2010 Epidemiology Poster Competition

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Interdisciplinary School of Health Sciences
University of Ottawa, Canada

Every academic year, third and fourth year undergraduate students enrolled in the Epidemiology course at the Interdisciplinary School of Health Sciences participate in a competition for the best epidemiological research project.

The products of their work — a research article and a poster presentation — are high quality examples of the output from undergraduate students finishing their Bachelor Degree. We would like to present the top scoring presentations of the 2011 poster competition and offer our congratulations for their contribution to epidemiological research.

Please note that these abstract did not go through the peer-review process of the RISS – IJHS.


 

From Womb to Doom: Effects of Maternal Health on Schizophrenic Offspring

K. Abd el al, K. Mezher, Z. Taleb

Known as one of the most devastating mental illnesses to affect the human brain, schizophrenia has been constantly studied as a major disease entity over the past century. The annual incidence of schizophrenia averages 15 per 100,000, and the point prevalence averages 4.5 per population of 1000. Risk of disease development is 0.7%. Despite disease commonality, the causes and pathogenesis of schizophrenia remain obscure, indicating a clear need for research aimed at detecting risk factors for disease development. Previous studies have proven that gene-environment interactions significantly contribute to the risks associated with schizophrenia onset. However, less emphasis is directed toward risk factors related to maternal exposure. This study aims to determine whether a relationship exists between maternal exposures to stress, viruses, and obstetric complications and the risk for schizophrenia development in offspring. Evidence is based on a collection of systematic reviews, meta-analysis, cohort, and case control studies; each study has presented significant and insignificant results. Overall results indicate that a relationship between prenatal maternal exposure and risk for schizophrenia development in offspring seems to exist.


The Post-therapy Effects of Testicular Cancer Treatments – Surgery and Chemotherapy – on Male Reproductive Fertility

O. D. Adeyemo, S. Barua, R. Saforo -Appiah

BACKGROUND INFORMATION: Testicular cancer (TC) affects men mostly between ages 15 and 49 years. The incidence rate of TC in 1989 was 4.2/100000 compared to 10.2/100000 in 2004. TC is the most curable solid tumour, with 10-year survival rate of more than 95%. Yet, preserved fertility is an important concern. This systematic review was implemented to determine which form of TC treatment (surgery or chemotherapy) had the most severe impact on post treatment fertility.

METHOD: A computerized search of English peer-reviewed literature on Fertility and Testicular Cancer published from June, 1995 through June, 2010 was conducted using the Pubmed Database. Pooled estimates were determined from the incidence of TC in relation to reduced fertility rate after treatment from 6 studies.

RESULT: It was observed that fertility rate was reduced in men after treatment for TC. In a self-reported survey of 297 patients treated for TC, 82.4% (98/119) of patients who tried to have children before treatment succeeded, and only 49.3% (74/150) were successful after treatment (p<0.001). The fertility rate of patients treated with surgery was markedly reduced to 56%. In another follow-up survey of 1462 patients diagnosed with TC from 1980 to 1994, it was observed that 85% (85 of 106, CI 95%) sustained fertility after treatment with two to four cycles of cisplastin-based chemotherapy.

CONCLUSION: This study suggests that overall fertility in men diagnosed with TC is reduced after treatment. Fertility is severely reduced after surgery; however, it is significantly preserved even after two to four cycles of chemotherapy.


Maternal Obesity During Prepregnancy and Neural Tube Defects

A. Bujak, C. Martin

Research Question: Does maternal obesity during prepregnancy modulate a higher risk of neural tube defects in offspring? Introduction: Past trends indicate prevalence of obesity will continue to rise in the future. Maternal obesity during prepregnancy has been shown to heighten risk of NTD in recent studies. Association means impact of NTD on healthcare and individuals will increase as rates rise in accordance with obesity prevalence.

Methodology: Four studies concerning obesity and NTD were retrieved from PubMed and Medline. From these studies, attack rate, relative risk and risk were calculated.

Results: Risk of NTD in pregnant women increases with both BMI groups and weight. The attack rate of NTD in obese women (0.24, 0.61, 0.56) was higher than the attack rate in non-obese women (0.11, 0.46, 0.42) in 3 of the 4 studies. The risk ratio of NTD is significant for 3 of the 4 studies.

Discussion: Major known confounding variables such as folate status were controlled in each of the studies. Results showing that prepregnancy obesity heightens NTD risk remained significant despite statistical controls in 3 of the 4 studies. 1 of the 4 studies found NTD rate to be significantly higher when mothers were both obese and diabetic during prepregnancy.

