsychotic medications. Auditory processing deficits in SZ are associated with abnormalities in the attention-dependent P300 (P3) event-related potential (ERP) sub-components, reflecting involuntary (P3a) and voluntary (P3b) attentional processes, modulated by slow wave oscillatory activity. This study investigated the effects of transcranial alternating current simulation (tACS) and P300 amplitude, evoked delta, theta power, and their association with psychometrically assessed schizotypy. tACS was predicted to increase P300 amplitudes and associated delta/theta power and these neural measures and their change with tACS was thought to be related to schizotypy scores. A second objective explored baseline dependency of tACS effects on P300 and evoked oscillatory activity. P300 amplitudes elicited by auditory stimuli were examined in a sample of 24 healthy males in a randomized, repeated-measures, double-blind design, involving separate administration of sham, theta (6Hz) and gamma (40Hz) tACS. No significant effects of tACS on P300 amplitude or power were observed. Significant relationships were found between baseline (sham) P3a gamma power and schizotypy and between effects of gamma tACS on P3a gamma power and schizotypy. P300 amplitudes were positively correlated with delta/theta power and tACS induced changes in P300 amplitude and power were found to be dependent on baseline values. These findings highlight a tentative role of tACS on neural measures of attentional functioning and its sensitivity to individual differences, which may be explored at the clinical level by examining its effects in SZ patient sub-groups with varying cognitive impairments.