Conference Program 2015 CSEB Conference June 1-4, 2015

“Paradigms to Pragmatism: Epidemiology and Biostatistics for the Changing World” Conference Program 2015 CSEB Conference June 1-4, 2015

Hilton Meadowvale Hotel 6750 Mississauga Rd, Mississauga, ON CSEB wishes to thank the conference sponsors for their generous support!

2 Table of Contents

WELCOME FEATURED SUPPLEMENTS Sponsor Acknowledgments 2 Concurrent Sessions At-A-Glance 14 Acknowledgements 3 Concurrent Sessions Guide 22 Floorplan 4 Session A 23 Session B 28 Session C 33 PROGRAM Session D 38 Conference At-A-Glance 5 Session E 43 Conference Agenda 6 Session F 48 Keynote Speakers 11 Session G 53 Poster Presentations At-A-Glance 58 GENERAL INFORMATION Poster Presentations Guide 65 Publicity 102 Day 1 66 Day 2 84

Acknowledgements

EXECUTIVE PLANNING COMMITTEE LOCAL ORGANIZING COMMITTEE

Susan Jaglal (Conference co-chair) Laura Rosella (Chair) Paul Arora (Conference co-chair) Jason Pole Eduardo Franco (Scientific chair) Edwin Khoo James Gomes Tiffany Fitzpatrick Laura Rosella Brendan Smith Sue Bondy Man Wah Yeung Thy Dinh Michael Lebenbaum James Valcour Amalia Plotogea Mark Oremus Kathryn McIsaac Parth Patel Elisa Candido Laura Bogaert Christopher Tait Wendy Lou Felicia Leung Andrew Lam Anja Bilandzic Sue Bondy Lauren Della Mora Aleksandra Zuk Ananya Banerjee Felicia Leung Debeka Navaranjan Deepit Bhatia Audrey Wong Linda Dodds Susan Bondy Audrey Wong

ABSTRACT REVIEWERS

Kelly Anderson Carmen Chan Jian Liu Paul Arora Christy Costanian Wendy Lou Bonnie Au Thy Dinh Rachel MacKenzie Janak Bajgai Eduardo Franco Colleen Maxwell John Baser Sandra Gawad Gad John Moraros Deepit Bhatia James Gomes Brandy Pratt Anja Bilandzic Steven Hanna Laura Rosella Melissa Billard Anne Holbrook Afshin Vafaei Laura Bogaert Susan Jaglal James Valcour Terry Boyle Philip Jones Audrey Wong Hilary Brown Conrad Kabali Jason (Jian-Yi) Xu Dianne Bryant Derrick Lee Farzana Yasmin Sarah Buchan Yvonne Lee Aleksandra Zuk Kelly Butt Felicia Leung

3 Arabica

Boardroom

4 Conference At-A-Glance

Monday, June 1, 2015 (Pre-Conference Day) 9:00am – 12:00pm BEST PRACTICES IN GRANT PREPARATION South Studio 3 9:00am – 12:00pm TOWARD A COMPETENCIES FOR EPIDEMIOLOGISTS IN CANADA FRAMEWORK Brittania 11:00am – 6:30pm PRE-REGISTRATION FOR CONFERENCE Foyer, Graydon Ballroom 1:00pm – 4:00pm CONTINUING EDUCATION TO ENHANCE THE PRACTICE OF PROFESSIONAL AND APPLIED EPIDEMIOLOGY: A NEEDS ASSESSMENT WORKSHOP (Invitation only) 1:00pm – 4:00pm BEST PRACTICES IN PUBLISHING EPIDEMIOLOGIC RESEARCH Brittania 1:00pm – 4:00pm LONGITUDINAL ANALYSIS USING MIXED MODELS + PROC GLIMMIX *Student-only Event - Sponsored by SAS Canada South Studio 3

Tuesday, June 2, 2015 (Conference Day 1) 7:30am – 8:30am NETWORKING BREAKFAST & POSTER VIEWING (View Poster Presentations Guide on pages 59 & 66) Graydon Ballroom 7:30am – 8:30am STUDENT CAREERS WORKSHOP (& BREAKFAST) Greenwich Room 8:30am – 8:35am OPENING REMARKS Graydon Ballroom 8:35am – 8:45am WELCOME REMARKS Graydon Ballroom 8:45am – 9:45am KEYNOTE PRESENTATION – A HISTORY OF EPIDEMIOLOGY Graydon Ballroom 9:45am – 11:00am CONCURRENT SESSIONS A (View Concurrent Sessions Guide on pages 15 & 23) 11:00am – 12:00pm SUB-PLENARY SESSIONS SP1 HORIZONS IN BIOSTATISTICS – Could Imperfect Adjudication of Causes of Death Have Affected The Results of a Trial of Prostate South Studio 3 Screening? A Statistical Investigation SP2 VIOLENCE PREVENTION – Violence Reduction, Paradigms and Pragmatism Greenwich Room SP3 PUBLIC HEALTH RESPONSE TO EBOLA – Epidemics old and new: how Ebola was entirely (un)predictable Brittania Room 12:00pm – 1:00pm NETWORKING LUNCH & POSTER VIEWING (View Poster Presentations Guide on pages 59 & 66) Graydon Ballroom 12:00pm – 1:00pm LUNCH WORKSHOP – Epidemiology and Public Policy: The role of the International Joint Policy Committee of the Societies of Greenwich Room Epidemiology (IJPC-SE) 1:00pm – 2:15pm CONCURRENT SESSIONS B (View Concurrent Sessions Guide on pages 16 & 28) 2:15pm – 2:30pm TRANSITION 2:30pm – 3:45pm CONCURRENT SESSIONS C (View Concurrent Sessions Guide on pages 17 & 33) 3:45pm – 4:00pm TRANSITION 4:00pm – 5:00pm KEYNOTE PRESENTATION – THE PROSTATE, LUNG, COLORECTAL AND OVARIAN CANCER SCREENING TRIAL: PAST INSIGHTS AND Graydon Ballroom FUTURE OPPORTUNITIES 5:00pm – 5:15pm CLOSING REMARKS Graydon Ballroom 5:15pm – 6:45pm WELCOME RECEPTION Graydon Ballroom Wednesday, June 3, 2015 (Conference Day 2) 7:15am – 8:30am CSEB ANNUAL GENERAL MEETING (Breakfast Available) Greenwich Room 7:15am – 8:30am NETWORKING BREAKFAST & POSTER VIEWING (View Poster Presentations Guide on pages 62 & 84) Graydon Ballroom 8:30am – 8:45am WELCOME REMARKS Graydon Ballroom 8:30am – 9:30am KEYNOTE PRESENTATION – BASIC SCIENCE OF TRANSLATIONAL RESEARCH: METHODS AND TOOLS Graydon Ballroom 9:30am – 11:00am CONCURRENT SESSIONS D (View Concurrent Sessions Guide on pages 18 & 38) 11:00am – 12:00pm SUB-PLENARY SESSIONS SP4 CANADIAN PARTNERSHIP FOR TOMORROW PROJECT South Studio 3 SP5 THE QUANTIFICATION OF CANCER BURDEN IN CANADA Greenwich Room SP6 GLOBAL & INDIGENOUS HEALTH – Global Health Technologies: What Drives Impact? Brittania Room 12:00pm – 1:00pm NETWORKING LUNCH & POSTER VIEWING (View Poster Presentations Guide on page 62 & 84) Graydon Ballroom 12:00pm – 1:00pm MENTORSHIP LUNCH & LEARN FOR STUDENTS Greenwich Room 1:00pm – 2:15pm CONCURRENT SESSIONS E (View Concurrent Sessions Guide on pages 19 & 43) 2:15pm – 2:30pm TRANSITION 2:30pm – 3:45pm CONCURRENT SESSIONS F (View Concurrent Sessions Guide on pages 20 & 48) 3:45pm – 4:00pm TRANSITION 4:00pm – 5:00pm PRESENTATION OF AWARDS Graydon Ballroom 5:00pm – 5:15pm CLOSING REMARKS Graydon Ballroom Thursday, June 4, 2015 (Conference Day 3) 7:30am – 8:30am NETWORKING BREAKFAST Graydon Ballroom 8:30am – 9:45am CONCURRENT SESSIONS G (View Concurrent Sessions Guide on pages 21 & 53) 9:45am – 10:15am COFFEE BREAK Foyer, Graydon Ballroom 10:15am – 11:30am KEYNOTE PRESENTATION – EPIDEMIOLOGY TODAY: MITIGATING THREATS TO AN ECOSYSTEM Graydon Ballroom 11:30am – 12:00pm CLOSING REMARKS & CONFERENCE ADJOURNMENT Graydon Ballroom 12:00pm – 3:00pm CSEB BOARD OF DIRECTORS MEETING Greenwich Room

5 Detailed Program Agenda

Monday, June 1, 2015 (Pre-Conference Day)

9:00am – 12:00pm BEST PRACTICES IN GRANT PREPARATION South Studio 3 Presented by Eduardo Franco, McGill University

9:00am – 12:00pm TOWARD A COMPETENCIES FOR EPIDEMIOLOGISTS IN CANADA FRAMEWORK Brittania Presented by Susan Bondy, University of Toronto; Thy Dinh, President, Canadian Society of Epidemiology and Biostatistics

11:00am – 6:30pm PRE-REGISTRATION FOR CONFERENCE Foyer, Graydon Ballroom

1:00pm – 4:00pm CONTINUING EDUCATION TO ENHANCE THE PRACTICE OF PROFESSIONAL AND APPLIED EPIDEMIOLOGY: A NEEDS ASSESSMENT WORKSHOP (Invitation only)

1:00pm – 4:00pm BEST PRACTICES IN PUBLISHING EPIDEMIOLOGIC RESEARCH Brittania Presented by Eduardo Franco, Editor-in-Chief, Preventive Medicine

1:00pm – 4:00pm LONGITUDINAL ANALYSIS USING MIXED MODELS + PROC GLIMMIX Presented by Lorne Rothman, SAS Canada South Studio 3 *Student-only Event - Sponsored by SAS Canada

Tuesday, June 2, 2015 (Conference Day 1)

7:30am – 8:30am NETWORKING BREAKFAST & POSTER VIEWING (View Poster Presentations Guide on pages 59 & 66) Graydon Ballroom

7:30am – 8:30am STUDENT CAREERS WORKSHOP (& BREAKFAST) Greenwich Room

8:30am – 8:35am OPENING REMARKS Graydon Ballroom Presented by Paul Arora & Susan Jaglal, Conference Chairs, 2015 CSEB Conference

8:35am – 8:45am WELCOME REMARKS Graydon Ballroom Presented by Howard Hu, Dalla Lana School of Public Health

8:45am – 9:45am KEYNOTE PRESENTATION – A HISTORY OF EPIDEMIOLOGY Presented by Alfredo Morabia, Professor of Epidemiology, Queens College, City University of New York and Columbia University Mailman School of Public Health

A widespread belief is that the intimately linked epidemiologic research and public health action of the period between 1945 Graydon Ballroom and 1965, harnessed to address health issues of great population significance, such as the causal relation to tobacco to lung cancer, has given way to action-smothering papers more concerned with the mathematical foundations of epidemiological methods and concepts, and with their applications to identify causes than with the consequences of epidemiologic results for the health of the public in general and for the health of the disadvantaged in particular. Is this belief accurate?

9:45am – 11:00am CONCURRENT SESSIONS A (View Concurrent Sessions Guides on pages 15 & 23)

A1 CANCER I South Studio 3

A2 INFECTIOUS DISEASES I Greenwich Room

A3 INJURY PREVENTION I Brittania Room

A4 SOCIAL DETERMINANTS I Club Studio 3

A5 METHODS I Graydon D

11:00am – 12:00pm SUB-PLENARY SESSIONS

SP1 HORIZONS IN BIOSTATISTICS Could Imperfect Adjudication of Causes of Death Have Affected The Results of a Trial of Prostate Screening? A Statistical Investigation Presented by Stephen Walter, McMaster University A European randomised trial of PSA screening has shown a substantial reduction in prostate cancer mortality. Accurate adjudication of the underlying cause of death is crucial for a conclusive evaluation of the effectiveness of screening, but there is no gold standard, and a major challenge is the potential misattribution of the cause of death in elderly men with multiple comorbidities. In order to determine if misclassification of causes of death might have biased the results, we analysed the variation between the trial adjudicators in six participating countries. Latent class models were formulated to estimate the accuracy of adjudication, and to assess if accuracy might have been differentially favourable to one or other of the randomised study arms. Finally we used the model to evaluate if correcting for variability in adjudication might substantially South Studio 3 modify the main trial results on the effect of screening on the rate of prostate cancer death.

Targeted inference: Aligning Statistical Tools with Epidemiologic Goals Presented by Robert Platt, McGill University This session will address the goals of inference in epidemiology, and propose “targeted inference” as a general paradigm for efficient inference. In general, traditional statistical methods and epidemiologic designs, as typically used, do not focus on parameters of interest. Participants will hear about newer methods for epidemiologic inference designed to focus on key, well-defined parameters of interest, and to be efficient and robust to mis-specification of non-essential components of the statistical model. Robert Platt will illustrate the use of these methods through examples in pharmacoepidemiology.

6 SP2 VIOLENCE PREVENTION Violence Reduction, Paradigms and Pragmatism Presented by Peter Donnelly, MD, President and CEO Public Health Ontario Greenwich Room To describe the importance of violence reduction as a Public Health issue. To discuss concepts in violence reduction and share challenges in undertaking pragmatic research in this area.

SP3 PUBLIC HEALTH RESPONSE TO EBOLA All Epidemics are the Same, All Epidemics are Different: Lessons Learned from Ebola Presented by David N. Fisman, Professor of Epidemiology, Dalla Lana School of Public Health, Dalla Lana School of Public Health The 2014-14 West African Ebola outbreak has sickened tens of thousands of individuals in Liberia, Sierra Leone and Guinea. Efforts to model and forecast epidemic growth were hampered by limited data, as well as the inability of forecast models to anticipate changes in population attitudes, behaviors and knowledge. At the same time, we know that in general terms, epidemics, and human responses to epidemics, have important commonalities. I will describe our efforts to model and forecast the Ebola epidemic, and show that our current approach was anticipated by epidemiologists dealing with similar challenges in the 19th century. Brittania Room

The Owl of Minerva: Are lessons ever truly learned? Presented by Ross Upshur, Professor, Department of Family and Community Medicine and Dalla Lana School of Public Health, Canada Research Chair in Primary Care Research During this session, participants will hear a review of the West Africa Ebola Virus Disease outbreak through the lens of experience gained in the past two decades of involvement in infectious disease outbreaks of global significance. Ross Upshur will raise questions as to how organizations interact both positively and negatively. The expected outcome would be for epidemiologists to be sensitized to the difficulties of institutional memory with the hope that they will not suffer the same lapses in their careers.

12:00pm – 1:00pm NETWORKING LUNCH & POSTER VIEWING (View Poster Presentations Guide on pages 59 & 66) Graydon Ballroom

12:00pm – 1:00pm LUNCH WORKSHOP Epidemiology and Public Policy: The role of the International Joint Policy Committee of the Societies of Epidemiology (IJPC-SE) Presented by Mark Oremus, Communications Officer, IJPC-SE and Vice President, CSEB; and Colin Soskolne, Professor emeritus, University of Alberta; Adjunct Professor, Faculty of Health, University of Canberra; Chair, International Joint Policy Committee of the Societies of Epidemiology

The IJPC-SE is a consortium currently including 18 epidemiology societies whose mandate is to facilitate and coordinate Greenwich Room joint policy actions among its member societies. The IJPC-SE is internationally known for having most recently developed a position statement that puts forth, from an epidemiological perspective, clear evidence confirming that all forms of asbestos should be banned. This statement was developed in response to the fact that some countries continue to promote the “safe use” of asbestos. The purpose of the symposium is to highlight the role of the IJPC-SE in public policy and its modus operandi. More broadly, the symposium will examine different perspectives on the degree to which epidemiologists could engage in the policy process. The pros and cons of such engagement and its challenges will be discussed. Progress on the IJPC-SE’s current initiative focusing on conflict-of-interest and disclosure will be highlighted.

1:00pm – 2:15pm CONCURRENT SESSIONS B (View Concurrent Sessions Guides on pages 16 & 28)

B1 CANCER II South Studio 3

B2 INFECTIOUS DISEASES II Greenwich Room

B3 INJURY PREVENTION II Brittania Room

B4 REPRODUCTIVE HEALTH I Club Studio 3

B5 CHRONIC DISEASES I Graydon D

2:15pm – 2:30pm TRANSITION

2:30pm – 3:45pm CONCURRENT SESSIONS C (View Concurrent Sessions Guides on pages 17 & 33)

C1 CANCER III South Studio 3

C2 INFECTIOUS DISEASES III Greenwich Room

C3 SOCIAL DETERMINANTS II Brittania Room

C4 METHODS II Club Studio 3

C5 SURVEILLANCE I Graydon D

3:45pm – 4:00pm TRANSITION

4:00pm – 5:00pm KEYNOTE PRESENTATION – THE PROSTATE, LUNG, COLORECTAL AND OVARIAN CANCER SCREENING TRIAL: PAST INSIGHTS AND FUTURE OPPORTUNITIES Presented by Mark Purdue, Principal Investigator, Ontario Institute for Cancer Research The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is a landmark U.S. study that evaluated the Graydon Ballroom potential benefits of screening regimens for multiple cancers. Dr. Purdue will provide an overview of the trial’s history and key findings, as well as a description of the rich collection of PLCO data and biospecimens accessible to the research community.

5:00pm – 5:15pm CLOSING REMARKS Graydon Ballroom Presented by Laura Rosella, Chair, Local Organizing Committee, 2015 CSEB Conference

5:15pm – 6:45pm WELCOME RECEPTION Graydon Ballroom Special presentation by Samantha Nutt, War Child Canada

7 Wednesday, June 3, 2015 (Conference Day 2)

7:15am – 8:30am CSEB ANNUAL GENERAL MEETING (Breakfast Available) Greenwich Room

7:15am – 8:30am NETWORKING BREAKFAST & POSTER VIEWING (View Poster Presentations Guide on pages 62 & 84) Graydon Ballroom

8:30am – 8:45am WELCOME REMARKS Graydon Ballroom Presented by Paul Arora & Susan Jaglal, Conference Chairs, 2015 CSEB Conference

8:30am – 9:30am KEYNOTE PRESENTATION –BASIC SCIENCE OF TRANSLATIONAL RESEARCH: METHODS AND TOOLS Presented by Sholom Wacholder, National Cancer Institute, National Institutes of Health, USA Graydon Ballroom Research in translational epidemiology and public health requires a somewhat different perspective from etiologic research. I will highlight some basic ideas that distinguish public health and clinical questions from etiologic questions. I will provide some design suggestions and discuss newly available analytic tools to facilitate progress on key translational questions.

9:30am – 11:00am CONCURRENT SESSIONS D (View Concurrent Sessions Guides on pages 18 & 38)

D1 CANCER IV South Studio 3

D2 INFECTIOUS DISEASES IV Greenwich Room

D3 HEALTH SERVICES I Brittania Room

D4 CHRONIC DISEASES II Club Studio 3

D5 REPRODUCTIVE HEALTH II Graydon D

11:00am – 12:00pm SUB-PLENARY SESSIONS

SP4 CANADIAN PARTNERSHIP FOR TOMORROW PROJECT The Canadian Partnership for Tomorrow Project (CPTP) is a collaboration across five Canadian population-based cohorts to develop a national platform supporting population health research. With questionnaire data from over 300,000 participants, and biospecimens from 130,000, CPTP is poised to support high-impact research in the coming years. This symposium will provide an overview of CPTP and its collection of data and biospecimens, and describe how researchers can apply for access to the first data release (now available). South Studio 3 Presented by: Mark Purdue, Principal Investigator, Ontario Institute for Cancer Research John Spinelli, Distinguished Scientist, BC Cancer Agency Trevor Dummer, Associate Professor, University of British Columbia Catherine Boileau, Research Associate, Centre de Recherche du CHU Sainte-Justine

SP5 THE QUANTIFICATION OF CANCER BURDEN IN CANADA The objective of the sub-plenary is to provide a summary of the current and future projects working to quantify the burden of cancer related to lifestyle and environment in Canada. The short presentations during the sub-plenary will be focused on: methodological issues related to this work; updates of current and future burden estimation projects; as well as priorities for knowledge translation related to this work.

Chaired by Christine Friedenreich, Alberta Health Services

Statistical Methods for calculating the population attributable risk Presented by Stephen Walter, Professor Emeritus, McMaster University

The cancer burden in Canada related to occupational exposures Presented by Paul Demers, Cancer Care Ontario Greenwich Room

Statistical Methods for calculating the population attributable risk Presented by Darren Brenner, Alberta Health

Methodological complications related to estimating the cancer burden associated with environmental exposures Presented by Will King, Queens University

The burden of cancer attributable to lifestyle and environment in Alberta, Canada Presented by Darren Brenner, Alberta Health Services

Translating knowledge of cancer burden quantification – Perspectives from the Canadian Cancer Society Presented by Leah Smith, Canadian Cancer Society

SP6 GLOBAL & INDIGENOUS HEALTH Global Health Technologies: What Drives Impact? Presented by Madhukar Pai, Canada Research Chair in Translational Epidemiology & Global Health, McGill University, Montreal Using a novel tuberculosis diagnostic as an example, we will explore the key drivers impact, including access to technologies, context, product vs. process innovation, and critical importance of implementation strategies. Brittania Room How can Life Course Epidemiology help to narrow the health gap in Aboriginal health? Presented by Jeffrey Reading, Professor and Interim Director, Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto The session will focus on Life Course Epidemiology as a framework to organizing and evaluating interventions that aim to narrow the gap in health and well-being for First Nations, Metis and Inuit Peoples of Canada and Indigenous Peoples abroad. The talk will include a discussion about social and economic conditions and their influence on the determinants of health.

8 12:00pm – 1:00pm NETWORKING LUNCH & POSTER VIEWING (View Poster Presentations Guide on pages 62 & 84) Graydon Ballroom

12:00pm – 1:00pm MENTORSHIP LUNCH & LEARN FOR STUDENTS Greenwich Room

1:00pm – 2:15pm CONCURRENT SESSIONS E (View Concurrent Sessions Guides on pages 19 & 43)

E1 CANCER V South Studio 3

E2 ENVIRONMENTAL HEALTH I Greenwich Room

E3 HEALTH SERVICES II Brittania Room

E4 MENTAL HEALTH I Club Studio 3

E5 SURVEILLANCE II Graydon D

2:15pm – 2:30pm TRANSITION

2:30pm – 3:45pm CONCURRENT SESSIONS F (View Concurrent Sessions Guides on pages 20 & 48)

F1 CANCER VI South Studio 3

F2 PHYSICAL ACTIVITY I Greenwich Room

F3 MENTAL HEALTH II Brittania Room

F4 METHODS III Club Studio 3

F5 HEALTH SERVICES III Graydon D

3:45pm – 4:00pm TRANSITION

4:00pm – 5:00pm PRESENTATION OF AWARDS CSEB Distinguished Service Award CSEB Early Career Award Graydon Ballroom CSEB Lifetime Achievement Award Geoffrey R. Howe Award

5:00pm – 5:15pm CLOSING REMARKS Graydon Ballroom Presented by Eduardo Franco, Scientific Chair, 2015 CSEB Conference

Thursday, June 4, 2015 (Conference Day 3)

7:30am – 8:30am NETWORKING BREAKFAST Graydon Ballroom

8:30am – 9:45am CONCURRENT SESSIONS G (View Concurrent Sessions Guides on pages 21 & 53)

G1 PHYSICAL ACTIVITY II South Studio 3

G2 CHRONIC DISEASES III Greenwich Room

G3 ENVIRONMENTAL HEALTH II Brittania Room

G4 HEALTH SERVICES IV Club Studio 3

9:45am – 10:15am COFFEE BREAK Foyer, Graydon Ballroom

10:15am – 11:30am KEYNOTE PRESENTATION – EPIDEMIOLOGY TODAY: MITIGATING THREATS TO AN ECOSYSTEM Presenter by Nancy Kreiger, Professor and Head, Division of Epidemiology, Dalla Lana School of Public Health, Graydon Ballroom University of Toronto

11:30am – 12:00pm CLOSING REMARKS & CONFERENCE ADJOURNMENT Graydon Ballroom Presented by Thy Dinh, President, Canadian Society of Epidemiology and Biostatistics

12:00pm – 1:30pm CSEB BOARD OF DIRECTORS MEETING Greenwich Room

9 FIT Breaks Prolong periods of inactivity and absence of whole body movement is distinctly related to risk of chronic disease independent of physical activity. Emerging epidemiological evidence, public health guidelines now recommend that people of all ages should avoid prolonged periods of sedentary behaviour and break up periods of sitting. Taking breaks as short as standing or moving for 2-3 minutes can be beneficial to improve overall health.

The CSEB-SCEB 2015 Conference will include fit breaks and attendees will have opportunities to engage in various types of aerobic, strength training and stretching exercises. These brief and sweat-free static and dynamic activities will re-charge the body and enhance concentration and information retention throughout the conference.

The FIT Breaks will be led and organized by Ananya Tina Banerjee, whose research focuses primarily in understanding determinants of physical activity and sedentary behaviour.

10 Keynote Speakers

11 DAVID FISMAN is Professor of Epidemiology in the Division of Epidemiology, Dalla Lana School of Public Health, Toronto, Ontario. He also practices clinical medicine in the Division of Infectious Diseases at the University Health Network in Toronto. He received his MD from the University of Western Ontario in 1994 and received an MPH from the Harvard School of Public Health (Clinical Effectiveness) in 2000, and has held prior faculty positions at McMaster, Drexel, and Princeton Universities. Dr. Fisman’s research interests include the epidemiology of emerging infections and sexually transmitted infections, and the use of modeling and simulation to inform optimal public health policy decision making related to communicable disease control.

NANCY KREIGER received her B.A. in psychology from the University of Pennsylvania, her M.P.H. and Ph.D. degrees in epidemiology from Yale University, and her commercial pilot’s license and instrument rating from Transport Canada. She was the first President of the Canadian Society for Epidemiology and Biostatistics from 1991 to 1993, and President of the American College of Epidemiology in 2007-2008. Her research interests include the epidemiology of osteoporosis and cancers, as well as research ethics and methods. She was a founding investigator and currently Co-Principal Investigator of the Canadian Multicentre Osteoporosis Study (CaMos), a population-based cohort study of 10,000+ individuals across Canada, which is now in its 20th year of follow-up. In 2004, she gathered and led a small group of experts in population health research, and together they developed and pilot-tested what would later become the Ontario Health Study (OHS). She has maintained her involvement with the OHS through her work on its Ethics Advisory Committee and in chairing its committee for recruitment and retention. Her teaching includes research methods at all levels of training in epidemiology: undergraduate, master’s, doctoral, and post-doctoral. She also has been involved in teaching research ethics, and in contributing to ethics adjudication for a number of Research Ethics Boards (REB’s): serving as Chair of the University of Toronto Health Sciences REB and, most recently, serving as a member of the newly created REB for Toronto Public Health. In addition to flying airplanes, Dr. Kreiger is a neophyte runner and bagpiper.

ALFREDO MORABIA is an M. D., board certified in internal and occupational medicine, with a PhD in Epidemiology and a Master of Science in Biostatistics from The Johns Hopkins University. Currently, professor of epidemiology at the Barry Commoner Center, Queens College, City University of New York, and at the Mailman School of Public Health, Columbia University, he is the author of “Enigmas of Health and Disease: How Epidemiology Helps Unravel Scientific Mysteries,” (Columbia University Press, 2014) and is preparing a textbook on the history of epidemiology supported by a grant from the National Library of Medicine. He is the principal investigator of a CDC-supported, long-term cohort study of cardiovascular diseases among 2001 World Trade Center responders, and has been building up the foundations of research on the health effects of using public transportation.

SAMANTHA NUTT is an award-winning humanitarian, bestselling author and acclaimed public speaker. A medical doctor and a founder of the renowned international humanitarian organization War Child, Dr. Nutt has worked with children and their families at the frontline of many of the world’s major crises – from Iraq to Afghanistan, Somalia to the Democratic Republic of Congo, and Sierra Leone to Darfur, Sudan. A leading authority on current affairs, war, international aid and foreign policy, Dr Nutt is one of the most intrepid and recognized voices in the humanitarian arena and is amongst the most sought-after public speakers in North America. With a career that has spanned more than two decades and dozens of conflict zones, her international work has benefited hundreds of thousands of war-affected children globally.

MADHUKAR PAI did his medical training and community medicine residency in Vellore, India. He completed his PhD in epidemiology at UC Berkeley, and a postdoctoral fellowship at the UCSF. He is currently a professor of epidemiology at McGill University in Montreal. He serves as the Director of Global Health Programs, and as an Associate Director of the McGill International TB Centre. In addition, he serves as a Consultant for the Bill & Melinda Gates Foundation. He also serves on the Scientific Advisory Committee of the Foundation for Innovative New Diagnostics, Geneva. Madhu has previously served as co-chair of the Stop TB Partnership’s Working Group on New Diagnostics. He is on the editorial boards of Lancet Infectious Diseases, PLoS Medicine, International Journal of TB and Lung Disease, among others. Madhu’s research is mainly focused on improving the diagnosis and treatment of tuberculosis, especially in high-burden countries like India and South Africa. His research is supported by grant funding from the Gates Foundation, Grand Challenges Canada, and Canadian Institutes of Health Research. He has more than 200 peer-reviewed publications. He is recipient of the Union Scientific Prize, Chanchlani Global Health Research Award, and Stars in Global Health award from Grand Challenges Canada. In 2014, he was selected as a member of the Royal Society of Canada’s College of New Scholars, Artists and Scientists.

ROBERT PLATT received his PhD in Biostatistics in 1996, and since then has been on faculty at McGill University. He is currently Professor in the departments of Epidemiology, Biostatistics, and Occupational Health and of Pediatrics. His primary research interest is in statistical methods for epidemiology, with applications in pharmacoepidemiology and drug safety and in perinatal epidemiology. His methodologic interests are in causal inference and prediction tools. He has made important contributions to the study and use of marginal structural models in pharmacoepidemiology, and to statistical methods for meta-analysis and network meta-analysis. He is a Chercheur-national of the Fonds de Recherche du Quebec – Sante, and is principal investigator on a CIHR-funded study of the use of propensity scores and marginal structural models in drug safety research and a Discovery Grant from NSERC, and co-investigator/subcontractor on multiple CIHR and NIH grants. Dr. Platt is leader of the methods team on the Canadian Network for Observational Drug Effect Studies. Dr. Platt has published over 220 articles, one book, and several book chapters on methods and substantive issues in epidemiology

12 MARK PURDUE, Ph.D., was the Executive Scientific Director for the Ontario Health Study (OHS), one of five regional population- based cohort studies participating in the national Canadian Partnership for Tomorrow Project. Prior to his arrival in Toronto, Dr. Purdue served as part of the leadership of the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial biorepository at the National Cancer Institute. In his personal research he has led many studies investigating occupational and genetic causes of kidney cancer, lymphoma, and other malignancies. He is a two-time recipient of the National Institutes of Health Merit Award in recognition of his accomplishments in molecular epidemiology.

JEFFREY L. READING, MSC PHD FCAHS is on leave from the University of Victoria School of Public Health and Social Policy, appointed as Professor and Interim Director of Waakebiness-Bryce Institute for Indigenous Health at the Dalla Lana School of Public Health, University of Toronto. Jeff obtained his PhD in Public Health Sciences, University of Toronto (1994) and was the inaugural Scientific Director of the Institute of Aboriginal Peoples’ Health at the Canadian Institutes of Health Research (2000-2008) and founding Director of the Centre for Aboriginal Health Research at the University of Victoria (2008-2012). Jeff is part of a movement for an advanced research agenda in Indigenous Peoples’ health. Jeff’s broad interest in Public Health has brought attention to issues such as promoting health through programs timed to stages of the life course, the social determinants of health and well-being, provision of safe potable water, chronic disease prevention and accessibility to health care.

ROSS UPSHUR is the Canada Research Chair in Primary Care Research. He is currently the Scientific Director, Bridgepoint Collaboratory for Research and Innovation and Head of the Division of Clinical Public Health at the University of Toronto Dalla Lana School of Public Health. At the University of Toronto he is a Professor at the Department of Family and Community Medicine and Dalla Lana School of Public Health, Adjunct Scientist at the Institute of Clinical Evaluative Sciences, an affiliate of the Institute of the History and Philosophy of Science and Technology and a member of the Centre for Environment. He is an Adjunct Associate Professor in the School of Geography and Earth Sciences and Associate Member of the Institute of Environment and Health at McMaster University. He is a member of the Institute Advisory Board for the CIHR Institute of Aging and Chair, Ethics Committee, Royal College of Physicians and Surgeons of Canada. He is the former Director of the University of Toronto Joint Centre for Bioethics (2006-2011). He is a member of The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. His research focuses on the intersection of primary care and public health particularly with respect to the interrelationship between ethics and evidence. His current interests include managing complex chronic disease in aging adults, clinical measurement, the concept of evidence in health care, philosophy of medicine including medical epistemology and the integration of ethics and clinical reasoning, public health ethics, global health ethics, empirical approaches in bioethics, primary care research methods, time series applications in health services research, communicable disease and environmental epidemiology. He has over 300 publications including more than 180 peer reviewed publications spanning these domains. He has consulted for numerous governmental and non-governmental organizations. Most recently, he has been the Chair of the WHO Ebola and Ethics Working Group and Special Advisor to the ethics committee of Doctors Without Borders.

SHOLOM WACHOLDER is an applied biostatistician and epidemiologist. After earning a PhD at the University of Washington, he joined the Department of Epidemiology and Biostatistics at McGill University; subsequently, he has worked at what is now called the Division of Cancer Epidemiology and Genetics in the Intramural Research Program of the National Cancer Institute, United States Department of Health and Human Services, in Rockville, Maryland. Most of Dr. Wacholder’s work has been in collaborations on substantive epidemiologic projects and in methods related to those projects. He retains a strong interest in unbiased, efficient study design, highlighted by a series of papers about control selection in case-control studies. In genetics, he spearheaded the development of the kin-cohort method to estimate penetrance and participated in the planning of early genome-wide association studies of cancer. Dr. Wacholder’s long-term interest in human papillomavirus (HPV), the basis of the best biomarkers we have in cancer, has led him to devote increasingly more time to challenging molecular epidemiology studies. Studies of natural history of HPV infection and cervical infection helped inform screening and vaccination studies and programs to prevent cervical cancer. These experiences have led, in part, to Dr. Wacholder’s current focus is on translational methods for public health and clinical epidemiology. He is particularly proud of several mentorees who now have thriving, independent research programs.

STEPHEN D. WALTER received his Ph.D. from the University of Edinburgh. After faculty appointments at the University of Ottawa and Yale, he joined the Department of Clinical Epidemiology and Biostatistics at McMaster University, where he is now a Professor Emeritus. Dr Walter has worked in several areas of epidemiology and clinical medicine, and has done research on related areas of biostatistical methodology. He has published approximately 450 refereed papers in the statistical and biomedical literature. Dr Walter is a past Editor of the American Journal of Epidemiology, and the Wiley Encyclopedia of Biostatistics. He has acted as coordinator of the Health Research Methods program at McMaster, and has worked with about 100 Masters and Ph.D. students. Stephen has received a number of honours, including research awards from the North American Congress of Epidemiology, the World Congress of Epidemiology and the Statistical Society of Canada. He was also a co-author on the “Best Paper of the Year”, selected by The Lancet from the world literature, and a co-recipient of a CIHR-CMAJ Award for Top Achievement in Health Research. Stephen has been elected to the International Statistical Institute, and as a Fellow of the American Statistical Association. He was recently honoured as a Fellow of the Royal Society of Canada.

13 Concurrent Sessions At-A-Glance

14 Concurrent Sessions A Tuesday, June 2, 2015 - 9:45am - 11:00am A1 CANCER I South Studio 3 A1.1 The role of genetic and epigenetic variation in the DNMT3B and MTHFR genes and colorectal adenoma risk Presented by VIKKI HO Postdoctoral Fellow, University of Montreal Hospital Research Center (CRCHUM)

A1.2 Proportion of cancer attributable to occupational silica exposure in Canada Presented by CHAOJIE SONG Junior Research Associate, Occupational Cancer Research Centre, Cancer Care Ontario

A1.3 Childhood leukemia and proximity to nuclear power plants: A systematic review and meta-analysis Presented by WILLIAM MUELLER Recent Graduate, London School of Hygiene and Tropical Medicine

A1.4 Cumulative exposure to radon progeny and cancer incidence and mortality among Ontario uranium miners Presented by GARTHIKA NAVARANJAN Research Associate, Occupational Cancer Research Centre

A1.5 Exposure to Stressful Life Events and Lung Cancer Risk Presented by HARTLEY DUTCZAK MSc. Student, University of Montréal School of Public Health A2 INFECTIOUS DISEASES I Greenwich Room A2.1 Impact of Pharmacist Delivery of Influenza Vaccines on Uptake in Canada Presented by SARAH BUCHAN PhD. Candidate, Dalla Lana School of Public Health, University of Toronto

A2.4 Voluntary HIV testing: Factors associated with repeated HIV testing among a sample of HIV-negative gay and bisexual men living in Toronto, Ontario Presented by TODD COLEMAN Post-doctoral Research Fellow, HIV Prevention Lab, Ryerson University A3 INJURY PREVENTION I Brittania Room A3.1 Prognostic Factors Following Mild Traumatic Brain Injury in Older Adults Presented by VICKI KRISTMAN Associate Professor, Lakehead University

A3.4 The association between depression and traumatic brain injury in older adults: A nested matched case control study Presented by CONNOR MCGUIRE Master of Health Science Candidate, Lakehead University Department of Health Sciences A4 SOCIAL DETERMINANTS I Club Studio 3 A4.1 Inequality by Race/Ethnicity in Survival Improvement of Children with Acute Lymphoblastic Leukemia in the United States and Canada Presented by LINWEI WANG Master Student, School of Public Health, University of Alberta

A4.2 The Construct Validity of Three Self-Reported Neighborhood Measures in Older Adults from Canada, Colombia and Brazil Presented by JUSTINE MCLEOD Graduate Student, Queen’s University

A5.3 Applying the Incidence Decay with Exponential Adjustment Model to Study Chikungunya Epidemic Growth in the Americas Presented by TAHMINA NASSERIE Student, Dalla Lana School of Public Health

A5.4 Estimation of intracluster correlation coefficient for survival data in cluster randomized trials Presented by SUMEET KALIA Student, University of Western Ontario

15 Concurrent Sessions B Tuesday, June 2, 2015 - 1:00pm – 2:15pm B1 CANCER II South Studio 3 B1.1 The Association between Leisure Time Physical Activity and Pancreatic Cancer Risk in Adults: A Systematic Review and Meta-analysis Presented by MEGAN FARRIS Master’s student/Research Assistant, Alberta Health Services

B1.4 Correlated cancers in women: A global analysis using data from 290 cancer registries Presented by MORTEZA BASHASH Research fellow, University of Toronto

B1.5 Cervical cancer screening in First Nations, Métis, and Inuit women in Quebec, Canada: A pooled cross-sectional analysis Presented by ALEXANDRA BLAIR PhD Student, University of Montreal B2 INFECTIOUS DISEASES II Greenwich Room B2.1 HIV/AIDS Knowledge, Attitude, and Practice among Youth in Iran Presented by MOHAMMAD KARAMOUZIAN Student, University of British Columbia

B2.3 Screening as a Potential Driver of Syphilis Outbreaks in Men Who Have Sex with Men Presented by ASHLEIGH TUITE PhD Student, University of Toronto B3 INJURY PREVENTION II Brittania Room B3.1 Strategies to improve the credibility of meta-analyses in spine surgery: A systematic survey Presented by NATHAN EVANIEW Resident Physician, PhD student, McMaster University

B3.2 COMPLICATIONS FOLLOWING ADMISSION FOR TRAUMATIC BRAIN INJURY Presented by MADIBA OMAR Student, Université Laval

B3.4 Neighbourhood environment factors and the occurrence of injuries in Canadian adolescents: a validation study and exploration of structural confounding Presented by AFSHIN VAFAEI Queen’s University B4 REPRODUCTIVE HEALTH I Club Studio 3 B4.1 Lifestyle factors and personal attributes in determining serum vitamin D status in Montréal women Presented by VIKKI HO Postdoctoral Fellow, University of Montreal Hospital Research Center (CRCHUM)

B4.4 Risk factors for caesarean section in nulliparous term singleton vertex pregnancies at a teaching hospital in Toronto, Canada: A clinical database analysis Presented by SHERYL HEWKO Clinical Research Nurse, Mount Sinai Hospital B5 CHRONIC DISEASES I Graydon D B5.1 Characteristics of electronic cigarette users and their perceptions of benefits and harms: results from a survey in Ottawa, Ontario Presented by KARENA VOLESKY Student, Carleton University

B5.3 Management of central post-stroke pain: a systematic review of randomized controlled trials Presented by SOHAIL MULLA PhD Student, McMaster University

B5.4 Reporting of patient-important core outcome domains among chronic pain clinical trials Presented by SOHAIL MULLA PhD Student, McMaster University

B5.5 Sleep Duration and Development of Hypertension: A Systematic Review and Meta-analysis Presented by DOUGLAS DORWARD Graduate Student, Clinical Epidemiology, Memorial University of Newfoundland

16 Concurrent Sessions C Tuesday, June 2, 2015 - 2:30pm - 3:45pm C1 CANCER III South Studio 3 C1.1 Type 2 diabetes mellitus and prostate cancer risk: a population-based case-control study in Montreal, Canada Presented by AUDREY BLANC-LAPIERRE Post-doctorante, INRS-Institut Armand Frappier

C1.3 Occupational Cancer Surveillance using the 1991 Census Cohort Presented by PAUL A. DEMERS Director, Occupational Cancer Research Centre, Cancer Care Ontario

C1.4 Association between lifetime alcohol consumption and prostate cancer risk: a case-control study in Montreal, Canada Presented by CLAIRE DEMOURY PhD, INRS - Institut Armand-Frappier C2 INFECTIOUS DISEASES III Greenwich Room

C2.1 Back to the drawing board: The epidemiological landscape of invasive pneumococcal disease among older adults in Ontario, Canada over the last decade Presented by MICHELLE POLICARPIO Epidemiologist, Public Health Ontario

C2.5 Prevention of Clostridium difficile infection: a systematic review and critical appraisal of clinical practice guidelines Presented by LYUBOV LYTVYN Student, McMaster University C3 SOCIAL DETERMINANTS II Brittania Room C3.1 The effectiveness of population and high-risk individual intervention strategies to reduce population and social inequalities in type 2 diabetes in Canada: a modelling study Presented by BRENDAN SMITH Scientist, Public Health Ontario

C3.2 Relationships between community social capital and injury in Canadian adolescents: a multilevel analysis Presented by AFSHIN VAFAEI Queen’s University

C3.3 The Unequal City: Toronto Public Health’s 2015 report on income and health inequities in Toronto Presented by TREVOR VAN INGEN Epidemiologist, Toronto Public Health

C3.4 Administrative data and Life Course Epidemiology Presented by ELIZABETH WALL-WIELER MSc (Candidate), University of Manitoba

C3.5 Predictors of Employment and Income Assistance Usage in Early Adulthood across Type and Income Quintile Presented by ELIZABETH WALL-WIELER MSc (Candidate), University of Manitoba C4 METHODS II Club Studio 3 C4.1 Patient Privacy, Big data, and PoLoR: Using an Old Tool for New Challenges Presented by PARAMITA SAHA-CHAUDHURI Assistant Professor, McGill University

C4.2 Good practice in the conduct of retrospective data harmonization Presented by MATILDA SALIBA Project manager, Research Institute McGill University Health Center

C4.4 Bayesian Adjustment for Confounding in Bayesian Propensity Score Estimation Presented by PABLO GONZALEZ GINESTET Graduate Student, McGill University

C4.5 Methodological challenges in cluster-randomized trials of vulnerable populations with a small number of clusters Presented by BRIANNE WOOD PhD Student, University of Ottawa C5 SURVEILLANCE I Graydon D C5.1 HPV vaccine uptake rates among females aged 9-45 years, Alberta, 2007-2013 by public vs. privately funded vaccine: preliminary findings Presented by LARRY SVENSON Director, Epidemiology and Surveillance, Alberta Health

C5.2 Spatial and Temporal Analysis of Chlamydia Trachomatis in Newfoundland and Labrador Presented by ADRIAN GEE Graduate Student, Memorial University of Newfoundland

C5.3 Getting strategic about infectious disease surveillance: Developing Public Health Ontario’s first Infectious Disease Surveillance Framework Presented by LIANE MACDONALD Public Health Physician, Public Health Ontario

C5.4 On the generalizability of a statistical natural language processing model for pneumonia surveillance in acute care hospitals Presented by CHRISTIAN ROCHEFORT PhD, McGill University

17 Concurrent Sessions D Wednesday, June 3, 2015 - 9:45am - 11:00am D1 CANCER IV South Studio 3 D1.1 Cancer in Ontario Metis people: Risk Factors and Screening Behaviours Presented by LORAINE D MARRETT Sr Scientist, Aboriginal Cancer Control Unit, Cancer Care Ontario

D1.2 Is there an association between trends in alcohol consumption and cancer mortality? Findings from a multi-country analysis Presented by NAOMI SCHWARTZ Research Associate, Cancer Care Ontario