Conclusions: In accordance with our hypothesis, maternal obesity during prepregnancy does increase the risk of NTD in offspring. Reducing the prevalence of obesity among women of reproductive age should result in fewer NTD amongst neonates.


Risk Factors Associated with Fractures in Postmenopausal Women with Osteoporosis

L. Carmanico , H. Duncan

Fractures are a major health concern since they decrease quality of life, have high morbidity and mortality as well as economic impact on the health care system. Postmenopausal women with osteoporosis are highly susceptible to fractures. The principle risk factors expected to be associated with increased fracture occurrence are vitamin D insufficiency, smoking and low body mass index (BMI). Other risk factors include social and cultural variables, medical history, substance use, hormonal profile and nutritional as well as body composition factors. The majority of the risk factors are interdependent or demonstrate correlation in occurrence, readily confounding individual analysis of relative risk. Although some factors are genetic, most are under an individual’s control. Understanding the risk factors associated with fractures in postmenopausal women with osteoporosis will help direct preventative care and allow risk reduction. Further research is warranted as a literature review revealed statistically insignificant findings and contradictions between studies.


 

The Mystery of Haiti’s Cholera Outbreak

K. Choi, A. Passingham

BACKGROUND: Following the January 12, 2010 earthquake, Haiti garnered much attention from the International community, receiving large amounts of Foreign Aid. On October 21, 2010, a cholera outbreak was confirmed. The pathogen, Vibrio cholerae, must be present in the environment, and is passed through contaminated water and can lead to death from dehydration. This study hopes to explore the impacts of the Vibrio cholerae outbreak on Haiti and how it has spread through the country.

METHODS: An online literature search of the PubMed and Google Scholar databases was conducted using the keywords ‘cholera’, ‘Haiti’, ‘outbreak’, ‘origin’ and ‘epidemiology’. Only articles published in English and within the last year (2010-present) were considered for inclusion. Health statistics were obtained from the WHO, CDC, and Haitian Ministry of Health. The incidence, prevalence and mortality rates of cholera were examined according to region. To determine the severity of the disease, the case fatality and projected rates were also analyzed.

RESULTS AND CONCLUSIONS: Cholera has spread quickly throughout the population; however, the case-fatality rate has decreased. Both the number of cases and case fatality rate are starting to plateau at 256,000 cases and 1.9% respectively. Even though a plateau seems to have been reached, experts predict that the number of cases will continue to increase.

IMPLICATIONS: The cholera outbreak has placed immense stress on the Haitian health care system causing increases in health expenditure and foreign aid dependence. Canada, for its part, has contributed more than $1 million to the cause.


Methods for Improving Adherence to Highly Active Antiretroviral Therapy (HAART) in Uganda

A. Kotb, R. Daoud, S. Ghavamzadeh, S. Chacon

Background: In Uganda, a total of 293,000 life years have been gained as a result of the use of highly active antiretroviral therapy (HAART) since 1996. This can only be achieved when patients adhere to their prescribed treatments. Poor adherence to HAART is the major cause of treatment failure, development of drug resistance, HIV disease progression and premature death.

Objective: To determine the innovative methods for improving adherence to HAART in Uganda and the limitations of applying these methods elsewhere.

Methods: A systematic review of peer-reviewed articles related to innovative methods of improving adherence to HAART in Uganda was carried out. Articles were found using PubMed and SCOPUS databases with the following keywords: HIV, adherence, antiretroviral, compliance, and Uganda.

Results: Four innovative methods were found that increased the rate of adherence to HAART: (1) the use of mobile phones to remind patients to take medications, (2) home or community based treatment programs in rural communities, (3) the use of mobile team on motorcycles to track patients, and (4) task shifting. Based on our criteria, mobile phone reminders was found to be the most transferable method.

Conclusion: In Uganda, adherence levels are as high as, if not even higher than the levels in North America. Their high level of adherence is in part due to the previously described innovative methods. Mobile phone reminders have been employed in Kenya and found to increase adherence to HAART. Future research should focus on assessing the potential success of these methods in North America.


Increased Risk of Suicide in Canadians with Bipolar Disorder

A. Dresch, R. Liang, S. Thomas, K. Tonkin

Background: Bipolar disorder is a major psychiatric disorder that affects over 500 000 Canadians, however little is known about its prevalence in relation to attempted suicide.

Objective: To determine a link between increased suicide rates and Bipolar disorder among the Canadian adult population when compared to other mental illnesses. Methods A search was conducted across multiple databases to find peer reviewed articles containing data related to prevalence and suicide rates of various mental disorders. In total 14 articles were chosen and included in the review for data abstraction.

Results: The prevalence of Bipolar disorder in Canada is 2.2% with the highest rate of attempted suicide at least once in their lifetime falling between 25-60%. Depression, anxiety disorders, and schizophrenia had attempted suicide rates of 15%, 28%, and 31% respectively. Conclusion These findings indicate that Bipolar disorder has the highest risk for attempted and completed suicide among other psychiatric disorders.


The effect of vitamin A micronutrient intervention on xerophthalmia prevalence in vulnerable populations

J. Gedeon, T. Rahman, H. Riddoch, H. Yan

Vitamin A is an essential nutrient in maintaining healthy eyes, vision, growth and development. Vitamin A deficiency (VAD), which affects over 250 million preschool-aged children worldwide, is characterized primarily by the prevalence of xerophthalmia. A literature review was used to determine the effectiveness of vitamin A supplementation programs in reducing xerophthalmia and its associated symptoms in vulnerable populations – namely in infants and pre-school aged children using Bitot’s spots and night blindness as indicators. Vulnerable populations for this study are defined as being vitamin A deficient as determined by serum-retinol levels. 8 studies were selected based on availability of comparisons between pre- and post-intervention data or experimental group and control group data- 4 of which were statistically significant. There has been a decrease of xerophthalmia prevalence after vitamin A supplementation in the experimental or post-intervention group from 1.9 to 0.3% (P<0.05), 2.31 to 0.64% (95% CI, 0.17-0.79), 24.6 to 11.2% (P<0.001), and from 6.9 to 3.3% (P<0.0001) in an RCT in Indonesia (n = 12591), an RCT in Nepal (n= 1871), a pre/post evaluation in India (n= 818, a pre/post evaluation in Mali (n=1524), respectively. Vitamin A supplementation greatly reduces xerophthalmia prevalence in infants under 65 months, while effects are reduced in children older than 65 months. Therefore, results are primarily applicable to vulnerable populations which fall within the 0-5 year age-range. Based on the results of the study, vitamin A supplementation is a key intervention in reducing prevalence of xerophthalmia in vulnerable populations.


Breast Cancer Risk After First Full-Term Pregnancy Among Canadian Women

T. Gordon, N. Maschi

Background: While there is no single cause of breast cancer, a number of risk factors have been identified. Pregnancy has been studied as a risk factor for its potential to increase the risk of breast cancer in terms of the effect of full-term pregnancy.

Methods: A computerized search was conducted using the PubMed database, using the following search strategies such as ‘full-term pregnancy’, ‘breast cancer or breast neoplasms’, ‘risk’ and ‘Canada’.

Results: During pregnancy, there are many permanent changes to a woman’s breast. It has been determined that Canadian women who have their first full-term pregnancy before the age of 30 are at a reduced risk of developing breast cancer. On the other hand, Canadian women who have their first full-term pregnancy after the age of 40 increase the risk of developing breast cancer. Also, Canadian woman who are predisposed to breast cancer in terms of carrying the BRCA1 or BRCA2 mutations do not benefit from early full-term pregnancy in the same ways as women without the mutations.


The Burden of TB in HIV-Positive South Africans

S. Gosain, N. Overhoff

BACKGROUND: HIV/TB co-infections rates in South Africa are among the highest in the world, and are climbing. Through knowledge of epidemiological information associated with HIV/TB co-morbidities, it is hopeful that policies will be created to reduce the incidence, prevalence and mortality rates associated with these infections.

METHODS: A thorough literature review was employed to determine the burden of TB among HIV-positive individuals in South Africa. Various databases were consulted to retrieve data on to the incidence, prevalence, and mortality rates of HIV/TB co-infections in South Africa.

RESULTS: It has been revealed that TB is the greatest killer of HIV-infected individuals in South Africa, where the incidence of co-morbidities is 563 per 100,000. As the prevalence of HIV increased in South Africa, the incidence of TB increased at a remarkable rate, resulting in the most dramatic rise in TB rates in Africa since the advent of antibiotics. The global burden of HIV/TB co-infections is greatest in Sub-Saharan Africa, and one third of all TB/HIV co-infections are isolated to South Africa; the highest rate of co-infections in the world.

CONCLUSIONS: Policies and interventions must focus on different perspectives; including HIV reduction to control co-infection rates. Additional research will be required to reduce the impact of concomitant HIV and TB infections in South Africa.