D1.3 Artificial tanning among Ontario adolescents: Pre-legislative patterns, prevalence and beliefs Presented by VICTORIA NADALIN Senior Research Associate, Cancer Care Ontario D2 INFECTIOUS DISEASES IV Greenwich Room D2.1 Probiotics for the prevention of Clostridium difficile-infection in adults and children: an individual patient data meta-analysis Presented by LYUBOV LYTVYN Student, McMaster University

D2.2 Influenza vaccine effectiveness in older adults with cardiovascular disease Presented by DEEPIT BHATIA Student, Institute for Clinical Evaluative Sciences

D2.3 Underreporting of Hepatitis A in Non-Endemic Countries: A Systematic Literature Review and Meta-Analysis Presented by RACHEL SAVAGE Doctoral Student, University of Toronto

D2.4 Controlling Tuberculosis Transmission in Canada’s North: A Mathematical Modeling Study Presented by ASHLEIGH TUITE PhD Student, University of Toronto

D2.5 Near Real-Time Monitoring and Forecasting of the West African Ebola Virus Disease Outbreak Using Publicly Available Data Presented by ASHLEIGH TUITE PhD Student, University of Toronto D3 HEALTH SERVICES I Brittania Room D3.1 The Burden of Biopsy-Proven Pediatric Celiac Disease in Ontario, Canada: Validation of Administrative Data Codes and Determination of Health Services Utilization Presented by JASON CHAN MSc. Candidate, University of Ottawa School of Epidemiology, Public Health and Community Medicine

D3.2 Palivizumab for use in infants with cystic fibrosis: A decision analysis model Presented by ASHLEIGH MCGIRR PhD Candidate, Dalla Lana School of Public Health, University of Toronto

D3.3 Cost-Utility Analysis of Gene Xpert MTB/RIF® for Diagnosing Pulmonary Tuberculosis (TB) Presented by SHOGHAG KHOUDIGIAN Full time graduate student, McMaster University

D3.4 Characteristics of Canadian mothers who report difficulty accessing health care for their infant: findings from the Maternity Experiences Survey Presented by ALISA FITISOVA MSc. Student, York University D4 CHRONIC DISEASES II Club Studio 3 D4.1 POPULATION-BASED EPIDEMIOLOGY OF AMYOTROPHIC LATERAL SCLEROSIS (ALS) IN AN AGEING EUROPE – THE FRENCH REGISTER OF ALS IN LIMOUSIN (FRALIM REGISTER) Presented by BELLO HAMIDOU PhD Student, UMR 1094 INSERM NEUROÉPIDÉMIOLOGIE TROPICALE (NET)

D4.2 The Incidence of Parkinson’s Disease: A Systematic Review and Meta-Analysis Presented by LAUREN HIRSCH MSc Candidate, Epidemiology, University of Calgary

D4.3 Exploring the potential effect of immunomodulators on digital ulcer formation for scleroderma patients: a retrospective cohort study Presented by BRIAN YOUNHO HONG Student, University of Ottawa

D4.4 Safety and Efficacy of Incretin-based Therapies in Patients with Type 2 Diabetes Mellitus and Renal Impairment: Systematic Review and Meta-analysis Presented by PATRICIA HOWSE MSc (Medicine) Candidate, Memorial University of Newfoundland D5 REPRODUCTIVE HEALTH II Graydon D D5.1 Smoking habits and gestational weight gain patterns: a novel approach using piecewise mixed-effects models Presented by ADAM HULMAN Postdoctoral Fellow, McMaster University, Departments of Obstetrics & Gynecology

D5.2 Risk factors for preterm birth: refugee status and secondary migration Presented by SUSITHA WANIGARATNE Post Doctoral Fellow, St. Michael’s Hospital

18 Concurrent Sessions E Wednesday, June 3, 2015 - 1:00pm - 2:15pm E1 CANCER V South Studio 3 E1.1 An evaluation of glyphosate use and the risks of non-Hodgkin lymphoma major histological sub-types in the North American Pooled Project (NAPP) Presented by MANISHA PAHWA Research Associate, Occupational Cancer Research Centre, Cancer Care Ontario

E1.2 Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49 year olds, 1969-2010 Presented by PARTH PATEL Epidemiology Student, University of Toronto

E1.3 Profiling Cancer within select Ontario Aboriginal Reserves Presented by MAEGAN PRUMMEL Senior Research Associate, Cancer Care Ontario

E2.2 Prenatal maternal blood mercury is associated with childhood BMI Presented by MORTEZA BASHASH Research fellow, University of Toronto

E2.4 Shift workers and day workers: Comparing cortisol production among female hospital employees Presented by ELEANOR HUNG BScH; Master’s Candidate, Queen’s University E3 HEALTH SERVICES II Brittania Room E3.1 Will baby boomers overload the health care system? An age-period-cohort analysis of physician visits in Canada Presented by MAYILEE CANIZARES MSc., University of Toronto

E3.4 Guideline Variability Index (GVI): Measuring Variability in Recommendations among Different Clinical Practice Guidelines Presented by JEMILA HAMID Scientist, St, Micheal’s Hospital E4 MENTAL HEALTH I Club Studio 3 E4.1 The First-Contact Incidence of Schizophrenia Among Immigrants and Refugees in Ontario Presented by KELLY ANDERSON Assistant Professor, The University of Western Ontario

E4.2 Neighborhood’s social capital and depressive symptoms among immigrants: results of two studies in Toronto Presented by NASIM HAQUE Lecturer, Ben-Gurion University of the Negev

E4.3 Policy Framework of Diversion Opportunities for Individuals with Mental Illness within the Criminal Justice System Presented by CARA ELLIOTT Student, University of Ottawa

E4.4 The Influence of Computer Mediated Communication Use on the Well-Being of Canadian Adolescents Presented by LINDSAY FAVOTTO Student, Queen’s University

E4.5 Dementia associated mortality risk among older adults in Sub-Saharan Africa:Results of a two-year follow-up in the EPIDEMCA study Presented by SAMBA HARIELLE PHD, student, Inserm U1094, Tropical Neuroepidemiology E5 SURVEILLANCE II Graydon D E5.1 Temporal trends of feline retroviral infections diagnosed at the Ontario Veterinary College (1999-2012) Presented by OLAF BERKE Associate Professor of Statistical Epidemiology, Population Medicine, U of Guelph

E5.3 Accuracy of using natural language processing techniques for detecting adverse events from electronic health record data Presented by CHRISTIAN ROCHEFORT PhD, McGill University

E5.4 Interprovincial Variation in Ideal Cardiovascular Health Status in Canada Presented by RUSSANTHY VELUMMAILUM MPH Student, University of Toronto

19 Concurrent Sessions F Wednesday, June 3, 2015 - 2:30pm - 3:45pm F1 CANCER VI South Studio 3 F1.1 Utilization of pre-operative imaging for muscle-invasive bladder cancer: a population-based study Presented by MATTHEW MCINNES Radiologist, University of Ottawa/ Ottawa Hospital Research Institute

F1.2 Dietary patterns and the risk of breast cancer in the Canadian National Enhanced Cancer Surveillance System Presented by KEITH VAN RYSWYK Scientific Project Coordinator, Carleton University

F1.3 Occupation and the risk of prostate cancer in Northeastern Ontario Presented by JEAVANA SRITHARAN PhD Student, Occupational Cancer Research Centre, Cancer Care Ontario and the University of Toronto F2 PHYSICAL ACTIVITY I Greenwich Room F2.1 Trajectories of Objectively Measured Sedentary Time among Secondary Students in Canada in the Context of a Province-Wide Physical Education Policy: A Longitudinal Analysis Presented by FEI ZUO Epidemiologist, Public Health Ontario

F2.2 Increases in physical activity due to active transportation: Implications for diabetes prevention Presented by LAUREN DELLA MORA MPH Student, Dalla Lana School of Public Health

F2.4 A methodology to leverage cross-sectional accelerometry to capture weather’s influence on active living Presented by TARUN KATAPALLY Postdoctoral fellow, University of Saskatchewan F3 MENTAL HEALTH II Brittania Room F3.1 Impact of Child Maltreatment, Marital and Socioeconomic Status on Suicidal Behaviours in Older Canadian Adults Presented by JINFU HU Research Scientist, Public Health Agency of Canada

F3.2 IS ARTERIAL STIFFNESS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN INCIDENT HEMODIALYSIS PATIENTS? Presented by ESTHER KIM Graduate Student, University of Toronto

F3.3 Enhancing the Effectiveness of School-Based Substance Use Educational Programs: Does School-Connectedness Play a Role? Presented by ROAH MERDAD Dalhousie University

F4.3 Methods for dealing with missing data in the multivariate growth curve model Presented by TIAN FENG Ph.D. student, McMaster University

F4.4 Are we approaching our maximum life expectancy? Presented by AUDREY WONG Master of Public Health Epidemiology Student, University of Toronto

F5.2 Using large data to inform health service provision for patients with brain injury Presented by WAYNE KHUU MPH Student, Dalla Lana School of Public Health

F5.3 Characterizing High-Intensity Use of the Emergency Department in a Tertiary-Care Centre Presented by ERIN LIU Methodologist, Ottawa Hospital Research Institute

F5.4 Out-of-Province Specialized Care for Eating Disorders: Understanding patterns of application and approval out-of-province services Presented by ERIN MACDONALD Epidemiologist, Institute for Clinical Evaluative Sciences

20 Concurrent Sessions G Thursday, June 4, 2015 - 8:30am - 9:45am G1 PHYSICAL ACTIVITY II South Studio 3 G1.1 The Effect of Body Mass Index on Recovery from Medically Attended Ankle Sprains among Adults Presented by IWONA BIELSKA PhD Candidate, Queen’s University

G1.2 Capturing mobility using wearable technology versus self-report assessments: implications for research and clinical use Presented by LYNN ZHU PhD Candidate, Western University

G1.3 Triggering fatal arrhythmia: Is exercise a double-edged sword? Presented by HARPREET CHAHAL Master’s student, University of Western Ontario

G1.4 A meta-analysis of prospective studies on the role of physical activity and the prevention of Alzheimer’s disease in older adults Presented by MICHAEL BECKETT York University G2 CHRONIC DISEASES III Greenwich Room G2.1 DURATION OF REMISSION AND OUTCOME IN MEMBRANOUS NEPHROPATHY: A LANDMARK ANALYSIS Presented by ESTHER KIM Graduate Student, University of Toronto

G2.2 Prevalence of chronic disease and chronic disease risk factors in Canadian truck drivers Presented by PHIL BIGELOW Associate Professor, Universtiy of Waterloo

G2.3 How much will new cases of diabetes cost the Canadian health care system in the next ten years? Presented by ANJA BILANDZIC Practicum research trainee, University of Toronto - Dalla Lana School of Public Health

G2.4 A population-based risk algorithm for the development of diabetes: validation of the Diabetes Population Risk Tool (DPoRT) in the United States Presented by CHRISTOPHER TAIT PhD Student, Dalla Lana School of Public Health, University of Toronto G3 ENVIRONMENTAL HEALTH II Brittania Room G3.1 Self-Report of Sun Exposure Behaviours in Pediatric Research: A Systematic Review of Measurement Properties Presented by SANDRA MAGALHAES PhD Cadidate, McGill University

G3.2 Evidence to Action: Use of predictive models for beach water quality postings Presented by CAITLYN PAGET Epidemiologist, Regional Municipality of York

G3.3 Pesticide use and the risk of multiple myeloma among men in The North American Pooled Project (NAPP) Presented by ROSEANNA PRESUTTI Research Associate, Cancer Care Ontario

G3.4 Association between Dietary Factors and Urinary Concentrations of Organophosphate and Pyrethroid Metabolites in a Canadian General Population Presented by MING YE PhD Candidate, University of Alberta G4 HEALTH SERVICES IV Club Studio 3 G4.1 Identifying risk factors for adverse events in major elective spine, knee, and hip in-patient orthopaedic surgery Presented by DOV MILLSTONE Student, University of Toronto

G4.2 Canada and New Zealand: A cross-national comparison of the barriers and enablers related to health care policy agendas Presented by MACKENZIE MOIR Student, Independent

G4.3 A scope review on economic evaluations of vaccines in Canada Presented by ELLEN RAFFERTY University of Saskatchewan

21 Concurrent Sessions Guide

22 Concurrent Sessions A Tuesday, June 2, 2015 - 9:45am - 11:00am A1 CANCER I South Studio 3 A1.1 The role of genetic and epigenetic variation in the DNMT3B and MTHFR genes and colorectal adenoma risk Presented by VIKKI HO Postdoctoral Fellow, University of Montreal Hospital Research Center (CRCHUM) It is increasingly recognized that gene function is influenced by both genetic and epigenetic variability. This study investigated the main and joint effects of polymorphisms and gene-specific DNA methylation in DNMT3B and MTHFR, genes critical to one-carbon metabolism, on the prevalence of colorectal adenomas. Among 272 screening colonoscopy patients, leukocytic DNA was used for genotyping (DNMT3B c.-6-1045G>T, MTHFR c.665C>T, MTHFR c.1286A>C) and quantifying DNA methylation. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for colorectal adenoma risk associated with main and joint effects, adjusting for sex and age. Analysis included methylation ratios for 66 and 28 CpG sites of DNMT3B and MTHFR, respectively. Methylation was conceptualized using averages and unsupervised principal component (PC) analysis. Only participants with data for ≥90% of the CpG sites were included yielding 259 and 260 participants for DNMT3B and MTHFR analysis. In main effect analyses, DNMT3B c.-6-1045 TT versus GG/GT genotypes was associated with increased colorectal adenoma risk (OR=2.12; 95% CI: 1.03-4.34). No association was observed between average DNMT3B or MTHFR methylation, and colorectal adenoma risk. Using PC analysis, two PCs were derived accounting for 42% and 32% of the variance in DNMT3B and MTHFR methylation, respectively. Increasing DNMT3B methylation in PC2 was associated with a higher risk of colorectal adenomas (OR=1.34; 95% CI: 1.01-1.79 per standard deviation). In joint effect analyses, a synergistic effect was observed for colorectal adenoma risk among the DNMT3B c.-6-1045 TT genotype and higher DNMT3B methylation category versus the GT/GG genotypes and lower methylation category (Average: OR=4.19, 95% CI: 1.45-12.13; PC1: OR=4.26, 95%CI: 1.31-13.87). This research provides evidence for strong joint effects of genetic and epigenetic variations in DNMT3B on affecting the risk of developing colorectal adenomas, precursors to the majority of colorectal cancers. Results of this novel research support consideration of both genetic and epigenetic effects in carcinogenesis. Co-Author(s): Janet Ashbury, Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada/ Sherryl Taylor, Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada / Stephen Vanner, Department of Medicine, Division of Gastroenterology, Hotel Dieu Hospital/Queen’s University, Kingston, Ontario, Canada / Will King, Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada

A1.2 Proportion of cancer attributable to occupational silica exposure in Canada Presented by CHAOJIE SONG Junior Research Associate, Occupational Cancer Research Centre, Cancer Care Ontario We are undertaking a large study to estimate the current burden of occupational cancers in Canada using several methodological improvements over previous studies. Silica is one of the most common occupational lung carcinogens in Canada and here we estimate the attributable fraction (AF) of lung cancers due to this exposure. To calculate AF we required estimates of the proportion of workers ever exposed (PrE) during the risk exposure period (REP, 1961-2000), and relative risk (RR) representative of exposure-disease association. Industry- and occupation-specific CAREX Canada estimates of prevalence and level of exposure and time trends estimated from Canadian exposure data were used to assess historical silica exposure. PrE was estimated from Canadian employment data, accounting for both labour force characteristics and survival probabilities. Estimates of cumulative exposure, derived from exposure levels, time trends, and employment duration, were used to calculate RRs from a continuous exposure-response relationship reported in the literature. Of the 780,000 workers ever exposed to silica during the REP, nearly half (46%) were in the high exposure group. An annual 4.1% increase in silica levels starting in 1999 and going backwards was estimated from an analysis of the Canadian workplace exposure data. Based on the modelled cumulative exposure during the REP and the dose-response relationship, the estimated mean RRs were 1.32, 1.22, and 1.07 for the high, medium, and low exposure groups respectively. Estimated AFs for silica-related lung cancers were: 2.63% for males, 0.1% for females, and 1.44% overall, which equates to 324 lung cancer cases in men and 11 in women. Over half of the cases (62%) were from the construction industry. Though silica exposure levels have decreased over time, it is still one of the most prevalent workplace lung carcinogens in Canada, resulting in a number of preventable cancers. The results of the broader burden project will aid in determining the priorities for occupational cancer prevention. Co-Author(s): Joanne Kim, Occupational Cancer Research Centre / Alex Hill, Occupational Cancer Research Centre / Cheryl Peters, CAREX Canada / Calvin Ge, CAREX Canada / Chris McLeod, School of Population and Public Health, University of British Columbia / Victoria Arrandale, Occupational Cancer Research Centre / Hugh Davies, School of Population and Public Health, University of British Columbia/ France Labrèche, Institut de recherche Robert-Sauvé en santé et en sécurité du travail du Québec (IRSST)/ Jérôme Lavoué, Dept of Environmental and Occupational Health, University of Montreal/ Manisha Pahwa, Occupational Cancer Research Centre/ Paul Demers, Occupational Cancer Research Centre

A1.3 Childhood leukemia and proximity to nuclear power plants: A systematic review and meta-analysis Presented by WILLIAM MUELLER Recent Graduate, London School of Hygiene and Tropical Medicine The objectives of this study are as follows: 1. Perform a systematic review to identify all analytical studies investigating incidence of childhood leukemia and proximity to nuclear power plants; 2. Comment on strengths, limitations, and biases of studies; and 3. Develop meta-risk estimates separately for each type of analytical study. We performed a systematic review by searching the MEDLINE database for published studies of childhood leukemia incidence and proximity to nuclear power plants. The primary analysis included children <15 years of age and defined exposure as living within 25 km of a nuclear power plant, and the secondary analysis focused exposure on children <5 years of age living within 5 km of such facilities. Meta-estimates for Standardized Incidence Ratios and Odds Ratios were calculated using both fixed-effects and random-effects methods. Thirteen studies were eligible for inclusion in the meta-analysis. Studies selected represented nine countries with a total of 63 nuclear power plants, plus three nuclear reprocessing facilities. Case-control study results within 25 km of facilities produced a weakly increased pooled-Odds Ratio of 1.11 (95% confidence interval (CI) = 0.99-1.26) with a meta-Standardized Incidence Ratio for cohort studies of 1.00 (95% CI = 0.95-1.06). A meta-analysis of a subset of case-control studies examining the risk in children <5 years of age within 5 km of a nuclear power plant produced a pooled-Odds Ratio of 1.45 (95% CI = 0.74-2.86), and an analysis of the same parameters using results from cohort studies generated a significantly elevated pooled Standardized Incidence Ratio of 1.33 (95% CI = 1.05- 1.68). It is reassuring that meta-estimates do not provide evidence of an increase in leukemia incidence in children <15 years of age living within 25 km of a nuclear power plant; however, there was weak evidence of elevated risks in children <5 years of age living <5 km from such a facility. To refine risk estimates and better understand methodological nuances, continuing to undertake large-scale studies of populations surrounding nuclear facilities is encouraged. Co-Author(s): Clare Gilham, London School of Hygiene and Tropical Medicine

A1.4 Cumulative exposure to radon progeny and cancer incidence and mortality among Ontario uranium miners Presented by GARTHIKA NAVARANJAN Research Associate, Occupational Cancer Research Centre Underground uranium mining and milling was conducted in Northern Ontario from 1954 to 1996. The Ontario uranium miner’s cohort was created to study health effects in these workers. This study provides updated estimates of cancer incidence and mortality for miners exposed to radon daughters. The cohort of mine and mill workers was created using data from Canada’s National Dose Registry, and the Ontario Mining Master File (work history information collected during annual chest x-rays). The cohort consists of men who worked for at least one week in the mines and is an updated analysis of the cohort with extended mortality follow-up (1954-2007 from 1955-1986), and for the first time includes cancer incidence (1969-2005). Poisson regression was used to estimate relative risks and their 95% confidence intervals with levels of cumulative radon exposure. We also investigated how risk varies across several established modifying factors. An increased risk of lung cancer mortality and incidence was observed with cumulative radon exposures, measured in Working Levels Months (WLM). For cumulative radon exposure levels >20-30 WLM, relative risk for mortality was 1.41 (95% CI: 1.03-1.94) and 1.18 (95% CI: 0.88-1.59) for incidence using a five year lag period. This risk increased further, whereby miners exposed to >100 WLM demonstrated a two-fold increase in the risk of lung cancer mortality (RR=2.32, 95% CI: 1.72-3.14) and incidence (RR= 1.89, 95% CI: 1.43-2.50) compared to the non-exposed group. This association was shown to be modified by factors including exposure rate, time since first exposure and time since last exposure. No excesses were observed with cancers other than lung with increasing cumulative exposure to radon. Compared to other cohorts of uranium miners, Ontario uranium miners had some of the lowest doses of exposure to radon. These low exposures are similar to the level of exposure experienced in modern mines (e.g., less than 0.2 WLM for modern Saskatchewan uranium miners). Co-Author(s): Garthika Navaranjan, Occupational Cancer Research Centre/ Colin Berriault, Occupational Cancer Research Centre/ Minh Do, Occupational Cancer Research Centre/ Paul Villeneuve, Occupational Cancer Research Centre; Department of Health Sciences, Carleton University/ Paul Demers, Occupational Cancer Research Centre; Cancer Care Ontario; School of Population and Public Health, University of British Columbia; CAREX Canada; Dalla Lana School of Public Health, University of Toronto

23 A1.5 Exposure to Stressful Life Events and Lung Cancer Risk Presented by HARTLEY DUTCZAK MSc. Student, University of Montréal School of Public Health While smoking is the leading cause of lung cancer, only ~15% of smokers develop the disease, and some cases have never smoked. Thus, other factors are clearly involved. Acute psychosocial stress is hypothesized to promote cancer. In experimental studies, environmental stressors increased lung tumor incidence and metastasis. Epidemiologic evidence is inconclusive, largely due to insufficient control for smoking. Our objective is to examine exposure to stressful life events (SLEs) in relation to lung cancer risk. Co-Author(s): Anita Koushik, École de santé publique de l’Université de Montréal, Quebec, Canada. Université de Montréal Hospital Research Centre, Montréal, Quebec, Canada./ Jack Siemiatycki, École de santé publique de l’Université de Montréal, Quebec, Canada. Université de Montréal Hospital Research Centre, Montréal, Quebec, Canada A2 INFECTIOUS DISEASES I Greenwich Room A2.1 Impact of Pharmacist Delivery of Influenza Vaccines on Uptake in Canada Presented by SARAH BUCHAN PhD. Candidate, Dalla Lana School of Public Health, University of Toronto Coverage levels of influenza immunization in Canada continue to be sub-optimal and accessibility may play a role. Legislation permitting the administration of influenza vaccines by pharmacists has been adopted by several provinces. This study aims to determine the impact of allowing pharmacists to provide influenza vaccines on uptake in Canada. Preliminary analysis was done using data from the 2007-2012 cross-sectional Canadian Community Health Surveys (CCHS) public use microdata file (PUMF). Analysis has now begun with the complete master file, including CCHS 2013. With pooled cycles, the total sample is estimated to be approximately 400,000 respondents. Modified Poisson regression with normalized weights will be used to estimate the prevalence ratio (PR) for presence of a pharmacist immunization policy associated with individual-level vaccine uptake, controlling for health behaviours and sociodemographic information associated with immunization. The model will be assessed for interaction of the pharmacist policy with age on vaccine uptake. Within the previous year, approximately 29% of respondents reported receiving their seasonal influenza immunization. Influenza immunization was strongly associated with being female, having a chronic condition, having a regular doctor, being a visible minority and smoking. The preliminary adjusted PR of vaccine uptake was higher for those living in provinces with pharmacist authorization to provide immunizations, as compared to those living in provinces without this policy. However, sensitivity analyses suggest that some of this association may be a result of underlying trends in different provinces across seasons. The PUMF did not include the 2013 cycle, which reflects Ontario’s first year of pharmacist legislation, and the results may change with this additional cycle. Further analyses will continue with the full data set at a Statistic’s Canada Research Data Center, to include additional covariates and the 2013 cycle. Co-Author(s): Sarah Buchan, Dalla Lana School of Public Health, University of Toronto/ Laura Rosella, Dalla Lana School of Public Health, University of Toronto; PHO; ICES/ Michael Finkelstein, Toronto Public Health/ David Juurlink, Institute for Clinical Evaluative Sciences/ Susan Quach, Public Health Ontario/ Margaret Russell, Cumming School of Medicine, University of Calgary/ Nancy Waite, School of Pharmacy, University of Waterloo/ Jeff Kwong, Dalla Lana School of Public Health, University of Toronto; PHO; ICES

A2.2 The Effect of Comprehensive School-Based Sexual Health Education Interventions on Adolescent STI/HIV Sexual Risk Behaviour: A Systematic Review Presented by AMBER CRAGG Research Associate, Dalhousie University Determine whether comprehensive school-based sex education interventions are more effective at preventing STI/HIV sexual risk behaviour (SRB) in adolescents (age 13-19) when compared to no sexual health intervention, abstinence-only education, or interventions designed to improve only STI knowledge and if these effects vary with follow-up time. Using a replicable strategy, one reviewer performed a comprehensive search of all literature in PubMed, CINAHL, EMBASE and PsycInfo published after March 2008 and combined these records with those from a rigorous but more inclusive search from before March 2008 published in a previous review. Using explicit criteria, two reviewers independently culled the search, assessed bias and extracted relevant outcome data. Data for sexual initiation, recent condom use and number of sexual partners were stratified by follow-up time (same school year/ later years) and pooled using the generic inverse variance input for random effects meta-analysis in RevMan5.3. Using data from 28 included studies, preliminary results indicate that when followed-up time is during the same school year as intervention there is no significant overall effect on sexual initiation (OR=0.96, 95% CI: 0.82-1.13) or number of sexual partners (OR=0.92, 95% CI:0.79-1.07) but there is a significant increase in odds of recent condom use (OR=1.32, 95 CI:1.17-1.50). Interventions with follow-up times in later grades did not show a significant overall effect on recent condom use (OR=0.98, 95% CI: 0.83-1.16) but did demonstrate a significantly decreased odds of sexual initiation (OR=0.92, 95% CI: 0.86-0.97) for the intervention group. There were insufficient data to provide a measure of effect on number of sexual partners in later grades.Comprehensive sex education is more effective than knowledge- based, abstinence only or no sex education at reducing SRB among adolescents; however, improved condom use among sexually active students was short lived. Comprehensive sex education should be provided to adolescents every year to preserve its effects on condom use. Co-Author(s): Amber Cragg, Dalhousie University/ Ashley Rowe, Dalhousie University/ Joanna Blodgett, Dalhousie University

A2.3 Factors associated with HIV Testing from an online survey of gay, bisexual, and other men who have sex with men living in Middlesex County, Ontario: The Health in Middlesex Men Matters (HiMMM) Project Presented by TODD COLEMAN Post-doctoral Research Fellow, HIV Prevention Lab, Ryerson University Gay, bisexual, and other men who have sex with men (GB-MSM) remain the group most heavily affected by HIV in Canada. There is a paucity of research available outside of larger metropolitan areas regarding GB-MSM use of HIV testing. The Health in Middlesex Men Matters (HiMMM) Project is a community-based research project examining health and HIV in GB-MSM in Middlesex County, Ontario. Respondents of an online, cross-sectional survey (n=202) were recruited through web- based, smart phone-based, and in-person promotion, and through social networks. Surveys were completed over 2011-2012 by adult GB-MSM living in Middlesex County, Ontario, Canada (n=202). Modified Poisson regression was utilized to calculate crude and adjusted prevalence ratios for whether participants had not been tested within the past 6 months. Additionally, reasons for not having been tested in the past 2 years are presented. Analyses were limited to HIV-negative individuals and those of unknown status (n=173). Almost two thirds (64.1%) had not received an HIV test within the past 6 months. Factors significantly associated with reduced likelihood of being untested – controlling for other predisposing, enable and need factors – included greater social connection to GLBT communities, being less religious or spiritual than in childhood, and having a high school (versus postgraduate) education. Being unemployed was associated with greater likelihood of being untested. Primary reasons for not having accessed testing within the past two years included feeling at low risk for HIV (69.2%), always having safer sex (51.9%), not having had sex with an infected person (28.9%), and being in relationships (15.5%). Knowledge of testing practices for GB-MSM subgroups in Middlesex County is important for directing competent, effective health promotion efforts, allowing local testing services to direct resources towards GB-MSM with lesser reported access testing services, depending on need. Co-Author(s): Todd Coleman, Western University, Ryerson University/ Greta Bauer, Western University/ Lyn Pierre Pitman, London InterCommunity Health Centre/ Daniel Pugh, Gay Men’s Sexual Health Alliance/ Meredith Fraser, Regional HIV/AIDS Connection/ Kevin Murphy, Regional HIV/AIDS Connection/ Leanne Powell, Middlesex-London Health Unit

A2.4 Voluntary HIV testing: Factors associated with repeated HIV testing among a sample of HIV-negative gay and bisexual men living in Toronto, Ontario Presented by TODD COLEMAN Post-doctoral Research Fellow, HIV Prevention Lab, Ryerson University Gay and bisexual men (GBM) remain disproportionately affected by HIV in Ontario. In Ontario, HIV testing is available to everyone at no cost, whether anonymously or through various health service providers. We explored factors associated with voluntary (not mandatory for work or immigration) number of times HIV testing was accessed over the past nine months in a sample of GBM in Toronto, Ontario. Data from 470 HIV-negative GBM from three time points (baseline, 3-month and 6-month follow-up) were used. Personal characteristics, psychosocial (depression, openness, sexual self-esteem and childhood trauma) and sexual risk behaviors (number of sexual partner, condomless anal sex and substance use before /during sex) were modelled as separate blocks, fitting negative binomial models with a sandwich estimator, calculating relative contribution of each factor, as well as blocks of factors. Our final model included significant (p<0.10) factors from three primary models. Most participants (mean age=35;SD=12) were White (59%), born in Canada (60%), and self-identified as gay (86%). Approximately 9% reported never having been tested, 58% once, 24% twice and 10% three times in last 9 months. In the final model, older age, being single, childhood trauma, and higher sexual self-esteem positively predicted increased HIV testing. Engagement in sexual risk was not associated with greater HIV testing in the final model. Our results have practical implications for promotion of HIV testing services with GBM, including considerations for GBM in relationships and potential for couples-based testing. Since engagement in sexual risk was not associated with increased utilization of HIV testing services, renewed focus into what does and does not constitute HIV-related sexual risk behaviour should be considered for GBM. Co-Author(s): Todd Coleman, Ryerson University/ Syed Noor, Ryerson University/ Trevor Hart, Ryerson University

24 A3 INJURY PREVENTION I Brittania Room A3.1 Prognostic Factors Following Mild Traumatic Brain Injury in Older Adults Presented by VICKI KRISTMAN Associate Professor, Lakehead University Although mild traumatic brain injury (MTBI) is a significant health problem for older adults; no prognostic model for MTBI in this population exists. We conducted a pilot study to determine the feasibility of a large-scale prognostic study of MTBI outcome among older adults. At three Ontario general hospitals, patients aged 65 and older visiting the Emergency Department (ED) were screened for MTBI. MTBI recovery was determined using the Rivermead Post-concussion symptom Questionnaire (RPQ), Glasgow Outcomes Scale-Extended (GOSE), physical and mental health functioning (SF-12), and a single question on self-assessed recovery. Outcomes were assessed by telephone shortly after ED visits (baseline) and again six months later. Predictors (psychosocial, biomedical and injury-related factors) were measured at baseline. Risk ratios were reported for unfavorable outcome/poor recovery on the RPQ, GOSE, and self-assessed recovery. Mean differences in exposure groups were compared using one-way ANOVA for SF-12 outcomes. Forty-nine of the 54 people enrolled completed follow-up. Forty-nine participants completed follow-up. Factors associated with poor recovery included reporting worse health one year before the injury (RRself-report = 2.78 (95% CI: 1.19, 6.51); RRRPQ = 5.93 (95% CI: 1.60, 21.98); RRGOSE = 4.44 (95% CI: 1.62, 12.16)), poor expectations for recovery (RRself-report = 2.57 (95% CI: 1.04, 6.34); RRRPQ = 5.50 (95% CI: 1.20, 25.20); RRGOSE = 3.30 (95% CI: 1.09, 10.00)), depression (RRRPQ = 3.8f4 (95% CI: 1.06, 13.98)), and fatigue (RRself-report = 4.87 (95% CI: 1.20, 19.70); RRGOSE = 7.96 (95% CI: 1.09, 58.15)). For MTBI recovery in older adults, psychosocial factors may be more important than biomedical and injury-related factors. Further study is needed to confirm these results and develop a clinical prediction tool for older adults. Co-Author(s): Robert Brison, Queen’s University/ Michel Bedard, Lakehead University/ Paula Reguly, Lakehead University/ Shelley Chisholm, Thunder Bay Regional Health Sciences Centre

A3.2 Using population health theory to assess school injury: Considering risk behaviour and school social climate as distinct and interactive determinants Presented by JONATHAN KWONG MSc Candidate, Queen’s University Mechanisms underlying the protective effects of positive school climates on injury occurrence remain unclear. This study uses population health theory to: 1) Conceptualize domains of risk behaviour and validate its individual-level associations with school injury; and, 2)Identify aspects of positive social environments (school climate) that are potentially protective for school injury. The Health Behaviour in School-aged Children (HBSC) study sampled a nationally representative cross-section of 30,000 Canadians aged 11-15 years in 2013-2014. HBSC evaluates aspects of health arising in home and school settings. To create scales measuring adolescent risk behaviour, exploratory factor analyses were performed on a selected subset of risk behaviours following a framework published by the US Centers of Disease Control (CDC). Scree plots, factor interpretability, RMSEA, and parallel analysis informed model selection. Confirmatory factor analyses validated newly developed risk scales and a published school climate scale. Future steps involve multi-level regression to assess individual, contextual, and cross-level associations. Three risk categories emerged from factor analyses: 1)Substance Use and Externalizing Behaviour (e.g., alcohol consumption, smoking, fighting), 2)Sedentary Behaviour and Junk Food Consumption (e.g., hours watching TV), and 3)Physical Inactivity and Low Fruit/Vegetable Consumption (e.g., hours playing sports). These categories encompass all six risk domains outlined by the CDC, but suggest that several domains may be related. We expect to validate previous studies by observing that risk behaviour will be positively associated with school injury. We also expect that positive social relationships among younger grades (6-8) will have a greater protective effect against injury (assessed via effect modification) than in older grades (9-10). We expect this based on prior research suggesting a negative relationship between student investment in school climate and grade. School injuries are common and lead to profound economic and developmental consequences. This study uses population health theory to evaluate possible contextual interventions that address risk behaviour - a well-known, strong injury predictor. Results will inform researchers and practitioners in health and education fields about specific social solutions to prevent injury. Co-Author(s): Jonathan Kwong, Queen’s University, Department of Public Health Sciences/ Don Klinger, Queen’s University, Faculty of Education/ William Pickett, Queen’s University, Department of Public Health Sciences

A3.3 Characteristics and incidence of traumatic brain injury in older adults of Ontario from 2003-2013 Presented by CONNOR MCGUIRE Master of Health Science Candidate, Lakehead University Department of Health Sciences To assess the characteristics and annual cumulative incidence of traumatic brain injury (TBI) in the older adult homecare population of Ontario from 2003 to 2013. A cross-sectional analysis of longitudinal data from the Ontario Association of Community Care Access Centers database were used. TBI, demographics, depression, neurological conditions and history of falling were measured from the validated Resident Assessment Instrument-Home Care. Included service users were 65 years old or greater and administered home care between 2003 and 2013. Comparisons were made between characteristics of service users who did and did not sustain a TBI using odds ratios and associated confidence intervals. The ten-year trend of annual cumulative incidence and standardized incidence rates were assessed using linear regression. 554,313 service users were included and 5215 (0.9%) had a TBI. Characteristics associated with TBI were: female gender (OR: 1.54, 95% CI: 1.45, 1.62), non-aboriginal origin (OR: 1.98; 95% CI: 1.57, 2.50), increasing age (OR: 1.22, 95% CI: 1.09, 1.35 for 70-74; up to OR: 2.31, 95% CI: 2.05, 2.59 for >90; referent group 65- 69), being widowed (OR: 1.59, 95% CI: 1.41, 1.80), having one or more falls (OR: 2.31, 95% CI: 2.19, 2.44) and the presence of depression (OR: 1.57, 95% CI: 1.43, 1.71), dementia (OR: 1.65, 95% CI: 1.54, 1.76), hemiplegia (OR: 4.34, 95% CI: 3.88, 4.85), multiple sclerosis (OR: 3.19, 95% CI: 2.49, 4.08) and parkinsonism (OR: 1.22, 95% CI: 1.07, 1.38). Incidence was higher then previously reported figures. There was no change in the annual cumulative incidence. Female standardized rates decreased significantly (p<0.05) while male and overall rates did not (p>0.05). Certain demographic characteristics, neurological diseases and a history of falling are associated with TBI. The incidence of TBI in the older adult homecare population of Ontario is higher than previous literature estimates and the incidence is not decreasing over time. A longitudinal analysis examining the characteristics associated with TBI should be conducted to assess causality. Co-Author(s): Vicki Kristman, Lakehead University, Department of Health Sciences/ Lynn Martin, Lakehead University, Department of Health Sciences/ Michel Bedard, Lakehead University, Department of Health Sciences

A3.4 The association between depression and traumatic brain injury in older adults: A nested matched case control study Presented by CONNOR MCGUIRE Master of Health Science Candidate, Lakehead University Department of Health Sciences To determine the association between depression and traumatic brain injury (TBI) in the older adult homecare population of Ontario from 2003 to 2013. A nested matched case control study was conducted to determine the association between depression and TBI. Data from the Ontario Association of Community Care Access Center’s database were retrieved for all service users 65 years or older who had home care between 2003 and 2013; these data are based on the Resident Assessment Instrument-Home Care. The variables use in the analyses included: TBI, depression, demographics, neurological conditions and history of falling. Incident cases of TBI were matched to four controls by gender, age and date of assessment. Crude odds ratios for the association between depression and TBI were determined. Multivariable conditional logistic regression analysis was used to adjust for potential confounders and identify effect modifiers. Estimates of association were stratified by a history of falling. A total of 554,313 service users were included, of which 5215 (0.9%) had sustained a TBI and 39,048 (7.0%) had depression. The crude odds ratio (OR) for the association between depression and TBI was 1.37 (95% CI: 1.23, 1.51). Stratified analyses indicated that the association was not significantly different for those with a history of falling (OR: 1.45, 95% CI: 1.22, 1.73) and those without a history of falling (OR: 1.19, 95% CI: 0.99, 1.42). Multivariable analysis suggested that depression was significantly associated with sustaining a TBI (OR: 1.24, 95% CI: 1.12, 1.38) after adjusting for important confounders. Our results indicate that depression is associated with sustaining a TBI using a cross-sectional design and is the first study to specifically examine this direct relationship . However, a longitudinal study will be required to confirm this finding. Co-Author(s): Vicki Kristman, Lakehead University, Department of Health Sciences/ Lynn Martin, Lakehead University, Department of Health Sciences/ Michel Bedard, Lakehead University, Department of Health Sciences

25 A4 SOCIAL DETERMINANTS I Club Studio 3 A4.1 Inequality by Race/Ethnicity in Survival Improvement of Children with Acute Lymphoblastic Leukemia in the United States and Canada Presented by LINWEI WANG Master Student, School of Public Health, University of Alberta Childhood acute lymphoblastic leukemia (ALL) survival improved dramatically from 5-year survival of 15% in 1960s to over 80% in late 1990s; whether the ongoing improvement has nullified inequalities in ALL survival between children of different race/ethnicity groups and whether there is inequality between US and Canadian children is unknown. Children aged 0-19 years with a first primary malignant ALL diagnosed in 1975-2010 in one of nine original cancer registries in the Surveillance, Epidemiology and End Results program (SEER) were included. Race/ethnicity was classified as non-Hispanic White, non-Hispanic Black, Hispanic, Asian/Pacific Islander (API), and American Indian/Alaska Native (AIAN). Age was categorized as <1, 1-9 and 10-19 years. Kaplan-Meier methods were used to estimate overall 5-year survival. Multivariable Cox regression analyses were applied to estimate hazard ratios (HRs) and their 95% confidence intervals (CI) by prognosis groups and diagnostic periods. Canadian survival statistics were obtained from the Canadian Cancer Registry’s publications. Survival improved in each race/ethnicity over past 3.5 decades with different magnitudes, resulting in change of inequality patterns. Compared to White children, adjusting for age and sex, the ALL-related-mortality hazard ratio (HR) in Black children dropped to 1.21 (95% CI, 0.74-1.96) in 2000-2010 from the largest inequality in 1984-1991 (HR=2.09, 95% CI, 1.57-2.79). In Hispanic children, the HR increased from 1.28 (95% CI, 0.98-1.66) in 1975-1983 to 1.95 (95% CI, 1.48, 2.58) in 2000-2010. API and AIAN children had HRs of 1.39 (95% CI, 0.92-2.11) and 2.31 (95% CI, 1.13-4.74), respectively, in 2000-2010, which did not change as greatly. Canadian children had five-year survival of 84% in 1994-1998 and 91% in 2004-2008, comparing to US-SEER White children of the same period (87% and 93%, respectively). Survival inequalities in children of different race/ethnicity remain appreciable in the US. While survival improvement over a decade between 1990s and 2000s appears similar between US White and Canadian children, the absolute 5-year survival remains slightly lower in Canadian children. Proper interventions need to be developed to reduce the inequalities. Co-Author(s): Linwei Wang, School of Public Health, University of Alberta/ Yutaka Yasui, School of Public Health, University of Alberta

A4.2 The Construct Validity of Three Self-Reported Neighborhood Measures in Older Adults from Canada, Colombia and Brazil Presented by JUSTINE MCLEOD Graduate Student, Queen’s University Neighborhood characteristics such as social cohesion, perception of safety, and physical barriers affect older adult health. Scales are available but have not yet been validated in international contexts. The objective of this work was to validate three neighborhood scales measuring those three aspects, both in Canadian and South American contexts. The data was collected in 2012 among 1601 community dwelling older adults (65-74) living in 99 neighborhoods in 4 cities ((Kingston and St-Hyacinthe (Canada), Manizales (Colombia), and Natal (Brazil)) as part of a prospective cohort study. The three scales were: the social cohesion scale (4 items), the perception of safety scale (10 items), and the community and transportation barrier scale (7 items). Exploratory factor analysis was performed to assess the psychometric properties of each scale in each site, followed by confirmatory factor analysis, always using polychoric correlation matrices. SAS and M-plus was used for our analysis. Both the social cohesion and perception of safety scales load in a single factor, after excluding one item (unsafe to walk) and two items (inadequate lighting and excess noise), respectively. Confirmatory factor analyses found both modified scales had adequate fit, with Tucker –Lewis indexes of 1.0 and 0.98. Cronbach α values were in the range of 0.76 and 0.86 respectively. Exploratory factor analysis of the community and transportation barrier scale found the presence of two factors after excluding one item (uneven sidewalks). Confirmatory analysis confirmed good fit of the scale with two factors in all four sites. Cronbachα values were in the range of 0.41 (Natal) and 0.79 (St-Hyacinthe) for the community factor, and from 0.14 (Manizales) to 0.68 (St-Hyacinthe) for the transportation factor. Our findings support the evidence of construct validity of the social cohesion, perception of safety, and community and transportation barrier scales in older adults both in Canadian and South American contexts. The community and transportation barrier scale needs further exploration before being used in a study. Co-Author(s): Afshin Vafaei, Queen’s University/ Beatriz Alvarado, Queen’s University/ Maria Victoria Zunzunegui, Universite de Montreal/ Carmen Lucia Curcio, Universidad de Caldas/ Fernando Gomez, Universidad de Caldas/ Ricardo Guerra, Universidad Rio Grande du Nord

A4.3 Self-reported household-level income versus neighbourhood-level income for examining income-related inequalities in the prevalence of diabetes, obesity, and smoking Presented by NITA PERUMAL Analyst, Canadian Institute for Health Information (CIHI) Income-related health inequalities can be examined by disaggregating health indicators by different measures of income. We examined the level of agreement between self-reported household- and neighbourhood-level income for categorizing Canadians into income quintiles. Using these two measures of income, we also compared prevalence rates by income quintiles and income-related inequality over time for diabetes, obesity, and smoking. Analyses were based on respondents aged 18+ years from the Canadian Community Health Survey (CCHS) and were stratified by sex. Neighbourhood-level income quintiles were assigned using Statistics Canada’s Postal Code Conversion File Plus, while self-reported adjusted household income quintiles were derived from the CCHS. Agreement between self-reported and neighbourhood-level quintiles was calculated for 2013 using the weighted Kappa statistic. National, age-standardized rates of diabetes, smoking, and obesity were calculated by income quintiles for survey cycles 2003 through 2013. Income-related inequality between the lowest and highest income quintiles was measured using rate ratios (RR, RateLowest/RateHighest) and rate differences (RD, RateLowest-RateHighest). Agreement between household- and neighbourhood-level income quintiles was poor for CCHS respondents with diabetes, smoking, and obesity (weighted Kappas ranged from 0.17 to 0.22). Indicator rates by income quintiles for 2003 and 2013 were largely consistent between the two income measures and showed worse health outcomes among Canadians in lower income levels (except obesity among men). Inequality estimates generated from neighbourhood-level income were generally lower than estimates from self-reported household income, although this difference was mostly not statistically significant. Inequality estimates in diabetes prevalence among men, however, were significantly lower for neighborhood-level income than household income in 2013 (RRNeighbourhood = 1.18, 95% CI: 0.95-1.48 vs. RRHousehold = 1.91, 95% CI: 1.51-2.42; RDNeighbourhood = 1.3%, 95% CI: -0.4-3.0 vs. RDHousehold = 5.3%, 95% CI: 3.3-7.1%). This study demonstrates that the agreement between self-reported household- and neighbourhood-level income quintiles is poor; however, both measures of income yielded similar patterns of inequality. This suggests that these measures of income capture different constructs, but both may be used for monitoring income-related health inequalities. Co-Author(s): Erin Pichora, Canadian Institute for Health Information/ Mohamed Kharbouch, Canadian Institute for Health Information/ Nita Perumal, Canadian Institute for Health Information/ Jing Jin, Canadian Institute for Health Information/ Jane Polsky, Canadian Institute for Health Information

A4.4 Equally inequitable? A cross-national comparative study of racial health inequalities by gender in Canada and the United States Presented by CHANTEL RAMRAJ PhD Epidemiology Student, Dalla Lana School of Public Health, University of Toronto Studies suggest that the influence of race on health varies to different extents in different societies. To help elucidate the influence of social context on health, this paper contrasts racial inequalities in health by gender between Canada and the United States. Data were obtained from the largest nationally representative health surveys in each country (Canadian Community Health Survey for Canada (n=522,201) and National Health Interview Survey for the United States (n=731,133)). Cross-sectional data was pooled across survey years (2000-2012). For each country, logistic regressions were used to calculate the odds of visible minorities compared to whites of having any chronic condition(s), self-rated health, and behavioural risk factors. Final models were adjusted for socioeconomic and behavioural factors and were stratified by gender. Visible minorities faired worse off for the majority of health outcomes in both Canada and the United States. Racial inequalities were present in Canada for asthma/emphysema but not in the US, and for heart disease and arthritis in the US but not in Canada. For men, inequalities were larger in Canada for self-rated health (OR=1.37, 95%CI=1.14, 1.65), whereas in the US, larger inequalities were observed for hypertension (OR=1.63, 95%CI=1.43, 1.86) and diabetes (OR=1.38, 95%CI=1.21, 1.56). For women, racial inequalities were greater in Canada for diabetes (OR=1.57, 95%CI=1.24, 1.99) and asthma/emphysema (OR=1.25, 95%CI=1.01, 1.55). Women in the US had larger inequalities for heart disease (OR=1.22, 95%CI=1.08, 1.38), hypertension (OR=2.15, 95%=1.94, 2.39), arthritis (OR=1.23, 95%CI=1.13, 1.34), obesity (OR= 1.57, 95%CI=1.52, 1.62) and self-rated health (OR=1.36, 95%CI=1.30, 1.42). Racial inequalities in health exist both in Canada and the United States; however, inequalities are greater across more health outcomes in the US. Minority women are the most disadvantaged, especially in the US. Co-Author(s): Susan Wang, Cancer Care Ontario/ Anthony Hong, Department of Economics, York University/ Arjumand Siddiqi, Dalla Lana School of Public Health, University of Toronto

26 A5 METHODS I Graydon D A5.1 Combined approach of stratified false discovery rate and bioinformatics to investigate quantitative phenotype-genotype associations in Alzheimer’s disease Presented by SEJAL PATEL Msc Student, Centre for Addiction and Mental Health Alzheimer’s disease (AD) is a devastating illness, affecting over 35 million people worldwide and steadily rising. Our goal is to identify biomarkers for AD-progression based on structural magnetic resonance imaging (MRI) and genetic data using a systematic bioinformatically-driven approach to shed light on the genetic of AD. T1 weighted MR images and genome wide association study (GWAS) data were obtained from the Alzheimer’s Disease Neuroimaging Initiative database (ADNI). Hippocampus segmentation was carried out on 662 subjects using the MAGeT Brain algorithm [Pipitone et al., 2014]. Hippocampal volumes were used for association testing with imputed GWAS data. A list of genes associated with AD by Lambert et al., 2013 were grouped into common Gene Ontology (GO) domains. Stratified false discovery rate (sFDR) [Sun et al., 2006] was used to prioritize SNPs in genes selected using GO nervous system development network which formed our stratum for sFDR. After quality control (QC) of ADNI1 GWAS data the sample contained in total 662 subjects (162 AD, 317 mild cognitive impairment, 183 cognitively normal) and the number of SNPs after GWAS QC was 529,623. After imputation of the GWAS data the number of SNPs used for association analysis was 5,706,974, and the following covariates were controlled for: gender, age, first principle component from multidimensional scaling, baseline diagnoses, APOE status and intracranial volume. From the GO nervous system development network, a total of 249,001 SNPs from the 1146 genes formed the stratum to be prioritized in sFDR. The remaining 5,457,557 SNPs formed our non-priority stratum. No significant SNPs were found to be associated with hippocampal volume. SNPs in this stratum may not play a specific role in hippocampal volume, for example growth arrest-specific protein 7 is involved in neuronal development and is expressed in mature cerebellar Purkinje cells. Further modifications to prune the nervous system development network by using GO terms associated to only hippocampal regions. Co-Author(s): Sejal Patel, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health/ Min Tae M Park, Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University/ Mallar M Chakravarty, Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University/ Jo Knight, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health/ The Alzheimer’s Disease Neuroimaging Initiative

A5.2 A model for assessing the concordance between genetic and epidemiological similarity of Campylobacter isolates: towards improved application of genomic epidemiology in public health Presented by BENJAMIN HETMAN MSc. Candidate, Public Health Agency of Canada & University of Lethbridge With recent advances in whole genome sequencing (WGS), public health initiatives worldwide are targeting analysis of bacterial pathogens by WGS for use in routine epidemiologic investigations aimed at prevention and control of disease. We aim to develop analytical methods that extract critical information from WGS data to facilitate genomic epidemiology. Campylobacter jejuni represents a leading bacterial foodborne pathogen in Canada, with a reported per capita incidence of 30 per 100,000 and likely to be as high as 1% of the population due to underreporting. Infections with C. jejuni represent a significant burden to our health care system and to the Canadian economy estimated at over $350 million per year. We have sequenced the genomes of approximately 300 environmental, animal, and clinically derived isolates of Canadian C. jejuni, and have developed a framework for assessing the concordance between epidemiological and genetic relationships in the R environment for statistical computing. We propose a simple yet robust model for measuring the epidemiological similarity (ES) of C. jejuni isolates that incorporates variables for source, temporal and spatial similarities, with coefficients to adjust the strength of contribution of each variable. The ES thus represents a quantitative summary statistic based on traditional epidemiologic parameters and allows for direct comparison with genetic similarity metrics, permitting assessment of concordance between traditional and molecular epidemiology data. We show that genetic similarity is best predicted by source and are currently using our model to optimize the interpretation of C. jejuni WGS data in the context of epidemiological investigations. Our model allows for direct comparison between epidemiologic and genomic data, paving the way for improved outbreak detection, source tracking and attribution. We are developing an online toolkit to be used in the development of interpretation criteria for WGS in epidemiologic investigations of C. jejuni and other high-risk bacterial pathogens. Co-Author(s): Steven Mutschall, Public Health Agency of Canada/ Victor Gannon, Public Health Agency of Canada/ James Thomas, University of Lethbridge/ Eduardo Taboada, Public Health Agency of Canada

A5.3 Applying the Incidence Decay with Exponential Adjustment Model to Study Chikungunya Epidemic Growth in the Americas Presented by TAHMINA NASSERIE Student, Dalla Lana School of Public Health Chikungunya, a neglected tropical disease transmitted by infected mosquitos, has led to over 1,200,000 cases in an ongoing epidemic concentrated in the Americas. This study uses the Incidence Decay with Exponential Adjustment (IDEA) model to describe Chikungunya epidemic growth and assess the extent to which the epidemic is being controlled. IDEA, a single-equation model, describes epidemic processes in terms of exponential growth and simultaneous decay due to changes that slow disease transmission. The model utilizes the functional form It=[R0/(1+d)t]t, where R0 represents the basic reproductive number, It represents incident cases in a generation, and d is a control parameter that causes incidence to decay. Generation time (t) was calculated as t=incubation + ½infective period. The start date was assumed to be December 6, 2013. Models were fit to data from the Latin Caribbean (LC) region and to the overall cumulative incidence curve (including all regions) using maximum likelihood estimation tools. As LC and overall cumulative incidence data were fit to successive generations, a similar pattern emerged for both curves. R0 and d initially declined, increased at generation 10 and steadied around generation 14. The best-fit models identified R0 as 6.329 and d as 0.075 for LC data and R0 as 5.790 and d as 0.067 for overall cumulative incidence data. The models projected 809,785 cumulative cases compared to 814,281 observed cases in the LC region, and 1,069,929 cumulative cases compared to 1,206,669 observed cases overall. The overall cumulative incidence curve appears to have an inflection point in the 14th outbreak generation, which may be indicative of a multiwave epidemic. This may explain the difference between predicted and observed cases in later generations. Chikungunya is evidently re-emerging in tropical and temperate areas, with significant public health implications. Best-fit estimates in this study identify R0 values that are higher than previous outbreaks. While the d parameter indicates control is evident, increased action is required. Next steps include assessing the possibility of a multiwave epidemic. Co-Author(s): David N. Fisman, University of Toronto / Ashleigh Tuite, University of Toronto

A5.4 Estimation of intracluster correlation coefficient for survival data in cluster randomized trials Presented by SUMEET KALIA Student, University of Western Ontario The intracluster correlation coefficient (ICC) is used to measure the degree of similarity among outcomes within a social unit. The purpose of this study is to compare the bias and efficiency of ICC estimators derived from correlated survival outcomes and censoring indicators. In many survival studies, investigators may randomize intact social units rather than independent individuals to improve the administrative convenience and subject compliance within cluster randomized trials (CRTs). The current literature suggests that the standard method of estimating the ICC for correlated survival outcomes in CRTs is unclear as it can be estimated from correlated survival outcomes and censoring indicators. A simulation study is conducted to assess the performance of the two ICC estimators under the assumptions of administrative censoring and no accrual period. Furthermore, two ICC estimates are computed from a published CRT with correlated survival outcomes. Preliminary results indicate that both ICC estimators are negatively biased. The magnitude of this negative bias is reduced when the negative ICC estimates are truncated to zero. The ICC estimates computed from a CRT of time-to-tubal failure further illustrate the disparity between the two methods. In summary, results show that the standard approaches to estimating ICC are problematic as they drastically underestimate the ICC parameter. In spite of these challenges, the estimation of ICC is crucial in CRTs. This is because standard statistical procedures which fail to account for within-cluster dependencies in study design may give rise to inconclusive study with low power and yet exaggerate the effect of significance. The next step in this work is to explore the ICC parameter for sample size estimation and statistical inference. Co-Author(s): Neil Klar, University of Western Ontario / Allan Donner, University of Western Ontario

27 Concurrent Sessions B Tuesday, June 2, 2015 - 1:00pm – 2:15pm B1 CANCER II South Studio 3 B1.1 The Association between Leisure Time Physical Activity and Pancreatic Cancer Risk in Adults: A Systematic Review and Meta-analysis Presented by MEGAN FARRIS Master’s student/Research Assistant, Alberta Health Services We conducted a meta-analysis of the association between leisure time physical activity (LTPA) and risk of pancreatic cancer to update previous analyses in light of newly published studies, and to examine subgroups of interest and potential sources of heterogeneity further. We searched the PubMed and MEDLINE databases for studies to October 1st, 2014 with the following keywords and medical subject heading (MeSH) terms: physical activity, motor activity, exercise, cancer, neoplasm, carcinoma, tumour, pancreas, pancreatic, risk factor, risk factors, and risk. Study information was collected using a standardized form to abstract relevant data on study design, number of cases and controls, participant and study characteristics, assessment of LTPA and pancreatic cancer, risk estimates, and adjustments for confounding by two independent abstractors. We used random-effects to pool estimates from included studies of lowest versus highest comparison of LTPA. The search initially identified 1,431 citations; upon further review 1,405 were excluded as either not meeting inclusion criteria or duplicates, leaving 26 studies eligible for inclusion into the meta-analysis. Of these 26 studies, seven reported men and women as separate populations, therefore, 33 risk estimates were included in the analysis. Twenty-three of the 33 risk estimates suggested a protective effect and the combined summary estimate was (RR, 0.89; 95% CI, 0.82-0.96). There was, however, some evidence of heterogeneity across studies (I2=22.1%, P-heterogeneity=0.130). Some of the heterogeneity could be explained by study design, with stronger protective effects observed among case-control risk estimates as compared to cohort studies. Across study designs, age of population was also a source of heterogeneity, with stronger effects observed among younger populations. The present meta-analysis supports a slightly protective association between LTPA and pancreatic cancer with 10% reduction of risk observed across studies. LTPA appears to have the strongest effect among young populations. Co-Author(s): Megan Farris, Alberta Health Services/ Alison McFadden, Alberta Health Services/ Christine Friedenreich, Alberta Health Services/ Darren Brenner, Alberta Health Services

B1.2 Alberta Physical Activity and Breast Cancer Prevention Trial: Changes in Markers of Oxidative Stress After a Year-long Exercise Intervention Presented by CHRISTINE FRIEDENREICH Scientific Leader, Alberta Health Services Oxidative stress may contribute to breast cancer etiology through several mechanisms involving damage to DNA, proteins and lipids leading to genetic mutations and genomic instability. The objective of this randomized controlled trial was to determine the effect of aerobic exercise on markers of oxidative damage and antioxidant enzymes. The Alberta Physical Activity and Breast Cancer Prevention Trial (ALPHA) was a two-centre, two-armed randomized trial in 320 inactive, healthy, postmenopausal women, aged 50-74 years, with a body mass index 22-40 kg/m2. Participants were randomly assigned to a year-long exercise intervention (EX) (225 minutes/week) or a control group (CTRL) while maintaining usual diet. Plasma concentrations of two oxidative damage biomarkers (8-hydroxy-2′-deoxyguanosine, F2- isoprostane isomer, 8-isoprostaglandin F2α) and three antioxidant enzymes (superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase) were measured at baseline, six, and 12-months. An intention-to-treat analysis was done using linear mixed models adjusted for baseline biomarker concentrations. Biomarker data were available at baseline, six and 12-months for 310, 308, and 310 women, respectively. For each biomarker the percent change from baseline to 12 months was similar between the two groups except for SOD (EX=-3.6%, CTRL= 4.5%). In intention-to-treat analyses, a statistically significant difference representing the EX:CTRL ratio of geometric means for biomarker levels over 12 months was found for GPx [treatment effect ratios (95% CI): -0.11 (-0.21,-0.02), p-value=0.02). A significant trend (p=0.04) was found when comparing across categories of exercise adherence with greater decreases in GPx levels for higher exercise levels. Preliminary results suggest that aerobic exercise impacts some anti-oxidant enzymes that may be associated with breast cancer risk but that there is little impact on oxidative damage biomarkers. Future analyses will explore these associations fully, including tests for interaction by baseline biomarker levels and other factors. Co-Author(s): Vincent Pialoux, Universite Claude Bernard Lyon 1/ Marc Poulin, University of Calgary/ Xavier Waltz, University of Calgary/ Qinggang Wang, Alberta Health Services/ Darren Brenner, Alberta Health Services/ Heather Neilson, Alberta Health Services/ Shannon Conroy, University of California at Davis/ Yutaka Yasui, University of Alberta/ Christy Woolcott, Dalhousie University/ Kerry Courneya, University of Alberta

B1.3 How do inflammatory markers in postmenopausal women change after a year-long high versus moderate exercise intervention? Presented by CHRISTINE FRIEDENREICH Scientific Leader, Alberta Health Services Inflammation is a proposed risk factor for postmenopausal breast cancer. In clinical trials exercise has been shown to decrease inflammation compared with no exercise. The objective of this randomized dose comparison trial was to determine if a higher exercise volume decreased inflammatory biomarkers more than moderate exercise volume. The Breast Cancer and Exercise Trial in Alberta (BETA) was a two-center, two-armed randomized trial in 400 inactive, healthy, postmenopausal women, aged 50-74 years, body mass index 22-40 kg/m2. Participants were randomly assigned to a HIGH (300 minutes/week) or MODERATE (150 minutes/week) volume of aerobic exercise, achieving 65%-75% heart rate reserve five times per week while maintaining usual diet. Fasting blood concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosing factor-alpha (TNF-α), were measured at baseline, six, and 12-months. An intention-to-treat analysis was conducted using linear mixed models adjusting for baseline biomarker concentrations. Biomarker data were available at baseline, six and 12-months for n=382 (192 HIGH and 190 MODERATE) participants. Average biomarker changes [12-months-baseline] for HIGH and MODERATE groups were: -11% and -17% for CRP, -6.4% and -6.3% for IL-6, -1.8% and -1.1% for TNF-α, respectively. In intention-to-treat analyses, no statistically significant group differences were found for changes [treatment effect ratios (95% CI): 1.07 (0.97-1.18), 1.04 (0.95-1.12), 1.00 (0.95-1.05), respectively, representing the HIGH:MODERATE ratio of geometric means for biomarker levels over 12 months. In analyses based on self-selected adherence levels (average minutes/week), the ratio of 12 months to baseline CRP levels decreased more in participants who exercised >250 minutes/ week (0.80 (0.68-0.94)) compared to those who exercised <150 minutes/week (0.86 (0.79-0.94)) (Ptrend=0.13). Per protocol analyses found a greater decrease in CRP for higher exercise volume (-17% in HIGH versus -15% in MODERATE) but the difference between groups was not statistically significant (p=0.70). Preliminary results suggest some advantage, with respect to inflammatory biomarkers, in performing >250 versus <150 minutes/week of moderate-vigorous aerobic exercise in inactive postmenopausal women. Future analyses will examine tests for interaction by baseline biomarker levels and baseline adiposity. Co-Author(s): Rachel O’Reilly, Alberta Health Services/ Darren Brenner, Alberta Health Services/ Eileen Shaw, Alberta Health Services/ Frank Stanczyk, University of Southern California/ Yutaka Yasui, University of Alberta/ Sarah MacLaughlin, Alberta Health Services/ Scott Adams, University of Alberta/ Andria Morielli, University of Alberta/ Kerry Courneya, University of Alberta

B1.4 Correlated cancers in women: A global analysis using data from 290 cancer registries Presented by MORTEZA BASHASH Research fellow, University of Toronto Cancer registries provide valuable standardized, high-quality and easily accesible information about different types of cancer in different populations. This study compares potential correlations between types of female cancers by examining similarities in incidence rates using data aggregated from different registries across the globe. Cancers that are correlated may denote shared genetic and/or environmental factors. Age-world-standardized incidence rates ASR (W) for the top 25 cancers in women were obtained from the publicly available online databases of the International Agency for Research on Cancer (IARC) and the International Association of Cancer Registries (IACR), Cancer Incidence in Five Continents (CI5) Volume X website. The data contains information from 290 cancer registries in 68 countries on cancers diagnosed from 2003 to 2007. Correlation were used to define pairwise linear relationship between cancer rates. Cancers with correlation coefficients higher than 0.7 were consider to be “highly linked”. Among the cancers studied, seven pairs of cancers were considered to be “highly linked”, including; Breast cancer / Non-Hodgkin’s lymphoma, Colorectal cancer/Pancreatic cancer, Breast cancer / Uterine cancer, Breast cancer/Colorectal cancer, Pancreatic cancer /Kidney cancer, Lung cancer/Kidney cancer, Multiple myeloma / Pancreatic cancer. The similarity in cancer incidence trends may represent underlying genetic factors that influence susceptibility, or common non-genetic factors that affect cancer risk, including environmental exposure and lifestyle. More study needs to be done to provide clues for the future identification of genetic or environmental- lifestyle factors that underlie these observations. Co-Author(s): Morteza Bashash, University of Toronto/ Siying Huang, University of Toronto/ Chris Bajdik, University of British Columbia / Rani Kotha, University of Toronto/ Howard Hu, University of Toronto

28 B1.5 Cervical cancer screening in First Nations, Métis, and Inuit women in Quebec, Canada: A pooled cross-sectional analysis Presented by ALEXANDRA BLAIR PhD Student, University of Montreal No published data on cervical cancer screening rates exist for Aboriginal women across Quebec. Grey literature suggests that Aboriginal women living off-reserve report comparable cervical cancer screening rates to non-Aboriginal women in Canada even though inequalities exist on other health indicators. We aimed to compare screening rates across these groups. We pooled four waves of the Canadian Community Health Survey (2003, 2005, 2008, 2012; weighted N=7,105,591). The outcome, non-recent screening (NRS), was defined as reported screening 3 or more years prior to the survey. Women who reported First Nations, Métis, or Inuit ancestry, or Cree as their mother tongue (Weighted N=2,529,590) were compared to non-Aboriginal women. Using Poisson regression models, we estimated cervical cancer screening rate ratios (RR) among Aboriginal women in Quebec adjusting for age, income, education, marital status, and access to a primary care physician. Confidence intervals (CI) were constructed using bootstrap variance weights. The overall prevalence of non-recent screening (NRS) was 24% and did not differ across Aboriginal (26%) and non-Aboriginal women (25%) (RR=1.02, 95% CI 0.84, 1.24). In the fully adjusted model, the strongest predictors of NRS were non-access to a primary care physician (RR=2.0, 95% CI 1.81,2.17), lower income (1st quintile RR=1.64, 95% CI 1.34,2.00; 2nd quintile vs. 5th quintile RR=1.41, 95% CI 1.16,1.71), educational achievement of less than high school graduation (vs. university degree, RR=1.62, 95% CI 1.42,1.81), and older age (50-65 years vs. 21-49 years) (RR=1.28, 95% CI 1.17, 1.41). We conclude that there are no inequalities in screening between Aboriginal women living off-reserve and non-Aboriginal women in Quebec. Additional comparative analyses of aboriginal women in other Canadian provinces seem warranted. Co-Author(s): Marie-Hélène Mayrand, CHUM Research Centre and University of Montreal/ Marie-Pierre Sylvestre, CHUM Research Centre and University of Montreal/ Lise Gauvin, CHUM Research Centre and University of Montreal/ Mylène Drouin, Public Health Agency of Montreal/ Geetanjali D. Datta, CHUM Research Centre and University of Montreal B2 INFECTIOUS DISEASES II Greenwich Room B2.1 HIV/AIDS Knowledge, Attitude, and Practice among Youth in Iran Presented by MOHAMMAD KARAMOUZIAN Student, University of British Columbia Youth are believed to lack adequate knowledge and have poor attitude on HIV and its modes of transmission. The aim of the current study is to assess the level of knowledge, attitudes, and practice of Iranian youth towards HIV/AIDS and its risk factors. This cross sectional survey was conducted from 13 provinces in Iran in winter 2014. Study participants were enrolled through multi-stage cluster sampling. The target participants in the current study were two age groups of 15-18 (N= 1622 subjects) and 19-29 (3246 subjects) years old. We developed a standardized questionnaire and obtained information on the knowledge of the participants regarding the HIV transmission, diagnosis, prevention and treatment. We also explored the attitude and practice of the participants towards HIV/AIDS as well as their frequency of high risk behaviors. Data was analyzed and adjusted for the clustering effect of the sampling sites using STATA survey package. Among 15-18 year-old participants, the overall HIV/AIDS low, moderate and high knowledge scores were 26.3%, 47.3% and 26.4%, respectively. While among the 19-29 year- old group, it was 16.7%, 40.8% and 42.4%, respectively. Although most participants of both age groups knew HIV could be transmitted through unsafe sex and unsterile injections, they had misconceptions about the casual transmission of the HIV. The low, medium and high level of attitude for 15-18 years old was 81.7%, 16.9%, and 1.4%, and among 19-29 year-old group it was 84.1%, 14.7% and 1.2%, respectively. Around 13.1% of the 19-29 year-old participants had ever tested for HIV, 22.2% had ever had extramarital sex, and 1.7% ever injected drugs. The findings showed that a high percentage of Iranian youth had low attitude towards people living with HIV, although their knowledge was relatively higher. To increase knowledge and improve attitude and practice, HIV/AIDS education should be introduced to the national educational curriculum. Mass media’s role is also inevitable in improving the level of knowledge, attitude, and practice of youth towards HIV/AIDS in Iran. Co-Author(s): Hamid Sharifi, Regional Knowledge Hub, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies for Health, Kerman University of Medical Sciences, Kerman, Iran/ Ali Akbar Haghdoost, Regional Knowledge Hub, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies for Health, Kerman University of Medical Sciences, Kerman, Iran/ Abbas Sedaghat, Center for Disease Control, HIV/STI Office, Ministry of Health and Medical Education, Tehran, Iran/ Mostafa Shokoohi, Regional Knowledge Hub, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies for Health, Kerman University of Medical Sciences, Kerman, Iran

B2.2 Effects of reproductive and genital health on the risk of Human Papillomavirus infection using data from the Ludwig-McGill cohort study Presented by EILEEN SHAW Epidemiology Research Associate, Alberta Health Services HPV has been established as a necessary but insufficient cause of cervical cancer. Little is known about reproductive and genital health determinants of HPV infection. This study examines these in the Ludwig-McGill Cohort Study, one of the largest longitudinal studies on the natural history of HPV infection and cervical pre-cancer. A subset of 1867 women with information from all four visits in the first year of follow-up was used for this analysis. The effects of self-reported contraceptive methods and characteristics of genital health, using questionnaire and laboratory data, on the risk of HPV infection was analyzed for a one-year period prevalence using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). Two outcomes were measured, the first based on phylogenetic grouping of HPV types within the alpha-papillomaviruses (Groups 1, 2 and 3), and the second based on transient or persistent HPV infections. Former (OR=2.00, 95% CI: 1.23-3.24) and current (OR=2.00, 95% CI: 1.15-3.47) condom use were mostly associated with an increased prevalence of Group 3 infections. For women using contraceptive injections, the ORs were 1.96 (95% CI: 1.22-3.16) for Group 1, 1.34 (95% CI: 1.00-1.79) for Group 2, and 1.58 (95% CI: 1.10-2.26) for transient infections. Intrauterine device use was protective for all outcomes, with more pronounced effects for Group 1 (OR=0.48, 95%CI: 0.30-0.75), Group 2 (OR=0.78, 95%CI: 0.62-0.98), and transient HPV infections (OR=0.78, 95%CI: 0.48-0.87). Oral contraceptives use was not associated with any outcome. Health and hygiene factors (tampon use, previous bacterial or fungal infections and local inflammation of the cervix) were also found to be significantly associated with an increased risk of HPV infection. This detailed analysis on the effects of reproductive and genital health factors on cervical HPV infection showed several factors were significantly associated with the prevalence of HPV infection. Further research using hypothesis-driven designs with more accurate measures of exposure is necessary to confirm the observed novel associations. Co-Author(s): Agnihotram V Ramanakumar, McGill University, Division of Cancer Epidemiology/ Mariam El-Zein, McGill University, Division of Cancer Epidemiology/ Lenice Galan, Ludwig Institute for Cancer Research/ Maria Luiza Pinto, Ludwig Institute for Cancer Research/ Joao Simao Sobrinho, Ludwig Institute for Cancer Research/ Jose Carlos Prado, Ludwig Institute for Cancer Research/ Luisa Villa, Ludwig Institute for Cancer Research/ Eduardo Franco, McGill University, Division of Cancer Epidemiology

B2.3 Screening as a Potential Driver of Syphilis Outbreaks in Men Who Have Sex with Men Presented by ASHLEIGH TUITE PhD Student, University of Toronto Syphilis outbreaks in urban men who have sex with men (MSM) are an ongoing public health problem in many high-income countries, despite intensification of efforts to screen and treat at-risk individuals. We sought to understand how population-level coverage of asymptomatic screening impacts the ability to control syphilis transmission. We developed a risk-structured deterministic compartmental mathematical model of syphilis transmission in a population of sexually active MSM, parameterized using the biomedical literature and by model calibration. We assumed a baseline level of treatment of syphilis cases due to seeking medical care in all scenarios. We evaluated the impact of sustained annual population-wide screening coverage ranging from 0 to 90% on syphilis incidence over the short-term (20-years) and at endemic equilibrium. Assumptions around immunity following treatment, sexual mixing, and screening frequency were tested in sensitivity analyses. The relationship between screening coverage and equilibrium syphilis incidence displayed an inverted U-shape relationship, with peak equilibrium incidence occurring with 20-30% annual screening coverage. 62% of the population needed to be screened annually for local elimination (incidence <1 case per 100,000 population). Results were qualitatively similar in the face of differing programmatic, behavioural, and natural history assumptions, although the screening thresholds for local elimination differed. With 6- or 3-monthly screening, the population coverage required to achieve local elimination was reduced to 39% or 23%, respectively. Although screening has the potential to control syphilis outbreaks, suboptimal coverage may paradoxically lead to higher equilibrium infection incidence than that observed in the absence of intervention. Suboptimal screening program design should be considered as a possible contributor to unsuccessful syphilis control programs in the context of the current epidemic. Co-Author(s): Ashleigh Tuite, University of Toronto /David Fisman, University of Toronto

29 B3 INJURY PREVENTION II Brittania Room B3.1 Strategies to improve the credibility of meta-analyses in spine surgery: A systematic survey Presented by NATHAN EVANIEW Resident Physician, PhD student, McMaster University Meta-analyses are powerful tools that can synthesize existing research, inform clinical practice, and support evidence-based care. Our primary objectives were to evaluate the methodological quality (credibility) of spine surgery meta-analyses and to propose strategies to improve future research. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently assessed eligibility and credibility. We evaluated credibility according to the Users’ Guide to the Medical Literature. We used multivariable linear regression to evaluate potential associations. We identified 132 eligible meta-analyses. The mean credibility score was 3 of 7 (SD 1.4; ICC 0.86), with agreement ranging from 0.54 to 0.83. Clinical questions were sensible in 125 (95%), searches were exhaustive in 102 (77%), and risk of bias assessments were undertaken in 91 (69%). Seven (5%) addressed heterogeneity using a priori subgroup hypotheses and 24 (18%) presented results that were clinically applicable. Investigators performed duplicate assessments of eligibility, risk of bias, and data extraction in 46 (35%), and rated confidence in the evidence in 24 (18%). Publication year, Impact Factor, number of databases, inclusion of RCTs, and inclusion of non-English studies were significantly associated with higher credibility (p<0.05). The mean score for reporting was 18 of 27 (SD 4.4; ICC 0.94). The credibility of many spine surgery meta-analyses is limited. Researchers can improve future meta-analyses by performing exhaustive literature searches, addressing possible explanations of heterogeneity, presenting results in a clinically useful manner, reproducibly selecting and assessing primary studies, addressing confidence in the effect estimates, and adhering to guidelines for complete reporting. Co-Author(s): Leon van der Watt, McMaster University/ Mohit Bhandari, McMaster University/ Michelle Ghert, McMaster University/ Ilyas Aleem, McMaster University/ Brian Drew, McMaster University/ Gordon Guyatt, McMaster University

B3.2 COMPLICATIONS FOLLOWING ADMISSION FOR TRAUMATIC BRAIN INJURY Presented by MADIBA OMAR Student, Université Laval The objective of this study was to obtain information on the incidence, determinants and impact on mortality and resource utilization of hospital complications potentially related to quality of care for patients with traumatic brain injury (TBI). We conducted a multicentre cohort study to assess the incidence of neurological and non- neurological complications and their determinants in adults with TBI between 2007 and 2012 in the integrated trauma system of the province of Quebec (Canada). Risk ratios were calculated for the influence of determinants on the occurrence of complications. Then we studied the impact of these complications on length of stay (LOS) and mortality adjusting for risk factors. The study population comprised 13446 patients. Globally 3.1%% of patients had at least one neurological complication and 22.1% had at least one non-neurological complication. The most important determinants of neurological complications were intensive care with ventilation, maximum AIS of TBI, number of comorbidities ≥3 and the Glasgow Coma Scale. The most important determinants of non-neurological complications were intensive care with ventilation, maximum AIS of concomitant injuries, the Glasgow Coma Scale and number of comorbidities ≥3. For neurological complications, stroke was associated with significant mortality (OR=4.8) and LOS (GMR=1.5). For non-neurological complications, cardiac arrest was associated with high mortality (OR=22.1) and LOS (GMR=1.5). More than 20% of patients with TBI have a complication related to quality of care but only one out of ten are neurological complications. Results indicate that efforts to reduce hospital complications in TBI patients could improve resource use and outcome in these patients. Co-Author(s): Lynne Moore, Faculté de médecine de l’université Laval/ Pier-Alexandre Tardif, Université Laval/ Philippe Dufresne, Université Laval/ Paule Lessard- Bonaventure, Université Laval/ François Lauzier, Faculté de médecine de l’université Laval/ Jérôme Paquet, Faculté de médecine de l’université Laval/ Gilles Bourgeois, Institut national d’excellence en santé et en services sociaux Québec/ Jean Lapointe, Institut national d’excellence en santé et en services sociaux Québec

B3.3 Occupational injuries in Canadian youth- An analysis of 19 years of surveillance data collected by the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) Presented by BRANDY PRATT MPH Student, University of Toronto Occupational injuries have declined in working-age Ontarians over the past decade. This study aims to investigate nationwide youth occupational injuries to examine whether a similar tendency is observed in young workers. We also describe characteristics of work-related injuries and quantify differences between occupational and non-occupational injuries in this age group. We analysed records for youth aged 10-17 presenting to CHIRPP emergency departments (EDs) from 1991-2009. Unadjusted trends in occupational injuries as a proportion of total reported youth injuries were analysed by fitting a simple linear regression model. The slope of the model was used to estimate the annual percent change in youth occupational injuries. Age and sex-adjusted proportionate injury ratios (PIRs) and 95% confidence intervals were calculated to compare the nature of injuries between occupational and non-occupational events. A total of 5428 injuries (0.74% of events) occurred while on duty at work; 64.0% of these cases were males. The most common occupational injuries were open wounds (32.5%), musculoskeletal injuries (21.9%), superficial wounds (12.7%), fractures/dislocations (8.6%), and burns (7.4%). Significantly elevated PIRs were observed for eye injuries (2.47, 95% CI 2.15-2.83), open wounds (2.62, 95% CI 2.50-2.75), bites (5.09, 95% CI 4.40-5.89), electrical injuries (5.51, 95% CI 3.13-9.71), crushing/amputations (6.28, 95% CI 5.35-7.39), and burns (9.45, 95% CI 8.57-10.42) in occupational versus non-occupational events. The proportion of occupational injuries grew by an average of 1.05% annually (95% CI 0.19-1.90%, p=0.02). A sensitivity model including only sites reporting data throughout the full study period showed a similar increase (1.07%, 95% CI 0.25-1.88%, p=0.01). While these preliminary results cannot be interpreted as representing population incidence rates, the increasing proportion of youth occupational injuries seen in EDs suggests that injury trends in employed youth may differ from those observed in working adults. Next steps involve coding youth jobs into well-defined domains to further describe injuries between occupations, and using Join Point Regression Software to conduct a detailed analysis of temporal trends in this population. Co-Author(s): James Cheesman, Public Health Agency of Canada /Minh Do, Public Health Agency of Canada

B3.4 Neighbourhood environment factors and the occurrence of injuries in Canadian adolescents: a validation study and exploration of structural confounding Presented by AFSHIN VAFAEI Queen’s University 1)To develop and test the reliability and validity of composite scales for the measurement of social capital (SC), socioeconomic status (SES) and built environment (BE) and 2) to explore the possible structural confounding roles of community level SC, SES and BE factors in studies of the aetiology of youth injury. Social sorting mechanisms may impose confounding effects in the study of aetiological relationships. Such processes are referred to as structural confounding. If present, certain strata of social factors could hypothetically never be exposed to specific risk factors. This prohibits exchangeability across groups that is needed for meaningful causal inference. We explored the potential for structural confounding due to SES and BE factors for the relationships between SC and injuries in Canadian adolescents. Scales describing these factors were developed and validated via exploratory and confirmatory factor analyses. We then used tabular analyses to explore structural confounding in our population. 23,532 youth aged 11–15 years from a nationally representative sample of over 26,000 Canadian students were included in this analysis. In exploratory and confirmatory factor analyses, all proposed scales demonstrated good psychometric properties with high loadings, satisfactory model fit indices, and good internal consistency. Despite variations in the number of adolescents across strata, no evidence for the presence of structural confounding was detected in our data. Student populations and injured cases were observed in all combination of strata of the three community measures and no cell remained empty or with sparse numbers of observation. Therefore, exchangeability is possible across exposure strata and a meaningful multilevel regression analysis to study relationships between SC and the occurrence of injuries in Canadian youth is feasible. Canada is a suitable place to disentangle the effects of different neighbourhood social and environmental exposures on occurrence of injuries and other outcomes in adolescent populations. However, more studies are needed to test the consistency of our findings in other populations and for different outcomes. Co-Author(s): William Pickett, Queen’s University /Beatriz E. Alvarado, Queen’s University

30 B4 REPRODUCTIVE HEALTH I Club Studio 3 B4.1 Lifestyle factors and personal attributes in determining serum vitamin D status in Montréal women Presented by VIKKI HO Postdoctoral Fellow, University of Montreal Hospital Research Center (CRCHUM) Serum 25-hydroxy vitamin D [25(OH)D], is the best indicator for current vitamin D status. However, the cost of its measurement can be prohibitive in epidemiology. We therefore assessed the utility of questionnaires in estimating vitamin D status, by examining the relationship between questionnaires on vitamin D exposure and serum 25(OH)D. ): In a case-control study in Montréal, 200 controls provided a blood specimen between 2012 and 2014. Liquid chromatography-tandem mass spectrometry was used to quantify 25(OH)D2, 25(OH)D3 and 3-epi-25(OH)D3. Reliability was assessed using two quality control samples measured in duplicate within each batch (intra-batch coefficients of variations (CVs)) and 10% of the population was measured in duplicate in different batches (inter-batch CV). Average intra-batch and inter- batch CVs were below 3% and 5%, respectively. Separate age-adjusted linear regression analyses were used to examine the relationships between questionnaires responses to each lifestyle and personal attribute variables and serum 25(OH)D3 levels. Among 184 women who had complete data, mean serum 25(OH)D3 level was 74.0 nmol/L (SD=27.7). Levels of 25(OH)D3 did not differ by season of blood draw; however, older age was associated with higher 25(OH)D3 levels. In separate age-adjusted models, eye colour (“non-brown” versus “brown”; adjusted mean difference: β=10.6, p<0.01), body mass index (“<18.5 kg/m2” β=12.3, “18.5-<25.0 kg/ m2” β=16.1 and “25.0-<30.0 kg/m2” β=17.9 versus “≥30.0 kg/m2; p=0.01), vitamin D supplement use (“Non-user” β=-37.6, “Moderate-user” β=-19.0 versus “High-user”; p<0.01) and post-menopausal hormone use (“Non-user” versus “User”; β=-13.0, p<0.01) were significantly predictive of serum 25(OH)D3 levels. These variables explained from 3% to 26% of total variance in serum 25(OH)D3 levels. These preliminary results agree with those previously reported by the Canadian Health Measures Survey Cycle 2. Determinants of 3-epi-25(OH)D3 will be examined; predictors of 25(OH)D2 will not be evaluated as most participants had levels below the limit of detection. Future analysis will utilize a multivariable approach and additionally investigate sun protection behaviours and dietary exposures in relation to levels of 25(OH) D3 and 3-epi-25(OH)D3. Co-Author(s): Michal Abrahamowicz, University of Montréal Hospital Research Centre (CRCHUM); McGill University, Montréal, Québec, Canada/ Anne-Sophie Belanger, Ste-Justine Hospital, Montréal, Québec, Canada/ Edgard Delvin, Ste-Justine Hospital, Montréal, Québec, Canada/ Julie Lacaille, University of Montréal Hospital Research Centre (CRCHUM)/ Maria Tran, University of Montréal Hospital Research Centre (CRCHUM)/ Anita Koushik, University of Montréal Hospital Research Centre (CRCHUM)

B4.2 Maternal telomere length change during pregnancy and lifestyle characteristics; a pilot study from the Ontario Birth Study Presented by LAURA ANDERSON Research Fellow, The Hospital for Sick Children To evaluate change in telomere length (TL) during pregnancy, a period of physiological stress, and to evaluate if common chronic disease risk factors were associated with TL. A prospective pregnancy cohort study was conducted. Women <17 weeks gestational age were recruited as part of the Ontario Birth Study pilot at Mount Sinai Hospital, Toronto. Questionnaires and blood were collected at two time points during pregnancy: 12-16 and 28-32 weeks gestation. Relative TL was measured using real-time PCR on leukocyte DNA. A reference sample was added to each plate and each sample was run in triplicate; between assay CVs for both genes were <5%. TL change during pregnancy was evaluated using paired t-test and longitudinal quantile regression analysis was used to evaluate characteristics associated with telomere length. 108 women were included in this analysis. In early pregnancy, the mean maternal age was 33 (SD=3.9) and mean body mass index was 24 (SD=4.0). 36% of women were nulliparous and the average age at menarche was 12.5 years (SD=1.34). There was no significant change in telomere length during pregnancy (p=0.19); the mean relative TL was 1.4 in early pregnancy and 1.5 in late pregnancy. Maternal pre-pregnancy and early pregnancy BMI were not significantly associated with TL. Increasing maternal age (beta=-0.017; p=0.05) and age at menarche (beta=-0.08; p=<0.001) were significantly associated with shorter TL. TL has been proposed as an intermediate marker of chronic disease risk, but little is known about TL change over the lifecourse or predictors of TL. Our preliminary results suggest TL may be stable during pregnancy and there are important chronic disease risk factors that may be associated with TL. Co-Author(s): Laura N. Anderson, The Hospital for Sick Children/ Julia A. Knight, Mount Sinai Hospital/ Kristin Connor, Mount Sinai Hospital/ Laurent Briollais, Mount Sinai Hospital/ Stephen Lye, Mount Sinai Hospital/ Alan Bocking, Mount Sinai Hospital

B4.3 Role of maternity related factors in predicting excellent physical, social, and cognitive development of children at three years of age Presented by KAMALPREET BANGA PhD Student, University of Saskatchewan Experiences in early childhood can impact intelligence, personality, social behaviour, and the capacity to reach full potential as an adult. This study examines the association between maternal mental health, prenatal behaviours, pregnancy outcomes, socio-demographic factors and early childhood development up to three years of age. Mothers who completed the three year follow up of five year longitudinal Feelings in Pregnancy (FIP) study in Saskatoon, Saskatchewan formed the cohort. The Ages and Stages Questionnaire (ASQ3) was used to measure physical, social, and cognitive development of the child. Communication, gross-motor, fine-motor, problem-solving, and personal-social scores were computed. Scores of the children with above normal cut-off were transformed into ordinal variable based on tertiles. Ordinal regression was used to test the association of excellent vs good/average child development with maternal prenatal behaviours, anxiety, depression, and other socio-demographic factors. Odds ratios with 95% CI were reported. The study included 339 mother-child dyads. Excellent problem-solving development was less likely in children when mothers reported anxiety (OR 0.97, 95%CI 0.95 – 0.99) and higher with depression treated with medications (OR 1.45, 95%CI 1.03 – 2.02). Excellent personal-social development was less likely when mothers reported prenatal smoking (OR 0.30, 95%CI 0.11 – 0.81) and recreational drug use (OR 0.09, 95%CI 0.01 – 0.59). Excellent fine motor (OR 2.79, 95%CI 1.65 – 4.72) and personal-social (OR 2.99, 95%CI 1.74 – 5.17) development was more common in girls. Excellent communication skills were less common in large-for-gestation babies (OR 0.33, 95%CI 0.17 – 0.63) with low apgar scores (OR 0.42, 95%CI 0.21 - 0.83). Excellent communication (OR 2.0, 95%CI 1.08 – 3.71) and gross-motor skills (OR 2.11, 95%CI 1.07 – 4.13) were associated with breastfeeding. High risk maternal behavior, maternal anxiety, and adverse pregnancy outcomes are associated with negative effects on early childhood development. Limiting exposure to risky behaviors, promoting breastfeeding, and maternal mental health screening and treatment during and after pregnancy can increase the opportunity for each child to have a healthy start. Co-Author(s): Nazeem Muhajarine, University of Saskatchewan/ Cheryl Waldner, University of Saskatchewan/ Angela Bowen, University of Saskatchewan