Domino Effect of the Female Athlete Triad

A. Gregory, C. Smith

Disordered eating, exercise-associated amenorrhea, and osteoporosis are the main constituents of the female athlete triad (FT) syndrome. Strenuous exercise and disordered eating act together synergistically to induce menstrual disorders and hypoestrogenism, leading to decreased bone mineral density and osteoporosis. Risk factors of the FT include being an elite or highly competitive level female athlete, age of adolescence and young adulthood, a family history of disordered eating, physiologic factors, higher socioeconomic status and athletic disciplines that emphasize low body weight and thinness. The true prevalence of FT is difficult to determine due to the secretive nature and denial of disordered eating. Consequences of the FT include impairment of athletic performance and increased risk of injury – primarily stress fractures. Prevention and early detection are crucial to decrease the risk of the FT. The ideal time to screen for the FT is during the preparticipation physical examination or during evaluations for other problems that may be suggestive of an underlying eating disorder, menstrual dysfunction or low bone density. Treatment of the FT focuses on recognition of the problem, identification and resolution of psychosocial issues, stabilization of medical and nutritional conditions and re-establishment of healthy eating patterns. Most importantly, coaches and parents need to be educated on prevention of disordered eating and awareness of the signs and symptoms.


Differences in HDL, LDL, and Total Cholesterol between Metabolically Healthy Obesity and Metabolically abnormal obesity

S. Bu, P. Duong, B. Ha, P. Lee

Objective: to determine the differences in blood lipid cholesterol levels between the subgroups of metabolically healthy obese (MHO) and metabolically abnormal obese (MAO) individuals within the obese population.

Methods: a literature review for studies reporting MHO and MAO cholesterol measures was conducted. Mean total, HDL, and LDL cholesterol of MHO and MAO subjects were extracted and synthesized into a table.

Results: MHO individuals were seen to have significantly higher HDL cholesterol in seven out of ten studies, with mean differences ranging from +0.16 to 0.37 mmol/L. In addition, MHO individuals were seen to have significantly lower LDL cholesterol in two out of five studies, and significantly lower total cholesterol in two out of six studies, with mean differences ranging from -0.80 to 0.89 mmol/L and -0.94 to 1.10 mmol/L, respectively.

Conclusion: Our findings support the use of elevated HDL cholesterol as a characteristic differentiating MHO and MAO. Further research is needed to verify whether lower levels of LDL cholesterol and total cholesterol can be reliable indicators of the MHO phenotype.


 

The Repercussions of Professional Sports – Recurrent Concussions and Dementia

S. Harris, J. Boyer

Objectives: To examine recurrent concussions as a risk factor for reduced cognitive functioning leading to dementia. Also, to discuss methods for reducing recurrent concussions as a risk factor as well as appropriate guidelines for “returning to play” after a concussion.

Methods: A computerized search of English language literature, with the key words “concussions”, “Dementia”, “Chronic traumatic encephalopathy”, and “Traumatic Brain Injury” using the PubMed, Medline and Ovid Healthstar databases. Evidence related to the objectives was extracted using only articles between the years 1999 and 2011.

Discussion: Currently millions of Canadians participate in sports and the economic burden of sports-related injuries is stagnant. Concussions and traumatic head injuries are common within professional sports such as football, hockey, boxing, wrestling, rugby, lacrosse, soccer and skiing. With higher incidences of dementia, high prevalence of concussions an Traumatic Brain Injuries (TBIs), as well as a decrease in life expectancy and mental function, it is apparent that this fairly new realization needs further longitudinal research.

Conclusion: CTE research is in its infancy and the relevant merit of this research is an important start to the evident prospective longitudinal cohort studies that are necessary. Interventions are needed that both delay disease onset and delay progression in order to significantly reduce the global burden of the disease. It is clear that the repetitiveness of head injuries creates compounding neurological damage. This research shows that recurrent concussions are a risk factor for dementia in athletes and that this is something that needs further attention.


 

Red Wine Consumption Level and Prostate Cancer Risk

A. Kartolo, A. Abimbola

Background: Prostate cancer has the highest incidence rates in North American males. Despite its less-pervasive lethality, high incidence rates accounts for the fifth leading cause of cancer death in males due to increased mortality cases. Studies indicate that red wine contains high amount of resveratrol, a chemopreventive agent that may reduce carcinogen growth by modulating enzymatic activities. This paper aims to identify the relationship between various red wine consumption and prostate cancer risk among North American males.