B4.4 Risk factors for caesarean section in nulliparous term singleton vertex pregnancies at a teaching hospital in Toronto, Canada: A clinical database analysis Presented by SHERYL HEWKO Clinical Research Nurse, Mount Sinai Hospital This study identifies characteristics of nulliparous women at term with a singleton fetus in vertex position (NTSV) attempting a vaginal delivery, and then examines their association with mode of delivery. Identifying modifiable risk factors among this population is paramount for creating targeted interventions to decrease the rates of CS. A clinical database analysis was performed using data from all NTSV women attempting a vaginal delivery between January 1, 2011 and December 31, 2013 at a large teaching hospital in Toronto, Canada. The outcome of interest was mode of delivery (vaginal versus emergency CS) and the exposures of interest were categorized by maternal, antenatal, neonatal, labour, and provider characteristics. Crude associations between exposures and mode of delivery were calculated using chi-square tests for categorical variables and t-tests for continuous variables (p<0.05). Statistically significant variables were retained for multi-variable analysis using forward regression. Of 7276 women included, 1822 (25%) delivered by CS while 5454 (75%) delivered vaginally. Increased odds of CS were associated with increasing maternal age (6% per year, 95% CI 1.05-1.07) and BMI (46% per category increase, 95% CI 1.35-1.59), pre-existing conditions (OR 1.35, 95% CI 1.14-1.84), increasing gestational age (12% per week, 95% CI 1.06-1.19), weight gain (12% per 5kg, 95% CI 1.06-1.19), hypertension (OR 1.45, 95% CI 1.14-1.84), and induction (OR 1.46, 95% CI 1.27-1.68). Odds of CS decreased among women carrying a female fetus (OR 0.80, 95% CI 0.71-0.90). Significant interactions existed between maternal height and infant birthweight (p=0.01) and labour analgesia and dilation at admission (p<0.001), with the effect of the exposure on delivery mode differing by strata of the second variable. While several factors - maternal age, height, presence of pre-existing conditions, fetal gender and birthweight - are not amenable to modification, they inform pre-pregnancy and antenatal counselling. Factors including labour onset mode, analgesia and cervical dilation on admission present the strongest opportunity for modification and require further well-designed RCTs. Co-Author(s): Sheryl Hewko, Mount Sinai Hospital /Mathew Sermer, Mount Sinai Hospital

31 B5 CHRONIC DISEASES I Graydon D B5.1 Characteristics of electronic cigarette users and their perceptions of benefits and harms: results from a survey in Ottawa, Ontario Presented by KARENA VOLESKY Student, Carleton University While the prevalence of e-cigarette use has increased dramatically in Canada over the past five years, there have been few attempts to describe these users. Our study objective was to describe the characteristics, reasons for use, and the perceptions of benefits and harms in a representative sample of Ottawa-area e-cigarette users. A 24-item online survey was developed and administered to individuals who purchased e-cigarettes at any one of Ottawa’s 17 e-cigarette shops. The survey was carried out from January 8 to March 1, 2015. Descriptive statistics were used to summarize the characteristics of e-cigarette users. Linear and logistic regression models will be applied to evaluate the relationship between e-cigarette perceptions and intention to stop using e-cigarettes. These models will be extended to evaluate whether associations vary across socio-demographic and lifestyle-related factors. Our analyses will also characterize the reasons for initiating e-cigarette use, and the potential for exposure to second-hand e-cigarette vapour. The mean age of the approximately 200 respondents was 37.7 (SD: 12.9), and nearly two-thirds were male (64.9%). More than half of respondents were married/common law (56.7%) and 64.9% had a college or university degree/diploma. The overwhelming majority of e-cigarette users are current or former cigarette smokers (97.9%). When asked when they started using an e-cigarette, 55.7% indicated that they have used an e-cigarette for one year or less. Only 4.1% of respondents reported that they do not use any nicotine in their e-cigarettes. Forty-percent of respondents reported that they regularly use their e-cigarettes at school or work, and 5% indicated that they regularly use e-cigarettes in restaurants. The majority of respondents (60.0%) indicated that they intend on stopping e-cigarette use at some point. At this time, we are still collecting responses from survey participants and the survey is scheduled to be completed in March 2015. Next steps include: performing additional statistical analyses, and developing knowledge mobilization activities aimed at informing local and federal government agencies of our findings. Co-Author(s): Anthony Maki, Carleton University/ Christopher Scherf, Carleton University/ Louis Watson, Carleton University/ Edana Cassol, Carleton University/ Scott Weichenthal, Health Canada/ Paul Villeneuve, Carleton University

B5.2 Efficacy of osteoporosis pharmacotherapies in preventing fractures among chronic oral glucocorticoid users: a network meta-analysis Presented by M AMINE AMICHE PhD student, Leslie Dan Faculty of Pharmacy, University of Toronto Several osteoporosis drugs are approved for the prevention and treatment of glucocorticoid(GC)-induced osteoporosis. However, the evidence base for the efficacy of pharmacotherapies among oral GC users is limited. We aim to examine the comparative efficacy of different osteoporosis treatments among chronic oral GC users. We updated a systematic review through to September 2013 to identify all double-blinded Randomized Controlled Trials (RCTs) that examined osteoporosis treatments among chronic GC users. We used a network meta-analysis with informative priors to derive comparative risk ratios (RRs) and 95% Credible Intervals (95% CrI) for vertebral and non-vertebral fracture and mean differences in lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD). Treatment ranking was estimated using the Surface Under the Cumulative RAnking curve (SUCRA) statistic. A meta-regression was completed to assess a subgroup effect between patients with prior GC exposures and GC initiators. We identified 27 eligible RCTs examining 9 active comparators. Etidronate (RR: 0.35, 95%CrI=0.15-0.86), risedronate (RR=0.29, 95%CrI=0.13-0.58), and teriparatide (RR=0.04, 95%CrI=0.001-0.38) showed better efficacy than placebo in preventing vertebral fractures; yet, no treatment effects were statistically significant in reducing non-vertebral fractures. Alendronate, risedronate, and etidronate increased LS BMD while alendronate and raloxifene increased FN BMD. In preventing vertebral fractures, teriparatide was the most efficacious agent (SUCRA: 79%), followed by both risedronate (78%) and zoledronic acid (78%). For non-vertebral fractures, teriparatide also had the highest SUCRA (87%), followed by risedronate (77%). No subgroup effect was identified with regards to prior GC exposure. Despite weak trial evidence available for fracture prevention among GC users, we identified several drugs that are likely to prevent osteoporotic fracture. Teriparatide and risedronate were associated with decreased fracture risk and were highly ranked in reducing fracture. More trial evidence is required to reduce uncertainty in future network meta-analyses. Co-Author(s): Jordan Albaum, Leslie Dan Faculty of Pharmacy, University of Toronto/ Mina Tadrous, Leslie Dan Faculty of Pharmacy, University of Toronto/ Petros Pechlivanoglou, Leslie Dan Faculty of Pharmacy, University of Toronto/ Jonathan Adachi, Department of Medicine, McMaster University/ Linda Lévesque, Department of Public Health Sciences, Queens University/ Suzanne Cadarette, Leslie Dan Faculty of Pharmacy, University of Toronto

B5.3 Management of central post-stroke pain: a systematic review of randomized controlled trials Presented by SOHAIL MULLA PhD Student, McMaster University Central post-stroke pain (CPSP) is a chronic neuropathic disorder that may develop up to years after a stroke. The underlying mechanisms of CPSP are poorly understood, thus contributing to challenges in its management. Existing systematic reviews addressing the topic have serious methodological limitations. We conducted a systematic review that addresses the limitations of prior reviews to inform evidence-based management of CPSP. We identified eligible trials, in any language, by systematic searches of eight electronic databases. Eligible trials enrolled ≥10 patients with CPSP, randomly assigned them to an active therapy or a control arm, and collected outcome data ≥14 days after treatment. Pairs of reviewers screened titles/abstracts of citations, reviewed the full texts of potentially eligible trials, and extracted information from eligible studies. We used a modified Cochrane tool to evaluate risk of bias of eligible studies, and collected patient-important outcomes across nine domains. We conducted, when possible, random-effects meta-analyses, and evaluated our certainty in treatment effects using the GRADE system. Eight English- language trials evaluated a range of therapies, including anticonvulsants, a tricyclic antidepressant, an opioid antagonist, repetitive transcranial magnetic stimulation, and acupuncture. Risk of bias within the studies was variable. None of the therapies reduced pain, and treatments had little to no effects on other patient-important outcomes, including emotional functioning, participant ratings of global improvement, symptoms and adverse events, and sleep and fatigue. Our certainty in the treatment estimates ranged from very low to low. Our findings are inconsistent with major clinical practice guidelines, which recommend antidepressants and anticonvulsants as first-line therapy. The available evidence suggests no beneficial effects of any therapies that researchers have evaluated in randomized controlled trials. Co-Author(s): Li Wang, McMaster University/ Rabia Khokhar, McMaster University/ Zain Izhar, McMaster/ Arnav Agarwal, McMaster University/ Rachel Couban, McMaster University/ D. Norman Buckley, McMaster University/ Dwight E. Moulin, Western University/ Akbar Panju, McMaster University/ Gordon Guyatt, McMaster University/ Jason Busse, McMaster University

B5.4 Reporting of patient-important core outcome domains among chronic pain clinical trials Presented by SOHAIL MULLA PhD Student, McMaster University The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has recommended that chronic pain clinical trials should consider reporting nine patient-important outcome domains. We examined the extent to which clinical trials evaluating the effect of opioids for chronic non-cancer pain (CNCP) report outcome domains recommended by IMMPACT. We systematically searched seven electronic databases for English-language studies that randomized patients with CNCP to receive an opioid or a non-opioid control. In duplicate and independently, reviewers established the eligibility of each identified study, and recorded all reported outcome domains from eligible trials. We conducted a priori regression analyses to explore factors that may be associated with the nine IMMPACT recommended outcome domains: (1) pain; (2) physical functioning; (3) emotional functioning; (4) participant ratings of global improvement and satisfaction with treatment; (5) symptoms and adverse events; (6) participant disposition; (7) role functioning; (8) interpersonal functioning; and (9) sleep and fatigue. Among 165 eligible trials, reporting of IMMPACT recommended outcome domains was highly variable, ranging from 99% for pain to 7% for interpersonal functioning. Recently published trials were more likely to report the effect of treatment on physical functioning, emotional functioning, role functioning, sleep and fatigue, and participant disposition. Trials published in higher impact journals were more likely to report treatment effects on emotional function, but less likely to report participant ratings of improvement and satisfaction with treatment. Most IMMPACT domains showed an increased rate of reporting over time, although many domains remained unreported by over half of all trials evaluating the effects of opioids for CNCP. Without consistent and more complete reporting of patient-important outcomes in trials for chronic pain, trialists will be unable to fully capture the effects of a given treatment. Co-Author(s): Amna Maqbool, McMaster University/ Laxsanaa Sivananthan, McMaster University/ Luciane Lopes, University of Sorocaba/ Stefan Schandelmaier, Schandelmaier/ Mostafa Kamaleldin, McMaster University/ Sandy Hsu, McMaster University/ D. Norman Buckley, McMaster University/ Daniel Sessler, Cleveland Clinic/ Gordon Guyatt, McMaster University/ Jason Busse

32 B5.5 Sleep Duration and Development of Hypertension: A Systematic Review and Meta-analysis Presented by DOUGLAS DORWARD Graduate Student, Clinical Epidemiology, Memorial University of Newfoundland Hypertension is common, is a risk factors for many cardiovascular diseases, and is influenced by several lifestyle factors. Our aim is to investigate whether sleeping ≤ six hours a night compared to sleeping ≥ seven hours a night affects the risk of developing essential hypertension in the general adult population. We searched PubMed, Embase and Cochrane Library for prospective cohort studies with follow up of ≥ two years investigating the incidence of hypertension in adults aged ≥ 19 years according to average nightly sleep duration. Quality of studies was assessed using US Preventative Services Task Force Quality Rating Criteria for cohort studies. Data extracted from studies rated “good” or “fair” was used to calculate the relative risk and 95% confidence intervals of developing hypertension in each sleep duration category. Results were presented in a forest plot using the random effects model. Subgroup analysis was performed for men and women. Eight studies were included in the systematic review, and six in the meta-analysis. Men and women sleeping ≤ six hours a night had increased risk of developing hypertension compared to those sleeping ≥ seven hours a night (RR 1.12, 95% CI: 1.02, 1.22). In subgroup analysis, women sleeping ≤ six hours a night had increased risk of developing hypertension compared to women sleeping ≥ seven hours a night (RR 1.19, 95% CI: 1.13, 1.24). Risk increased when women sleeping ≤ five hours a night were compared to the same reference group (RR 1.28, 95% CI: 1.11, 1.47). Men sleeping ≤ five hours a night did not have significantly increased risk compared to men sleeping ≥ seven hours a night (RR 1.08, 95% CI: 0.73, 1.60). Nightly sleep duration affects risk of developing hypertension differently in men and women. Women sleeping ≤ six hours a night have higher risk of developing hypertension than women sleeping ≥ seven hours a night. Short nightly sleep duration may be considered a risk factor for development of hypertension in women. Co-Author(s): Jacqueline Fortier, Memorial University of Newfoundland/ Marshall Godwin, Memorial University of Newfoundland Concurrent Sessions C Tuesday, June 2, 2015 - 2:30pm - 3:45pm C1 CANCER III South Studio 3 C1.1 Type 2 diabetes mellitus and prostate cancer risk: a population-based case-control study in Montreal, Canada Presented by AUDREY BLANC-LAPIERRE Post-doctorante, INRS-Institut Armand Frappier Little is known about the role of time since diabetes onset, Metformin use, and metabolic syndrome on the inverse relation usually observed between type 2 diabetes mellitus (T2DM) and prostate cancer (PCa). We addressed these issues in a large population-based case–control study in Montreal. Cases were 1937 men with histologically-confirmed incident PCa, aged ≤75 years, diagnosed across French hospitals in the Montreal area between 2005 and 2009. Concurrently, 1995 population controls from the same residential area and age distribution were randomly selected from electoral list of French-speaking men. Detailed lifestyle and medical histories were collected during in-person interviews. Prevalence of T2DM was estimated at 2 years before index date (diagnosis for cases/interview for controls). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between T2DM and PCa risk. T2DM was associated with a reduced risk of PCa (OR=0.60, 95% CI: 0.49-0.74) after adjusting for age, family history of PCa, ancestry, recent PCa screening and education. The ORs were similar for low-grade (Gleason scores lower than 7 or [3+4]) and high-grade (Gleason scores greater than 7 or [4+3]) cases. The association was stronger with Metformin use (OR=0.51, 95% CI: 0.39-0.67), particularly for low-grade PCa (OR=0.44, 95% CI: 0.33-0.60). A more pronounced negative association was also observed between low-grade cases and T2DM diagnosed more than four years before index date (OR= 0.54, 95%CI: 0.42-0.70). The risk decrease persisted among subjects with a history of metabolic syndrome (OR=0.64, 95% CI: 0.49-0.85). The negative association observed between T2DM and PCa concords with previous findings. The lower risks observed with Metformin use and long-standing diabetes, resulting both in a decline in insulin levels, suggest a role of insulin in PCa development. Co-Author(s): Audrey Blanc-Lapierre, INRS-Institut Armand-Frappier, Laval, Quebec, Canada/ Pierre I. Karakiewicz, Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada/ Armen Aprikian, Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada/ Fred Saad, Department of Surgery, Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, Canada/ Marie-Élise Parent, INRS-Institut Armand-Frappier, Laval, Quebec, Canada

C1.2 One cancer or two? The impact of changes to the rules for counting multiple primary cancers on estimates of cancer burden in Ontario Presented by ELISA CANDIDO Senior Research Associate, Cancer Care Ontario In 2014, the Ontario Cancer Registry (OCR) implemented the North American Association of Central Cancer Registries (NAACCR) rules for counting multiple primary (MP) cancers. This study aimed to examine the impact of these rules on cancer incidence estimates in Ontario and describe strategies for handling this change in surveillance analyses. Data on cancers in the OCR for 2010–2011—the period for which NAACCR rules have been implemented—were examined. For comparison purposes, data were converted to the International Association of Cancer Registries (IACR) standards for counting MP cancers. Case counts for all cancers and the most common cancers were calculated by sex and five-year age groups using both the NAACCR and IACR rules. Percentage differences were calculated using the IACR counts as the base. Age-standardized incidence trends were examined for the period 1981–2011 and short-term projections of incidence rates based on historic trends were calculated through to 2015. In 2010–2011, 148,636 cancer cases were registered by the OCR, representing a 5.8% increase in case counts compared with the MP rules previously used. While case counts increased for most cancers, the magnitude of increase varied by cancer type, with the highest percent changes seen for melanoma (15.2%), female breast (13.4%), and colorectal (7.5%) cancer. For most cancers examined and both sexes, percent increases were generally higher in the oldest age groups. To examine incidence trends over time periods that span the implementation of the new MP rules, data from 2010 onwards must be converted to the IACR MP rules. Projections of future incidence will also need to adjust for the impact of this change, accounting for variations by cancer type and diagnosis age. Adopting the NAACCR rules for counting MP cancers has increased the number of cases in the OCR, with variation by age and cancer type. While the number of cancers treated has not changed, understanding the impact of this change is imperative when examining time trends and projecting future cancer incidence. Co-Author(s): Elisa Candido, Cancer Care Ontario/ Stephanie Young, Cancer Care Ontario/ Diane Nishri, Cancer Care Ontario

C1.3 Occupational Cancer Surveillance using the 1991 Census Cohort Presented by PAUL A. DEMERS Director, Occupational Cancer Research Centre, Cancer Care Ontario Canada lacks any ongoing means to assess cancer risks among occupational or industrial groups or associated with specific workplace exposures. The objective of this study was to explore the utility of a linkage of the 1991 Long-Form Census with the Canadian Cancer Registry for occupational cancer surveillance. The cohort was created at Statistics Canada by linking the 1991 Census long-form records with the Canadian Mortality Database, Canadian Cancer Registry, and annual Tax Summary Files. For this study the cohort was restricted to individuals 25 years and older who reported a valid occupation in 1991. Follow-up for cancer incidence was through 2010. The risks of cancer in selected occupations and industries, as well as by exposure to selected carcinogens, were examined. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards modeling, controlling for sex, age, province, and socioeconomic variables. The linkage resulted in a nationally-representative cohort of approximately 900,000 women and 1,108,000 men, representing approximately 15% of the working population, with 186,000 cancers over the 19 years of follow-up. Analyses were able to identify expected excess risks among groups with exposure to known carcinogens, such as lung cancer among male brick and cement workers (HR=1.23, CI=1.07-1.41)(silica exposure), drivers (HR=1.19, CI=1.13-1.25)(diesel exhaust exposure), and miners (HR=1.26, CI=1.09-1.45)(many lung carcinogens), as well as suspected associations, such as among printers (HR=1.21, CI=1.03-1.42) and welders (HR=1.15, CI=1.02- 1.30). Similarly, for prostate cancer previously seen (i.e. firefighters, HR=1.18, CI=1.01-1.37) and unexpected (i.e. other protective services (HR=1.12, CI=1.05-1.19) associations were observed. The cohort is also of sufficient size to examine some of the rarer cancer, such as mesothelioma (650 cases, overall). These analyses have demonstrated that the 1991 Census cohort is a useful means for conducting cancer surveillance for occupations and industries across Canada. Future analyses will focus on the risk of cancer among working women and among targeted groups with occupational exposures to known and suspected carcinogens. Co-Author(s): Jill S. Hardt, Occupational Cancer Research Centre, Cancer Care Ontario/ M. Anne Harris, School of Occupational and Public Health, Ryerson University

33 C1.4 Association between lifetime alcohol consumption and prostate cancer risk: a case-control study in Montreal, Canada Presented by CLAIRE DEMOURY PhD, INRS - Institut Armand-Frappier To study the association between alcohol consumption and prostate cancer (PCa) risk, according to disease aggressiveness, while accounting for time-related changes in alcohol consumption over the lifetime. A case-control study was conducted in Montreal, Canada. 1,933 incident PCa cases aged ≤75 were ascertained across French hospitals between 2005 and 2009, and 1,994 age-matched (±5 years) controls were selected from French electoral lists. Lifestyle and occupational factors were collected during interviews. Lifetime consumption of beer, wine and spirits was elicited, taking into account changes in levels over time. Cumulative intake (drink-years) was calculated for each alcohol type. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for the association between alcohol consumption and PCa, adjusting for age, ancestry, and first-degree family history of PCa. There was no association between overall alcohol consumption and PCa risk. However, the odds ratio for the association between the cumulative intake of beer (per unit of 100 drink-years) and aggressive PCa, defined as a Gleason score of ≥ 7 (4+3), was 1.11 (95%CI 1.01; 1.21). In order to take into account changes in intake levels over time, future analyses will apply a Cox model for population-based case- control studies with time-dependent covariates. The results from the logistic regression models will be compared to those derived from the Cox models. Co-Author(s): Hugues Richard, INRS - Institut Armand-Frappier /Marie-Élise Parent, INRS - Institut Armand-Frappier C2 INFECTIOUS DISEASES III Greenwich Room C2.1 Back to the drawing board: The epidemiological landscape of invasive pneumococcal disease among older adults in Ontario, Canada over the last decade Presented by MICHELLE POLICARPIO Epidemiologist, Public Health Ontario To describe the epidemiology of invasive pneumococcal disease (IPD) among adults 65+ years in Ontario. Confirmed cases of IPD that occurred among persons 65+ years between 2005 and 2014 were extracted from the integrated Public Health Information System (iPHIS). Cases were classified into pneumococcal conjugate vaccine (PCV) 13, unique pneumococcal polysaccharide vaccine (PPV) 23 serotypes (STs) and non-vaccine serotypes (NVSTs). Serotyping was performed by the capsular swelling (Quellung) reaction. Poisson regression was used to assess trends over time. Data were analyzed using SAS and Excel. Between 2005 and 2014, a total of 4,610 IPD cases in adults 65+ years were reported in Ontario. The majority of cases were hospitalized (59.5%) and case fatality was 16.8%. Incidence rates increased from 2005 to 2014 (21.8 to 23.0/100,000). Among those with known immunization status, 64.3% were unimmunized and 35.7% had at least one dose of pneumococcal vaccine. Serotype distribution varied by year. Serotype-specific incidence revealed a significant increase of PCV 13 ST (1.1 to 12.0/100,000; p<.0001) between 2005 and 2010, followed by a decrease in rates (9.8 to 4.9/100,000; p<.0001) from 2011 to 2014. For serotypes unique to PPV 23 and NVSTs there was a significant increase over time (0.7 to 5.2/100,000; p<.0001) and (0.5 to 6.3/100,000; p<.0001) respectively. An overall increase in IPD incidence in adults 65+ years was observed between 2005 and 2014. The epidemiology suggests herd effect related to the decrease in PCV 13 ST since introduction of the infant program. Further research to understand the increase in PPV23 ST as well as NVST is recommended. Co-Author(s): Shalini Desai, Public Health Ontario/ Kenny Wong, Public Health Ontario/ Jill Fediurek, Public Health Ontario/ Vica Dang, Public Health Ontario/ Jonathan Gubbay, Public Health Ontario/ Shelley Deeks, Public Health Ontario

C2.2 Poor adherence to national recommendations could explain the ongoing scabies epidemic in France: cross-sectional study Presented by JACQUELINE GENOW Epidemiologist, Ecole des Hautes Etudes en santé publique (EHESP) The aim of the study was to gain insights into the management practices of scabies cases among general practitioners, paediatricians, and dermatologists in France in terms of diagnosis, prescription of preventive and curative treatments, and clinical follow-up. A cross-sectional survey was administered to private practice physicians in one French region (Brittany). The sample was stratified by type of physician (dermatologists, general practitioners, and paediatricians), urban/rural regions, and by the four departments within the region. A multivariate logistic regression analysis was used to compare physicians’ compliance to the national recommendations concerning treatment and management of scabies. Scabies incidence was estimated at approximately 12,200 new cases between September 2012 and March 2013. Only 34% (95%CI [27.8%, 40.4%]) of physicians follow national recommendations in terms of treatment duration, and 53.2%(95%CI [46.7%, 59.5%]) treat close contacts of a diagnosed case. Dermatologists were the only group, regardless of other factors, who were significantly more likely to comply with national treatment recommendations. Being a general practitioner (OR=0.049, 95%CI [0.01, 0.22]) or a paediatrician (OR=0.056, 95%CI [0.01, 0.32]) was significantly associated with being non-compliant compared to dermatologists. A majority of physicians managing cases of scabies are not in compliance with the national recommendations, which could explain the sustained spread of the parasite. However, many physicians were unaware of the current treatment guidelines and are willing to receive additional information for themselves and their patients. Co-Author(s): Anders Boyd, INSERM UMR_S1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique/ Hélène Tillaut, Institut de Veille Sanitaire-Cire Ouest/ Rémi Demillac, Institut de Veille Sanitaire-Cire Ouest/ Pascal Crepey, Ecole des Hautes Etudes en santé publique

C2.3 The effect of deworming on cognitive, language and motor development in children between one and two years of age in Peru: results from a randomized controlled trial Presented by SERENE JOSEPH Research Associate, McGill University Health Centre The objective of this study is to determine the effect of early childhood deworming on development in a soil-transmitted helminth-endemic area in Peru. This evidence is important in the critical window of growth and development before two years of age. A randomized controlled trial of the benefit of deworming on development was conducted in Iquitos, Peru. Children were enrolled during routine 12-month growth and development visits and randomly allocated to: 1) deworming at the 12-month visit and placebo at the 18-month visit; 2) placebo at the 12-month visit and deworming at the 18-month visit; 3) deworming at the 12 and 18-month visits; or 4) placebo at the 12 and 18-month visits. The Bayley Scales of Infant Development III was used to assess cognitive, language and motor skills at the 12 and 24-month visits. One-way ANOVA analyses used an intention-to-treat approach. Between September 2011 and June 2012, 1760 children were enrolled in the trial. Follow-up of a total of 1563 (88.8%) children was completed in July 2013. Raw scores on all subtests increased over 12 months; however, cognitive and expressive language scaled scores decreased. There was no statistically significant benefit of deworming, or effect of deworming timing or frequency, on any of the development scores. Results were consistent in adjusted, per-protocol and complete case analyses, and in subgroup analysis of malnourished children at baseline.After 12 months of follow-up, an overall benefit of deworming on development was not observed. Continued follow-up may detect longer-term benefits of deworming. Co-Author(s): Serene A. Joseph, McGill University Health Centre/ Martín Casapía, Asociación Civil Selva Amazónica/ Theresa W. Gyorkos, McGill University

C2.4 Probiotics and synbiotics for the prevention of post-operative infections following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials Presented by LYUBOV LYTVYN Student, McMaster University Post-operative infections, particularly surgical site infections, cause substantial morbidity and mortality. A promising novel infection prevention strategy includes probiotic administration, or probiotics combined with non-digestible fibers (synbiotics). In this systematic review we assessed the efficacy and safety of probiotics and synbiotics for preventing infections after abdominal surgery. We searched bibliographic databases and grey literature sources for randomized trials which included participants undergoing abdominal surgery, who were administered probiotics or synbiotics compared to placebo or standard care, and reported on the incidence of post-operative infections. Primary outcomes were surgical site infections and adverse events. Secondary outcomes were respiratory tract infections, urinary tract infections, combined infections, length of hospital stay, and mortality. We used random-effects meta-analyses to estimate the relative risk (RR) and 95% confidence intervals (95%CI). We independently rated the overall quality of evidence for the primary outcomes using the Grading of Recommendations Assessment, Development and Evaluation methods. We identified 20 unique studies with data on 1,374 participants. Seven trials used probiotics and 13 used synbiotics. All studies were conducted in adults. Compared to the control group, probiotics or synbiotics significantly reduced surgical site infections (RR 0.63; 95%CI 0.41-0.98), urinary tract infections (RR 0.29; 95%CI 0.15-0.57), and combined infections (RR 0.49; 95%CI 0.35-0.70). There was no significant difference in adverse events (RR 0.89; 95%CI 0.61-1.30), respiratory tract infections (RR 0.60; 95%CI 0.36-1.00), length of hospital stay (mean difference -1.19; 95%CI -2.94-0.56), or mortality (RR 1.20; 95%CI 0.58-2.48). No serious adverse events associated with the use of probiotics or synbiotics were reported. The overall quality of the evidence for outcomes was low to very low, most often due to risk of bias and imprecision. The use of probiotics or synbiotics in perioperative care reduced the risk of surgical site infections in adult patients undergoing elective abdominal surgerycompared to placebo or standard care, with no difference in adverse events. To overcome uncertainty in estimates, a large well-designed trial is needed. Co-Author(s): Kevin Quach, Department of Clinical Epidemiology and Biostatistics, McMaster University/ Laura Banfield, Health Sciences Library, McMaster University/ Bradley C Johnston, Child Health and Evaluative Sciences, The Hospital for Sick Children Research Institute/ Dominik Mertz, Department of Medicine, McMaster University

34 C2.5 Prevention of Clostridium difficile infection: a systematic review and critical appraisal of clinical practice guidelines Presented by LYUBOV LYTVYN Student, McMaster University Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. Prevention efforts are of high priority, and clinical practice guidelines exist to provide evidence-based recommendations. In this review, we summarized the recommendations and analysed the quality of guidelines on the prevention of CDI in hospitals. We performed an exhaustive search of medical databases and grey literature for guidelines on preventing CDI with a methodology section published January 2004-January 2015. Two reviewers independently screened articles and rated the quality of guidelines using the AGREE II instrument, which is comprised of 23 items within six domains, and an overall score. Each item was rated 1-7, and for each guideline we calculated the score for domains as a percentage of their maximum possible score and standardized range. We extracted and summarized recommendations, including the corresponding risk reduction, when available, and evidence quality using the Oxford Levels of Evidence. Of 2,577 studies screened, five met our inclusion criteria. Three guidelines were from the United States, two from Europe (organization comprising 11 countries), and one from the United Kingdom. All guidelines addressed strategies for CDI prevention in hospitals, such as practicing antibiotic stewardship, implementing additional contact precautions, using hypochlorite solutions for environmental cleaning, administering probiotics as prophylaxis, and applying ‘bundle’ strategies. Across guidelines, the median AGREE II scores and interquartile ranges are as follows: (1) scope and purpose 72.2% (72.2%-80.6%), (2) stakeholder involvement 41.7% (41.7%-44.4%), (3) rigor of development 15.6% (15.6%-36.5%), (4) clarity of presentation 72.2% (69.4%-77.8%), (5) applicability 41.7% (14.6%-45.8%), and (6) editorial independence 62.5% (50%-66.7%). The median overall score for guidelines was 4, and all were classified as “recommended with modifications.” The poorest scores were for rigor of development, due to insufficient links between recommendations and evidence, followed by applicability and stakeholder involvement. The available CDI prevention guidelines did not adhere well to reporting standards endorsed by the AGREE II group, and recommendations were not consistent with the quality of evidence. Co-Author(s): Dominik Mertz, McMaster University/ Faisal Alaklobi, King Saud Medical City/ Behnam Sadeghirad, McMaster University/ Anna Selva, Sant Pau Biomedical Research Institute (IIB Sant Pau)/ Pablo Alonso-Coello, Sant Pau Biomedical Research Institute (IIB Sant Pau)/ Bradley Johnston, Hospital for Sick Children Research Institute C3 SOCIAL DETERMINANTS II Brittania Room C3.1 The effectiveness of population and high-risk individual intervention strategies to reduce population and social inequalities in type 2 diabetes in Canada: a modelling study Presented by BRENDAN SMITH Scientist, Public Health Ontario Prevention strategies that address both the growing burden and observed social inequalities in type 2 diabetes are urgently needed in Canada. The objective was to model the potential effectiveness of population and high-risk individual interventions to reduce both population burden and social inequalities in diabetes over 10 years in Canada. Using the validated Diabetes Population Risk Tool (DPoRT), ten-year diabetes incidence was estimated for respondents to the 2011-12 Canadian Community Health Survey who were over 28 years of age and diabetes free (n=74,444). The intervention benefit was assessed across four levels of education and estimated under two prevention strategies: 1) treating high-risk individuals, defined as obese (body mass index (BMI)>30) or having a 10-year DPoRT risk≥16.5% (threshold that was empirically derived previously), with best practice lifestyle counseling and pharmacotherapy interventions; 2) a hypothetical intervention(s) applied to the entire population that uniformly reduced body weight by 1%, 2% or 3%. In Canada, 10-year diabetes incidence is predicted to be 9.5% in 2021 (n=1,742,067) ranging from 14.1% to 7.4% in the lowest (less than secondary graduation) compared to the highest (bachelor’s degree or higher) education group (risk difference (RD)=6.7%). Compared to no intervention, 2021 diabetes incidence would be reduced by 19% and 22% (lifestyle interventions) or 12% and 13% (pharmacotherapy interventions) by implementing interventions that independently target obese or DPoRT high-risk groups. Population reductions in body weight by 1%, 2% and 3% would reduce diabetes by 3%, 5% and 8% respectively in 2021. Similarly, lifestyle (obese:RD=5.1%; DPoRT risk:RD=3.8%), pharmacotherapy (obese:RD=5.7%; DPoRT risk:RD=4.9%), and population body weight reduction interventions (1%:RD=6.6%; 2%:RD=6.5%; 3%:RD=6.3%) translated into reduced educational inequalities in diabetes comparing the lowest to highest education group. Despite reductions in future diabetes incidence across education, even in the most optimistic scenario social inequalities remained. Further analyses will add additional complexity to the modelled intervention scenarios by quantifying the impact of combined population and high-risk interventions and varying the population coverage of interventions. Co-Author(s): Laura Rosella, Dalla Lana School of Public Health, University of Toronto

C3.2 Relationships between community social capital and injury in Canadian adolescents: a multilevel analysis Presented by AFSHIN VAFAEI Queen’s University Characteristics of social environments are potential risk factors for adolescent injury. The objective of this study was to examine relations between community level social capital and the occurrence of injuries. Secondary objective was to quantify the variations in the occurrence of injuries due to between-school differences. General health questionnaires were completed by 11,371 youth aged 14 years and older as part of the 2010 Canadian Health Behaviour in School-Aged Children study. These were supplemented with community level data from the 2006 Canada Census of Population and objective measurement of built environment factors via Geographic Information System technology. Between-school variations were quantified by calculating Interclass Correlation Coefficient (ICC), Median Odds Ratio (MOR), and 80% Interval Odds Ratio (IOR). Multilevel logistic regression models with random intercepts were fit to examine associations of interest. Analyses were based upon variables that had been validated previously or via factor analysis. Between school differences explained 2% of the variance in the occurrence of injuries (ICC=2%). Along with the MOR of 1.25, this size of between-school variations justified the use of multilevel analysis. The 80% IOR of 0.81-1.49 suggests that variations in the occurrence of injuries are being weakly affected by differences between schools. After adjustment for all true confounders, community social capital did not have any impact on the occurrence of injuries in boys: Odds Ratio (OR): 1.01; 95% Confidence Interval (CI): 0.79-1.29. However, in girls a strong protective effect was observed (OR 0.69; 95% CI 0.55-0.86). Other factors that were significantly related to injuries in both genders were younger age, engagement in more risky behaviours, and negative behavioural influences from peers. After simultaneously taking into account the influence of community and individual level factors, community levels of social capital remained a relatively strong predictor of injury among girls but not boys. Such gender effects provide important clues into the social etiology of youth injury. Co-Author(s): William Pickett, Queen’s University /Beatriz E. Alvarado, Queen’s University

C3.3 The Unequal City: Toronto Public Health’s 2015 report on income and health inequities in Toronto Presented by TREVOR VAN INGEN Epidemiologist, Toronto Public Health In 2008, the Toronto Public Health (TPH) Unequal City report showed that serious differences in health status exist between income groups in Toronto. TPH built on these findings by updating information on the income and health relationship for 19 health indicators and measuring changes in this relationship over 8-12 years. Administrative health, mortality and survey data were analyzed for 19 health indicators. Toronto’s population was divided into equally sized groups according to income level, using area-based low income measure rates from tax records or individual-level self-reported survey data. Age-standardized rates of health status were calculated for each income group for several points in time. Changes in the income and health relationship were quantified by assessing changes in the strength and significance of the Relative Index of Inequality (RII) (a summary measure of socioeconomic inequality) between the earliest and most recent time points. For the most recent time point analyzed, 22 of 34 sex-specific health indicators showed significant income-related health inequities where lower income groups had worse health. Income and heath inequities for men persisted for 14 of 17 health status indicators: the RII for diabetes prevalence increased significantly, the current smoking prevalence RII was significant where previously it had not been, and the colorectal cancer incidence RII was not significant where previously it had been. Income and health inequities for women persisted for 14 of 19 health status measures: The RII for diabetes prevalence and physical inactivity increased significantly, while overweight and obese prevalence, colorectal cancer incidence, and life expectancy RII were not significant where previously they had been. This analysis showed that clear and persistent differences in health status exist between income groups in Toronto. This research provides compelling evidence for developing healthy public policy, advocating for the health needs of low income people, and planning focussed and responsive public health services. Co-Author(s): Trevor van Ingen, Toronto Public Health/ Erika Khandor, Toronto Public Health/ Paul Fleiszer, Toronto Public Health

35 C3.4 Administrative data and Life Course Epidemiology Presented by ELIZABETH WALL-WIELER MSc (Candidate), University of Manitoba Systematic comparisons of the events at different life stages depend on very large number of cases with many variables measured over substantial periods of time. Using high school graduation as an example, this study aims to demonstrate the unique suitability of administrative data to conduct life course epidemiology. Files from the Population Health Research Data Repository at the Manitoba Centre for Health Policy (MCHP), linked across ministries, include information on individual level health and education. A cohort of children born in Manitoba, Canada in 1984-1989 residing in province until age 19 (N = 45 734) were followed to determine the mechanisms by which time-varying predictors influenced the odds of graduating high school. Six distinct models – the full life course model, the accumulation of risk model, the sensitive periods model and three critical period models – were examined for seven time-varying predictor while controlling for a set of background variables. The data proved to give significant insight into how and when events in childhood and adolescence influenced the odds of graduating high school. The models that worked best differed across predictors; each ‘group’ of predictors was best fit using a different model. The full model worked best for the family instability variables (residential mobility and family structure changes), sensitive periods models worked best for externalizing mental conditions (ADHD and Conduct Disorder/ODD) and the accumulation of risk model worked best for major injuries. Two variables were not significant and were removed from the model. These predictors provided a reasonable fit for the outcome (c-statistic = 0.781, Brier Score = 0.13). This study provides a framework and demonstrates the usage of administrative data to conduct life course epidemiology. Administrative data is an invaluable tool for conducting life course research as it is more cost effective than large scale cohort studies relying on surveys and provide more accurate timing of events. Co-Author(s): Elizabeth Wall-Wieler, University of Manitoba/ Leslie Roos, Manitoba Centre for Health Policy/ Dan Chateau, Manitoba Centre for Health Policy

C3.5 Predictors of Employment and Income Assistance Usage in Early Adulthood across Type and Income Quintile Presented by ELIZABETH WALL-WIELER MSc (Candidate), University of Manitoba The objective of this study is to examine differences in predictors of early adult (18 – 25) Employment and Income Assistance (EIA) usage across income quintiles of the neighborhood an individual lives at age 18 and the type of EIA (General Assistance, Single Parent or Disability) that an individual receives. Linked administrative data housed at the Manitoba Centre for Health Policy was used to create a birth cohort of all born in Manitoba, Canada between 1979 and 1987 who lived in the province until their 26th birthday, and lived in an urban neighborhood at age 18 (N = 47 588). Predictors include time-invariant birth and family characteristics and time-varying predictors of family instability, mental and physical health. Odds ratios from logistic regression models were used to compare the importance of these predictors across income quintiles, EIA type and income quintiles within each EIA type. Individuals living in low income neighborhoods at age 18 had the greatest prevalence of using EIA in early adulthood; as income quintile increased, the proportion of those using EIA as single parents decreased and the proportion of those using EIA for disability increased. Childhood/adolescent mental health conditions affected the odds of EIA usage in early adulthood most for those living in high income neighborhoods; family instability affected the odds of EIA usage in early adulthood most for those living in low income neighborhoods. Predictors varied across type of EIA usage, but regardless of type, mental health conditions remained the most significant predictor of EIA usage in early adulthood for those living in high income neighborhoods. The use of EIA in early adulthood is a good indicator of inability to transition successfully into adulthood. Differences in predictors seen in these models suggest programs need to take into account the characteristics and developmental trajectories of individuals from different neighborhoods when addressing EIA uptake in early adulthood. Co-Author(s): Elizabeth Wall-Wieler, University of Manitoba/ Leslie Roos, Manitoba Centre for Health Policy/ Dan Chateau, Manitoba Centre for Health Policy C4 METHODS II Club Studio 3 C4.1 Patient Privacy, Big data, and PoLoR: Using an Old Tool for New Challenges Presented by PARAMITA SAHA-CHAUDHURI Assistant Professor, McGill University Recently, distributed data networks have emerged as a viable resource for medical research. As the use of confidential patient information from such source becomes more common, maintaining privacy of patients is important. For a binary disease outcome of interest, our goal is to propose an approach to analyze distributed data. For a binary outcome, we show that techniques of specimen pooling and {Po}oled {Lo}gistic {R}egression (PoLoR) could be applied for analysis of large and/or distributed data while respecting patient privacy. PoLoR is exactly the same as standard logistic regression, but instead of using individual covariate level, PoLoR uses aggregate covariate level when aggregation is conditional on the outcome status. Aggregate levels of covariates can be passed from the nodes of the network to the analysis center without revealing individual covariate level and can be used with logistic regression for estimation of disease odds ratio for a set of covariates. We demonstrate the approach and compare PoLoR with standard logistic regression using simulated data. Simulations show feasibility of PoLoR and that the results (estimate of log odds ratio, it’s standard error, coverage probability, power and type I error rate) are comparable to the results of standard approach. Also, PoLoR reduces data dimension and simulation studies demonstrate that PoLoR can be used to quickly analyze big data with a binary outcome. PoLoR can be used as an alternate to existing approaches to analyze distributed data and large data.

C4.2 Good practice in the conduct of retrospective data harmonization Presented by MATILDA SALIBA Project manager, Research Institute McGill University Health Center Integrating data from multiple pre-existing studies can be highly challenging due to the inevitable heterogeneity of the information. Retrospective data harmonization, if not applied properly, might lead to substantial data measurement and assessment error. This paper guides the reader through the main steps of retrospective data harmonization. This is a conceptual paper that lists the main steps to retrospective data harmonization. It highlights main elements that ensures validity and transparency of the process and proposes tools and resources that can facilitate its implementation. Harmonization of individual participant data is an iterative process composed of a series of key closely related and inter-dependent steps, including: 1) developing a research protocol to reflect the potential and limitations of the collaborative research project and to clearly define the research question(s) and objectives, 2) selecting participating studies based on a rigorous criteria, 3) defining core variables and assessing the harmonization potential to ensure content equivalence of the harmonized variables to be created across studies, 4) processing study-specific data into common format, and 5) generating harmonized outcome, which entails harmonized dataset(s) and related documentation. The validity of the harmonized outcome is ensured through applying rigorous scientific procedures within each step and providing proper documentation about the quality and content of the harmonized dataset(s). Harmonization allows effective co-analysis (through study level meta-analysis, pooled individual-level data analysis, and/or federated data analysis) and is essential to support scientific progress in multiple contexts. Applying transparent and rigorous harmonization methods will provide a strong foundation upon which to build collaborative and replicable science. Co-Author(s): Isabel Fortier, Research Institute at McGill University Health Center

C4.3 Identifying low frequency variants in genetic association analysis: Prospective vs. retrospective penalized logistic regression Presented by JIHYUNG SHIN Postdoctoral Fellow, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto For many complex diseases, genetic variants of low frequency (minor allele frequency (MAF) <5%) are thought to be important. However, genome-wide association studies (GWAS) usually exclude such variants even when the sample size is moderate (n>1,000). We aim to provide practical recommendations for alternative logistic regression methods in this setting. Because standard logistic regression can fail for low frequency variant counts and/or low disease prevalence, we evaluate Firth’s penalized logistic regression analyses of low frequency variants, through simulation, under two models: (i) prospective model with disease outcome as the response variable and genotype as a predictor variable; and (ii) retrospective model with genotype as the response variable and disease outcome as a predictor variable. For our simulation study, we generate additively coded genotypes (G), a quantitative covariate (X), which may or may not be correlated with G, and disease outcome, varying disease prevalence, minor allele frequency, and genetic effect size. Penalized regression yields finite odds ratio estimates, whereas standard regression can suffer from data separation where odds ratio estimates do not exist. In sparse data settings, the likelihood ratio test of the null hypothesis of no association between genotype and disease status is preferable to the Wald test. Our preliminary results suggest that when genetic and non-genetic covariates are uncorrelated, prospective and retrospective penalized logistic regression approaches have similar performance. Penalized logistic regression, in general, estimates genetic parameters better than the standard logistic regression; and both prospective and retrospective penalized likelihood ratio tests maintain valid type 1 error, while standard logistic regression can have inflated type 1 error. When the genetic and quantitative covariates are correlated, no one approach performs uniformly better. When analyzing low frequency variants, penalized logistic regression is a better choice than the standard regression. We are conducting additional type I error and power comparisons between the prospective and retrospective approaches to identify more clearly the situations in which one type of analysis can be recommended over another. Co-Author(s): Shelley B. Bull, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Dalla Lana School of Public Health, University of Toronto

36 C4.4 Bayesian Adjustment for Confounding in Bayesian Propensity Score Estimation Presented by PABLO GONZALEZ GINESTET Graduate Student, McGill University The objective of this work aims at estimating the average causal effect as a weighted average over different PS by a new strategy in order to overcome the limitation that suffers the previous work with respect to the variable selection problem in the PS, which tends to include covariates that are strongly associated with exposure even if they are not associated with the outcome impacting negatively in the efficiency of the causal estimates. Bayesian methods have been recently applied in estimating causal effects with Propensity Score (PS) methods in order to adjust for observed confounding factors. The two major motivation for Bayesian PS estimation comes from the fact that the Bayesian framework allows to account for two sources of uncertainty: i) the uncertainty regards the PS (an unknown quantity), and ii) the model uncertainty. I propose two approaches for PS variable selection: a two-stage and three-stage modeling. Both approaches are based on specifying three models: (1) the outcome as a function of the potential confounders (the prognostic score model); (2) the exposure as a function of the potential confounders (the PS model), and (3) the outcome as a function of the exposure, the potential confounders and PS (the outcome model). The first stage is shared by both approaches. The different between both approaches lies in the second stage where the first approach combines the PS and outcome model, whereas the second approach only uses the PS model and in its third stage proceed as in the traditional sequential estimation. The key to my approach is the incorporation in the second stage of an informative prior distribution on the selection variable parameter that controls the inclusion of each covariate in the PS, which is obtained from the first stage. This informative prior links the prognostic score model with the PS model. Throughout, I use a Metropolis-Hastings MCMC algorithm for each stage to sample from the posterior distributions. Co-Author(s): Pablo Gonzalez Ginestet, McGill University /Robert Platt, McGill University

C4.5 Methodological challenges in cluster-randomized trials of vulnerable populations with a small number of clusters Presented by BRIANNE WOOD PhD Student, University of Ottawa Cluster-randomized trials, commonly used to evaluate health services or community outreach interventions, raise certain methodological challenges, including the need to account for intracluster correlation. We describe challenges encountered in a community-randomized trial with a small number of communities in a vulnerable population, describe proposed solutions, and discuss their implications. We reviewed the literature on cluster-randomized trials with specific foci on (a) community intervention trials and (b) cluster-randomized trials with a small number of clusters. Ethical and pragmatic challenges of implementing a community-randomized trial were evaluated in the context of working with vulnerable populations. We empirically evaluated the implications of alternative strategies for analysis of dichotomous outcomes, including three cluster-level and three individual-level procedures. We compared results in terms of estimated intervention effects and standard errors. The implications of adjustments for stratification and baseline variables were considered. A participatory action research approach was emphasized as an important strategy to overcome some of the ethical, economic, and sociopolitical challenges of working with vulnerable communities. This collaborative framework encourages participation by members of the community that may lead to an intervention design that is more acceptable to communities. The joint leadership may address ethical and political barriers to participant recruitment, and long-term sustainability of the intervention. Due to randomization of a limited number of communities, imbalances were observed between trial arms. Cluster- and individual-level methods led to effect estimates that were imprecise, with wide confidence intervals. The cluster-level t-test of log odds was selected as the most robust method to compare intervention effects between arms and was preferred to the more conservative permutation test. Participatory action approaches can address some challenges of community-randomized trials in vulnerable populations. Randomization of a limited number of clusters can lead to inadequately powered trials and limit the options for analysis. The choice of primary method should be carefully motivated a priori, and this choice and uncertainties transparently reported. Co-Author(s): Julian Little, University of Ottawa /Monica Taljaard, Ottawa Hospital Research Institute C5 SURVEILLANCE I Graydon D

C5.1 HPV vaccine uptake rates among females aged 9-45 years, Alberta, 2007-2013 by public vs. privately funded vaccine: preliminary findings Presented by LARRY SVENSON Director, Epidemiology and Surveillance, Alberta Health In Alberta, HPV vaccines (licensed for women aged 9-45 years) are publicly funded and have been delivered to females in grade 5 and 9 since 2008/2009. We describe HPV vaccine uptake rates among females aged 9-45 years in Alberta between 2007 and 2013 by age-group and type of vaccine funding. Immunization data for each year by age-group for those who had received publicly funded HPV vaccine were extracted from Alberta’s Immunization and Adverse Reaction to Immunization (Imm/ ARI) repository; data on those immunized with privately purchased vaccines were extracted from Alberta’s Pharmaceutical Information Network (PIN). Population estimates for denominator data were obtained from the Alberta Health Care Insurance Plan Population Registry. Annual age-group specific vaccine uptake rates were estimated as the number of females who received ≥1 doses of HPV vaccine per 100,000 persons by type of funding for vaccine. Between January 1 2007 and December 31 2013, 162,999 females aged 9-45 years received ≥1 doses of HPV vaccine. Uptake rates over the period (ignoring funding source) were highest for those aged 9-14 years followed by those aged 15-19 years. Uptake rates consistently increased each year for those aged 9-14 years (30/100,000 in 2007; 17,469/100,000 in 2010; 29,177/100,000 in 2013) and for those aged 35-45 years (1/100,000 in 2007; 24/100,000 in 2010; 205/100,000 in 2013). This pattern was not consistently observed for those aged 15-34 years. Of those who received any HPV vaccine, 86% received publicly funded vaccine. Annual publicly funded HPV vaccine uptake rates were highest among those aged 9-14 years while privately funded HPV vaccine uptake rates were highest for age-groups 15-24 years. Rates of HPV vaccine uptake increased over the period and were highest among those aged 9-14 years. Uptake rates were much lower among those aged 15 years or older. This is consistent with the targeting of Alberta’s publicly funded HPV immunization program, primarily delivered to school girls. Co-Author(s): Xianfang Liu, University of Calgary/ Chris Bell, Alberta Health/ Kimberley Simmonds, Alberta Health/ Margaret Russell, University of Calgary/ Larry Svenson, Alberta Health

C5.2 Spatial and Temporal Analysis of Chlamydia Trachomatis in Newfoundland and Labrador Presented by ADRIAN GEE Graduate Student, Memorial University of Newfoundland Sexually transmitted infection incidence rates continue to increase in Newfoundland and Labrador with little explanation on origin, location, or risk factors. This study will examine the spatial and temporal distribution of Chlamydia trachomatis in the province. Sex, age, and urban-rural stratified rates will be investigated as well as overall incidence. Confirmed chlamydial infections from 2007-2013 will be obtained from the four provincial health authorities along with demographic information. Population data and chlamydial cases will be indirectly standardized and then aggregated to the level of census subdivision for analysis. Spatial autocorrelation will be assessed using Moran’s I. Spatial clustering will be examined using the spatial scan statistic and space time permutation scan statistic. Seasonal and long term trends will be assessed using Poisson regression to look at the pattern(s) of incidence rates over time in each census subdivision. The temporal analysis will be presented using graphs while spatial analysis will be presented using choropleth maps. Co-Author(s): James Valcour, Faculty of Medicine - Memorial University of Newfoundland/ Shabnam Asghari, Faculty of Medicine - Memorial University of Newfoundland/ Maria Mathews, Faculty of Medicine - Memorial University of Newfoundland

37 C5.3 Getting strategic about infectious disease surveillance: Developing Public Health Ontario’s first Infectious Disease Surveillance Framework Presented by LIANE MACDONALD Public Health Physician, Public Health Ontario In order to develop a strategic approach to infectious disease surveillance at Public Health Ontario (PHO), a working group engaged PHO staff, leaders and clients in a collaborative process to develop a framework for infectious disease surveillance at PHO for 2014-2019. The framework development process involved i) an environmental scan of surveillance strategies in other jurisdictions, ii) establishing a governance structure with a steering committee and a working group with representatives from key client groups (e.g., public health units, health care sector), iii) internal and external consultations using focus groups involving public health and health care sector participants as well as provincial advisory committees, iv) thematic analysis of the consultation data. v) iterative review and validation by working group members to refine key themes and translate these into a framework. The consultation process elicited input from 56 representatives from local, provincial and federal public health and health care sectors, 44 PHO staff and senior management, and three Provincial Infectious Disease Advisory Committees. Four cross-cutting themes form the framework’s four priorities: 1) data quality improvements; 2) acceleration of integrated population health monitoring; 3) transformation of data into accessible information and knowledge to enable policy, program and practice action; and 4) strengthen collaboration and capacity building. The framework identifies supporting strategies and actions for these priorities, and specifies measurable targets for the following areas of infectious disease surveillance in Ontario: antibiotic resistance and use, emerging infectious diseases, healthcare associated infections, laboratory, reportable diseases, and vaccine safety and immunization coverage. Engaging PHO staff, management, and clients in a collaborative process enabled PHO to develop its first Infectious Disease Surveillance Framework. This framework will provide strategic guidance for PHO’s infectious disease surveillance initiatives over the next five years. PHO aims to conduct a formal evaluation of the framework as part of the implementation process. Co-Author(s): Liane Macdonald, Public Health Ontario/ Morgan Barnes, Public Health Ontario/ Tina Badiani, Public Health Ontario/ Natasha Crowcroft, Public Health Ontario/ Doug Sider, Public Health Ontario/ Lisa Fortuna, Public Health Ontario

C5.4 On the generalizability of a statistical natural language processing model for pneumonia surveillance in acute care hospitals Presented by CHRISTIAN ROCHEFORT PhD, McGill University Natural language processing (NLP) models are increasingly used for disease surveillance, but limited information is available on their generalizability. We examined the generalizability of a statistical NLP model for identifying pneumonia from electronic health record (EHR) data. We randomly sampled 4,000 narrative reports of chest radiological examinations performed at a university health network (UHN) in Quebec (Canada) between 2008 and 2012. We manually identified pneumonia within each report, which served as our reference standard. We used a nested cross-validation approach to train and validate a support vector machine (SVM) model predicting pneumonia. This model was then applied to a random sample of 2,281 narrative radiology reports from another UHN in Ontario (Canada), and accuracy was measured. The accuracy of the Quebec model, as applied to Ontario data, was compared to that of two alternative models: 1) a model retrained on Ontario data and; 2) a model trained and validated using all available data (pooled Quebec-Ontario model). On manual review 640 (16.0%) and 303 (13.3%) reports were pneumonia-positive in Quebec and Ontario data, respectively. The SVM model predicting pneumonia on Quebec data achieved 83% sensitivity (95%CI: 78%-88%), 98% specificity (95%CI: 97%-99%) and 88% PPV (95%CI: 83%-94%). When applied to Ontario data, this model achieved 57% sensitivity (95%CI: 51%-63%), 99% specificity (95%CI: 98%- 99%) and 86% PPV (95%CI: 80%-90%). In comparison, the model retrained on Ontario data achieved 76% sensitivity (95%CI: 70%-82%), 98% specificity (95%CI: 97%-99%) and 86% PPV (95%CI: 82%-91%), while the pooled Quebec-Ontario model performed worse than the Quebec model, but better that the Ontario one. The results of this study suggest that a statistical NLP model predicting pneumonia has limited generalizability when it is directly applied to EHR data from another institution. However, once this model has been recalibrated to local data, it can achieve good prediction performances. Co-Author(s):Christian Rochefort, McGill University/ Aman Verma, McGill University/ Alan Forster, The Ottawa Hospital Research Institute/ Tewodros Eguale, McGill University/ David Buckeridge, McGill University Concurrent Sessions D Wednesday, June 3, 2015 - 9:45am - 11:00am D1 CANCER IV South Studio 3 D1.1 Cancer in Ontario Metis people: Risk Factors and Screening Behaviours Presented by LORAINE D MARRETT Sr Scientist, Aboriginal Cancer Control Unit, Cancer Care Ontario To understand the burden of cancer and other chronic diseases in Ontario Métis through a focus on risk factors and screening uptake. Métis people, who represent nearly one-third of Canada’s Aboriginal population, are under-represented in Indigenous health research, so little is known about their burden of chronic diseases, including cancer. The Ontario portion of the Canadian Community Health Survey for 2007-2012 was used to estimate the prevalence of important risk factors for cancer - non- traditional tobacco use; alcohol consumption; inadequate consumption of vegetables and fruit; overweight/obesity; physical inactivity; and sedentary behaviour – as well as participation in breast, cervical and colorectal cancer screening, in both Métis and non-Aboriginal Ontarians. All prevalence estimates were age-standardized to the Ontario Aboriginal identity population (2006 census). Prevalence was examined by sex, age groups and selected socio-demographic characteristics (north vs south residence; level of education; income quintile). Cigarette smoking is common among Métis men (40%) and women (34%), and many non-smokers are exposed to second-hand smoke (over 50% of teens and one third of adults). Relative to non-Aboriginal Ontarians, significantly more Métis both smoke and consume more alcohol than recommended for cancer prevention. Métis adults are 40-60% more likely to be obese than non-Aboriginal Ontarians and nearly 50% are physically inactive during leisure time. Most of these cancer risk factors demonstrate an income gradient with higher prevalence in lower income groups. Fewer Métis women aged 50-74 have been recently screened for breast cancer (49% vs. 61%), especially at ages 50-64 (47% vs. 64%). Rates of cervical screening and colorectal tests are more similar in the two populations. Results indicate that Ontario Métis are at increased risk of cancers associated with tobacco, alcohol and obesity, as well as diabetes, heart and chronic respiratory diseases. Métis Nation of Ontario and Cancer Care Ontario are implementing strategies to reduce the burden of cancer and other chronic diseases in this population. Co-Author(s): Storm J Russell, Healing & Wellness Branch, Metis Nation of Ontario/ Abigail Amartey, Aboriginal Cancer Control Unit, Cancer Care Ontario/ Whitney Montgomery, Healing & Wellness Branch, Metis Nation of Ontario/ Diana R Withrow, Aboriginal Cancer Control Unit, Cancer Care Ontario/ Anna Crosskill, Aboriginal Cancer Control Unit, Cancer Care Ontario/ Brooke Filsinger, Prevention & Cancer Control, Cancer Care Ontario

D1.2 Is there an association between trends in alcohol consumption and cancer mortality? Findings from a multi-country analysis Presented by NAOMI SCHWARTZ Research Associate, Cancer Care Ontario Alcohol consumption is a major preventable cause of morbidity and mortality. The International Agency for Research on Cancer (IARC) has alcohol classified as a “Group 1” carcinogen. This presentation examines long-term trends in apparent alcohol consumption and associations with lagged data on specific types of cancer mortality. Variables of interest include: per capita (age 15+) annual sales of pure alcohol; mortality rate among those aged 25+ for three alcohol-related cancers ― larynx, esophageal, and lip, oral cavity and pharynx; and grams per adult per year of all tobacco products. We focused on countries with over three decades of alcohol sales data; and several decades of cancer data available from IARC mortality database. Analysis focused on 17 countries using a two-step process, using lagged data: tobacco use and specific cancers, and then adding in the alcohol variable. We used the Unobservable Components Model (UCM) for this time series analysis. There was a statistically significant association between alcohol sales and cancer mortality approximately 8 to 10 years later, and this remained after controlling for tobacco use. For example, in France there has been a long-term decline in per capita alcohol consumption (from 26.04/year in 1961 to 11.7 in 2010) and a lagged parallel decline in mortality from cancers of the oral cavity (from 28.3 per 100,000 in 1970 to 16 per 100,000 in 2009) and larynx (from 24.5 per 100,000 in 1970 to 5.2 per 100,000 in 2009). This relationship was significant (p<0.05) after controlling for tobacco use. Significant associations were also observed in other countries with rising, declining or stable trends in alcohol consumption and corresponding lagged trends in mortality from specific cancer types. Preliminary results suggest a significant association between alcohol consumption and mortality from selected cancers of the upper digestive tract after controlling for tobacco use, using an ecological study design. Declining consumption appears to contribute to reduction of mortality from specific cancer types with approximately an 8 to 10 year lag. Co-Author(s): Norman Giesbrecht, Centre for Addiction & Mental Health/ Julie Klein-Geltink, Cancer Care Ontario/ Diane Nishri, Cancer Care Ontario/ Sandrene ChinCheong, Cancer Care Ontario

38 D1.3 Artificial tanning among Ontario adolescents: Pre-legislative patterns, prevalence and beliefs Presented by VICTORIA NADALIN Senior Research Associate, Cancer Care Ontario To establish prevalence of tanning equipment use, location of use (e.g., gym, spa), tanning beliefs and behaviours, and awareness of signage about risks and restrictions, and to determine frequency of tanning service refusal, immediately prior to enactment of Ontario’s Bill-30 banning use of tanning equipment among those under 18. In the spring of 2014 a survey company was contracted to email members of an online panel that completes surveys in exchange for reward points, and identify parents of children in grades 7-12 (under age 18). These parents were asked if their adolescent children would complete an on-line questionnaire. The 15 minute questionnaire included questions about demographics (age, sex, grade), methods used to obtain or keep a tan, the length, frequency and location of tanning bed/lamp use, if tanning services were ever refused and why, awareness and content of signs/warning labels, tanning beliefs and knowledge, and use of eye protection. The response rate was approximately 10%. Of 1,561 participants, 49% were male, 51% female. Seven percent (108) had used tanning equipment. Tanning bed/lamp use increased with school grade, significant for higher grades compared with grade 7, particularly grade 12 [odds ratio (OR)=6.84, 95% confidence interval (CI): 2.75-17.01]. Females were significantly more likely to ever engage in artificial tanning than males [OR=2.66, 95% CI: 1.71-4.17]. Males and females differed significantly regarding other tanning behaviours (e.g. lying in the sun, spray tanning, not tanning). Males were more likely to be refused tanning services than females, however this result was not significant. Over half (53) of those using indoor tanning equipment at commercial establishments noticed warning signs/labels, and most (43) noticed the need for protective eyewear. Another survey of adolescents is planned for May 2015, 12 months following enactment of Bill-30, to examine effectiveness of the Bill, to identify any important changes in tanning behaviours, such as place of use, and to further explore sex differences in this behaviour. Co-Author(s): Loraine Marrett, Cancer Care Ontario/ John Atkinson, Canadian Cancer Society/ Thomas Tenkate, Ryerson University/ Cheryl F Rosen, University of Toronto D2 INFECTIOUS DISEASES IV Greenwich Room D2.1 Probiotics for the prevention of Clostridium difficile-infection in adults and children: an individual patient data meta-analysis Presented by LYUBOV LYTVYN Student, McMaster University Clostridium difficile infection (CDI) causes significant morbidity and mortality. A 2013 Cochrane meta-analysis of randomized trials demonstrated a 64% relative risk reduction in C. difficile among patients administered probiotics concurrently with antibiotics. In this study, we obtained individual patient data to adjust for patient and study level variables. We updated the search, and for eligible trials we contacted a minimum of two authors on three occasions. We will pool individual patient data across trials and conduct a multivariate random-effects model, adjusting for age, hospitalization status and length, pharmacological class and length of antibiotic therapy, multi-strain versus single-strain probiotics, and probiotic dose. The primary outcome will be CDI, and the secondary outcome will be adverse events. We will conduct multiple imputation and plausible worst-case analyses for missing patient data. We will assess overall quality of evidence for each individual outcome using Grading of Recommendations Assessment, Development and Evaluation methods. We identified 32 eligible trials (8,027 patients, 187 cases with CDI), and received responses from 27 (84%) of authors, of which 15 (46.9%) authors agreed to share their anonymized patient data, containing a total of 6,217 patients (77.5%) and 124 (66.3%) CDI cases. Among authors who did not share their data, 5 (15.6%) no longer had access to the data, 3 (9.4%) were not ultimately eligible based on inappropriate outcome criteria, 3 (9.4%) did not respond to follow-up emails, and 1 (3.1%) was unable to share their data due to research ethics board restrictions. We will conduct the individual patient data meta-analysis to assess the effect and safety of probiotic prophylaxis on preventing C. difficile infection. The preliminary analysis of data will be presented at the time of conference. Co-Author(s): Dominik Mertz, Department of Medicine, McMaster University/ Lehana Thabane, Department of Clinical Epidemiology and Biostatistics, McMaster University/ Stephen J Allen, Liverpool School of Tropical Medicine/ Duolao Wang, Liverpool School of Tropical Medicine/ Hania Szajewska, The Medical University of Warsaw/ Mark Miller, McGill University/ John Sampalis, McGill University/ Deniz G Duman, Marmara University/ Pietro Pozzoni, “A Manzoni” Hospital AO Provincia di Lecco/ Agostino Colli, “A Manzoni” Hospital AO Provincia di Lecco/ Elisabet Lonnermark, Gothenburg University/ Christian P Selinger, St. James University Hospital, Leeds/ Sue Plummer, Cultech Ltd/ Mary Hickson, Imperial College London/ Sandra Hirsch, University of Chile/ Bengt Klarin, Lund University/ Li Wang, McMaster University/ Bradley C Johnston, The Hospital for Sick Children Research Institute

D2.2 Influenza vaccine effectiveness in older adults with cardiovascular disease Presented by DEEPIT BHATIA Student, Institute for Clinical Evaluative Sciences To determine the effectiveness of seasonal influenza vaccines against laboratory-confirmed influenza hospitalizations among community-dwelling older adults with a history of cardiovascular disease (myocardial infarction, congestive heart failure, or stroke). The study population comprised community-dwelling adults aged >65 years with pre-existing cardiovascular disease who were admitted to acute care hospitals and tested for influenza using nucleic acid amplification techniques during the 2010-11 to 2013-14 influenza seasons. Results of respiratory specimens tested for influenza by Public Health Ontario laboratories were linked to provincial health administrative data, including hospitalization, immunization, and demographic information. We used the test-negative design and logistic regression to obtain crude estimates of vaccine effectiveness (VE) overall and for each influenza season. VE was defined as 1 – odds ratio of laboratory-confirmed influenza hospitalization by influenza vaccine receipt. Fifty percent (2,509/5,054) of subjects were immunized against seasonal influenza prior to hospitalization, and 23% (1,174/5,054) tested positive for influenza. Compared to test-negative controls, test-positive cases were more likely to be older, female, or have a history of myocardial infarction and stroke, and less likely to have a history of COPD or congestive heart failure. Immunized subjects were more likely to be older, have a history of cancer, congestive heart failure, and COPD than unimmunized subjects. The crude estimate of VE for the four influenza seasons combined was 24% (95%CI: 14%, 33%). Crude season-specific estimates of VE for the 2010-11, 2011-12, 2012-13, and 2013-14 seasons were 44% (95%CI: 28%, 57%), -27% (95%CI: -101%, 20%), 9% (95%CI: -10%, 25%), and 42% (95%CI: 18%, 59%), respectively. These preliminary results suggest that influenza vaccine receipt is associated with modestly reduced risk of laboratory-confirmed influenza hospitalizations among older adults with cardiovascular disease. After incorporating additional laboratory and health administrative data, we will conduct multivariable, subgroup, and sensitivity analyses, including obtaining influenza subtype-specific estimates of VE. Co-Author(s): Michael Campitelli, Institute for Clinical Evaluative Sciences/ Jonathan Gubbay, Public Health Ontario/ Tim Karnauchow, Children’s Hospital of Eastern Ontario/ Dennis Ko, Institute for Clinical Evaluative Sciences/ Allison McGeer, Mount Sinai Hospital/ Susan Richardson, The Hospital for Sick Children/ Andrew Simor, Sunnybrook Health Sciences Centre/ Marek Smieja, McMaster/ George Zahariadis, London Health Sciences Centre/ Jeff Kwong, Institute for Clinical Evaluative Sciences

D2.3 Underreporting of Hepatitis A in Non-Endemic Countries: A Systematic Literature Review and Meta-Analysis Presented by RACHEL SAVAGE Doctoral Student, University of Toronto Routine evaluation of the completeness of infectious disease case ascertainment and reporting is vital to produce accurate estimates of disease burden needed for public health planning and priority setting. We undertook a systematic review and meta-analysis to determine the reporting completeness for hepatitis A in non-endemic countries. Ovid Medline, EMBASE, and grey literature were searched for papers published in English between 1997 and 2013 using keywords and mapped subject headings for disease notification, surveillance, underreporting, incidence, prevalence, epidemiology, travel, non- or low-endemic countries, and hepatitis A search terms. Two authors independently reviewed all articles. Primary studies on hepatitis A surveillance and underreporting in non-endemic countries were included and assessed for risk of bias. The DerSimonian and Laird random-effects model was used to incorporate between-study variance and to pool proportions transformed using a double arcsine transformation. Statistical heterogeneity was assessed using Cochran’s Q statistic and the I2 statistic. Eight studies assessed underreporting by comparing hepatitis A case reports received by public health with hepatitis A cases identified from ≥1 supplementary data source(s) and were included in the review. The majority of studies linked public health reportable disease data with laboratory testing data (n=5) to assess completeness; the three remaining studies used record linkage with hospital discharge data and electronic medical records. Underreporting of hepatitis A was found in all studies (range: 4% to 88%) despite the legal requirement to report cases in each study setting. The overall pooled estimate of reporting completeness was 53% (95% CI 28-77%); however, substantial heterogeneity was observed (Q=891.83, P<0.001; I2=99%). None of the included studies stratified reporting completeness estimates by age, sex or risk group. Given the importance of this data for disease prevention, efforts to improve hepatitis A surveillance are needed. Future research should characterize the degree of underreporting in high risk populations to examine whether public health resources are being equitably allocated, and evaluate the effectiveness of hepatitis A vaccine recommendations. Co-Author(s): Rachel Savage, University of Toronto, Dalla Lana School of Public Health/ Kevin Brown, University of Toronto, Dalla Lana School of Public Health/ Laura Rosella, University of Toronto, Dalla Lana School of Public Health/ Kamran Khan, St. Michael’s Hospital and University of Toronto/ Natasha Crowcroft, Public Health Ontario and University of Toronto

39 D2.4 Controlling Tuberculosis Transmission in Canada’s North: A Mathematical Modeling Study Presented by ASHLEIGH TUITE PhD Student, University of Toronto In Canada, tuberculosis (TB) disease rates remain disproportionately higher among the Aboriginal population, especially among the Inuit in the north. We used mathematical modeling to evaluate how different interventions might enhance existing TB control efforts in a region of Nunavut. We developed a stochastic, agent-based model of TB transmission that captured the unique household and community structure of the region. The model was calibrated to diagnosed pulmonary TB cases in the Kivalliq region of Nunavut between 1999 and 2012. Evaluated interventions included: (i) rapid treatment of active cases; (ii) rapid contact tracing; (iii) expanded screening programs for latent TB infection (LTBI); and (iv) reduced household density. Total diagnosed active TB disease and incident latent TB infections over a 10- year time period in the presence of these different interventions were compared to no additional intervention. Model-projected incidence in the absence of additional interventions was highly variable (range: 33-369 cases) over 10 years. Compared to the ‘no additional intervention’ scenario, reducing the time between onset of active TB disease and initiation of treatment was an effective means of reducing both TB incidence (median reduction: 47%) and diagnoses of active TB disease (median reduction: 19%). Expanding general population screening was also projected to reduce the burden of TB, although these findings were sensitive to assumptions around the relative amount of transmission occurring outside of households. Other potential interventions were expected to be of limited effectiveness. In a region of northern Canada experiencing a significant TB burden, more rapid treatment initiation in active TB cases was the most impactful intervention evaluated. Mathematical modeling can provide guidance for allocation of limited resources in a way that minimizes disease transmission and protects population health. Co-Author(s): Ashleigh Tuite, University of Toronto/ Victor Gallant, Public Health Agency of Canada/ Elaine Randell, Nunavut Department of Health/ Annie-Claude Bourgeois, Public Health Agency of Canada/ Amy Greer, University of Guelph

D2.5 Near Real-Time Monitoring and Forecasting of the West African Ebola Virus Disease Outbreak Using Publicly Available Data Presented by ASHLEIGH TUITE PhD Student, University of Toronto The Ebola Virus Disease (EVD) outbreak in West Africa is unprecedented in magnitude and duration. Monitoring changes in transmission dynamics is critical for planning and evaluation. We used a descriptive mathematical model that accounts for control to characterize and predict the future course of the outbreak in near real time. We used the Incidence Decay with Exponential Adjustment model, which describes epidemic processes in terms of exponential growth, as determined by the basic reproductive number (R0) and simultaneous decay, represented by the control parameter (d), due to processes that slow disease transmission, including behaviour change and public health interventions. Best-fit estimates of R0 and d were derived by fitting model-projected cumulative cases to confirmed, probable, and suspected EVD cases reported by the World Health Organization, using maximum likelihood methods. The model was refit over the course of the epidemic, allowing us to update estimated epidemic final size and peak. The model fit well to available data and generated accurate short-term projections of future EVD cases. For example, fitting to cases reported until 18 September 2014, we projected 9560 (95% CI: 9210-9920) cumulative EVD cases reported by 18 October 2014 versus 9594 reported cases. Projecting cases beyond 6 weeks resulted in less reliable forecasts. Throughout the course of the outbreak, R0 estimates ranged from 1.7-2. Estimated epidemic final size reached a maximum of >300,000 cases when fit to data from early October 2014. The control parameter began increasing in November, with a resulting decrease in projected final epidemic size. Using data to 31 January 2015, we estimated that the epidemic peaked in early January and projected a final epidemic size of approximately 35,000 reported cases. Incorporating real-time data on reported EVD cases allowed us to model the impact of changing control on projected epidemic trajectory. Although the current EVD epidemic appears to be slowing, ongoing control efforts remain critical to prevent resurgence, as small decreases in control can result in dramatic increases in projected incidence. Co-Author(s): Ashleigh Tuite, University of Toronto/ Ashleigh McGirr, University of Toronto/ David Fisman, University of Toronto D3 HEALTH SERVICES I Brittania Room D3.1 The Burden of Biopsy-Proven Pediatric Celiac Disease in Ontario, Canada: Validation of Administrative Data Codes and Determination of Health Services Utilization Presented by JASON CHAN MSc. Candidate, University of Ottawa School of Epidemiology, Public Health and Community Medicine Ontario health administrative data has been used to conduct population-based health surveillance of children with chronic diseases. The main objective of the project is to develop an algorithm to accurately identify cases of biopsy-proven Celiac Disease (CD) in children aged 6 months-14 years old from Ontario health administrative data. All cases of biopsy-proven CD diagnosed 2005-2011 were identified from the Children’s Hospital of Eastern Ontario (CHEO) through retrospective chart review, and linked to the health administrative data to serve as reference for algorithm validation. Case-identifying algorithms based on outpatient physician visits with ICD-9 code for CD plus endoscopy billing code were constructed and tested. The algorithm with highest PPV while maintaining >80% sensitivity was chosen to identify biopsy-proven CD. From the retrospective chart review at CHEO, 115 cases of biopsy-proven CD cases were identified, which represented an incidence rate of 8.7 cases per 100,000 person-years from 2005-2011 in Ottawa; 62 cases (54%) were female patients, and the median age of diagnosis was 7.4 years old (IQR: 4.6-11.1). The use of a single diagnostic code for CD to ascertain cases corresponds to a sensitivity of 88.7% and a PPV of 9.0%. The best algorithm to identify biopsy-proven CD cases from Ontario health administrative data required an endoscopy billing code plus 1 or more adult or pediatric gastroenterologist visits after the endoscopic procedure. The sensitivity, specificity, PPV, and NPV for the algorithm were 70.4%, >99.9%, 53.3% and >99.9% respectively. Preliminary results suggest that Ontario health administrative data may not be suitable in identifying incident CD cases; the poor PPVs of the algorithms increase the risk of misclassification bias, which can lead to an overestimation of the CD incidence rate. Reasons for the poor performances of the algorithms will be discussed. Co-Author(s): David Mack, Children’s Hospital of Eastern Ontario/ Douglas Manuel, Ottawa Hospital Research Institute/ Steven Hawken, Ottawa Hospital Research Institute/ Joseph de Nanassy, Children’s Hospital of Eastern Ontario/ Eric Benchimol, Children’s Hospital of Eastern Ontario

D3.2 Palivizumab for use in infants with cystic fibrosis: A decision analysis model Presented by ASHLEIGH MCGIRR PhD Candidate, Dalla Lana School of Public Health, University of Toronto Children with cystic fibrosis (CF) are at higher risk of severe respiratory syncytial virus (RSV) infection. Palivizumab (PMB) effectively prevents RSV hospitalizations; however, the high cost of PMB limits its widespread use. We assess the effectiveness and cost-effectiveness of PMB prophylaxis in CF children less than 2 years of age. A Markov cohort model of CF disease and infant RSV infections was developed based on data from the literature. Infants were treated with monthly PMB injections over the five-month RSV season. Lifetime health outcomes, quality-adjusted life years (QALYs) and costs, discounted at 5%, were estimated from the Canadian healthcare payer’s perspective. Findings are summarized as incremental cost-effectiveness ratios (ICERs) and budget impact. Deterministic sensitivity analysis was conducted to assess parameter uncertainty. Implementation of a hypothetical RSV prophylaxis program resulted in ICERs of $652,560 (all CF infants) and $157,331.55 (high-risk CF infants) per QALY gained and an annual budget impact of $1,400,000 (all CF infants) and $285,000 (high-risk CF infants). The analysis was highly sensitive to the probability of severe RSV, the degree of lung deterioration following infection, and the cost of PMB. While not considered cost-effective by commonly used thresholds, PMB prophylaxis may be considered for select CF infants given the potential long-term health benefits and relatively small budget impact. Co-Author(s): Kevin Schwartz, The Hospital for Sick Children, Division of Infectious Disease. University of Toronto, Institute for Health Policy, Management, and Evaluation/ Upton Allen, The Hospital for Sick Children, Division of Infectious Disease. The Hospital for Sick Children, Division of Respirology/ Melinda Solomon, The Hospital for Sick Children, Division of Respirology/ Beate Sander, University of Toronto, Institute of Health Policy, Management, and Evaluation. Public Health Ontario. Institute for Clinical Evaluative Sciences

40 D3.3 Cost-Utility Analysis of Gene Xpert MTB/RIF® for Diagnosing Pulmonary Tuberculosis (TB) Presented by SHOGHAG KHOUDIGIAN Full time graduate student, McMaster University Diagnosing active TB is time-consuming and resource-intensive. Patients with suspected active TB are isolated for up to seven days while awaiting diagnosis by smear microscopy, the current gold standard. Gene Xpert®MTB/RIF is a new, more sensitive diagnostic test, for which results are available within two hours. In high-incidence settings, using Xpert® is cost-effective. We investigated the economic value of using Xpert® in Canada, a low-incidence setting. A decision-tree was constructed to compare the costs and QALYs of the current TB diagnostic algorithm(smear,culture) to an algorithm using Xpert®(Xpert®,culture) in individuals with suspected active TB. The analysis was conducted from a Ministry of Health perspective over a three-year time horizon. One-way and probabilistic sensitivity analyses were conducted to investigate the effect of the uncertainty of included parameters on outcomes. Compared to the current algorithm, the algorithm with Xpert® resulted in lower total healthcare costs per patient ($16,551CAD vs $22,322CAD), and improved health outcomes (2.84QALYs vs 2.81QALY). In terms of cost-effectiveness, Xpert® was the dominant strategy (lower costs, more QALYs). The probabilistic sensitivity analysis demonstrated that incorporating Xpert® to the current algorithm would be cost- effective over a wide range of WTP values. Our study found that incorporating Gene Xpert®MTB/RIF into the diagnostic algorithm would be less expensive and result in slightly better patient health than current practice. However, we used United States Xpert® cost since Canadian cost was not available, and did not include potential costs and outcomes associated with TB transmission that may occur during diagnostic delay. Co-Author(s): Lytvyn Lyubov, McMaster University/ Bernice Tsoi, McMaster University/ Dominik Mertz, McMater University/ Gord Blackhouse, McMaster University; Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph’s Healthcare/ Daria O’Reilly, McMaster University; Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph’s Healthcare

D3.4 Characteristics of Canadian mothers who report difficulty accessing health care for their infant: findings from the Maternity Experiences Survey Presented by ALISA FITISOVA MSc. Student, York University The aim of this study was to determine the characteristics of Canadian mothers who report difficulty accessing non-routine health care for their infant. Data for this secondary analysis was drawn from the Maternity Experiences Survey (MES), a cross sectional, nationally representative survey that assessed peri- and post-natal experiences of mothers aged 15 and above who had singleton live births between November 2005 and May 2006, and lived with their infant at the time of survey administration. Surveys were conducted when infants were between 5 and 9 months old. A multivariable logistic regression analysis was conducted to determine characteristics associated with reporting difficulty, with difficulty defined as a mother reporting it being somewhat or very difficult to access a health care provider. Analysis of 2832 mothers who had to contact a health care provider for their infant found that 13% had difficulty accessing that provider. Factors associated with increased difficulty were: mother being an immigrant (OR 1.58, 95% CI: 1.10-2.27), living in Quebec (OR 1.89, 95% CI: 1.31-2.73), having a mistimed pregnancy (OR 1.44, 95% CI: 1.05–1.98), a self-reported ‘too-short’ postpartum hospital stay (OR 1.69, 95% CI: 1.21–2.35), less than optimal health (OR 1.88, 95% CI: 1.43–2.47) , low social support (OR 1.69, 95% CI: 1.05–2.73) and postpartum depression symptoms (OR 1.55, 95% CI: 1.02–2.37). Additionally, having a normal weight infant at birth (OR 2.43, 95% CI: 1.02–5.82), was associated with reporting difficulty. This was the first national, population based study to examine maternal characteristics associated with infants’ poor health care access. Demographic, maternal, health service and infant characteristics were found to negatively affect infants’ health care access. Co-Author(s): Alisa Fitisova, School of Kinesiology and Health Science, York University, Toronto, ON, Canada/ Christy Costanian, School of Kinesiology and Health Science, York University, Toronto, ON, Canada/ Hala Tamim, School of Kinesiology and Health Science, York University, Toronto, ON, Canada D4 CHRONIC DISEASES II Club Studio 3 D4.1 POPULATION-BASED EPIDEMIOLOGY OF AMYOTROPHIC LATERAL SCLEROSIS (ALS) IN AN AGEING EUROPE – THE FRENCH REGISTER OF ALS IN LIMOUSIN (FRALIM REGISTER) Presented by BELLO HAMIDOU PhD Student, UMR 1094 INSERM NEUROÉPIDÉMIOLOGIE TROPICALE (NET) The main objective of establishing the French register of amyotrophic lateral sclerosis (ALS) in the Limousin region (FRALim) was to assess the incidence of ALS, in this ageing region of Europe, over a 12-year period (2000–2011). Patients were included if they lived in Limousin at the time of diagnosis of ALS according to El Escorial revised criteria and were identified by at least one of the following sources: (i) the French national body coordinating ALS referral centers; (ii) public and private hospitals in the region; (iii) health insurance data related to long-term diseases. Medical administrative data resulted in verification of diagnosis by a neurologist. A capture–recapture method was used to assess the exhaustiveness of case ascertainment. This study has been approved on the regulatory side by the CNIL and CCTIRS and ethically by CPPSOOM-IV. The FRALim register identified 279 incident cases (2000–2011). The crude and European population standardized incidences of ALS were as high as 3.19/ 100 000 person-years of follow-up (95% CI 2.81–3.56) and 2.58/100 000 person-years of follow-up (95% CI 2.27–2.89) respectively. Median age at onset was 70.8 years (interquartile range 63.1–77.1). Onset was bulbar in 33.1%. At the time of diagnosis, 17.6% were classified as definite ALS. The standardized sex incidence ratio (man/woman) was 1.3 overall, but 1.1 under the age of 65 years, 1.7 between 65 and 75 years and 1.9 above 75 years. The exhaustiveness of the register has been estimated at 98.4% (95% CI 95.6–99.4) by capture–recapture analysis. It was possible for the first time in France to monitor accurately the incidence of ALS over a long time period. It appears to be in the upper range of data reported in western countries. Patterns displayed here might anticipate the epidemiology of ALS in ageing western countries. Co-Author(s): Bello Hamidou, INSERM UMR1094, Neuroépidémiologie Tropicale, Limoges/ Philippe Couratier, CHU Limoges, Service de Neurologie, Centre SLA, Limoges/ Marie Nicol, CHU Limoges, Service de Neurologie, Centre SLA, Limoges/ Aurelie Delzor, INSERM UMR1094, Neuroépidémiologie Tropicale, Limoges/ Farid Boumediene, INSERM UMR1094, Neuroépidémiologie Tropicale, Limoges/ Pierre-Marie Preux, INSERM UMR1094, Neuroépidémiologie Tropicale, Limoges/ Benoit Marin, INSERM UMR1094, Neuroépidémiologie Tropicale, Limoges

D4.2 The Incidence of Parkinson’s Disease: A Systematic Review and Meta-Analysis Presented by LAUREN HIRSCH MSc Candidate, Epidemiology, University of Calgary Parkinson’s disease (PD) is a common neurogenerative disorder that becomes increasingly prevalent with age. We sought to synthesize studies on the incidence of PD to obtain an overall view of how the incidence of this disease varies by age and sex. We searched MEDLINE and EMBASE for epidemiological studies of PD incidence from 2001 to 2014. Data were abstracted and analyzed using a standardized procedure and the quality of the included articles was assessed. We analyzed the data by age group and sex. A random-effects model was used to calculate the pooled incidence rate per 100,000 person-years. Meta-regression was then used to determine if age-specific estimates are significantly different between males and females. For studies where the period of time over which new cases developed was not reported, incidence estimates were compiled separately as incidence proportions rather than incidence rates. Twenty-seven PD incidence studies were included. . Meta-analysis of the data showed a rising prevalence of PD with age in both sexes. For females, pooled estimates of PD incidence rates were (all per 100,000): 2.45 in 40-49 years, 8.63 in 50-59 years, 31.3 in 60-69 years, 96.59 in 70-79 years, and 128.38 in 80+ years. For males, PD incidence rates were (all per 100,000): 3.73 in 40-49 years, 16.08 in 50-59 years, 59.86 in 60-69 years, 163.4 in 70-79 years, and 297.22 in 80+ years. Similar trends were observed in the incidence proportion meta-analysis. Males had significantly higher PD incidence rates in the 60-69 (p=0.003) and 70-79 age groups (p=0.04) and small, non- significantly higher PD incidence rates in all other age groups. There is a steady increase in PD incidence with age. In contrast to a previous study, we found higher incidence rates in males. Our data analysis found considerable heterogeneity of results between studies of older age groups (80+). Further research into the potential causes of these phenomena should be considered. Co-Author(s): Alex Frolkis, University of Calgary/ Nathalie Jette, University of Calgary/ Thomas Steeves, University of Toronto/ Tamara Pringsheim, University of Calgary

41 D4.3 Exploring the potential effect of immunomodulators on digital ulcer formation for scleroderma patients: a retrospective cohort study Presented by BRIAN YOUNHO HONG Student, University of Ottawa As part of the skin involvement in scleroderma, digital ulcers present a major cause of pain and functional impairment. This study uses the prospective data accumulated by the Canadian Scleroderma Research Group to investigate the role of immunomodulators for preventing the development of digital ulcers in patients with scleroderma. Prospective clinical and demographic data from adult scleroderma patients are collected annually from 15 CSRG treatment centers. Laboratory parameters, self-reported socio-demographic data, current and past medications and disease outcome measures are recorded. Data were analyzed using multivariable logistic regression and generalized estimating equations (GEE) to determine whether immuno-modulators can be preventative against development of digital ulcers at least once during the study period and development of digital ulcers in scleroderma patients, respectively. Sensitivity analyses were conducted after propensity score analysis and Markov chain Monte Carlo multiple imputation (MI). Covariates such as gender, disease subset and skin score were used. Data from 1010 of 1487 patients within the CSRG database were included in the analysis. Immunomodulators had no significant effect on the development of at least one digital ulcer: odds ratio (OR) of 0.77 (95% confidence interval [CI]: 0.57 – 1.05). Results of propensity score and MI sensitivity analyses did not change the findings. Also, there was no significant effect on immunomodulator and development of digital ulcers: OR = 0.93 (95% CI: 0.75, 1.15). Although it seems to be beneficial, this study found that immunomodulators use and its preventative effect on digital ulcers in patients with scleroderma is not statistically significant. Co-Author(s): Brian Younho Hong, Faculty of Medicine, University of Ottawa/ Ellen McDonald, St. Joseph’s Healthcare, Hamilton/ Gary Foster, Department of Clinical Epidemiology and Biostatistics, McMaster University/ Maxime Rheaume, Division of Rheumatology, McMaster University/ Nader Khalidi, Division of Rheumatology, McMaster University/ Maggie Larche, Division of Rheuamtology, McMaster University/ Lehana Thabane, Department of Clinical Epidemiology and Biostatistics, McMaster University