Method: A literature review was conducted by using Medline and Scopus databases to search for related English language studies within the past 11 years in North America. Age adjusted data from 4 studies were standardized and categorized into low- (<6 oz/wk), medium- (6-28 oz/wk), and high- (>28 oz/wk) consumption level groups (LCLG, MCLG, HCLG respectively). Meta analysis of fixed effect model was conducted to analyze the association between MCLG/HCLG and prostate cancer risk. Analysis of the LCLG was conducted by calculating RR (95% CI) because there were only 2 studies with relevant data.

Results and conclusions: Inconsistent association was shown in the LCLG (RR 0.88, 95% CI 0.75-1.03; RR 0.79, 95% CI 0.73-0.85). Result of the meta analysis of MCLG and HCLG revealed no significant association (RR 1.01, 95% CI 0.94-1.08; RR 1.01, 95% CI 0.87-1.18) and high heterogeneity levels of i2 = 78.5% and i2 = 59.1% respectively.

Implications: Futures studies need to consider the possibility of other components in the red wine that may interact with the protective effect of resveratrol.


Running Away from Depression: The Effects of Physical Activity on Depression

A. Lavoy, M. Cloutier

Background: Students face many changes in their transition to university. Depression is common in this age group, affecting 1 in 4 students.

Objective: We explored associations among physical activity and depressive symptoms in university students.

Methods: We conducted a literature review examining studies that investigated the levels of exercise and self-reports of feelings of depression.

Results: Overall, males and females who engaged in physical activity demonstrated reduced levels of depressive symptoms.

Conclusion: There is an established association between increased physical activity and reduced depression which demonstrates that adding an exercise component to current treatment interventions would be beneficial.


Men and HPV: To Vaccinate or not to Vaccinate

E.-M. Leclair, P. Salemi

Background: HPV is the most common sexually transmitted disease. There is a great amount of data on HPV in females, however emerging research is showing that HPV is a concern in males also.

Objectives: To determine if males should be vaccinated against HPV, and if vaccinating men will decrease the incidence and prevalence of HPV.

Methods: Various government websites and computerized databases were searched for key terms such as “HPV”, “males”, “vaccination”, “disease burden”, “incidence”, “prevalence”, and “cancer”.

Results: HPV has the potential to cause cancers in men, more specifically penile, anal, and oropharyngeal. The Gardasil vaccine was recently approved for use in males, and was shown to be almost 90% effective in preventing HPV. Conclusion: Males should also be included in vaccination efforts, as this will impact both males and females.


Weighing in: How Public Perception of the Causes of Obesity is Keeping North Americans Overweight

M. Loncar, A. Pontone

The prevalence of obesity has increased substantially over the past several decades both in Canada and the United States. Despite efforts to reduce the rising levels of obesity, existing preventative strategies have had very limited success. We examine evidence surrounding public perceptions of the causes of obesity and their impact on support for public policy solutions to reduce obesity rates seeing as public perception of risk is an important consideration in public health policies. Through a comprehensive literature review of English-language publications within the last 10 years, several obesity-related metaphors have been recognized to play a significant role in shaping public attitudes about the causes of obesity and promoting stigmatization of obese individuals. The public uses metaphors to help explain why North Americans have become overweight. These metaphors are also powerful indicators of support for public policy interventions, with varying influence across different types of obesity-related policies. Participants commonly blamed the individual for being obese. Those who blamed the individual hesitated to support obesity-related health policies. Current evidence concludes that obesity-related metaphors are not beneficial health. Lack of support results to serious risks of physiological and physical health, generates health disparities and interferes with implementation of effective obesity prevention efforts. Public support is key for sustained implementation of preventative measures to identify potential starting points for enhancing support of obesity reduction initiatives. Increased support for policies aimed at reducing obesity rates may be achieved if the public embraces low-blame metaphors, thereby agreeing that obesity is caused by both genetic and environmental factors.


Pregnancy as a Risk Factor for Mortality in Breast Cancer

G. Maurice, R. Caley

BACKGROUND: Pregnancy-associated breast cancer is an uncommon, yet serious occurrence (1 in 1,500 to 4,000 pregnancies in Canada). Studies have been conducted to understand the prevalence and prognosis of women diagnosed with pregnancy-associated breast cancer (PABC). To further the understanding of the above relationship, a meta-analysis was conducted of several cohort retrospective studies as well as case-control studies.

METHODOLOGY: A computerized search of English language literature was conducted using the PUBMED® and Google Scholar database. This search was limited to original articles only, and only studies published from 1992 until 2011. Shared information examining this issue was derived from 10 studies.