D4.4 Safety and Efficacy of Incretin-based Therapies in Patients with Type 2 Diabetes Mellitus and Renal Impairment: Systematic Review and Meta-analysis Presented by PATRICIA HOWSE MSc (Medicine) Candidate, Memorial University of Newfoundland We conducted a systematic review and meta-analysis to investigate the safety and efficacy of incretin-based therapies (dipeptidyl peptidase-4 inhibitor and glucagon-like peptide-1 receptor agonist) in patients with type 2 diabetes and moderate to severe impaired kidney function. Two reviewers independently screened studies identified through bibliographic databases (Cochrane Library, Pubmed, Embase, IPA), trial registries, and references from pertinent articles and clinical practice guidelines. Eligible studies included randomized controlled trials, irrespective of language or publication status, evaluating incretin-based medications in adults with type 2 diabetes and an estimated glomerular filtration rate <60 mL/min/1.73m2. Primary outcomes were change in glycolated hemoglobin (HbA1c) and hypoglycemia. Secondary outcomes included all-cause mortality, fasting plasma glucose, cardiovascular events, and end-stage renal disease (ESRD). Random effects models were used to calculate weighted mean differences (WMD) for continuous outcomes, and relative risks (RR) for dichotomous outcomes. Of 899 non-duplicate records screened, 13 studies were included. Compared to placebo, incretin-based therapies significantly reduced HbA1c (n=8; WMD -0.53; 95%CI -0.64, -0.42; I2=0%); however, they did not reduce HbA1c compared to active comparators (AC) (n=6; WMD 0.11; 95%CI -0.15, 0.37; I2=71%). Incretin-based therapies were not associated with hypoglycemia (Placebo control [PC]: n=8; RR 0.73; 95%CI 0.36-1.47; I2=66%; AC: n=6, RR 0.75; 95%CI 0.30-1.90; I2=38%). Incretin-based therapies were not associated with an increased or decreased risk of mortality (PC: n=5; RR 1.02; 95%CI 0.50-2.06; I2=0%; AC: n=5; RR 0.76; 95%CI 0.39-1.47 I2=0%), myocardial infarction (PC: n=5; RR 1.02; 95%CI 0.50-2.06; I2=0%; AC: n=4; RR 0.76; 95%CI 0.39-1.47 I2=0%), stroke (PC: n=2; RR 1.02; 95%CI 0.50-2.06; I2=0%), or ESRD (PC: n=2; RR 1.02; 95%CI 0.50-2.06; I2=0%). Incretin-based therapies are effective in reducing HbA1c, without causing hypoglycemia, relative to placebo in patients with reduced kidney function. More data is needed to precisely quantify associations with all-cause mortality, cardiovascular events, and ESRD. Co-Author(s): Lyudmila Chibrikova, Memorial University of Newfoundland/ Brendan Barrett, Memorial University of Newfoundland/ Laurie Twells, Memorial University of Newfoundland/ John-Michael Gamble, Memorial University of Newfoundland D5 REPRODUCTIVE HEALTH II Graydon D D5.1 Smoking habits and gestational weight gain patterns: a novel approach using piecewise mixed-effects models Presented by ADAM HULMAN Postdoctoral Fellow, McMaster University, Departments of Obstetrics & Gynecology Excess gestational weight gain, that affects women after smoking cessation, is associated with adverse perinatal outcomes. We aimed to compare weight gain patterns by smoking status for the first time using serial antenatal weight measurements, in order to avoid the bias that exists with conventional assessment based on single measurements. Participants (n=509) were recruited from seven obstetric/midwifery clinics in Southwestern Ontario, between May and September 2013. We analyzed 1,503 serial antenatal weight gain measurements obtained from patients’ medical charts with a piecewise linear mixed-effects model. Two linear segments were specified in the model with a breakpoint at the end of the first trimester. The interaction of timing variables and smoking was included in the model to explore differences in weight gain trajectories by smoking status. First trimester weight gain and weekly rate for the rest of the pregnancy were calculated as linear combinations of coefficient estimates using model contrasts. Women who never smoked and those who quit gained a similar amount (P=0.31) in the 1st trimester, while those who smoked during pregnancy gained double (3.5 kg, 95% CI: 2.4-4.6). In the 2nd and 3rd trimesters, women who quit smoking gained weight the most rapidly (0.60 kg/week, 95% CI: 0.54-0.65), which was 0.11 kg/week (95% CI: 0.05-0.17) and 0.21 kg/week (95% CI: 0.12-0.29) faster than women who never smoked and who smoked, respectively. Despite different patterns of weight gain in women who never smoked and those who smoked during pregnancy, both groups gained approximately 14 kg by the end of the 39th week of pregnancy. In contrast, women who quit smoking gained on average 16.7 kg (95% CI: 15.1-18.4) during the same period. Longitudinal analysis of serial antenatal weight gain measurements revealed patterns that cannot be captured with conventional analysis. Large epidemiological studies with serial measurements are needed to advance knowledge on factors driving gestational weight gain. Women who quit smoking should be targeted with interventions to reduce their gestational weight gain. Co-Author(s): Olha Lutsiv, McMaster University, Department of Obstetrics & Gynecology/ Christina Park, McMaster University, Department of Clinical Epidemiology & Biostatistics/ Lynette Krebs, McMaster University, Department of Clinical Epidemiology & Biostatistics/ Joseph Beyene, McMaster University, Department of Clinical Epidemiology & Biostatistics/ Sarah McDonald, McMaster University, Departments of Obstetrics & Gynecology; Radiology; Clinical Epidemiology & Biostatistics

D5.2 Risk factors for preterm birth: refugee status and secondary migration Presented by SUSITHA WANIGARATNE Post Doctoral Fellow, St. Michael’s Hospital To determine whether the relationship between refugee status (refugees vs. other immigrants) and preterm birth (PTB) differed among secondary migrants, those who lived in a transition country prior to migrating to Canada, and primary migrants, those who migrated to Canada directly from their country of birth. Linked Ontario immigration (2002-2010) and hospitalization data (2002-2010) were used for the analysis. Random effects models for ordinal outcomes (22-31, 32-36 and 37-41 weeks gestation) were used to estimate adjusted cumulative odds ratios (COR) with 95% confidence intervals (95% CI). A product term incorporating refugee status and secondary migration addressed the study objective. Secondary refugees experienced 58% greater cumulative odds of PTB (COR=1.58, 95% CI=1.25-2.00) when compared to secondary non-refuges, which was substantially larger than the 12% greater cumulative odds of PTB (COR=1.12, 95% CI=1.02-1.23) among primary refugees compared to primary non-refuges. Secondary and primary refugees experienced higher risk of PTB compared to their non-refugee counterparts, with secondary refugees experiencing the largest excess risk. Future research may consider examining the role of psychosocial factors and chronic stress in understanding the difference. Co-Author(s): Susitha Wanigaratne, St. Michael’s Hospital/ Donald Cole, University of Toronto/ Kate Bassil, Toronto Public Health/ Ilene Hyman, University of Toronto/ Rahim Moineddin, University of Toronto/ Marcelo Urquia, St. Michael’s Hospital

42 Concurrent Sessions E Wednesday, June 3, 2015 - 1:00pm - 2:15pm E1 CANCER V South Studio 3 E1.1 An evaluation of glyphosate use and the risks of non-Hodgkin lymphoma major histological sub-types in the North American Pooled Project (NAPP) Presented by MANISHA PAHWA Research Associate, Occupational Cancer Research Centre, Cancer Care Ontario Glyphosate is among the most commonly used herbicides worldwide. Some epidemiological studies have linked exposure with the development of non-Hodgkin lymphoma (NHL), a cancer encompassing several sub-types with distinct risk factors and etiologies. This study aimed to evaluate possible associations between glyphosate exposure and NHL risks for major histological sub-types. The NAPP, composed of pooled case-control studies from the U.S. and Canada, includes NHL cases (N=1690) and controls (N=5131) who provided information on pesticide use. Histopathologically confirmed cases (follicular lymphoma [FL]: N=468; diffuse large B-cell lymphoma [DLBCL]: N=647; small lymphocytic lymphoma [SLL]: N=171; other: N=404) from cancer registries and hospitals were frequency-matched to population- based controls. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) by ever/never; duration (years); frequency (days/year); and lifetime days (years*days/year) of glyphosate use. Models were adjusted for age, sex, location, proxy respondent, family history of lymphatohematopoietic cancer, and personal protective equipment. Cases who ever used glyphosate (N=133, 7%) had elevated risk of NHL overall (OR=1.51, 95% CI: 1.18, 1.95) compared to controls. The highest risks were observed for individuals with “other” sub-types (OR=1.91, 95% CI: 1.20, 3.04). Subjects who used glyphosate for >5 years had increased risk of developing SLL (OR=2.58, 95% CI: 1.03, 6.48). Handling glyphosate for >2 days/year was also associated with significantly elevated risks of NHL overall (OR=2.66, 95% CI: 1.61, 4.40) and FL (OR=2.36, 95% CI: 1.06, 5.29), DLBCL (OR=3.11, 95% CI: 1.61, 6.00), and other (OR=2.99, 95% CI: 1.10, 8.09) sub-types, but not SLL (OR=2.34, 95% CI: 0.67, 8.20). There were suggestive increases in NHL risks overall with greater lifetime days of glyphosate use but this trend was statistically insignificant (p=0.0653). This study provides some evidence that glyphosate use may be associated with an increased risk of NHL and that these effects may differ by histological sub-type. Results, however, were not entirely consistent across the different exposure metrics and some exposure-response trends were not statistically significant. Co-Author(s): Manisha Pahwa, Occupational Cancer Research Centre / John J. Spinelli, BC Cancer Agency / Laura Beane Freeman, U.S. National Cancer Institute/ Paul A. Demers, Occupational Cancer Research Centre/ Punam Pahwa, University of Saskatchewan/ James A. Dosman, University of Saskatchewan/ John R. McLaughlin, Samuel Lunenfeld Research Institute/ Shelley A. Harris, Cancer Care Ontario/ Investigators of the U.S. National Cancer Institute Case-Control Studies (Aaron Blair, Shelia Hoar Zahm, Kenneth P. Cantor, Dennis D. Weisenburger)

E1.2 Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49 year olds, 1969-2010 Presented by PARTH PATEL Epidemiology Student, University of Toronto The overall incidence of colorectal cancer in Canada has been decreasing. However, recent evidence from some countries show that the rates have been increasing in those under the age of 50. This research analysis aims to study the trends in incidence rate of colorectal cancer and associated lifestyle risk factors in Canadians aged 15-49 years. Incidence data for colorectal cancer and its subsites were obtained for the years 1969-2010 from the Canadian Cancer Registry and trends in age- standardized incidence rates were examined using Joinpoint regression by age groups and sex. Trends in prevalence of certain risk factors of colorectal cancer were similarly examined using data from national health surveys conducted in Canada from 1970 to 2012. The age-standardized incidence rates (ASIR) of colorectal cancer have increased by 6.7% annually from 1997-2010 for 15-29 year olds. The ASIR rose by 2.4% per year from 1996-2010 for those aged 30-39 years and increased by 0.8% per year from 1997-2010 for 40-49 year olds. Similar trends were observed in each sex independently. The rise in ASIR has been more rapid for cancers of the rectum/rectosigmoid region compared to colon cancers for all age groups. Trends in the prevalence of risk factors of colorectal cancer show that the prevalence of excess weight has risen significantly in the past three decades for all age groups. The prevalence of fruit and vegetable consumption has increased slightly, alcohol consumption changed little, smoking rates have dropped significantly for all age groups and physical inactivity rates have remained high. The ASIR of colorectal cancer in young Canadians has been increasing since the mid-1990’s. The rising prevalence of excess weight and, to a lesser extent the moderately high levels of physical inactivity have likely played a role in the rising incidence rates. Greater vigilance of colorectal cancer symptoms and an emphasis on healthy living are prudent approaches to curb the rising incidence of colorectal cancer in young people. Co-Author(s): Parth Patel, University of Toronto/ Prithwish De, Cancer Care Ontario

E1.3 Profiling Cancer within select Ontario Aboriginal Reserves Presented by MAEGAN PRUMMEL Senior Research Associate, Cancer Care Ontario Objective: Several Aboriginal communities in Ontario have requested cancer profiles to assist in priority setting and planning. Unfortunately, Aboriginal ethnicity is not captured by the Ontario Cancer Registry (OCR) and the only geographic identifier is postal code. We will identify and evaluate approaches for creating Aboriginal community cancer profiles. Several Aboriginal communities in Ontario have requested profiles of cancer among their populations to assist in priority setting and planning. Our objective is to identify and evaluate approaches for creating accurate and useful Aboriginal community cancer profiles from the Ontario Cancer Registry (OCR). Methods: Postal code at diagnosis from the OCR can be used to allocate cancer cases to a particular area, and population estimates can be obtained from the Canadian census. This approach is compatible for communities in areas of Ontario where postal codes are more likely to map directly to Aboriginal reserve boundaries. Since many Aboriginal reserves are small and/or located in areas where reserve postal code(s) also cover substantial off-reserve areas, other or modified approaches are needed. Consultation with the community of interest is required to determine the approach that is most valuable. Preliminary Results: We will report on our evaluation of various methodological approaches unique to each community. For one Aboriginal reserve, we successfully prepared a cancer profile using a postal code that mapped with reasonable accuracy to the reserve. Overall cancer incidence was similar to the Ontario population, although there were significantly fewer prostate cancers and more lung cancers. To increase sample size, diagnosis years were combined, although results that can be released under small numbers guidelines are still limited. Feedback from the reserve was extremely positive and our results were useful for their priority setting. Conclusions: Our enhanced approaches to creating cancer profiles may provide accurate and useful information for community planning. Co-Author(s): Maegan Prummel, Cancer Care Ontario/ Abigail Amartey, Cancer Care Ontario/ Diane Nishri, Cancer Care Ontario/ Stephanie Young, Cancer Care Ontario/ Loraine Marrett, Cancer Care Ontario

E1.4 Determinants of screening accuracy of visual inspection for cervical cancer with acetic acid (VIA) and lugol iodine (VILI) performed by nurse and physician Presented by AMIDU OLALEKAN RAIFU PhD Student, Department of Epidemiology and Biostatistics, University of Western Ontario Visual inspection with acetic acid (VIA) and lugol iodine (VILI) are routinely used to screen women for cervical cancer in low-resource settings. We examined the determinants of the diagnostic accuracy of VIA and VILI, performed by trained nurses and a physician, in detecting cervical precancerous lesions. 1528 women aged 30 years and older were screened for cervical cancer with VIA and VILI applied independently by trained nurses and physician in a cross-sectional screening study, conducted in Kinshasa, Democratic Republic of Congo (2003-2004). Separate logistic regression models were fitted using the Coughlin model to estimate the sensitivity and specificity of VIA and VILI by nurses and physician. The models were adjusted for the following covariates: age, parity, colposcopy with biopsy, age at first sexual intercourse, number of lifetime sex partners, history of sexually transmitted diseases, menopausal status, medical consultation, history of Pap test, cytology and HPV DNA. Overall positivity rate varied: nurses (VIA: 36.3%; VILI: 26.2%) and physician (VIA: 30.2%; VILI: 25.2%). The sensitivity was higher among younger women based on the measurement by nurses (VIA: 82%; VILI: 77%) and physician (VIA: 93%; VILI: 93%) with lower specificity (VIA: 54%; VILI: 72%) and (VIA: 64%; VILI: 72%) respectively. Women with high parity had higher sensitivity by nurses (VIA: 77%; VILI: 74%) and physician (VIA: 90%; VILI: 90%) with lower specificity (VIA: 63%; VILI: 74%) and (VIA: 70%; VILI: 76%) respectively. There was higher sensitivity for women with HPV DNA positive based on the measurement by nurses (VIA: 78%; VILI: 75%) and physician (VIA: 92%; VILI: 92%) with lower specificity (VIA: 59%; VILI: 71%) and (VIA: 58%; VILI: 64%) respectively. Younger women, high parity, HPV DNA test positivity, pre-menopausal status, and cytology test with Atypical Cells of Undetermined Significance cut-off were the determinants of the diagnostic accuracy of VIA and VILI performed by nurses and a physician. Co-Author(s): Mariam El-Zein, Division of Cancer Epidemiology, Department of Oncology, McGill University/ Ghislain Sangwa-Lugoma, Department of Obstetrics & Gynaecology, University of Kinshasa, Kinshasa, Democratic Republic of Congo/ Ramanakumar Agnihotram, Division of Cancer Epidemiology, Department of Oncology, McGill University/ Stephen D. Walter, Department of Clinical Epidemiology & Biostatistics, McMaster University/ Eduardo L. Franco, Division of Cancer Epidemiology, Department of Oncology, McGill University

43 E2 ENVIRONMENTAL HEALTH I Greenwich Room E2.1 Effect of farming environment on childhood asthma incidence in Canada: Results from the National Longitudinal Survey of Children and Youth Presented by MARC PARSONS MSc student, School of Public Health, University of Alberta Asthma is a common chronic disease among children. Some studies have suggested that living in a farming environment protects against asthma, the hygiene hypothesis postulating a mechanism for this effect. This cohort study examined the association between living environment and asthma incidence. Data from the National Longitudinal Survey of Children and Youth conducted by Statistics Canada were considered. Starting at the baseline in 1994-95, follow-up occurred biennially until either the end of the study in 2008-09, the child reached 25 years of age, or loss-to-follow-up. Data were collected from interviewer-administered questionnaires that were completed by the person most knowledgeable of the child for children less than 16 years old or by the child themselves otherwise. Living environment was categorized as non-rural, rural residential, or rural farming at baseline from the questionnaire. Weighted Cox’s regression was used to estimate hazard ratios. After excluding children with pre-existing asthma or wheeze and those missing information on living environment, data for over 10,900 children were included. Children in a non-rural living environment had a cumulative asthma incidence of 16.50% over the 14-year follow-up while rural residential and rural farming children had 13.12% and 10.18%, respectively. Rural farming living environment was found to have a strong protective effect in comparison to non-rural for asthma incidence after adjusting for potential confounders (HR = 0.58; 95% CI: [0.43, 0.80]) while living in a rural residential environment had a weaker effect (HR = 0.79; 95% CI: [0.62, 1.02]). Other factors found to be associated with asthma include number of older siblings, child ever-allergy, family asthma history, and dwelling needing repairs. This population-based longitudinal study suggests that living in a rural farming environment reduces the childhood risk of developing asthma. The results from this study add to the evidence supporting the hygiene hypothesis. Co-Author(s): Marc Parsons, School of Public Health, University of Alberta/ Ambikaipakan Senthilselvan, School of Public Health, University of Alberta/ Jeremy Beach, Faculty of Medicine and Dentistry, University of Alberta

E2.2 Prenatal maternal blood mercury is associated with childhood BMI Presented by MORTEZA BASHASH Research fellow, University of Toronto Increased Body Mass Index (BMI) has been shown to be associated with child and adulthood chronic conditions such as Coronary Heart Disease. Several studies have reported genetic and environmental factors associated with BMI, however little is known about the effect of exposure to environmental toxicants during critical early-life periods. This study tests the hypothesis that prenatal mercury exposure is associated with offspring BMI during mid-childhood. We examine 230 mothers –child pairs (460 individuals), recruited from within the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort based in Mexico City. Blood mercury was measured at each trimester of pregnancy and averaged to reflect representative prenatal exposures. BMI was measured during a follow-up visit when children were aged 7-12. Bivariate and multivariate association of prenatal mercury level (log-transformed) and BMI were analysed using Generalized Linear Models. All models were run as combined samples and stratified based on subject’s sex. Both bivariate and multivariate analysis indicated significant association (p<0.01) between prenatal mercury level and child BMI. Multivariate analysis adjusted for categorical (child sex, cohort number, birth order, fish consumption) and numerical (maternal caloric intake at deliver, age of child at measurement, age of mother at birth, maternal education, weight and height of child at birth and gestational age) variables. Stratified analysis showed that observed associations have been seen in girls group (p<0.01) but not in boys. We observed a direct association between prenatal mercury exposure and child BMI. Our observation may be interpreted mercury’s oxidative stress effect at prenatal exposure that contributes to increased fat mass gain during childhood. Further studies are needed to characterize the underlying mechanisms. Co-Author(s): Morteza Bashash, University of Toronto/ Niladri Basu, McMaster University/ Karen Peterson, University of Michigan/ Brisa Sanchez, University of Michigan/ Zhenzhen Zhang, University of Michigan/ Siying Huang, University of Toronto/ Lourdes Schnaas, National Institute of Public Health, Mexico/ Alejandra Cantoral-Preciado, National Institute of Public Health, Mexico/ Martha Maria Téllez-Rojo, National Institute of Public Health, Mexico/ Howard Hu, University of Toronto

E2.3 Development of an exposure database as a key component in a new research platform Presented by PAUL A. DEMERS Sr. Research Associate, Occupational Cancer Research Centre (CCO) & Dalla Lana School of Public Health (U of T) The creation of quantitative exposure databases is a key component in the development of occupational epidemiology. The use of quantitative exposure data results in decreased exposure misclassification and facilitates the modeling of exposure-response relationships. This abstract describes the Ontario Mining Exposure Database as part of a larger mining research platform. The OCRC has worked closely with the Ontario Ministry of Labour (MoL) and others to locate and retrieve exposure data from the mining industry. Hard copy data is now being entered into a secure electronic database, including mining-specific data such as information on ore type(s) and whether the sample was collected above or underground. The database is part of a larger platform for mining and health research that includes a prospective Ontario mining cohort with detailed job history information for approximately 93,000 workers. The OMED will be used to assess occupational exposure in this large prospective occupational cohort study. The collected paper records are believed to include over 100,000 exposure measurements for at least seventeen agents covering the time period of approximately 1960 to 1990. Almost 40,000 measurements have been entered to-date. The five most common exposures present in the database to-date are: dust n.e.c (49.6%), silica (18.0%), radon (16.4%) carbon monoxide (5.8%) and nitrogen dioxide (4.6%). The OMED will be used to construct a series of job-exposure matrices (JEMs) that can be used to assign quantitative job and time-period specific exposure estimates to subjects in the Ontario mining cohort; a significant improvement to previous exposure assessment methodology in this cohort. The use of this data in epidemiological analyses will result in decreased exposure misclassification and less attenuation in risk estimates. Once complete, this database will be used to describe the historical exposures in Ontario mining operations and will be used for exposure assessment in epidemiological studies of occupational cancer in the mining industry. These results will help target prevention efforts to have the greatest impact on workers’ health. Co-Author(s): Katherine J. Jardine, Occupational Cancer Research Centre, Cancer Care Ontario, Toronto ON/ Nancy E. Lightfoot, School of Rural and Northern Health, Laurentian University, Sudbury ON/ Leon J. Genesove, Occupational Health and Safety Branch, Ontario Ministry of Labour, Toronto ON/ Paul A. Demers, Occupational Cancer Research Centre, Cancer Care Ontario, Toronto ON

E2.4 Shift workers and day workers: Comparing cortisol production among female hospital employees Presented by ELEANOR HUNG BScH; Master’s Candidate, Queen’s University To compare cortisol production between current shift workers and day workers, and to determine if current and/or cumulative duration of shiftwork exposure are associated with total cortisol levels, or its diurnal pattern. Studies have shown an association between shiftwork and CVD, but a mechanism has not been determined. This study explores changes in cortisol production as a potential mechanism. We conducted a cross-sectional study between September 2011 and February 2014. We recruited female employees from a tertiary acute care teaching hospital in Kingston (n=328). A questionnaire was used to ascertain shiftwork exposure. Urine samples were collected at every void over a 48-hour period and lab analyses determined free cortisol levels. Graphs and mixed modeling will be used to determine how cortisol production differs according to day work and shiftwork exposure. In our descriptive analysis of 24-hour, creatinine-adjusted urine cortisol curves, we found that current exposure to shiftwork results in an acute decrease in peak cortisol levels, and a less pronounced decrease from the peak in comparison to day workers. Preliminary unadjusted results also suggest that there is an acute increase in 24-hour cortisol production for current shift workers when compared to current day workers (p-value=0.0001), and a difference in the diurnal pattern of production (p=0.003). They also suggest that shiftwork impact may be long-term. Participants with greater than 6 years of shiftwork exposure have significantly higher total cortisol production over a 24-hour period in comparison to those with less than 6 years of exposure (p-value=0.01), but there is no significant difference in diurnal patterns (p-value=0.93). Next, confounders will be controlled using a mixed model, and we will consider the impact of cumulative duration of shiftwork exposure. Our study is large, observational, and one of the few that considers both current and long-term exposure as a potential risk factor for CVD. Co-Author(s): Joan Tranmer, Queen’s University/ Kristan Aronson, Queen’s University/ Andrew Day, Queen’s University/ Renee Corbin, Queen’s University

44 E3 Brittania Room E3.1 Will baby boomers overload the health care system? An age-period-cohort analysis of physician visits in Canada Presented by MAYILEE CANIZARES MSc., University of Toronto There is concern that the aging baby boomer population will overwhelm the healthcare system. We examine the use of health services by baby boomers and their older and younger counterparts by comparing the age-trajectories of physician visits (primary care (PCP) and specialists) across six birth cohorts. Data from the Longitudinal National Population Health Survey (1994-2010) were used. We compared birth cohorts born in six decades from 1925-34 to 1975-84 (n = 11,260) with particular focus on baby boomers (older baby boomers, born 1945-1954 and younger baby boomers, born 1955-64). Multilevel growth models were used to estimate the age-trajectory for the number of visits to physicians overall, to PCP and to specialists accounting for cohort, period, enabling (sex, education), predisposing (income, having a regular doctor, unmet healthcare needs, area of residence), need (self-rated health, chronic conditions, disability), and lifestyle factors (obesity, physical activity, sedentary behavior, smoking). There were significant differences in the overall number of visits to physicians by birth cohort (p<0.0001) so that, at the same age, younger cohorts made fewer overall visits to physicians. There were also differences in the number of visits to PCP and to specialists by birth cohort: younger cohorts made fewer visits to PCP and more visits to specialists than older cohorts. The overall age-trajectories of PCP and specialist visits were J-shaped. The effect of period was significant but small. Predictors of both PCP and specialist visits were being female, predisposing and need factors. In contrast, visits to specialists were less affected by lifestyle factors. The effect of these factors did not substantially change the effects of age, cohort, and period. Overall baby boomers make fewer physician visits than the two older cohorts, but made more visits to specialists. Given the government impetus in refocusing services to primary healthcare, a concerning finding is that every successive younger cohort make fewer visits to primary care and instead see specialists. Co-Author(s): Elizabeth M Badley, University of Toronto/ Sheilah Hogg-Johnson, Institute for Work & Health/ Monique Gignac, Institute for Work & Health/ Richard Glazier, Institute for Clinical Evaluative Sciences

E3.2 Integrating Qualitative and Quantitative Studies describing Patient-Centered Outcomes to Develop a Questionnaire: A Meta-Synthesis Approach Presented by SHABNAZ SIDDIQ MSc. Student, University of Ottawa We sought to develop a questionnaire for parents of children with inherited metabolic diseases (IMD) participating in a national research program. The questionnaire’s purpose is to ascertain families’ experiences with managing illness and navigating the health care system that are most relevant to include as patient/family-reported outcomes when evaluating interventions. We used an adapted meta-synthesis approach to integrate the findings of previous work, including: a scoping review that identified the outcomes most widely used in studies of chronic pediatric conditions; a qualitative study of the perceptions of patient support organizations regarding the most important concerns for families; and a literature scan of qualitative and quantitative studies specific to the field of IMD. Through an iterative, consensus-based compare and contrast exercise, we identified the key similarities and differences across these findings. We also identified areas requiring further investigation, to be pursued through an ongoing qualitative study with parents of affected children. Outcomes that appeared consistently across the synthesized components (e.g., health- related quality of life, mental health for the child and parents, and family functioning), and those that were hypothesized as important priorities from the work related specifically to rare diseases (e.g., diagnostic challenges, uncertainty about prognosis, challenges in interacting with the health care and education systems) are being incorporated into the questionnaire, using established, validated instruments and/or items where possible. Areas requiring further investigation (e.g., the importance of transitions to school and in adolescence, the role of parenting styles, and parents’ expectations from treatment) are being probed through ongoing qualitative research. Once the questionnaire is drafted, it will be evaluated using cognitive interviews with parents of affected children prior to implementation in our full national sample. We developed an adapted meta-synthesis method for integrating diverse research findings to prioritize content for a questionnaire. While the approach was designed specifically to measure patient-reported outcomes for evaluative research in the field of pediatric IMD, these methods may be valuable in research contexts requiring data synthesis from multiple sources. Co-Author(s): Brenda Wilson, University of Ottawa/ Ian Graham, University of Ottawa/ Sara Khangura, University of Ottawa/ Kylie Tingley, University of Ottawa/ Beth Potter, University of Ottawa

E3.3 Cross-sectional small area variation study of cancer, glucose, and cholesterol screening in Ontario Presented by KIMBERLY FERNANDES Senior Research Analyst, Institute for Clinical Evaluative Sciences Screening for cervical, breast, and colon cancers, and elevations of cholesterol and glucose, reduces premature cause-specific mortality. Despite promotion strategies aimed at primary care providers and individuals, participation is suboptimal. This work aims to provide information to motivate strategies to improve participation at the small area level. Using healthcare administrative databases, we conducted a cross-sectional analysis of 6,656,632 individuals eligible for each test, and participation, in each of 18,951 dissemination areas (referred to as small areas) in Ontario in 2011. We calculated rates for each test, and all tests combined, among small areas, stratified by sex, demographic, socioeconomic, and primary care descriptors. Continuous variables were categorized by small area such that those among the 0-10th and 90-100th percentiles were categorized as levels of high and low deprivation respectively. Screening prevalence ratios (PR) were calculated comparing participation rates among small areas with low vs. high deprivation levels. Among small areas, mean participation in all tests combined among women is 31.6% (SD 11.0), median 31.9%, IQR (25.0, 38.8), and among men is 41.2% (SD 12.0), median 42.2%, IQR (34.4, 49.1). Median screening prevalence among small areas for all tests combined, stratified by women and men respectively, increased with increasing percent of persons with high school completion (PR 1.49 and 1.35), increasing income quintile (PR 1.54 and 1.45), and increasing percent of persons with an identifiable physician (PR 1.40 for both women and men). Similar trends were seen for each individual test. These data show major small area variations in participation associated with factors of demography, deprivation, barriers and primary care. We suggest community- and primary-care-based strategies focus on small areas where rates of participation are lower, rather than strategies that collectively target ‘average risk’ individuals. Co-Author(s): Rinku Sutradhar, Institute for Clinical Evaluative Sciences/ Cornelia Borkhoff, Institute for Clinical Evaluative Sciences/ Nancy Baxter, Institute for Clinical Evaluative Sciences/ Aisha Lofters, Institute for Clinical Evaluative Sciences/ Linda Rabaneck, Institute for Clinical Evaluative Sciences/ Jill Tinmouth, Institute for Clinical Evalulative Sciences/ Lawrence Paszat, Institute for Clinical Evalulative Sciences

E3.4 Guideline Variability Index (GVI): Measuring Variability in Recommendations among Different Clinical Practice Guidelines Presented by JEMILA HAMID Scientist, St, Micheal’s Hospital Clinical practice guidelines (CPGs) bridge the gap between research and evidence-based practice. CPGs on the same topic should ideally include similar recommendations, but studies have described variability among CPGs. We propose a method for quantifying variability in CPGs and provide a statistical framework for identifying factors associated with this variability. We used data from CPGs in pediatric bronchiolitis to address our objective. Recommendations from CPGs were first categorized depending on whether a particular therapy is: recommended for, is optional, recommended against, not discussed or the guideline developers explicitly abstain from making a recommendation. We adapted a method based on the concept of leverage to develop a guideline variability index (GVI) for conditions and the corresponding recommendations, as well as calculated the contribution of each CPG to the variability. Preliminary results indicate that variability in CPGs exists in pediatric bronchiolitis (GVI value range 0-4.8; mean 1.81[SD = 1.57]). Analysis of leverage to the GVI indicates that topic level factors rather than guideline factors are associated with variability in CPGs, where the value of GVI for the different topics is clustered into two groups (mean GVI in cluster one range 0-1.5; in cluster two range 2-5). Findings for bronchiolitis CPGs indicate that more effort should be placed in generating evidence around certain topics to help reduce variation in patient care. The GVI proposed here is a first attempt in quantifying variability in CPGs and allows statistical analysis for identifying factors that might be associated with variability. Co-Author(s): Leigh Anne Bakel, Hospital for Sick Children/ Monika Kastner St. Micheal’s Hospital, / Joycelyne Ewusie, McMaster University/ Kai Liu, McMaster University/ Joseph Mussa, McMaster University/ Eyal Cohen, Hospital for Sick Children/ Patricia Parkin, Hospital for Sick Children/ Sharon Straus, St. Micheal’s Hospital

45 E4 MENTAL HEALTH I Club Studio 3 E4.1 The First-Contact Incidence of Schizophrenia Among Immigrants and Refugees in Ontario Presented by KELLY ANDERSON Assistant Professor, The University of Western Ontario International research suggests that migrant groups have an increased risk of schizophrenia, and the magnitude of risk varies by country of origin. Epidemiological information among migrants to Canada is lacking. We sought to examine the first-contact incidence of schizophrenia for immigrants and refugees in Ontario, relative to the non-migrant population. We constructed a retrospective cohort that included all people between 14 and 40 years of age residing in Ontario as of April 1, 1999. Population-based administrative data from physician billings and hospitalizations were used to identify incident cases of schizophrenia over a ten-year follow-up period. These data were linked to data from Citizenship and Immigration Canada, which allowed us to identify new migrants within our cohort. We used Poisson regression models to calculate age- and gender-adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) for immigrant and refugee groups over a ten-year period. We found higher rates of schizophrenia among immigrants from the Caribbean and Bermuda (IRR = 1.60, 95%CI = 1.29-1.98). We found lower rates of schizophrenia among immigrants from Northern Europe (IRR = 0.50, 95%CI = 0.28-0.91), Southern Europe (IRR = 0.60, 95%CI = 0.41-0.90), and Eastern Asia (IRR = 0.56, 95%CI = 0.41-0.78). Refugee status was an independent predictor of the risk of schizophrenia among all migrants (IRR = 1.27, 95%CI = 1.04-1.56), and higher rates of schizophrenia were found specifically for refugees from East Africa (IRR = 1.95, 95%CI = 1.44-2.65) and South Asia (IRR = 1.51, 95%CI = 1.08-2.12). The differential pattern of risk across ethnic subgroups suggests that psychosocial and cultural factors associated with migration and integration into Ontario may contribute to the risk of schizophrenia. Particular immigrant and refugee groups may be at highest risk, whereas others are protected. Co-Author(s): Joyce Cheng, Centre for Addiction and Mental Health/ Ezra Susser, Columbia University/ Kwame McKenzie, Centre for Addiction and Mental Health/ Paul Kurdyak, Centre for Addiction and Mental Health

E4.2 Neighborhood’s social capital and depressive symptoms among immigrants: results of two studies in Toronto Presented by NASIM HAQUE Lecturer, Ben-Gurion University of the Negev Objectives: Social capital (SC) is considered a critical component of healthy communities. Few studies examined associations between neighborhood social capital types (bonding, bridging and linking) and depressive symptoms (DS). We aim at examining these associations among immigrants residing in randomly selected neighborhoods versus a single low-income, immigrant receiving neighborhood (IRN). Methods: We draw on data from two studies of Toronto neighborhoods that asked the same questions: the Neighborhood Effects on Health and Wellbeing (NEHW) study conducted in 47 randomly selected greater Toronto area (GTA) neighborhoods, (weighted sample=1465); and a study of one low-income, immigrant receiving neighborhood (IRN) where English was not the first language of participants recruited (weighted sample, =601). Depressive symptoms (DS) measured by the Epidemiologic studies Depression Scale (CES-D), was regressed in multivariable models with each of the types of social capital: bonding (social cohesion and informal social control), bridging (group membership) and linking (engagement in political activities). Results: The prevalence of DS was 22.9% in IRN and 21.4% in NEHW. Low levels of SC types were found in IRN and high levels in NEHW. Immigrants in IRN had low income (67%), high unemployment (63%) but high education (50%). They were less Eng. proficient (80%) and lived less years in Canada (78%). Immigrants in NEHW had high SEP and language proficiency and lived more years in Canada. Lower social cohesion and bridging SC were associated with higher levels of DS in NEHW only. Odd ration, OR (95% Confidence intervals, CI)=0.91(0.87,0.95) and 1.43(1.09, 1.89) respectively. In both samples, linking social capital (never participated in political activities) contributed to lower risk of depression also after adjustment; OR(95% CI)= 0.60(0.39,0.93) in IRN and 0.61(0.45,0.84) in NEHW. Conclusions: SC types relate differently to the risk of DS in the two samples. This suggests that SC might have protective effect against DS among immigrants in GTA neighborhoods. In IRN social isolation might increase the DS risk. Higher DS among immigrants who reported more political activity require more research. Co-Author(s): Patricia O’Campo, Centre for Research on Inner City Health, St. Michael Hospital/ Nasim Haque, Wellesley Institute, Toronto, Ontario, Canada/ Meiyin Gao, Wellesley Institute, Toronto, Ontario, Canada/ Rosane Nisenbaum, Centre for Research on Inner City Health, St. Michael Hospital/ Carles Muntaner, University of Toronto, Toronto ON Canada

E4.3 Policy Framework of Diversion Opportunities for Individuals with Mental Illness within the Criminal Justice System Presented by CARA ELLIOTT Student, University of Ottawa We sought to analyze the flow of mentally ill individuals through societal institutions to identify nodes at which they may be diverted back into the community. Our goal was to develop a conceptual framework for policy development relevant to Canada’s mental health sector. A systems and network thinking approach was informed by literature sources, with special attention to existing health policy frameworks which could be modified to suit specific mental health needs. Case studies were then applied to test the validity of the resulting framework. Three primary opportunities for diversion into the community were identified and have been deemed a “Diversion Sector”: pre-charge diversion, non-disclosure of mental health information on police record checks, and post-charge diversion. A conceptual framework is being constructed around the Diversion Sector, comprising of six pillars: 1) health workforce, 2) health information, 3) leadership/ governance, 4) medical technologies, 5) service delivery, and 6) health financing. Preliminary results suggest that opportunities exist to enact policies to reduce the over-representation of individuals with mental illness within the criminal justice system, thus reducing overall costs and improving community health. Co-Author(s): Raywat Deonandan, University of Ottawa

E4.4 The Influence of Computer Mediated Communication Use on the Well-Being of Canadian Adolescents Presented by LINDSAY FAVOTTO Student, Queen’s University Social communication and relationships are increasingly being navigated by handheld and laptop devices along with social media platforms. The proposed study aims to determine quantitatively if the frequency of daily computer mediated communication (CMC) is associated with loneliness in Canadian adolescents grades 6-10 and if so, whether the relationship is mediated by the quality of relationships young people have with parents or peers. Further, through qualitative analysis the potential impacts of CMC on adolescent health will be investigated. Co-Author(s): Colleen Davison, Queen’s University / Valerie Michaelson, Queen’s University

E4.5 Dementia associated mortality risk among older adults in Sub-Saharan Africa:Results of a two-year follow-up in the EPIDEMCA study Presented by SAMBA HARIELLE PHD, student, Inserm U1094, Tropical Neuroepidemiology Previous cohort studies among older adults suggest that people with dementia or cognitive impairment (MCI) had a shorter survival time than non-demented people. We assessed the link between dementia and mortality among a Congolese elderly cohort from the EPIDEMCA (Epidemiolgie des Démences en Afrique central) study after 2 years of follow-up. A longitudinal population-based study was carried out in rural and urban Congo between 2012 and 2014 in order to follow-up yearly the older adults included in the EPIDEMCA study. Participants were traced and interviewed. DSM-IV and NINCDS-ADRA were required for dementia and Alzheimer ‘s disease diagnoses, MCI was diagnoses according to Petersen’s criteria. Data on vital status were collected at each visit trough an oral interview and verbal autopsies were performed when the older person was deceased and reliable informant available. Multivariate logistic regression model was used to asses the link between dementia and mortality. Of 1029 participants at baseline, there were 791(76.87%) people without cognitive impairment, 56(5.44%) with MCI, 63 (6.12%) with dementia and 119 without clinical diagnosis. After two years of follow-up 101 (9.8%) participants were died. Compared to people without cognitive impairment, MCI and dementia have a higher mortality risk. After adjusting for age and sex, mortality risk for people with MCI or dementia was still significantly increased( Odds Ratio [OR]=2.77, 95% CI: 1.88-4.06, P<0.001). This risk increased more than two-fold among those with dementia (OR= 2.88, 95% CI: 1.23-6.23, p=0.015), while the risk was not significantly increased for MCI group (OR=1.31, 95% CI:0.47-3.62, p=0.06). Furthermore, age(per 5 year increase (OR: 1.37, 95% CI: 1.31-1.65, p=0.001) and Low Brachial Index (ABI less or equal to 0.90) (OR: 1.86, 95% CI :1.04-3.30,p=0.034) at baseline were independently associated with increased mortality risk. Among Congolese older adults , dementia is associated to an increased mortality risk. These results suggest that the impact of dementia on life expectancy in low and middle income countries is worthy of attention. Co-Author(s): Harielle SAMBA, Inserm, U1094, Tropical Neuroepidemiology, Limoges France/ Maëlenn Guerchet, King’s college London, Centre fro Global Mental Health, Institute of Psychaitry,Psychology and Neuroscience,Health Servive and Population Research Departement,London UK/ Bebene Ndamba Bandzouzi, Dept of Neurology, Brazzaville University Hospital, Brazzaville, Republic of Congo/ Pascal Mbelesso, Dept of Neurology, Amitié Hospital, Bangui, Centrafrican Republique/ Philippe Lacroix, CHU, Departement of Cardiovascular Surgery,F-87000,Limoges France/ Jean François Dartigues, Inserm U897, Victor Segalen Bordeaux II University, Bordeaux France/ Pierre-Marie Preux, CHU, CEBIMER, Limoges France

46 E5 SURVEILLANCE II Graydon D E5.1 Temporal trends of feline retroviral infections diagnosed at the Ontario Veterinary College (1999-2012) Presented by OLAF BERKE Associate Professor of Statistical Epidemiology, Population Medicine, U of Guelph It is speculated that the seroprevalence of feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) infection are evolving differently over time. The objectives of this study were to assess a) the temporal trends in the seroprevalence of these infections and b) the effect of vaccine introduction on FIV seroprevalence. The monthly seroprevalence of FIV and FeLV based on positive tests performed from 1999-2012 at the Ontario Veterinary College (OVC) were modeled as a function of trend (linear and quadratic functions), seasonality (first and second degree harmonics) and known risk factors (age, sex and neuter status) using Poisson regression and generalised linear autoregressive moving average (GLARMA) time series regression (α = 0.05). To assess the effect of the vaccine introduction to control FIV, an intervention term (dichotomous variable) was added to indicate periods without (1999-2002) and with vaccine availability (2003-2012). The overall seroprevalence for the time period was 4.5% and 3.3% for FIV and FeLV, respectively. The monthly seroprevalence ranged from 0-44.0% and 0-33.3% for FIV and FeLV, respectively. Poisson and GLARMA regression models provided no evidence for a secular trend, seasonal effect or a statistically significant FIV vaccine intervention effect. However, the proportion of males among the tested cats was a significant predictor for FIV seropositivity (RR=1.01 (95% CI: 1.01, 1.03), P= 0.02). There was no evidence to indicate that FIV and FeLV seroprevalence are declining among population served by OVC. Further, FIV vaccine introduction did not have an effect on seroprevalence of FIV. Co-Author(s): Bimal Chhetri, Population Medicine, University of Guelph/ Olaf Berke, Population Medicine, University of Guelph/ David Pearl, Population Medicine, University of Guelph/ Beverly McEwen, Animal Health Laboratory, University of Guelph/ Dorothee Bienzle, Pathobiology, University of Guelph

E5.2 Occupational Cancer Surveillance: Linking workers’ compensation claims to the Ontario Cancer Registry Presented by JILL HARDT Research Associate, Occupation Cancer Research Centre, Cancer Care Ontario Canada collects information on new cancers through provincial and national registries, but these data lack work history information for occupational cancer surveillance. A pilot study linking Ontario Workplace Safety and Insurance Board (WSIB) claims (N=981,320) to Ontario Cancer Registry (OCR) files (N=1,801,930) estimated work- related cancer burden among Ontario workers. A 20% sample of 1975-2011 WSIB claims were linked with 1964-2012 OCR records through probabilistic record linkage to (a) assess the feasibility of record linkage for occupational cancer surveillance and (b) estimate occupational cancer burden among Ontario workers. This pilot study tested known and suspected occupational associations with cancer. Descriptive analyses examined counts and rates of cancer by occupation and industry. Using cancer-free survival analysis we estimated hazard ratios (HRs) by industry and occupation groups for any cancer and 7 selected cancers including common types such as breast and lung, and rarer cancers such as sino-nasal and mesothelioma. Despite data quality issues that improved over time, the pilot project demonstrated the feasibility of this linkage, and probabilistic methods yielded a substantial number of successful links. 69,673 WSIB workers were positively matched to 81,010 cancer records. Supporting the validity of this record linkage for occupational cancer surveillance, we observed associations between industry and occupation groups and risks of any cancer and particular cancer sites which are consistent with established risk factors including elevated risks of lung cancer and mesothelioma among construction workers (HR 1.08, 95%CI 1.01-1.15 and HR 1.78, 95%CI 1.26-2.53, respectively), lung cancer among miners (HR 1.42, 95%CI 1.27-1.59, respectively) and breast cancer among educational service industry workers (HR 1.57, 95%CI 1.40-1.75). The pilot project demonstrated that a linkage between Ontario WSIB claims and OCR records is feasible, and this linkage provides an efficient approach for occupational cancer surveillance. Based on the established feasibility, the linkage will be expanded to provide ongoing occupational cancer surveillance using existing administrative databases in Ontario. Co-Author(s): Paul Demers, Occupational Cancer Research Centre, Cancer Care Ontario/ Chris McLeod, Centre for Health Services and Policy Research, University of British Columbia/ Anne Harris, School of Occupational and Public Health, Ryerson University

E5.3 Accuracy of using natural language processing techniques for detecting adverse events from electronic health record data Presented by CHRISTIAN ROCHEFORT PhD, McGill University Adverse events (AEs) are associated with significant morbidity, mortality and cost in hospitalized patients. Measuring AEs is necessary for quality improvements but current detection methods are inaccurate. We determined the accuracy of a potential alternative, the natural language processing (NLP) of electronic health record data, for detecting three highly prevalent AEs: a) deep vein thrombosis (DVT), b) pulmonary embolism (PE) and, c) pneumonia. A validation study was conducted at a university health network in Montreal (Canada). We randomly sampled 6,000 narrative radiology reports performed between 2008 and 2012; 2,000 from patients who had a radiologic workup for DVT/PE, and 4,000 from patients who had a radiological imaging of the chest. We manually identified DVT, PE or pneumonia within each report, which served as our reference standard. Using a bag-of-words approach, we trained support vector machine (SVM) models predicting DVT, PE and pneumonia. SVM training and testing was performed with nested 10-fold cross-validation, and the average accuracy of each model was measured. On manual review, 324 (16.2%) reports were DVT-positive, 154 (7.7%) were PE-positive and 640 (16.0%) were pneumonia-positive. On average, the SVM model predicting DVT achieved sensitivity of 0.80 (95%CI: 0.76-0.85), specificity of 0.98 (95%CI: 0.97-0.99) and positive predictive value (PPV) of 0.89 (95%CI: 0.85-0.93). The SVM model predicting PE achieved, on average, sensitivity of 0.79 (95%CI: 0.73-0.85), specificity of 0.99 (95%CI: 0.98-0.99), and PPV of 0.84 (95%CI: 0.75-0.92). The pneumonia model achieved, on average, sensitivity of 0.83 (95%CI: 0.78-0.88), specificity of 0.98 (95%CI: 0.97-0.99) and PPV of .88 (95%CI: 0.83-0.94). Statistical NLP can accurately identify DVT, PE and pneumonia from narrative radiology reports. The SVM models validated in this study could assist prevention and quality improvement efforts. Co-Author(s): Christian Rochefort, McGill University/ Aman Verma, McGill University/ Tewodros Eguale, McGill University/ David Buckeridge, McGill University

E5.4 Interprovincial Variation in Ideal Cardiovascular Health Status in Canada Presented by RUSSANTHY VELUMMAILUM MPH Student, University of Toronto The purpose of this study is to investigate the interprovincial variation in ideal cardiovascular health across Canada, which has important implications for health policy and planning regionally-targeted public health interventions. Analyses were performed using data from the Canadian Community Health Survey Public Use Microfile, 2011-2012 cycle to calculate the prevalence of cardiovascular health risk factors (smoking, physical activity, fruit and vegetable consumption, overweight/ obesity, diabetes and hypertension) in Canadian adults 20 years and older by province/region. The CANHEART health index definition was used for ideal cardiovascular health . A multivariable logistic regression model was created to predict ideal cardiovascular health. We found that in 2011 to 2012, the proportion of Canadians in ideal cardiovascular health was 10.6%; 6.1% among males and 14.8% among females. The proportion of individuals with ideal health by provincial grouping was greatest in residents from British Columbia (14.3%), followed by Alberta (11.3%), Quebec (10.5%), Ontario (9.8%), the Prairies (8.9%) and the Atlantic provinces (8.2%). The following variables in the logistic regression model predicted ideal cardiovascular health: being female, higher education, being less than 50 years of age, provincial groupings (BC, Alberta, Quebec, Ontario, the Prairies, Atlantic provinces), higher income, marital status, absence of a regular medical doctor, and having a job. There were interactions between marital status with sex and with age. This study allowed us to quantify the prevalence of ideal cardiovascular health across Canada using the recent CCHS cycle. We found a large degree of regional variation in cardiovascular health in Canada. Co-Author(s): Laura C. Maclagan, Institute for Clinical and Evaluative Sciences/ Jack V. Tu, Institute for Clinical and Evaluative Sciences

47 Concurrent Sessions F Wednesday, June 3, 2015 - 2:30pm - 3:45pm F1 CANCER VI South Studio 3 F1.1 Utilization of pre-operative imaging for muscle-invasive bladder cancer: a population-based study Presented by MATTHEW MCINNES Radiologist, University of Ottawa/ Ottawa Hospital Research Institute To test the hypotheses that: a) use of pre-operative imaging for muscle-invasive bladder cancer (MIBC) conforms to practice guidelines; b) pre-operative imaging, through more accurate staging is associated with improved outcomes. In this population-based cohort study, records of treatment were linked to the Ontario Cancer Registry to identify all patients with MIBC treated with cystectomy from 1994-2008. Utilization of chest, abdomen-pelvis and bone imaging were evaluated. Trends were evaluated over time. Logistic regression was used to analyze factors associated with utilization. Cox model analyses were used to explore associations between imaging and survival. 2802 patients with MIBC underwent cystectomy during 1994-2008. An increase in the proportion of patients having pre-operative: chest imaging, bone scan and abdomen/pelvis imaging was observed. Use of chest imaging was associated with age (OR 1.24-1.59), N-stage (OR 0.79), surgeon volume (OR 0.47-0.53) and geographic region (OR 0.47-2.19). Use of bone scan was associated with N-stage (OR 0.57) and geographic region (OR 0.71-1.34 ). In adjusted analyses we found that patients who did not have pre-operative chest imaging had inferior overall survival (OS) hazard ratio (HR) 1.12(95%CI 1.01-1.25) but not cancer specific survival (CSS) HR 1.09(0.97-1.22); those who did not have pre-operative bone scan had inferior OS HR 1.11(1.01-1.22) and CSS HR 1.09(95%CI 1.01-1.25). In routine clinical practice there is considerable variation in use of pre-operative chest, body, and bone imaging. Pre-operative chest and bone imaging is associated with improved outcomes; this association likely reflects better patient selection for cystectomy. Co-Author(s): Robert Siemens, Queen’s University/ William Mackillop, Queen’s University/ Yingwei Peng, Queen’s University/ Shelly Wei, Queen’s University/ Nicola Schieda, University of Ottawa/ Christopher Booth, Queen’s University

F1.2 Dietary patterns and the risk of breast cancer in the Canadian National Enhanced Cancer Surveillance System Presented by KEITH VAN RYSWYK Scientific Project Coordinator, Carleton University Previous research into the dietary causes of female breast cancer has primarily focused on the role of specific nutrients. An alternative approach classifies individuals’ diets into distinct profiles by examining correlations between individual dietary items. This investigation aimed to characterize dietary patterns of subjects who participated in Canadian case-control study and relate these dietary patterns to the incidence of breast cancer. Dietary data from cases and controls were collected from participants of the National Enhanced Cancer Surveillance System between 1994 and 1997. Principal components factor analysis was applied to characterize dietary patterns. Breast cancer risk related to adherence to dietary patterns found in the PCFA was determined using logistic regression. Odds ratios generated from the regression analysis were adjusted for several recognized and suspected breast cancer risk factors including smoking, environmental tobacco smoke exposure and obesity. Three distinct dietary patterns were found and these represented 20% of the variability in the dietary data: a ‘western’ dietary pattern high in red and processed meats, desserts and refined grains; a ‘healthy’ dietary pattern high in vegetables, fish and chicken; and a vitamin and mineral supplemented diet. The ‘western’ dietary pattern was related to a 26% increase in breast cancer risk (95%CI: 1.04-1.52) for the highest relative to the lowest quartile of dietary pattern adherence. The ‘healthy’ dietary pattern was associated with a 21% decrease in breast cancer risk (95%CI: 0.65-0.96). No statistically significant associations between the vitamin dietary profile and breast cancer were found. Associations between diet and breast cancer incidence were neither confounded nor modified by menopausal status. Our analyses reveal that individual dietary items tend to cluster together into three distinct dietary patterns. These patterns, in turn, were associated with reduced and increased risks of female breast cancer. Our findings suggest that dietary changes provide an opportunity to reduce the public health burden of breast cancer. Co-Author(s): Paul J. Villeneuve, Carleton University/ Kenneth C. Johnson, University of Ottawa/ Farah McCrate, The Canadian Cancer Registries Epidemiology Research Group/ Ron Dewar, The Canadian Cancer Registries Epidemiology Research Group/ Nancy Kreiger, The Canadian Cancer Registries Epidemiology Research Group/ Donna Turner, The Canadian Cancer Registries Epidemiology Research Group

F1.3 Occupation and the risk of prostate cancer in Northeastern Ontario Presented by JEAVANA SRITHARAN PhD Student, Occupational Cancer Research Centre, Cancer Care Ontario and the University of Toronto Previous studies have found elevated risks of prostate cancer among workers in agriculture, logging and forestry, and mining industries; however these findings have been inconsistent across the literature. This study will examine the risk of prostate cancer in these industries by using data from a Canadian population based case- control study. Cases were males (n=760) from Northeastern Ontario diagnosed with prostate cancer identified from the Ontario Cancer Registry between January 1995 and December 1998 and aged 45 to 84 years. Controls (n=1632) were frequency matched approximately 2 to 1 based on 5 year age groups. Cases and controls completed a 25 page questionnaire that included lifetime occupational history. Odds ratios (OR) and 95% confidence intervals (CI) were estimated, using logistic regression models, for employment in specific industries or occupations, adjusted for age and family history of prostate cancer. No significant associations were found for employment in agriculture (OR 1.16, 95% CI 0.97-1.39) or overall in mining industries (OR 0.95, 95% CI 0.78-1.15). There were elevated prostate cancer risks for employment in logging (OR 1.94, 95% CI 1.33-2.84), mining services (OR 2.19, 95% CI 1.24-3.87), paper and allied products (OR 1.45, 95% CI 1.04-2.02), and wood industries (OR 1.46, 95% CI 1.08-1.98). At an occupation level, elevated risks were found in logging and forestry occupations for chain-saw and skidder operators (OR 1.57, 95% CI 1.07-2.30) and logging and forestry labourers (OR 7.00, 95% CI 1.90-25.73). Elevated risks were found in mining occupations for mining and quarrying supervisors (OR 2.26, 95% CI 1.19-4.29) and underground mine service and support workers (OR 1.77, 95% CI 1.13-2.77). This study contributes to the understanding of occupational risk factors for prostate cancer related to agriculture, logging and forestry, and mining work. With further analysis, detailed industry and occupation exposures in agriculture, logging and forestry, and mining will be assessed using work history records and expert assessed exposure estimates. Co-Author(s): Paul A. Demers, Occupational Cancer Research Centre, Cancer Care Ontario and the University of Toronto/ Shelley A. Harris, Occupational Cancer Research Centre, Cancer Care Ontario and the University of Toronto/ Donald C. Cole, Dalla Lana School of Public Health, University of Toronto/ Nancy Kreiger, Cancer Care Ontario and the University of Toronto/ Andrea M. Sass-Kortsak, University of Toronto/ Nancy E. Lightfoot, School of Rural and Northern Health, Laurentian University F2 PHYSICAL ACTIVITY I Greenwich Room F2.1 Trajectories of Objectively Measured Sedentary Time among Secondary Students in Canada in the Context of a Province-Wide Physical Education Policy: A Longitudinal Analysis Presented by FEI ZUO Epidemiologist, Public Health Ontario The objective of this study was to examine longitudinal changes in and factors associated with sedentary time among secondary students in Manitoba in the context of a province-wide physical education policy. Secondary schools offering grades 9 through 12 and with enrolment greater than 100 were block randomized to represent urban and rural geography of Manitoba. In each selected school, grade 9 or 10 PE students were screened to exclude those who were absent for baseline recruitment, unable to perform regular daily living activities, or living with chronic conditions. Students not meeting the minimum baseline accelerometer wear time or with an extreme MVPA baseline measurement were removed from analysis, leading to a final sample size of 447 students. Factors examined include gender, BMI, baseline physical activity, school location, and neighbourhood socioeconomic status. Secondary schools offering grades 9 through 12 and with enrolment greater than 100 were block randomized to represent urban and rural geography of Manitoba. In each selected school, grade 9 or 10 PE students were screened to exclude those who were absent for baseline recruitment, unable to perform regular daily living activities, or living with chronic conditions. Students not meeting the minimum baseline accelerometer wear time or with an extreme MVPA baseline measurement were removed from analysis, leading to a final sample size of 447 students. Factors examined include gender, BMI, baseline physical activity, school location, and neighbourhood socioeconomic status. At baseline, students with low or moderate baseline physical activity accumulated an average of 54.6 and 45.9 more minutes of Sedentary Time (ST) per day compared to students with high baseline physical activity (P < 0.0001). For ST trajectories from grade 9 to 12, female students showed a higher rate of decline in ST than male students (P = 0.0408), adjusting for time. Compared with students who had high baseline Physical Activity (PA), the adjusted ST trajectories of students with low and moderate baseline PA declined less steeply, differing by an average of 7.8 minutes per semester (P = 0.0097) and 4.3 minutes per semester (P = 0.1533), respectively. Adjusted ST trajectories did not differ significantly across BMI status, school location, and neighbourhood socioeconomic status. Sedentary behaviour may be well established by early adolescence and remain stabilized throughout the course of secondary school despite a physical education policy. Baseline physical activity and gender are significantly associated with sedentary time (ST) trajectories although their roles in modifying ST trajectories appeared to be minimal in this study. Co-Author(s): Erin Hobin, Public Health Ontario/ Jannice So, Mount Sinai Hospital/ Laura Rosella, University of Toronto/ Melisa Comte, Manitoba Institute of Child Health/ Steve Manske, Propel Centre for Population Health Impact, University of Waterloo/ Jonathan McGavock, Manitoba Institute of Child Health

48 F2.2 Increases in physical activity due to active transportation: Implications for diabetes prevention Presented by LAUREN DELLA MORA MPH Student, Dalla Lana School of Public Health Walkability is a feature of the built environment that can facilitate physical activity and therefore modify risk of type 2 diabetes mellitus (diabetes). This study quantifies the potential benefits of increased walkability on diabetes risk in Ontario’s major urban regions using a prediction model. We used a validated diabetes population risk prediction tool (DPoRT) to predict diabetes incidence in target adult populations. Built environment scenarios affecting major urban regions in Ontario (Toronto, York, Durham, Peel, Hamilton, Halton and Simcoe-Muskoka) were modeled to produce estimates of the potential number of diabetes cases averted and absolute reduction in 10-year population-level diabetes risk. The diabetes risk reduction from an average increase of 30 minutes of walking per weekday was drawn from a published meta- analysis and adjusted based on the age distribution and walking habits reported in the National Health Survey and Transportation Tomorrow Survey (TTS). In the next 10 years, we estimate 485 thousand new diabetes cases in the seven urban regions studied, with 304 thousand occurring among those aged 35-64. According to the TTS, proposed transportation investments would increase active transportation with 30% of those aged 35 – 64 (range 23-36%) expected to walk an additional 30 minutes per weekday on average. We estimated that over 10 years this would prevent over 20,000 new diabetes cases in that age group. The extent of these benefits will vary according to the baseline risk of individuals who increase walking, and coverage. For example, the same increase in walking activity by overweight/obese individuals 35-64 years of age would increase the relative benefit. Creating more walkable communities through modifications to the built environment, such as transportation enhancements, will increase walking activity in working-age adults and subsequently reduce the burden of diabetes. Quantifying these future benefits in the general population and specific target groups can inform healthy community design in Ontario’s urban regions. Co-Author(s): Lauren S. Della Mora, Dalla Lana School of Public Health, University of Toronto; Public Health Ontario/ Laura C. Rosella, Dalla Lana School of Public Health, University of Toronto; Public Health Ontario

F2.3 Breast Cancer and Exercise Trial in Alberta (BETA): A Randomized Trial of the Effect of a Year-long High versus Moderate Aerobic Exercise Intervention on Adiposity Presented by CHRISTINE FRIEDENREICH Scientific Leader, Alberta Health Services Postmenopausal breast cancer risk is increased with physical inactivity and obesity. The optimal amount of physical activity needed to reduce body fat levels and, consequently, breast cancer risk is unknown. This study’s objective was to compare the effects of two different doses of aerobic exercise on adiposity levels in postmenopausal women. BETA was a 12-month, two-armed, two-centre randomized controlled trial conducted between 2010-2013 in Calgary and Edmonton. Participants were healthy, inactive, postmenopausal women between 50-74 years with a body mass index between 22-40 kg/m2. 400 women were randomized to either 150 (MODERATE) or 300 (HIGH) minutes/week of aerobic exercise. Participants were asked not to change their usual diet. Weight, height and waist and hip circumferences were measured and total body fat assessed by dual energy X-ray absorptiometry and abdominal fat using a computed tomography scan. An intention- to-treat analysis was based on two-sample t-tests to assess differences in mean adiposity changes between groups. Ninety six percent of participants completed the trial and exercise adherence was very good (MODERATE:137 (25th and 75th percentiles=111, 150); HIGH: 254 (166, 290) minutes/week). The primary intent-to-treat analysis showed that all measures of adiposity change were, on average, greater in the HIGH versus MODERATE arm except hip circumference and intra-abdominal fat changes, however, only changes in total fat and subcutaneous abdominal fat differed significantly between groups In post hoc analyses, the dose-response relation between adherence and adiposity changes was further explored by removing the randomization and categorizing women into subgroups of self-selected adherence (weeks 1-52) defined by public health guidelines (≤150, 150-250, ≥250 minutes/week). In this analysis, a favourable dose-response effect was found with increasing change in adiposity outcomes with higher exercise levels. Over one year, the 300 minutes/week exercise prescription resulted in greater reductions in total fat and subcutaneous abdominal fat, but not intra-abdominal fat than 150 minutes/week. These data provide support for recommending 300 minutes/week moderate-vigorous aerobic exercise to optimize fat loss for postmenopausal breast cancer prevention. Co-Author(s): Heather Neilson, Alberta Health Services/ Rachel O’Reilly, Alberta Health Services/ Aalo Duha, Alberta Health Services/ Yutaka Yasui, University of Alberta/ Sarah MacLaughlin, University of Alberta/ Andria Morielli, University of Alberta/ Scott Adams, University of Alberta/ Kerry Courneya, University of Alberta

F2.4 A methodology to leverage cross-sectional accelerometry to capture weather’s influence on active living Presented by TARUN KATAPALLY Postdoctoral fellow, University of Saskatchewan While active living interventions focus on modifying built and social environment, weather variation, a phenomenon that perennially interacts with these environmental factors, is consistently underexplored. The objective of this study is to develop a methodology to leverage existing cross-sectional accelerometry data in developing active living interventions that factor-in weather variation. As part of an active living initiative in Saskatoon, Canada (www.smartcitieshealthykids.com), urban design, and built and social environment were measured. Actical accelerometers were used to collect physical activity data in 25 sequential one week cycles between April and June, 2010. Each accelerometry cycle was conducted on different cohorts within the total sample of 455 children. Each accelerometry cycle was matched with localized weather categories (e.g. Warm-Wet-Calm) simulated by factoring-in the interrelationship between temperature, precipitation and wind. Multilevel modeling using Hierarchical Linear and Non-linear Modeling software was conducted to depict the influence of environmental exposures (including weather variation) on physical activity. As part of an active living initiative in Saskatoon, Canada (www.smartcitieshealthykids.com), urban design, and built and social environment were measured. Actical accelerometers were used to collect physical activity data in 25 sequential one week cycles between April and June, 2010. Each accelerometry cycle was conducted on different cohorts within the total sample of 455 children. Each accelerometry cycle was matched with localized weather categories (e.g. Warm-Wet-Calm) simulated by factoring-in the interrelationship between temperature, precipitation and wind. Multilevel modeling using Hierarchical Linear and Non-linear Modeling software was conducted to depict the influence of environmental exposures (including weather variation) on physical activity. Utilizing the proposed methodology, weather variation’s influence on physical activity was captured with cross-sectional accelerometry during a single seasonal transition (spring to summer). Overall, physical activity increased during warmer days and decreased during colder days, thus corroborating existing evidence that physical activity is positively associated with increasing temperature. However, after simulation of localized weather patterns by factoring-in the interrelationship between different weather variables, a more nuanced picture emerged. Wind was the detrimental factor which modified the influence of both temperature and precipitation on physical activity. Multilevel models, taking into account urban design, built and social environment at the neighbourhood level depicted that irrespective of weather patterns, children residing in denser neighbourhoods with high diversity of destinations were more likely to be active. As weather is non-modifiable, the focus falls on understanding how diverse environmental exposures interact with varying weather patterns to influence physical activity. The proposed methodology could be utilized to leverage globally available existing cross-sectional accelerometry data to develop place-specific active living interventions across the world. Co-Author(s): Daniel Rainham, Dalhousie University/ Nazeem Muhajarine, University of Saskatchewan F3 MENTAL HEALTH II Brittania Room F3.1 Impact of Child Maltreatment, Marital and Socioeconomic Status on Suicidal Behaviours in Older Canadian Adults Presented by JINFU HU Research Scientist, Public Health Agency of Canada Risk factors accumulate through the life-course, with factors in childhood contributing to mental health status in adulthood. The objective of the study is to assess association between factors of childhood maltreatment, marital and socioeconomic status and suicidal behaviours (SB) in older Canadian adults over a life time. We used the Canadian Community Health Survey (CCHS)-Mental Health (2012) data, and selected all adults aged 55 years and older, providing a sample size of 9891 (4222 men and 5669 women). SB over a life time included subjects with suicidal ideation, and those reporting they have planned and/or attempted suicide. Unconditional multiple logistic regression was used to estimate odds ratios (OR) and the corresponding 95% confidence intervals (CI), including terms for age, body mass index (kg/ cm2), alcohol consumption, smoking status, chronic condition, major depressive episode, alcohol abuse/dependence and drug abuse/dependence. All estimates were weighted. We used the Canadian Community Health Survey (CCHS)-Mental Health (2012) data, and selected all adults aged 55 years and older, providing a sample size of 9891 (4222 men and 5669 women). SB over a life time included subjects with suicidal ideation, and those reporting they have planned and/or attempted suicide. Unconditional multiple logistic regression was used to estimate odds ratios (OR) and the corresponding 95% confidence intervals (CI), including terms for age, body mass index (kg/cm2), alcohol consumption, smoking status, chronic condition, major depressive episode, alcohol abuse/dependence and drug abuse/dependence. All estimates were weighted. Childhood maltreatment was significantly associated with SB later in life; the ORs were 1.93 (95%CI 1.29-2.88) in men and 3.46 (95%CI 2.37-5.03) in women. Subjects who were widow/separated/divorced/single were positively associated with the risk of SB, the ORs were 1.85 (95%CI 1.34-2.56) in men and 1.90 (95%CI 1.31-2.75) in women, compared with subjects who were married/common law. Low income adequacy was positively association with SB; the ORs for the lowest quintile versus the highest were 4.55 (95%CI 2.29-9.02) in women and 1.55 (95%CI 0.88-2.73) in men. Education was not clearly associated with the risk of SB in both men and women. However, after adjustment for childhood maltreatment, income adequacy and marital status, an increased risk of SB with education levels was found in men (OR=1.66). The findings suggest that socioeconomic inequalities were related to report SB and those factors in childhood can affect mental health later in life. Mental health is related to the life-course. Improvement to social connectedness may play an important role in preventing SB among older Canadian adults. Co-Author(s): Simone Powell, Public Health Agency of Canada/ Patti Gorr, Public Health Agency of Canada/ Margaret de Groh, Public Health Agency of Canada

49 F3.2 IS ARTERIAL STIFFNESS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN INCIDENT HEMODIALYSIS PATIENTS? Presented by ESTHER KIM Graduate Student, University of Toronto Cognitive impairment is commonly observed in hemodialysis patients and places a significant burden on patients and the healthcare system. Though studies suggest that cerebrovascular diseases predominantly underlie cognitive impairment in kidney failure, very few have examined the relationship between vascular stiffness and cognitive function in dialysis patients. This study included 402 incident hemodialysis patients enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study from 2008 until 2012. The main exposure was arterial stiffness measured using pulse wave velocity (PWV). The outcome was cognitive function measured using the time to complete Trail making tests A and B (TMT A and TMT B), and the modified mini-mental state exam (3MS) score. Potential confounders included baseline demographic and clinical factors. Multivariable log-linear, Tobit, and linear regression models were used to examine the baseline association of PWV with TMT A, TMT B, and 3MS, respectively. This study included 402 incident hemodialysis patients enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study from 2008 until 2012. The main exposure was arterial stiffness measured using pulse wave velocity (PWV). The outcome was cognitive function measured using the time to complete Trail making tests A and B (TMT A and TMT B), and the modified mini-mental state exam (3MS) score. Potential confounders included baseline demographic and clinical factors. Multivariable log-linear, Tobit, and linear regression models were used to examine the baseline association of PWV with TMT A, TMT B, and 3MS, respectively. In the unadjusted analysis, every 1 m/s increase in PWV was associated with a longer time to complete TMT A and TMT B (β = 0.03, 95% CI: 0.02, 0.04, and β = 4.49, 95% CI: 1.83, 7.15, respectively), however, PWV was not significantly associated with 3MS (β = -0.21, 95% CI: -0.24, 0.17). In the adjusted analysis, every 1 m/s increase in PWV was associated with 1% increase in the time to complete TMT A (β = 0.01, 95% CI: 0.002, 0.02), however, PWV was not significantly associated with TMT B or 3MS β( = 1.29, 95% CI: -1.19, 3.77 and β = -0.04, 95% CI: -0.24, 0.17, respectively). Higher PWV is associated with longer time to complete TMT A, which indicates that arterial stiffness may be associated with lower executive cognitive function in hemodialysis patients. This suggests that further studies are required to investigate this relationship in larger dialysis population and perhaps over a longer follow-up time. Co-Author(s): Stephen Sozio, Johns Hopkins University, Department of Medicine, School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research/ Michelle Estrella, Johns Hopkins University, Department of Medicine, School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research/ Bernard Jaar, Johns Hopkins University, Department of Medicine, School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research/ Tariq Shafi, Johns Hopkins University, Department of Medicine, School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research/ Lucy Meoni, Johns Hopkins University, Department of Biostatistics, School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research/ Linda Kao, Johns Hopkins University, Department of Medicine, School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research/ Rulan Parekh, Johns Hopkins University, Department of Medicine, University of Toronto, Department of Pediatrics and Medicine, Hospital for Sick Children and the University Health Network

F3.3 Enhancing the Effectiveness of School-Based Substance Use Educational Programs: Does School-Connectedness Play a Role? Presented by ROAH MERDAD Dalhousie University Numerous school-based programs have been developed with the aim of educating young people about abstinence from substance use, reducing harms, and helping them acquire the skills necessary to resist environmental influences. Research evaluating their effectiveness has shown inconsistent results. The primary aim of our study is to examine whether higher levels of school connectedness are associated with better receptivity of school-based alcohol and drug educational programs, and lower levels of substance use and misuse. Co-Author(s): Roah Merdad, Dalhousie University/ Mark Asbridge, Dalhousie University/ Donald Langille, Dalhousie University

F3.4 An imbalance of high negative and low positive emotional expressivity captured in a single autobiography is predictive of dementia over half a century later Presented by JILL MORRISON Student, University of Waterloo Negative emotions adversely affect health and thus may contribute to the development of dementia. Positive emotions have been found to counteract the effects of negative emotions. Our study investigated the association between negative emotional expressivity (EE) and dementia, and the potential modifying effect of positive EE on this association. The Nun Study is a longitudinal study of 678 religious sisters aged 75+ at baseline. Autobiographies handwritten in early adulthood (mean age=22) were available from convent archives for 180 U.S.-born participants; after restricting by education and missing data, 149 (83%) were retained for analysis. Autobiographies were scored for positive and negative EE and idea density, a linguistic measure associated with dementia. EE was ranked within convents by number of emotion words and categorized dichotomously and in tertiles. Dementia was diagnosed using standard criteria (DSM-IV). Logistic regression models were adjusted for age and apolipoprotein E, a genetic risk factor for dementia. The Nun Study is a longitudinal study of 678 religious sisters aged 75+ at baseline. Autobiographies handwritten in early adulthood (mean age=22) were available from convent archives for 180 U.S.-born participants; after restricting by education and missing data, 149 (83%) were retained for analysis. Autobiographies were scored for positive and negative EE and idea density, a linguistic measure associated with dementia. EE was ranked within convents by number of emotion words and categorized dichotomously and in tertiles. Dementia was diagnosed using standard criteria (DSM-IV). Logistic regression models were adjusted for age and apolipoprotein E, a genetic risk factor for dementia. The association between EE and dementia was modified by idea density. No significant associations were found among individuals with low idea density. Thus, results are presented for the higher (top three quartiles) idea density subgroup only. The odds of dementia more than tripled in individuals with moderate (vs. low) negative EE (odds ratio [OR]=3.59, 95% confidence interval [CI]= 1.13-11.89) when ranked in tertiles. Initially, negative EE, ranked dichotomously, was not associated with dementia. However, a significant interaction was found between positive and negative EE; after stratification by positive EE, the odds of dementia increased eight-fold among individuals with high negative EE (OR=8.17, 95% CI=1.66-58.96) when positive EE was low. No association was found when positive EE was high. Among lower-risk individuals (i.e., those with high idea density), negative EE in handwritten autobiographies was associated with dementia only when positive EE in the same documents was low. Imbalanced high negative and low positive EE may reflect poor emotion regulation that has implications for the long-term risk of dementia. Co-Author(s): Jill M. Morrison, School of Public Health and Health Systems, University of Waterloo/ Myra A. Fernandes, Department of Psychology, University of Waterloo/ Maryam Iraniparast, School of Public Health and Health Systems, University of Waterloo/ Mushaal Ijaz, School of Public Health and Health Systems, University of Waterloo/ Michael L. MacKinley, School of Public Health and Health Systems, University of Waterloo/ Sanduni M. Costa, School of Public Health and Health Systems, University of Waterloo/ Suzanne L. Tyas, School of Public Health and Health Systems, University of Waterloo

F3.5 Examining the Interpersonal Theory of Suicide Using a Sample of Community-Residing Older Adults: Associations Between Perceived Burdensomeness, Thwarted Belongingness, Social Hopelessness and Suicide Ideation Presented by DORIAN MURARIU Western University Suicide among older adults is understudied. The objective of this study is to test the Interpersonal Theory of Suicide (IPTS: Joiner, 2005; Van Orden et al., 2010) in a community-based sample of older adults. We investigated potential associations between suicide ideation and perceptions of burdening others and of social disconnection. We recruited 173 community residing older adults in London, Ontario into a 2-year longitudinal study investigating associations between risk and resiliency factors associated with the onset or exacerbation of suicide ideation. Participants completed measures of suicide ideation, depression, and interpersonal factors at 6-22 month and 1-2 year follow-up assessments. We hypothesized that the IPTS constructs of Perceived Burdensomeness and Thwarted Belongingness will associate (1) with death ideation and (2) with suicide ideation in the presence of social hopelessness. Multiple Linear regression models were employed in cross-sectional and longitudinal analyses. We recruited 173 community residing older adults in London, Ontario into a 2-year longitudinal study investigating associations between risk and resiliency factors associated with the onset or exacerbation of suicide ideation. Participants completed measures of suicide ideation, depression, and interpersonal factors at 6-22 month and 1-2 year follow-up assessments. We hypothesized that the IPTS constructs of Perceived Burdensomeness and Thwarted Belongingness will associate (1) with death ideation and (2) with suicide ideation in the presence of social hopelessness. Multiple Linear regression models were employed in cross- sectional and longitudinal analyses. In cross-sectional analyses (n=124), perceptions of thwarted belonging, but not of burden, were significantly associated with the wish to die, controlling for participant age, sex, and depressive symptom severity. A three-way interaction of perceived burden, thwarted belonging, and social hopelessness was significantly associated with suicide ideation. A two-way interaction of thwarted belongingness and perceived burdensomeness significantly associated with death ideation, and with suicide ideation (GSIS total) after controlling for poor perceptions of social support and loneliness. In longitudinal analyses (n=107), the main effects of thwarted belonging and perceived burden were non-significant, as were the two and three-way interaction terms, controlling for covariates. In all regression models the interpersonal variables accounted for significantly more variance in suicidal thoughts than age, sex and depression combined. Cross-sectional findings partially supported associations between aspects of the IPTS and suicide ideation; however, these variables did not significantly predict the onset of suicidal thoughts. Future research is needed testing refined versions of this theory and investigating alternative suicide risk factors and processes. Co-Author(s):Marnin J. Heisel, Western University, Lawson Health Research Institute/ Paul Links, Western University, Lawson Health Research Institute/ Gordon Flett, York University

50 F4 METHODS III Club Studio 3 F4.1 Variable Selection and Prediction with Dependent Clinical Assessments Presented by YING WU Student, University of Waterloo There is increasing interest in the development of predictive models for risk stratification and personalized medical decision making. Such models are often formulated based on disease status at a landmark time using a high dimensional vector of fixed markers. Often however, the disease status is unknown because individuals are only examined intermittently. We present methods for developing and assessing predictive models under a dependent intermittent observation scheme. Co-Author(s): Richard Cook, University of Waterloo

F4.2 Simulation Study of Joint Models for Longitudinal and Time-to-event Traits in Genetic Association Studies under a Cohort Design Presented by OSVALDO ESPIN-GARCIA Biostatistician, University of Toronto / Lunenfeld-Tanenbaum Research Institute Investigate properties of two model formulations for trait-genotype association, so-called trajectory and shared random effects models, when longitudinal measurements are subject to censoring by a clinical event. ∗ Evaluate through simulations the validity and power of the aforementioned models when tests of genotype-time interaction are the main interest. We carry out simulation studies to examine statistical properties of joint models for longitudinal and time-to-event data analysis in the context of genetic association. Using available phenotype data, we define four censoring scenarios for evaluating model adequacy under alternative degrees of censoring. We use an available-upon-request SAS macro: JMfit (Zhang et al, 2014) for model implementation. Our simulations incorporate joint and two-stage fitting methods for parameter estimation and hypothesis testing under the two model formulations. We evaluate single parameter tests, as well as multi-degree of freedom (df) hypothesis tests utilizing Wald and likelihood ratio statistics. We carry out simulation studies to examine statistical properties of joint models for longitudinal and time-to-event data analysis in the context of genetic association. Using available phenotype data, we define four censoring scenarios for evaluating model adequacy under alternative degrees of censoring. We use an available-upon-request SAS macro: JMfit (Zhang et al, 2014) for model implementation. Our simulations incorporate joint and two-stage fitting methods for parameter estimation and hypothesis testing under the two model formulations. We evaluate single parameter tests, as well as multi-degree of freedom (df) hypothesis tests utilizing Wald and likelihood ratio statistics. Assessment of genetic association with time-to-event under null genotype simulations suggests that inference under joint estimation is usually valid whereas two-stage estimation yields liberal tests. This effect is more pronounced under extreme censoring. Overall, under joint estimation, both shared random effects and trajectory models render valid tests for the main effects in the longitudinal part. However, if extreme censoring is present, tests of genotype by time interaction can yield liberal results especially in the trajectory model. This also holds true for the two-df test of genotype and genotype- time interaction. Tests for the genetic effect in the time-to-event part provide similar results for the random effects and the trajectory models except when events are sparse and the trajectory model shows slightly liberal results. We are currently conducting simulation studies under the alternative hypothesis of genetic association. We plan to evaluate AIC and BIC for model selection and assessment of goodness-of-fit. Our aim is to understand differences between models and identify circumstances (if any) when one would be preferred over the other. Co-Author(s): Linda Hiraki, The Hospital for Sick Children, Toronto, Canada/ Andrew Paterson, University of Toronto / The Hospital for Sick Children, Toronto, Canada/ Angelo Canty, McMaster University/ Shelley Bull, University of Toronto / Lunenfeld-Tanenbaum Research Institute

F4.3 Methods for dealing with missing data in the multivariate growth curve model Presented by TIAN FENG Ph.D. student, McMaster University To conduct a comprehensive review and compare and contrast statistical methods proposed in the literature for dealing with missing data in GCM. We performed a comprehensive search of the statistics literature for statistical and computational methods that allow the application of growth curve models in the presence of missing data. We also carried out an extensive simulation, varying the extent of missingness, and compared the performance of the methods we identified. Performance was evaluated using optimality measures including bias and mean square error. We performed a comprehensive search of the statistics literature for statistical and computational methods that allow the application of growth curve models in the presence of missing data. We also carried out an extensive simulation, varying the extent of missingness, and compared the performance of the methods we identified. Performance was evaluated using optimality measures including bias and mean square error. Generalized least squares estimation (GLSE), weighted and un-weighted estimation, and the expectation-maximization (EM) algorithm were found to be generally useful methods in handling missing data in the context of the GCM. Overall, the EM algorithm performed best in a wide range of scenarios. All methods have good performance when the extent of missingness is small, but deteriorate in scenarios where there is a large proportion of missing data. And missing at random (MAR) is assumed in this study. Methods that are valid in the presence of informative missingness would also be desirable. Co-Author(s): Joseph Beyene, McMaster University/ Hamid Jemila S., McMaster University

F4.4 Are we approaching our maximum life expectancy? Presented by AUDREY WONG Master of Public Health Epidemiology Student, University of Toronto To determine whether a maximum life exists and when it will be reached so that medical and public health professionals will be better prepared for the future. An innovative three-step process was developed to determine whether there is a maximum LE, what the maximum is, and when it will be achieved. Step 1 determined the slow-down in LE increase with chronological age. The reduced increase in LE with age allows projection to a specific age that has no expected further LE increases. Step 2 was a projection to zero LE increase. Step 3 estimated the target year to achieve maximum LE. Canadian vital statistics data from 1921 to 2009 were used. An innovative three-step process was developed to determine whether there is a maximum LE, what the maximum is, and when it will be achieved. Step 1 determined the slow-down in LE increase with chronological age. The reduced increase in LE with age allows projection to a specific age that has no expected further LE increases. Step 2 was a projection to zero LE increase. Step 3 estimated the target year to achieve maximum LE. Canadian vital statistics data from 1921 to 2009 were used. The maximum LE was estimated at 108.5 years (95% CI: 88.4 years, 135.5 years) for both sexes combined and is expected to be achieved around 2131 (95% CI: 2120, 2142). For females, the maximum is 114.3 years (95% CI: 98.0 years, 134.8 years) by 2111 (95% CI: 2095, 2127), and for males the maximum is 97.6 years (95% CI: 74.5 years, 131.2 years) by 2134 (95% CI: 2114, 2155). Our study indicates a need for medical and public health professionals to refocus on improving quality of life instead of quantity. Future efforts should emphasize increasing health-adjusted life expectancy (HALE), and narrowing the gap between HALE and LE. Co-Author(s): Dr. Bernard Choi, Public Health Agency of Canada/ Audrey Wong, University of Toronto/ Lidia Loukine, Public Health Agency of Canada

F4.5 Effects of Grouping of Medical Codes on the Performance of the High-Dimensional Propensity Score (hd-PS) Algorithm in Small Sample, Rare Outcome Incidence, and Low Exposure Prevalence Presented by VANHOA LE Manager, GlaxoSmithKline Research and Development The hd-PS algorithm can select and adjust for baseline confounders of treatment-outcome associations in pharmacoepidemiologic studies that use healthcare claims data. Our objective is to evaluate the effects of aggregating medications or diagnoses on hd-PS performance using an empirical example and resampled cohorts with small sample size, rare outcome incidence, or low exposure prevalence. In an incident-user cohort of RA/OA patients with upper gastrointestinal complications celecoxib or traditional NSAIDs use, we (1) aggregated medications and ICD-9 diagnoses into hierarchies of the ATC and CCS, respectively, and (2) sampled the full cohort to create 9,600 samples to compare 16 aggregation scenarios We applied hd-PS to estimate RR using five dimensions, predefined confounders, ≤ 500 hd-PS covariates, and PS deciles. For each scenario, we calculated: (1) the geometric mean RR; (2) the difference between the scenario mean ln(RR) and the ln(RR) from published RCTs; and (3) the proportional difference in the degree of estimated confounding between that scenario and the base scenario. In an incident-user cohort of RA/OA patients with upper gastrointestinal complications celecoxib or traditional NSAIDs use, we (1) aggregated medications and ICD-9 diagnoses into hierarchies of the ATC and CCS, respectively, and (2) sampled the full cohort to create 9,600 samples to compare 16 aggregation scenarios We applied hd-PS to estimate RR using five dimensions, predefined confounders, ≤ 500 hd-PS covariates, and PS deciles. For each scenario, we calculated: (1) the geometric mean RR; (2) the difference between the scenario mean ln(RR) and the ln(RR) from published RCTs; and (3) the proportional difference in the degree of estimated confounding between that scenario and the base scenario. Aggregations of medications into level 4 of the Anatomical Therapeutic Chemical classification (ATC) alone or in combination with aggregation of diagnoses into level 1 of the Clinical Classification Software (CCS) improved the hd-PS confounding adjustment in most scenarios, reducing residual confounding compared with the randomized controlled trials (RCT) findings by up to 19%. Aggregation of codes using hierarchical coding systems may improve the performance of the hd-PS to control for confounders in some research settings. The balance of advantages and disadvantages of aggregation is likely to vary across settings. Co-Author(s): Hoa Le, Epidemiology Department, University of North Carolina at Chapel Hill, United States; GlaxoSmithKline Research & Development, United States/ Charles Poole, Epidemiology Department, University of North Carolina at Chapel Hill, United States/ Alan M Brookhart, Epidemiology Department, University of North Carolina at Chapel Hill, United States/ Victor Schoenbach, Epidemiology Department, University of North Carolina at Chapel Hill, United States/ Kathleen Beach, GlaxoSmithKline Research & Development, United States/ Til Stürmer, Epidemiology Department, University of North Carolina at Chapel Hill, United States

51 F5 HEALTH SERVICES III Graydon D F5.1 The Impact and Cost-Effectiveness of the Amref Health Africa-Smile Train Cleft Lip and Palate Surgical Outreach Programme in Eastern and Central Africa Presented by HASAN HAMZE Master of Public Health Student, University of Alberta Health policy makers require estimates of the economic benefit of treating Cleft Lip with/or without Cleft Palate (CLP) deformity to justify investment in CLP surgical interventions. The present study measured the economic benefit and cost-effectiveness of surgical treatment of CLP in eastern and central Africa. We analysed anonymised data from the Smile Train database for 37,274 CLP patients operated between 2006 and 2014 in eastern and central Africa. Cases were analysed by age, sex, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs); delayed averted DALYs; cost-effectiveness; and economic benefit. Averted DALYs were estimated from Years Lived with Disability (YLD) using World Health Organization country-specific life expectancy tables and established disability weights. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) method. We analysed anonymised data from the Smile Train database for 37,274 CLP patients operated between 2006 and 2014 in eastern and central Africa. Cases were analysed by age, sex, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs); delayed averted DALYs; cost-effectiveness; and economic benefit. Averted DALYs were estimated from Years Lived with Disability (YLD) using World Health Organization country-specific life expectancy tables and established disability weights. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) method. During 2006–2014 a total of 37,503 cleft operations were performed on 37,274 patients. The median age at the time of primary surgery was 5.4 years. A total of 207,879 DALYs were averted at a total estimated cost of US$13.0 million. Mean averted DALYs per patient were 5.6, and mean cost per averted DALY was $62.8. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach, and $2.4 billion using the VSL method. Cleft surgeries are cost-effective interventions to reduce the burden of disease. Dedicated programs that provide essential CLP surgery can produce substantial clinical and economic benefits. Further investment is justified to reduce the burden of disability in eastern and central Africa. Future challenges include increased collaboration and partnerships among cleft care providers. Co-Author(s): Asrat Mengiste, Amref Health Africa/ Jane Carter, Amref Health Africa

F5.2 Using large data to inform health service provision for patients with brain injury Presented by WAYNE KHUU MPH Student, Dalla Lana School of Public Health Brain injury is responsible for significant public costs from acute care and rehabilitation. The objective of this study is to present findings from a large population based study on the predictors of rehabilitation outcomes for brain injury from non-traumatic causes in the Ontario population, by sex. The Discharge Abstract Database (DAD) and the National Rehabilitation Reporting System were used to identify patients discharged to inpatient rehabilitation within one year of acute care discharge. Patients with non-traumatic brain injury (nTBI) were identified by the presence of specified International Classification of Diseases Version 10 codes in the DAD. The demographic, clinical, and environmental characteristics of patients with nTBI were analyzed. Between 2002 and 2011, 3099 patients with a nTBI listed as the most responsible diagnosis for admission to acute care were discharged from acute care to inpatient rehabilitation. Of these patients, 47.3% were female, 55.3% were less than 65 years of age, 44.7% were 65 years of age or older, and the majority (90.9%) were urban dwelling. Patients with non-traumatic brain injury (nTBI) were identified by the presence of specified International Classification of Diseases Version 10 codes in the DAD. The demographic, clinical, and environmental characteristics of patients with nTBI were analyzed. Between 2002 and 2011, 3099 patients with a nTBI listed as the most responsible diagnosis for admission to acute care were discharged from acute care to inpatient rehabilitation. Of these patients, 47.3% were female, 55.3% were less than 65 years of age, 44.7% were 65 years of age or older, and the majority (90.9%) were urban dwelling.The average length of stay in acute care was 24.1 days (SD=25.8) and the average length of stay in inpatient rehabilitation was 39.3 days (SD=46.7). The average gain in functional independence measure score between admission to and discharge from inpatient rehabilitation was 21.3 points (SD=17.9). Future work includes using multivariable analyses to determine significant predictors, with a focus on comorbidity, for rehabilitation outcomes, including length of stay and functional gains by sex. These results can be used to support the planning and provision of health services to optimize patient outcomes and health care service provision. Acknowledgements: “This study was supported through provision of data by the Institute for Clinical Evaluative Sciences (ICES) and Cancer Care Ontario (CCO) and through funding support to ICES from an annual grant by the Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Institute for Cancer Research (OICR). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, CCO, OICR or the Government of Ontario is intended or should be inferred.” Co-Author(s): Vincy Chan, Rehabilitation Sciences Institute, University of Toronto/ Tatyana Mollayeva, Rehabilitation Sciences Institute, University of Toronto/ Kenneth Ottenbacher, Division of Rehabilitation Science, University of Texas Medical Branch/ Angela Colantonio, Toronto Rehabilitation Institute-University Health Network