RESULTS: Statistically, a synthesis of six studies has demonstrated that cases with PABC had a lower 5-year survival rate than non-PABC cases; 51.9% compared with 75.2% respectively.

DISCUSSION: Generally, these studies submit that the higher death rate of PABC cases has been attributed to three factors: (1) diagnosis delays, (2) possible pathology, and (3) maternal age. A review of this literature suggests that the data relating to risk factors of PABC are limited and require further investigation.

CONCLUSION: Pregnancy can be a risk factor for mortality in breast cancer. As such, health care professionals play an important role in the early detection of PABC and in promoting breast cancer awareness specifically during pregnancy.


The Spread Trees, Not AIDS Programme in KwaZulu-Natal, South Africa

S. Mohamed

BACKGROUND: South Africa’s HIV epidemic remains the largest in the world, where young women represent half of all HIV infections in the country [1]. The province of KwaZulu-Natal has the highest HIV prevalence rate (39.5%) in the country [2]. There is a definite need for HIV prevention/education programmes.

OBJECTIVE: To investigate community interest and acceptance of a peer education programme (Spread Trees, Not AIDS) that focuses on the issues of both HIV prevention and environmental degradation among youth aged 10-19 in the Amajuba, eThekwini, uThukela and uThungulu districts in KwaZulu-Natal, South Africa.

METHODS: A prospective cohort study was conducted from mid-June to late-July 2008. Participating sites (i.e. Rural Partner Organizations) were selected by the AIDS Foundation of South Africa where each was then responsible for recruiting thirty youth within the target age range. Youth were selected to participate in two subsequent peer education workshops focusing on HIV, the environment and leadership. Age, gender and attendance to workshops were collected by our team.

RESULTS: The combined mean age of all participants was 14.61 years old. The cumulative attendance at all workshops per community was: Amajuba (93.33%), eThekwini (100%), uThukela (96.15%) and uThungulu (60.00%).

CONCLUSION: There is an interest for HIV education/prevention programmes such as Spread Trees, Not AIDS in each Rural Partner Organization community.


Genetic Indicators: Examining the internal time bomb that is Huntington’s Disease

C. Persic, H. VrBanac, A. Edwards

The age of onset (AOO) of Huntington’s Disease (HD) is inversely related to the CAG-expansion length in the short arm of chromosome 4. CAG-expansion length is only one of the factors that influences AOO; environmental factors and other candidate gene modifiers have the potential to impact AOO as well. A review of published statistical models was conducted to assess the accuracy in predicting the AOO of HD from the CAG-repeat length. A comparison longitudinal observational study, PREDICT-HD, was used to assess accuracy. Earlier detection of HD can lead to faster targeted treatments and therefore slow progression.


Obsessive-Compulsive Personality Disorder: What is its Relationship with Anorexia Nervosa in a Female Athlete Population?

M. Prentice

In recent years, Obsessive Compulsive Personality Disorder (OCPD) has been implicated in the development of Anorexia Nervosa (AN) – an often chronic and life-threatening eating disorder. The personality traits shared across both OCPD and AN, which include a high degree of perfectionism, a preoccupation with details, and a need for order and control, are particularly manifest in female athletes – a population with a markedly elevated risk for AN. A systematic review of the literature was thus undertaken to elucidate the influence of OCPD on the development of AN in the female athlete population. Results suggest that the author is the first to explore this relationship: no epidemiological studies have established the prevalence of OCPD in female athletes, let alone its relationship to AN. This review has thus uncovered a new focus for women’s mental health research, with important implications for prevention and treatment of AN in the growing population of female athletes.


Targeting Parkinson’s Disease: A Systematic Review of the Association of Parkinson’s and Coffee Drinking

M. Rashid, M. Watson, H. Alturki

INTRODUCTION: About 1 in 100 Canadians over the age of 60 are diagnosed with Parkinson’s disease (PD) (Parkinson’s Disease Foundation, 2011). Risk factors need to be explored to help develop effective prevention methods. Studies have shown that caffeine intake may have a relationship with the risk of developing PD. Coffee represents a major source of caffeine for Canadians and coffee consumption increased by 3.6% to 90 Liters/person in 2009 (Statistics Canada, 2010).

OBJECTIVE: To determine whether increased coffee intake reduces the risk of PD.

METHODS: A systematic review was performed through searching the MeSH terms “Parkinson’s disease”, “coffee”, and “risk factor” using MEDLINE® database. Inclusion criteria incorporated articles in the English language, conducted within the past 20 years, and that reported risk of association between coffee and PD. Through analysis of titles and abstracts, followed by full texts, 7 articles were obtained. Associations between PD and other caffeinated beverages were excluded. Critical appraisal for each study was done and results were obtained.

RESULTS: Overall, studies showed decreased risk of PD as coffee dose increases. Risk ratio for highest exposure ranged 0.18-2.0 compared to 0.50-2.7 for lowest exposure. Only one dependable study showed increased risk (for specific results refer to table 1 in the full study).

CONCLUSION: There is an overall decreased risk of developing PD as intake of coffee increases, however, further research needs to be done to account for confounders, standardize dose and conduct meta-analysis to determine heterogeneity of the studies.


Chloroform Carcinogenesis: A Review of Literature Regarding The Carcinogenic Effects of a Highly Prevalent Chlorination Disinfection By-product

L. Remillard, S. Vaid

Context: Chlorinated by products have detrimental health effects in high consumptions. Specifically, evidence has shown a correlation between Trihalomethanes (THM) and bladder cancer. Chloroform, the most abundant THM, has been listed by numerous health agencies as a probable carcinogen. The purpose of this presentation is to gather evidence, summarize results, and draw a conclusion determining the relationship between chloroform and bladder cancer.

Methods: A thorough literature review was established using government and peer reviewed resources relevant to chloroform and bladder cancer. Regions concentrated with high and low rates of chloroform and bladder cancer were examined to determine whether there is a correlation between the two.

Conclusion: After reviewing current literature about the concentrations of chloroform and its contributing factors towards the incidence and prevalence of bladder cancer, conclusions were drawn. There is a correlation between bladder cancer and the consumption of chlorinated water. However, there is no definitive correlation between bladder cancer and chloroform. Nevertheless, chloroform is the most abundant THM leading to belief that an association between the two can be drawn. In brief, more research is needed to clarify chloroform’s role in the development of bladder cancer.


Examining the efficacy of anti-depressant medication in the treatment of severe major depression: A meta-analysis

C. Rowed, R. Winterbottom

Introduction: Approximately 8% of Canada’s adult population is affected by Major Depressive Disorder (MDD). The most commonly prescribed forms of pharmacotherapy are selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressants (TCA). There is a lack of comprehensive analysis of the full efficacy of these drugs in placebo-controlled clinical trials despite their widespread usage.

Objectives: Examine the efficacy of SSRIs and TCAs in patient’s with severe major depression.

Methodology: 8 placebo-controlled clinical trials were selected and included in this metaanalysis (n=1696). The primary measure of outcome was the Hamilton Rating Score for Depression (HRSD). From these results relative risks were calculated (CI 95%) and grouped according to medication.

Results: RR TCA= 1.52, NNT=6 (weighted mean of 4 studies) and RR SSRI 1.36, NNT=6 (weighted mean of 4 studies).

Discussion: Based on these results we can conclude that SSRIs and TCAs are both significantly effective in the treatment of severe melancholic major depressive disorder.


Does Prostate Cancer Discriminate? – Analyzing the Prevalence of Prostate Cancer Among Different Ethnicities

C. Seabrook, E. Weichert

Prostate cancer is the most common type of male reproductive cancer. Several risk factors that contribute to its development have been established, with racial background being cited as one of the most influential. This literature review aimed to assess the discrepancies in prevalence of prostate cancer among African-American men, as compared to Caucasian men in the United States. Other potential risk factors contributing to prostate cancer development were controlled for, to see if this difference was attributable to racial background alone. The review assessed peer-reviewed articles published after the year 2000, and all were subject to a very specific set of inclusion/exclusion criteria, including controls for SES, age, treatment/assessment techniques, and consistency in defining African-American and Caucasian populations. Insufficient literature exists on the exact prevalence of the two racial groups, therefore incidence rates and survival rates were analyzed to extrapolate a theoretical prevalence. The results yielded a consistently higher incidence rate for the African-American population in each of the studies reviewed, as well as a consistently indifferent survival rate between the two populations. From these results, it was concluded that African-American men are being afflicted by prostate cancer at a higher rate, yet both African-Americans and Caucasians are dying or surviving the disease at the same rate. This would leave a net effect of more African-Americans having prostate cancer. Since the exact prevalence values could not be identified, it is uncertain if this discrepancy exists currently; however, should these trends persist, the African-American prevalence will surpass that of the Caucasians.


Examining the Effects of Physical Activity as a Post-Cancer Intervention Treatment

J. Tennant

BACKGROUND: There are currently over 600,000 cancer survivors in Canada, and this number is expected to grow steadily with continual advances in treatment, early detection, and screening. Cancer treatments often produce debilitating side effects, negatively affecting physical functioning and quality of life. In the past, cancer patients were strongly advised to rest and to avoid physical activity. However, emerging research on exercise and physical activity during, and post-cancer treatment, has challenged this long-held belief. The objective of this research paper is to examine the effects of physical activity as a post-cancer intervention treatment. I hypothesize that all cancer survivors would benefit from physical activity.

METHODS: Literature for this review was obtained through a PubMed database search from 2006-2011, using the following MeSH terms: “effects”, “physical activity”, “cancer”, “treatment” and “Canada”.

RESULTS & CONCLUSION: Not surprisingly, research strongly indicates that exercise is both safe and beneficial during cancer treatment. Its effects included improved physical functioning on many different levels as well as improved aspects of quality of life, such as fatigue, anxiety and depression. However, due to the distinguishing symptoms and unique challenges of different cancers and their treatments, it is imperative that exercise regimens be carefully modified to individual patients, to ensure safety and efficacy. With the growing prevalence of cancer survivors in Canada, future initiatives encouraging physical activity as a post-cancer intervention treatment are essential. Further randomized clinical trials are justified and necessary.


Evaluating the relationship between reproductive outcomes and ovarian cancer: a systematic review

V. Beinuma, S. Ingimundson, Z. Wong

Background & Rationale: Ovarian cancer has one of the highest mortality rates of all reproductive cancers. Nonspecific symptoms and a lack of knowledge about etiology make effective screening and early diagnosis difficult. Current theories of ovarian cancer causes include excessive ovulation, hormone exposure, and exposure to carcinogens. Some pregnancy outcomes suppress ovulation and may reduce the risk of cancer. A recent database search revealed no recent literature reviews on the effects of pregnancy outcomes on ovarian cancer risk exists.

Research Question: How does the current literature surrounding ovarian cancer and pregnancy outcomes support theories of etiology of ovarian cancer?

Methods: Databases MEDLINE, Scopus, and PubMed were systematically searched for peerreviewed journals published since 2000 using relevant MeSH terms. Articles were reviewed for validity, effect size, and potential bias using a data abstraction tool.

Results: Searches produced a total of 2581 articles. 289 articles were deemed relevant after reviewing titles and abstracts; 79 remained after deletion of duplicates. After review of full papers, 40 remained for data abstraction. Resulting ORs and RRs were compared for breastfeeding, pregnancy, abortion, number and sex of children. No strong trends were found. The heterogeneity of studies included meant that no pooled statistic could be calculated.

Conclusion: Outcomes that suppressed ovulation showed a protective effect though this was not consistent across studies. Neither abortion nor sex of child showed any trend across studies. More research is needed into the specific role ovulation plays in the etiology of ovarian cancer.


Making an informed decision on taking the pill: A systematic review of evidence regarding the association between oral contraceptive use and female reproductive cancers

K. A. Sabarre, A. Young

Objective: To assess the association between the duration of oral contraceptive (OC) use and reproductive cancers.

Background: OCs are a common and effective method of contraception. OCs acts as an ovulation suppresser by inhibiting hormone synthesis and excretion. In Canada, 66.6% of sexually active females ages 15-19 and 58.3% of sexually active females ages 20-29 used oral contraceptives. Dated studies have shown an association between OC use and cancer. Here, a review of recent literature (2006-2011) was conducted to assess the relationship between duration of OC use and reproductive cancers.

Research Question: For females using oral contraceptives, what does evidence suggest regarding the association between the duration of oral contraceptive use and reproductive cancers?

Methods: Literature review of English peer-reviewed cohort and case-control studies regarding OC use, cervical, ovarian, uterine and breast cancer. Studies were assessed by reproductive cancers, duration of OC use, relative risk (RR), odds ratio (OR) and statistical significance of results.

Results: Cervical cancer: RR=1.11-6.10(95%CI); Ovarian cancer: RR=0.30-1.12(95%CI), OR=0.30-0.74(95%CI); Uterine cancer: RR=0.10-0.60(95%CI), OR=0.50-0.94(95%CI); Breast cancer: RR=0.90-1.22(95%CI), OR=1.30-2.40(95%CI).

Conclusion: Statistically significant associations included: increased risk of cervical cancer and decreased risk of ovarian cancer (OC use > 96 months); a reduced risk of uterine cancer (OC use > 48 months); increased risk of breast cancer (OC use > 12 months).

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