F5.3 Characterizing High-Intensity Use of the Emergency Department in a Tertiary-Care Centre Presented by ERIN LIU Methodologist, Ottawa Hospital Research Institute High users of emergency department (ED) services are often identified by number of visits per year, with little exploration of the distribution/pattern of visits over time. The purpose of this study is to examine intensity of use among high ED users to identify sub-groups who may benefit from specialized care. We identified all adults with ≥3 visits to the Ottawa Hospital ED within a one-year period from April 1, 2011 to March 31, 2013. Within this high user cohort, we then measured intensity of use by calculating average daily visit rates to identify individuals with a cluster of ED visits. Those with ≥3 ED visits/7 days at any point during follow-up were considered patients with clustered ED use. Descriptive statistics were employed to compare patient and encounter-level characteristics between the clustered and non-clustered groups. Analyses were repeated using varying cut-points to define high users (≥5 and ≥8 visits per year). We identified all adults with ≥3 visits to the Ottawa Hospital ED within a one-year period from April 1, 2011 to March 31, 2013. Within this high user cohort, we then measured intensity of use by calculating average daily visit rates to identify individuals with a cluster of ED visits. Those with ≥3 ED visits/7 days at any point during follow-up were considered patients with clustered ED use. Descriptive statistics were employed to compare patient and encounter-level characteristics between the clustered and non-clustered groups. Analyses were repeated using varying cut-points to define high users (≥5 and ≥8 visits per year). Of the 16,153 patients identified as high ED users during the study period, 13.5% had their visits clustered within a short period of time. These clustered users were more likely to be homeless, require psychiatric services, to leave without being seen by a physician, and less likely to be admitted to the hospital. Approximately one in three (31.3%) high ED users with clustered visits returned for the same medical problem (namely pain-related disorders, shortness of breath and cellulitis) within a one-week period. Similar trends were observed when the high user cohort was restricted to those with ≥5 and ≥8 ED visits/year with modest increases in the proportion of patients that were single/widowed/divorced, homeless, and requiring psychiatric services. Using a novel methodology that accounts for both number and intensity of ED encounters over time, we were able to identify specific sub-populations of high ED users. Further work is required to determine if this methodology has utility for targeting care pathways within this heterogeneous and high-risk patient group. Co-Author(s): Erin Yiran Liu, Ottawa Hospital Research Institute/ Alan Forster, Ottawa Hospital Research Institute/ Daniel Kobewka, The Ottawa Hospital/ Jennifer McKay, Ottawa Hospital Research Institute/ Sunita Mulpuru, The Ottawa Hospital/ Monica Taljaard, Ottawa Hospital Research Institute/ Le Li, Ottawa Hospital Research Institute/ Paul Ronksley, University of Calgary

52 F5.4 Out-of-Province Specialized Care for Eating Disorders: Understanding patterns of application and approval out-of-province services Presented by ERIN MACDONALD Epidemiologist, Institute for Clinical Evaluative Sciences Eating disorders (ED) are associated with significant mortality and morbidity. Guidelines indicate specialized inpatient care for moderate-severe or non-responsive ED. In Ontario, many ED patients are sent out-of-country for treatment. This study sought to understand patterns of application and approval for out-of-country care and the impact of referral policy changes. Provincial referral data were linked to health care data at Institute for Clinical Evaluative Sciences. Analyses included 498 individuals applying for out-of-country treatment and 1588 receiving specialized treatment only in Ontario from 2000 to 2011. In total, 1,714 individuals received specialized treatment, in Ontario only (1588), out-of-country only (126) or both (160). Of applicants, 286 were approved, 148 denied (64 cancelled or lacked funding information). Patient demographics and prior health contacts were examined as predictors of application and approval. Changes in approval rate and predictors were examined in relation to introduction, in 2008) of adjudication of applications by ED specialists. Provincial referral data were linked to health care data at Institute for Clinical Evaluative Sciences. Analyses included 498 individuals applying for out-of-country treatment and 1588 receiving specialized treatment only in Ontario from 2000 to 2011. In total, 1,714 individuals received specialized treatment, in Ontario only (1588), out-of-country only (126) or both (160). Of applicants, 286 were approved, 148 denied (64 cancelled or lacked funding information). Patient demographics and prior health contacts were examined as predictors of application and approval. Changes in approval rate and predictors were examined in relation to introduction, in 2008) of adjudication of applications by ED specialists. Adults (relative to pediatric patients) were more likely to apply for out-of-country care as were individuals in the highest neighbourhood income quintile. Having a psychiatrist did not increase the likelihood of applying; however, there was a 3% increased likelihood of application with every 4 additional psychiatrist visits in the prior year. While adults were more likely to apply, pediatric patients were more likely to be approved. Approval was positively associated with severity of illness, as measured by a mental health hospitalization or psychiatrist visit. A substantial number of individuals received specialized care both in- and out-of-province and likely represent a more complex patient population. Changes in the application adjudication process decreased the proportion of approved applications from 2008 onwards. Increasing capacity to address complexity and comorbidity within the Ontario ED treatment system would likely need to occur to reduce out-of-country spending for this population. However, there are substantial potential benefits to patients and families by providing specialized treatment closer to home and in Ontario centres with appropriate program evaluation. Co-Author(s): Susan Bondy, University of Toronto Dalla Lana School of Public Health/ Diane Green, Institute for Clinical Evaluative Sciences/ Claire de Oliveira, Centre for Addiction and Mental Health/ Patricia Colton, University Health Network, Psychiatry, U Toronto/ Marion Olmstead, University Health Network, Psychiatry, U Toronto/ Paul Kurdyak, Centre for Addiction and Mental Health Concurrent Sessions G Thursday, June 4, 2015 - 8:30am - 9:45am G1 PHYSICAL ACTIVITY II South Studio 3 G1.1 The Effect of Body Mass Index on Recovery from Medically Attended Ankle Sprains among Adults Presented by IWONA BIELSKA PhD Candidate, Queen’s University Ankle sprains are common injuries which may lead to long-term morbidity. Overweight and obese individuals are at greater risk for sprains but the association between body mass index (BMI) and recovery is not well understood. Therefore, this study investigated the impact of BMI on recovery from medically attended ankle sprains. A prospective study of participants (≥16 years old) who sought emergency department treatment for grades 1 or 2 ankle sprains in Kingston, Ontario, in 2009-2013 was undertaken. Baseline characteristics including measured height and weight were collected. Participants were classified as normal weight (BMI<25), overweight (25≤BMI<30), and obese (BMI≥30) using internationally accepted cut-offs for youth and adults. Recovery was assessed at one, three, and six months post-injury using the Foot and Ankle Outcome Score (FAOS). Full recovery was defined as FAOS≥450. Logistic regression analyses were used to examine the association between BMI and recovery, adjusting for known confounders. A prospective study of participants (≥16 years old) who sought emergency department treatment for grades 1 or 2 ankle sprains in Kingston, Ontario, in 2009-2013 was undertaken. Baseline characteristics including measured height and weight were collected. Participants were classified as normal weight (BMI<25), overweight (25≤BMI<30), and obese (BMI≥30) using internationally accepted cut-offs for youth and adults. Recovery was assessed at one, three, and six months post-injury using the Foot and Ankle Outcome Score (FAOS). Full recovery was defined as FAOS≥450. Logistic regression analyses were used to examine the association between BMI and recovery, adjusting for known confounders. Overall, 504 individuals were recruited and 411 (82%) completed six months follow-up. Of the participants, 38% were classified as normal weight, 31% as overweight, and 31% as obese. Baseline FAOS was similar across BMI. Obese individuals tended to be female and older than normal weight individuals. All BMI groups showed improvements in FAOS over time. At six months, 65% (95% CI: 57%-72%) of normal weight, 59% (50%-68%) of overweight, and 52% (44%-61%) of obese individuals were classified as fully recovered. Odds of recovery were lower among the overweight (0.85, 95% CI: 0.50-1.45) and obese (0.72, 0.42-1.22) individuals compared to the normal weight individuals, although the difference was not statistically significant after controlling for sex, age, baseline FAOS, previous injury, and injury to dominant lower limb. At six months, a large proportion of individuals report ankle dysfunction as demonstrated by FAOS<450 among all BMI groups. As ankle sprains are common injuries, it is important for physicians to closely monitor high-risk patients during the post-injury months to ensure that they achieve symptom improvement and a full recovery. Co-Author(s): William Pickett, Queen’s University/ Ian Janssen, Queen’s University/ Robert Brison, Queen’s University/ Brenda Brouwer, Queen’s University/ Andrew Day, Queen’s University/ Ana P. Johnson, Queen’s University

G1.2 Capturing mobility using wearable technology versus self-report assessments: implications for research and clinical use Presented by LYNN ZHU PhD Candidate, Western University Wearable sensors are increasingly used to gather large datasets over time. However, the reliability and validity of using wearable sensors to capture long duration mobility are not well established. This study compares and contrasts real-life community mobility outcomes measured by self-report versus wearable technology. Over 14 days, 70 people with early to mid-stage Parkinson’s disease (mean age = 67.4 ± 6.5 years; mean disease duration = 7.6 ± 6.2 years; 47 men) wore a wireless isoinertial measurement unit with GPS (WIMuGPS) during hours awake, and completed the commonly used Life Space Assessment (LSA) and daily mobility diaries. Agreement between WIMuGPS and the self-report measures on daily frequency (LSA and diaries) and duration (diaries) of trips outside of home were assessed using intraclass correlation (ICC) and kappa statistic. Convergent validity between WIMuGPS and self-report measures on respective outcomes were assessed using repeated measures correlation. Over 14 days, 70 people with early to mid-stage Parkinson’s disease (mean age = 67.4 ± 6.5 years; mean disease duration = 7.6 ± 6.2 years; 47 men) wore a wireless isoinertial measurement unit with GPS (WIMuGPS) during hours awake, and completed the commonly used Life Space Assessment (LSA) and daily mobility diaries. Agreement between WIMuGPS and the self-report measures on daily frequency (LSA and diaries) and duration (diaries) of trips outside of home were assessed using intraclass correlation (ICC) and kappa statistic. Convergent validity between WIMuGPS and self-report measures on respective outcomes were assessed using repeated measures correlation. Moderate agreement was observed between WIMuGPS and diary for daily outside trip frequency (ICC = 0.74, 95% CI = 0.6 – 0.8), but low agreement was observed for daily outside duration (ICC = 0.43, 95% CI = 0.2 – 0.6). Convergent validity was attained for frequency of trips (r = 0.62, p = 0.0001) but not duration outside (r = 0.46, p = 0.0005). WIMuGPS data contained 16.8% data loss and 3.1% of diary entries included missing or erroneous records. Reasons included technical issues (WIMuGPS), difficulties with compliance (both) and recall (diary). Analyses only included concurrent recordings. Moderate agreement and convergent validity between the WIMuGPS and the LSA were observed on biweekly trips outside (к = 0.76, p = 0.01; r = 0.68, p = 0.03, respectively). Self-report and wearable technology could be interchangeably used for basic mobility measures, such as trip frequencies, but not for duration. Long duration recordings provide rich sets of mobility data, but under-reporting of mobility outcomes may occur due to random errors (i.e., technical glitches) and bias (i.e., recall, study protocol noncompliance). Co-Author(s): Lynn Zhu, Western University/ Patrick Boissy, Université de Sherbrooke/ Christian Duval, Université du Québec à Montréal/ Mandar Jog, London Health Sciences Centre/ Rod Edwards, University of Victoria/ Catherine Lavigne-Pelletier, Université du Québec à Montréal/ Mark Speechley, Western University

53 G1.3 Triggering fatal arrhythmia: Is exercise a double-edged sword? Presented by HARPREET CHAHAL Master’s student, University of Western Ontario The relationship between physical activity and fatal arrhythmia is complex and incompletely understood – particularly concerning the presumed deleterious effects of strenuous exertion. Among patients with Implantable Cardioverter Defibrillator, we aim to relate prospectively collected incident ventricular arrhythmia with objectively measured physical activity data. We will assess the risk of fatal arrhythmia during physical exertion compared to rest. Moreover, we will investigate if this risk differs by exercise capacity, measured by peak oxygen uptake. While the primary use of ICDs have been to detect and treat lethal arrhythmia, modern devices contain sensors that measure activity via single-axis-accelerometer. These accelerometers are comprised of a piezoelectric crystal mounted to the circuitry board inside the generator and essentially act as miniature pedometers permanently situated in the ICD, at the subcutaneous infraclavicular implant site. While the traditional clinical utility for the activity sensor is to aid in determining appropriate pacing rate, the sensor records and stores both activity level at the time of shock and activity trends over the past week. Study participants who experienced shock had also completed a detailed survey on physical exertion within 72 hours of ICD discharge, which will be used to corroborate activity levels at the time of shock. To test the association between exertion and arrhythmia, a nested case-crossover analysis will be employed where each case acts as their own control. Exposure distribution at the time of event will be compared to exposure distribution in baseline control time using the Mantel-Haenszel estimator of the incident relative risk. Confidence intervals will be constructed around the relative risk estimate using methods for sparse person-time data. Results will be stratified by peak oxygen uptake quartiles to assess the impact of exercise capacity. Co-Author(s): Mark Speechley, University of Western Ontario/ Allan Skanes, London Health Sciences Centre/ Peter Leong-Sit, London Health Sciences Centre/ George Klein, London Health Sciences Centre/ Raymond Yee, London Health Sciences Centre/ Jaimie Manlucu, London Health Sciences Centre/ Anthony Tang, London Health Sciences Centre/ Lorne Gula, London Health Sciences Centre

G1.4 A meta-analysis of prospective studies on the role of physical activity and the prevention of Alzheimer’s disease in older adults Presented by MICHAEL BECKETT York University The incidence of Alzheimer’s disease is increasing as the global population ages. Evidence suggests physical inactivity is a risk factor for Alzheimer’s in older adults. This study used a meta-analytic approach to determine if physical activity is associated with a reduced risk of Alzheimer’s in adults 65 years or older. A systematic review was performed and nine longitudinal studies, with a total of 20, 326 participants, were included in this meta-analysis. Physical activity levels were recorded for all participants at baseline and the primary analysis focused on comparing the most physically active older adults with their least active counterparts. Both fixed and random effects meta-analysis methods were considered to obtain pooled estimates of the hazard or risk ratios across studies. A systematic review was performed and nine longitudinal studies, with a total of 20, 326 participants, were included in this meta-analysis. Physical activity levels were recorded for all participants at baseline and the primary analysis focused on comparing the most physically active older adults with their least active counterparts. Both fixed and random effects meta-analysis methods were considered to obtain pooled estimates of the hazard or risk ratios across studies. Based on the meta-analysis and minimal between study heterogeneity, the fixed effects risk ratio was estimated as 0.61 (95% CI 0.52-0.73) corresponding to a statistically significant reduction in the risk of Alzheimer’s disease in physically active older adults compared to their non-active counterparts. Overall, six of the nine longitudinal studies included in the meta-analysis showed a statistically significant reduction in risk of Alzheimer’s disease in the physically active older adults. Physical activity is associated with a reduced risk of Alzheimer’s disease in older adults. Given the limited success of pharmaceuticals, emphasis on prevention through physical activity amongst older adults could be beneficial. Future initiative to develop a greater understanding on the role of physical activity in reducing Alzheimer’s is recommended. Co-Author(s): Christopher Ardern, York University, Faculty of Health Science and Kinesiology/ Michael Rotondi, York University, Faculty of Health Science and Kinesiology G2 CHRONIC DISEASES III Greenwich Room G2.1 DURATION OF REMISSION AND OUTCOME IN MEMBRANOUS NEPHROPATHY: A LANDMARK ANALYSIS Presented by ESTHER KIM Graduate Student, University of Toronto Membranous nephropathy (MN) remains one of the leading causes of nephrotic syndrome and increases the risk of chronic kidney disease. Although remission (complete [CR] or partial [PR]) has been associated with improved long-term outcome in MN, the quantitative relationship between durability of remission and renal survival remains uncertain. We examined 688 biopsy-proven cases of primary MN from 1958 to 2011 using a landmark analysis. The exposure was CR or PR (and duration remission) examined at landmark time points of 3, 6, 12, and 24 months after the date of first remission. Additional patient characteristics were collected both at baseline and updated at each landmark. The primary outcome was a composite of end-stage kidney disease or 50% reduction from baseline kidney function. Cox proportional hazards models were fitted to examine the association of remission durability and outcome. We examined 688 biopsy-proven cases of primary MN from 1958 to 2011 using a landmark analysis. The exposure was CR or PR (and duration remission) examined at landmark time points of 3, 6, 12, and 24 months after the date of first remission. Additional patient characteristics were collected both at baseline and updated at each landmark. The primary outcome was a composite of end- stage kidney disease or 50% reduction from baseline kidney function. Cox proportional hazards models were fitted to examine the association of remission durability and outcome. Unadjusted analysis showed persistent remission versus relapse was associated with a decreased risk of the composite endpoint at the 3-month (HR 0.46 [95% CI: 0.26, 0.82]) to 12-month (HR 0.46 [95% CI: 0.27, 0.78]) landmarks. After adjustment for patient characteristics, immunosuppressive medications at baseline, and kidney function, staying in remission continued to be associated with improved renal survival at the 3-month (HR 0.39 [95% CI: 0.21, 0.71]) to 24 month (HR 0.41 [95% CI: 0.20, 0.84]) landmarks. Longer duration of remission is associated with a progressive reduction in the risk of kidney failure. This benefit is seen within 3 months of remission. This suggests that remission may be a valid surrogate for long-term renal outcome, and provides practical information that nephrologists can use to counsel their patients. Co-Author(s): S. Joseph Kim, Toronto Glomerulonephritis Registry, University of Toronto/ Heather Reich, Toronto Glomerulonephritis Registry, University of Toronto/ Michelle Hladunewich, Toronto Glomerulonephritis Registry, University of Toronto/ Daniel Cattran, Toronto Glomerulonephritis Registry, University of Toronto

G2.2 Prevalence of chronic disease and chronic disease risk factors in Canadian truck drivers Presented by PHIL BIGELOW Associate Professor, Universtiy of Waterloo Truck drivers are reported to be a higher risk for obesity and a number of chronic diseases as compared to workers in other industrial sectors. The objectives of this study were to determine the prevalence of chronic diseases and associated risk factors in a population of Canadian truck drivers. 991 truck drivers were compared to 29,958 respondents employed in other industrial sectors in the Canadian Community Health Survey (CCHS) from 2009-2010 (Cycle 5.1). Cycle 5.1 was used as this was the last year that occupation was measured in the CCHS. The reporting of occupation made this analysis on truck drivers possible. The CCHS is a cross sectional design survey which had a multi-stage stratified clustering sample design which obtained an excellent sample from all health regions of Canada. Chi-Squared and regression analyses were performed, following bootstrapping and application of sample weights. 991 truck drivers were compared to 29,958 respondents employed in other industrial sectors in the Canadian Community Health Survey (CCHS) from 2009-2010 (Cycle 5.1). Cycle 5.1 was used as this was the last year that occupation was measured in the CCHS. The reporting of occupation made this analysis on truck drivers possible. The CCHS is a cross sectional design survey which had a multi-stage stratified clustering sample design which obtained an excellent sample from all health regions of Canada. Chi-Squared and regression analyses were performed, following bootstrapping and application of sample weights. Truck drivers had higher rates of heart disease and obesity, less regular visits with healthcare professionals, poorer health-based knowledge and awareness (concerning the importance of food, and regular healthcare “checkups”), poorer mental health, higher amphetamine usage, lower condom usage, and lower seat belt usage. Truck drivers reported higher rates of smoking, lower fruit/vegetable intake, lower levels of physical activity and heart disease. In a multiple linear regression model, smoking status was significantly associated with an increased BMI and daily physical activity over 15 minutes long was negatively correlated with BMI. This sample of truck drivers was markedly different from other employed Canadian workers with respect to chronic disease prevalence and overweight. Findings, such as the relationship of physical activity and BMI, will be useful in designing intervention studies to improve the health of truck drivers. Co-Author(s): Peter Wawzonek, University of Waterloo/ Philip Bigelow, University of Waterloo

54 G2.3 How much will new cases of diabetes cost the Canadian health care system in the next ten years? Presented by ANJA BILANDZIC Practicum research trainee, University of Toronto - Dalla Lana School of Public Health The aim of this study was to estimate the future direct health care costs due to diabetes for a ten year period in Canada using national survey data and individual-level attributable costs within the context of a diabetes risk prediction tool. The Diabetes Population Risk Tool (DPoRT) was used to predict the number of new diabetes cases over a ten-year period, using 2011-2012 Canadian Community Health Survey (CCHS) data. Attributable costs due to diabetes were derived from a propensity-matched case control study using the Ontario Diabetes Database (ODD) and other administrative data. Total costs by subgroup were calculated by applying the respective attributable costs to the incident cases, accounting for sex, year of diagnosis and annual disease-specific mortality rates for the Canadian population. The Diabetes Population Risk Tool (DPoRT) was used to predict the number of new diabetes cases over a ten-year period, using 2011-2012 Canadian Community Health Survey (CCHS) data. Attributable costs due to diabetes were derived from a propensity-matched case control study using the Ontario Diabetes Database (ODD) and other administrative data. Total costs by subgroup were calculated by applying the respective attributable costs to the incident cases, accounting for sex, year of diagnosis and annual disease-specific mortality rates for the Canadian population. The predicted ten year risk of developing diabetes for the Canadian population in 2011-2012 was 9.98%, corresponding to 2.2 million new cases. Future incidence was highest in the elderly (65 years and older) at 16.45%, and the majority of cases will occur in those aged 45 to 64 years in 2011-12 with (1.5 million cases). Diabetes risk was higher among males compared to females (11.23 % versus 8.85%). Total healthcare costs attributable to diabetes during this period were estimated to be $7.5 billion (CAD) for females and $7.8 billion for males, resulting in a ten-year total health care cost of $15.4 billion. The majority of costs occurred in the first year after diagnosis, accounting for 52.4% of the total expenditures. Diabetes represents a high health care cost burden in Canada over the next ten years. This future cost calculation method can provide decision makers and planners with a useable tool to predict future expenditures attributable to the disease. Future work should be expanded to look at incorporating indirect attributable costs. Co-Author(s): Laura Rosella, University of Toronto - Dalla Lana School of Public Health

G2.4 A population-based risk algorithm for the development of diabetes: validation of the Diabetes Population Risk Tool (DPoRT) in the United States Presented by CHRISTOPHER TAIT PhD Student, Dalla Lana School of Public Health, University of Toronto Population-based risk tools are an important way to assess population risk of disease, estimate future disease burden, and determine the impact of interventions. The objective of this study was to validate the Diabetes Population Risk Tool (DPoRT) in a nationally-representative sample of the US population for the first time. We used data from adult respondents to each annual cycle of the National Health Interview Survey (NHIS) from 2003-2013 to estimate the observed number of incident diabetes cases over 10 years. We applied a 25% correction factor, taken from validation studies, to account for the underestimation of self-reported versus physician-diagnosed diabetes. We assessed predictive accuracy compared to the observed with two estimates of the number of incident cases of diabetes from 2003-2013: 1) the predicted crude estimate from DPoRT using the 2003 NHIS and 2) the predicted estimate using a newly calibrated DPoRT-USA logistic model adding SES, ethnicity, and insurance as predictors. We used data from adult respondents to each annual cycle of the National Health Interview Survey (NHIS) from 2003-2013 to estimate the observed number of incident diabetes cases over 10 years. We applied a 25% correction factor, taken from validation studies, to account for the underestimation of self-reported versus physician-diagnosed diabetes. We assessed predictive accuracy compared to the observed with two estimates of the number of incident cases of diabetes from 2003-2013: 1) the predicted crude estimate from DPoRT using the 2003 NHIS and 2) the predicted estimate using a newly calibrated DPoRT-USA logistic model adding SES, ethnicity, and insurance as predictors. The observed cumulative number of incident diabetes cases from 2003-2013 was 17,231,000 in the United States. The adjusted estimate accounting for the discrepancy between self-reported and physician-diagnosed diabetes was 21,539,000 new cases over 10 years. The predicted crude estimate using DPoRT on the 2003 NHIS cycle was 24,917,000. The predicted estimate using the DPoRT-USA model was 22,758,000. Our results show that the newly calibrated DPoRT-USA model including risk factors that are particularly predictive of diabetes risk in the US population performed better than the uncalibrated DPoRT model when estimating the number of new cases over a 10-year period. This indicates that SES, ethnicity, and insurance coverage are important calibration variables when adapting DPoRT for the US population. This study represents the first validation of DPoRT outside of Canada and using nationally-representative data from the US. Importantly, this study established a methodology that can be used to adapt population risk tools across populations and nations. Finally, these results highlight the importance of considering population-specific drivers of risk when applying risk tools in new populations. Co-Author(s): Christopher Tait, 1) Dalla Lana School of Public Health, University of Toronto 2) Public Health Ontario/ Laura Rosella, 1) Dalla Lana School of Public Health, University of Toronto 2) Public Health Ontario 3) Institute for Clinical Evaluative Sciences G3 ENVIRONMENTAL HEALTH II Brittania Room G3.1 Self-Report of Sun Exposure Behaviours in Pediatric Research: A Systematic Review of Measurement Properties Presented by SANDRA MAGALHAES PhD Cadidate, McGill University Sun exposure is a risk factor for several pediatric diseases. As observational studies often use self-reported questionnaires to collect exposure information measurement properties are important considerations. The objective of this work was to identify, describe and compare self-reported questionnaires that ascertain sun exposure information in children. We used systematic review methodology to identify publications that: (i) report on a questionnaire that assesses sun exposure, (ii) assess measurement properties, (iii) include children, and (iv) are written in English. PubMed, EMBASE and CINAHL were searched in June 2014 using a validated measurement properties search strategy. Two reviewers independently extracted data and performed quality assessment using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The ‘worst score’ COMSIN scoring system was used to rate quality of each domain. Reference lists of included articles were pearled. Data extraction and quality assessment disagreements were resolved by consensus. We used systematic review methodology to identify publications that: (i) report on a questionnaire that assesses sun exposure, (ii) assess measurement properties, (iii) include children, and (iv) are written in English. PubMed, EMBASE and CINAHL were searched in June 2014 using a validated measurement properties search strategy. Two reviewers independently extracted data and performed quality assessment using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The ‘worst score’ COMSIN scoring system was used to rate quality of each domain. Reference lists of included articles were pearled. Data extraction and quality assessment disagreements were resolved by consensus.Of the 4538 abstracts screened, 37 met the inclusion criteria. Studies assessed sun protection (n=26), sun sensitivity (n=14), current sun exposure behaviour (n=12), sun exposure behaviour at a specified time (n=7) and cumulative sun exposure (n =4). Twenty-one questionnaires were identified; five of which were discussed in more than one article. Measurement properties were examined through assessment of forty-eight domains including convergent validity (n=18), reliability (test-retest: n=10; inter-rater (parent/child): n=4), internal consistency (n=12), content validity (n=3), and criterion validity (n=1). Overall study quality appeared good, but using the ‘worst score’ scoring system the majority of COSMIN domains scored poor (n=24) or fair (n=17), while only 7 of 48 domains scored good (n=6) or excellent (n=1). Low quality scores related primarily to incomplete reporting. Validity and reliability of the questionnaires varied widely. Overall studies were of good quality, but this was not properly represented using the ‘worst score’. The results of this review will provide investigators designing questionnaires with key information about measurement properties of assessing sun exposure behaviours in children. Co-Author(s): Sandra Magalhaes, Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC,/ Catherine Tansey, McGill University, Montreal, QC/ Brenda Banwell, Children’s Hospital of Philadelphia, Philadelphia, PA, United States/ Amit Bar-Or, Neurology and Neurosurgery, McGill University, Montreal, QC/ Isabel Fortier, Research Institute of the McGill University Health Centre, Montreal, QC/ Heather Hanwell, Hospital for Sick Children, Toronto, ON/ Maura Pugliatti, University of Sassari, Sassari, Italy/ Christina Wolfson, Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC

55 G3.2 Evidence to Action: Use of predictive models for beach water quality postings Presented by CAITLYN PAGET Epidemiologist, Regional Municipality of York In Ontario, beach users are notified when E.coli levels exceed the provincial standard, however water conditions often change within the 24-hours required for laboratory results, leading to inaccurate postings. York Region conducted a three-year pilot project to improve accuracy of beach postings, using predictive models for real-time E.coli estimation. York Region’s beach inspection database includes water quality results and environmental conditions at the time of sampling. Linear regression models were used to estimate E.coli concentrations based on four years of historical data. Multiple models were created for each beach, and simulations by year were used to select the final models. Success was measured against the previous monitoring system. Each year, model performance was evaluated mid-season, for potential adjustment. In subsequent years of the pilot, models were either updated to include the recent year of inspection data, or were rebuilt, depending on the previous year’s performance. York Region’s beach inspection database includes water quality results and environmental conditions at the time of sampling. Linear regression models were used to estimate E.coli concentrations based on four years of historical data. Multiple models were created for each beach, and simulations by year were used to select the final models. Success was measured against the previous monitoring system. Each year, model performance was evaluated mid-season, for potential adjustment. In subsequent years of the pilot, models were either updated to include the recent year of inspection data, or were rebuilt, depending on the previous year’s performance. In 2012, predictive models were implemented at 3 York Region beaches, and the pilot was expanded to 6 beaches in 2013 and 2014. Some environmental conditions were more commonly selected as predictors, such as turbidity, rainfall and air temperature. The predictive models outperformed the previous monitoring system, with small improvements in accuracy and dramatic improvements in sensitivity; representing better public protection. However, these results varied by beach and by year. 2013 had unusual weather and water quality patterns, resulting in similar performance between the predictive and the previous monitoring systems. In 2014, the models which were rebuilt outperformed the beta re-estimate models, indicating that recent inspection data should be included in the model building process. Overall, the pilot has shown that it is possible to build predictive models that are more accurate than the previous monitoring system using inspection data. Continued data collection of environment conditions and water sampling is needed to account for differences in weather patterns between swim seasons. Co-Author(s): Caitlyn Paget, Regional Municipality of York/ Debeka Navaranjan, Regional Municipality of York/ Bernard Mayer, Regional Municipality of York

G3.3 Pesticide use and the risk of multiple myeloma among men in The North American Pooled Project (NAPP) Presented by ROSEANNA PRESUTTI Research Associate, Cancer Care Ontario Multiple myeloma (MM) is a relatively rare hematopoietic cancer that has been linked with farming and pesticide exposures. The objective of this analysis was to evaluate associations between pesticide use and MM risk using data from previously conducted US and Canadian case-control studies that were pooled to form the NAPP. The NAPP includes frequency-matched male MM cases and population-based controls from Iowa, Nebraska, and 6 Canadian provinces. Participants provided information on pesticide use and other potential MM risk factors via questionnaires. Self-reported pesticide use was classified dichotomously (ever/never) and by duration (years and lifetime days). Multivariate logistic regression models were used to calculate odds ratios (OR) and corresponding 95% confidence intervals (CI). Models were adjusted for age, province/state of residence, use of proxy respondent, ever diagnosed with any allergy, rheumatoid arthritis, or hayfever. The NAPP includes frequency-matched male MM cases and population-based controls from Iowa, Nebraska, and 6 Canadian provinces. Participants provided information on pesticide use and other potential MM risk factors via questionnaires. Self-reported pesticide use was classified dichotomously (ever/never) and by duration (years and lifetime days). Multivariate logistic regression models were used to calculate odds ratios (OR) and corresponding 95% confidence intervals (CI). Models were adjusted for age, province/state of residence, use of proxy respondent, ever diagnosed with any allergy, rheumatoid arthritis, or hayfever. Among 547 cases and 2700 controls, statistically significant associations were observed among men reporting any exposure to captan (OR=1.98, 1.04-3.77), carbaryl (OR=2.02, 1.28-3.21) and DDT (OR=1.44, 1.05-1.97). Positive associations that were not statistically significant were observed for the ever use of lindane (OR=1.38, 95% CI: 0.90-2.10), malathion (OR=1.19, 95% CI: 0.84-1.69) and glyphosate (OR=1.29, 95% CI: 0.90-1.85). Significantly elevated risks were observed for years of use (ptrend=0.02) and cumulative lifetime days of exposure (ptrend=0.02) to carbaryl. Although significant increases in MM risk were observed among participants who used captan for 1-10 years compared to never users, (OR=3.46; 95% CI: 1.64-7.32, ptrend=0.31), risks were not elevated in the highest exposure category (OR=0.49; 95% CI:0.11-2.21). This analysis supports previously reported associations in Canada for captan and Canada and the US for carbaryl for ever use. The additional 205 cases from the US enhanced power and facilitated evaluation of MM risks using metrics of lifetime exposure, which identified increased risks, but a complex pattern of associations. Co-Author(s): Shelley Harris, Cancer Care Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada/ John Spinelli, British Columbia Cancer Agency Research Centre, University of British Columbia, Vancouver, BC, Canada/ Manisha Pahwa, Cancer Care Ontario, Toronto, ON, Canada/ Linda Kachuri, Cancer Care Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Samuel Lunenfeld Research Institute, Toronto, ON, Canada/ U.S. National Cancer Institute case-control study investigators , U.S. National Cancer Institute, Bethesda, MD, USA/ Punam Pahwa, University of Saskatchewan, Saskatoon, SK, Canada;Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK,/ James A. Dosman, University of Saskatchewan, Saskatoon, SK, Canada/ John R. McLaughlin, Samuel Lunenfeld Research Institute, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada/ Laura Beane Freeman, U.S. National Cancer Institute, Bethesda, MD, USA

G3.4 Association between Dietary Factors and Urinary Concentrations of Organophosphate and Pyrethroid Metabolites in a Canadian General Population Presented by MING YE PhD Candidate, University of Alberta Few studies have characterized the relationship between dietary factors and pesticide exposures in general populations. In the current study, associations between dietary factors and urinary concentrations of organophosphate (OP) and pyrethroid (PYR) insecticide metabolites were examined in a Canadian general population using data from the Canadian Health Measures Survey (CHMS). In the CHMS, urinary concentrations of six OP metabolites (DMP, DMTP, DMDTP, DEP, DETP and DEDTP) and five PYR metabolites (3PBA, 4-F-3-PBA, cis-DCCA, trans-DCCA and cis-DBCA) were measured in 5,604 participants aged 6-79 years. The association between dietary factors and pesticide metabolite concentration was examined by multiple linear regression analysis. In the CHMS, urinary concentrations of six OP metabolites (DMP, DMTP, DMDTP, DEP, DETP and DEDTP) and five PYR metabolites (3PBA, 4-F-3-PBA, cis-DCCA, trans-DCCA and cis-DBCA) were measured in 5,604 participants aged 6-79 years. The association between dietary factors and pesticide metabolite concentration was examined by multiple linear regression analysis. Over 90% of CHMS participants aged 6-79 years had detectable OP metabolites, and almost all CHMS participants (99.8%) in the same age group had detectable PYR metabolites in their urine samples. After adjusting for age, sex, ethnicity, immigrant status and body mass index, increasing frequencies of fruit and vegetable consumption were significantly associated with total DAP concentration (p-values<0.001), and increasing frequencies of pulse/nut and vegetable consumption were significantly associated with total PYR concentration (p-values<0.01). Urinary concentration of total PYR was also significantly associated with the household use of chemicals to control head lice or pet flea (p=0.002). Significant associations between urinary concentrations of OP and PYR metabolites and dietary factors suggest greater regulation of pesticide residual levels in certain food products may help to reduce pesticide exposures and any associated risks among the general population. Co-Author(s): Jeremy Beach, University of Alberta/ Jonathan Martin, University of Alberta/ Ambikaipakan Senthilselvan, University of Alberta

56 G4 HEALTH SERVICES IV Club Studio 3 G4.1 Identifying risk factors for adverse events in major elective spine, knee, and hip in-patient orthopaedic surgery Presented by DOV MILLSTONE Student, University of Toronto Orthopaedic surgeries for degenerative musculoskeletal conditions are highly common. Adverse events (AE) following surgery can have negative physical and psychological consequences for patients and are associated with increased costs to the health care system. Our objective was to identify risk factors for AEs in hip, knee, and spine orthopaedic surgeries. Data on in-hospital AEs were recorded over a two-year period for elective inpatient knee, hip, and spine orthopaedic procedures for degenerative musculoskeletal conditions (predominantly osteoarthritis/spinal stenosis) using a novel clinical point-of-care AE capture system (Orthopaedic Surgical AdVerse Event Severity system (OrthoSAVES)). As well, age, sex, surgical site, body mass index, surgical risk class, procedure time, and medical comorbidities were recorded for each patient, and considered as potential risk factors for AEs. Multivariable logistic regression was employed to investigate the association between these potential factors and the likelihood of experiencing an AE. Data on in-hospital AEs were recorded over a two-year period for elective inpatient knee, hip, and spine orthopaedic procedures for degenerative musculoskeletal conditions (predominantly osteoarthritis/spinal stenosis) using a novel clinical point-of-care AE capture system (Orthopaedic Surgical AdVerse Event Severity system (OrthoSAVES)). As well, age, sex, surgical site, body mass index, surgical risk class, procedure time, and medical comorbidities were recorded for each patient, and considered as potential risk factors for AEs. Multivariable logistic regression was employed to investigate the association between these potential factors and the likelihood of experiencing an AE. The sample included 2,146 patients. The overall adverse event rate was 27%: spine 29%; knee 27%; and hip 25%. Factors independently associated with greater odds of an adverse event included increasing age (Odds Ratio=1.29, 95% CI: 1.11-1.49, per 15 year interval), male sex (OR=1.36, 95% CI: 1.11-1.68), longer procedure time (OR=1.19, 95% CI: 1.10-1.30, per 30 min increase), and undergoing revision surgery (OR=2.10, 95% CI: 1.30-3.38). Decreased odds were associated with being overweight (OR=0.73, 95% CI: 0.55-0.97) and for undergoing spine surgery (OR=0.49, 95% CI: 0.32-0.77) once procedure time was taken in account. No significant effects relating to medical comorbidities were found. A point-of-care AE capture system revealed higher AE rates compared to typically reported estimates. We report increasing age, male sex, revision surgery, and longer procedure times as AE risk factors in this population. Our findings have implications for the development of measures to reduce the incidence of AEs. Co-Author(s): Anthony V. Perruccio, University Health Network, Toronto Western Hospital/ Elizabeth M. Badley, University Health Network, Toronto Western Hospital/ Y. Raja Rampersaud, University Health Network, Toronto Western Hospital

G4.2 Canada and New Zealand: A cross-national comparison of the barriers and enablers related to health care policy agendas Presented by MACKENZIE MOIR Student, Independent Political attention and policy agendas are influenced by a number of factors that impact what issues emerge on the reform table. This paper examines factors that have shaped the unique health policy agendas of Canada and New Zealand (NZ) during their health care reform attempts from 2003-2010. All data were collected from Health Policy Monitor (HPM) reports published from 2003-2010 for Canada and NZ. Health policy attention patterns were determined by tallying official HPM theme tags that were attached to reports based on policy target and content. Report content was collected and organized into categories. This content consisted of specific barriers and enablers that played a role in shaping issue attention and the reform agendas of both countries. Previously published categories were used to group the intended health outcomes of each policy. All data were collected from Health Policy Monitor (HPM) reports published from 2003-2010 for Canada and NZ. Health policy attention patterns were determined by tallying official HPM theme tags that were attached to reports based on policy target and content. Report content was collected and organized into categories. This content consisted of specific barriers and enablers that played a role in shaping issue attention and the reform agendas of both countries. Previously published categories were used to group the intended health outcomes of each policy. In total, 121 reports were analysed (Canada: 53, NZ: 68). Preliminary results suggest there are significant differences regarding the barriers and enablers that shape the health policy agendas of both countries. These included factors related to government financing, cost, reimbursement systems, organizational context, governance, government elections, existing or new policies and political complexity. Influential actors included the public, health care practitioners, advocacy organizations, pharmaceutical industry, government, payers, and the media. These data revealed unique patterns of policy attention between each country. Significant differences were noted in the areas of health care system responsiveness, pharmaceutical policy, disease prevention, and primary care. Furthermore, differences were noted in how similar issues were framed and approached. For example, Canadian primary care reforms focused on promotion of interdisciplinary practice and implementation of electronic health records; whereas the focus in NZ was on patient access, new regulatory structures, and development of the primary care nursing role. This paper highlights the different patterns of policy attention between Canada and NZ. The barriers and enablers that shape these respective agendas were discussed and compared. Specific differences regarding how these factors were framed within the policy agenda context were used to explain divergent approaches to common challenges. Co-Author(s): Ana Johnson, Queen’s University/ Mackenzie Moir, / Tim Tenbensel, University of Auckland

G4.3 A scope review on economic evaluations of vaccines in Canada Presented by ELLEN RAFFERTY University of Saskatchewan This study aims to determine what has been published regarding economic evaluations on vaccines in Canada. Using a scope review method we hope to provide a broad overview and analysis of the work being completed in this area. We followed Arksey & O’Malley’s framework for completing a scope review, by (1) Determining the research question and relevant studies (2) Selecting appropriate studies (3) Organizing/charting the data (4) summarising and dessiminating the findings. We gathered relevant research from both academic and grey literature, including four electronic databases (EMBASE, MEDLINE, Global Health and Cochrane Library) along with Proquest Dissertations and Theses and relevant government websites. We followed Arksey & O’Malley’s framework for completing a scope review, by (1) Determining the research question and relevant studies (2) Selecting appropriate studies (3) Organizing/charting the data (4) summarising and dessiminating the findings. We gathered relevant research from both academic and grey literature, including four electronic databases (EMBASE, MEDLINE, Global Health and Cochrane Library) along with Proquest Dissertations and Theses and relevant government websites. Following abstract and full-text review we identified 53 articles to be included in the final analysis. Since, 1989, there has been a steady increase in the number of economic evaluations of vaccines in Canada with a focus on the more recently licensed and expensive vaccines (e.g. HPV, Pneu). At the same time, here were relatively few studies focusing on the economic evaluations of classic EPI vaccines and their schedules, traveller’s vaccinations or vaccines in the pipeline. Furthermore, we identified some general limitations in the economic evaluation methods being employed in these studies including, the lack of consideration for herd immunity, the modelling techniques chosen and inconsistent compliance with CADTH guidelines. Although economic evaluations of vaccines are increasing in numbers there is room for improvement. This review demonstrates that it is important for researchers to begin to address the gaps in vaccine economic evaluation in Canada and make them relevant, accurate and usable to fellow researchers, the public and decision-makers.

57 Poster Presentations At-A-Glance

58 Poster Presentations Tuesday, June 2, 2015 1 Diabetes And The Association Of Skin And Soft Tissue Infection: A Systematic Review Of Observational Studies WASEEM ABU-ASHOUR PharmaD, MSc. Student, Memorial University of Newfoundland

4 Disparities in childhood: examining the role of income, parental education and immigrant generational status across child health and achievement outcomes HUMNA AMJAD BHSc. Student, McMaster University

5 Brain Cancer Survival Rates in Canada: an analysis of Canadian Cancer Registry data by histology and province, 1992-2008 FAITH DAVIS Vice-Dean, School of Public Health, University of Alberta

6 Multistate Markov Models for Longitudinal and Event-Time Data ESHETU ATENAFU Senior Biostatistician, University Health Network

7 Sex differences in the prevalence and incidence of mild cognitive impairment: a systematic review and meta-analysis BONNIE AU Research Associate, Sunnybrook Health Sciences Centre

9 The Influence of Satisfaction with Pre and Postnatal Healthcare Encounters on Postpartum Weight Retention ANDREEA BENTE Master’s Student, Western University

11 Updated non-malignant mortality experience of Ontario uranium miners COLIN BERRIAULT Research Associate, Occupational Cancer Research Centre

12 What Really Happens to Women After They Have a Low-grade Abnormal Cervical Smear? ABHI BHANDARI Master’s Student, University of Ottawa

13 THE CURRENT STATE OF AND GAPS IN PUBLIC HEALTH INFORMATICS RESEARCH: A SCOPING REVIEW IN MEDLINE ARJUN BHATTARAI University of Waterloo

14 Development of a national study on the health and wellness of Canadian commercial motor vehicle (CMV) drivers PHIL BIGELOW Associate Professor, Universtiy of Waterloo

15 Assessing the intrepretability of different pooling methods that can be used within a systematic review for a meta-analysis VICTORIA BORG DEBONO Graduate Student, McMaster University

16 Routine follow-up care after curative treatment of head and neck cancer from the perspective of the patient KELLY BRENNAN Graduate Student, Queen’s University

17 Measures of Excess Body Weight and Anthropometry among Adult Albertans: Results from Alberta’s Tomorrow Project DARREN BRENNER Research Scientist, Alberta Health Services

19 Cancer Incidence Attributable to Excess Body Weight in Alberta, Canada in 2012 DARREN BRENNER Research Scientist, Alberta Health Services

20 Cancer Incidence Attributable to Physical inactivity in Alberta Canada in 2012 DARREN BRENNER Research Scientist, Alberta Health Services

21 Incidence rates of lymphoma and leukemia in rheumatoid arthritis patients using adalimumab: a literature review AUDREY CARON Student, University of Ottawa

22 The Healthy Pregnancy Strategy: Establishing a Baseline ADELE CARTY M.Sc. Student, University of Guelph

23 Implantable Cardioverter Defibrillator activity sensors overestimate activity at time of shock HARPREET CHAHAL Master’s student, University of Western Ontario

25 Variation in MMR Immunization Rates Across Calgary Zone Community Health Centres MONICA CHAWLA MPH Student, Alberta Health Services & University of Alberta

26 Knowledge, Attitudes and Practices about Hepatitis B among Adolescents in the Upper West Region of Ghana: The Rural-Urban Gradient BATHOLOMEW CHIREH Graduate Student, University of Saskatchewan

59 27 Prevalence Estimates of Five Mental Health Conditions: A Comparison of Approaches LUC CLAIR PhD Candidate, McMaster University

28 Effects of school and home neighbourhood food outlets on junk food consumption among elementary school children in a mid-size Canadian city KRISTA COOK Student, Western University

30 Are primary care patients with different patterns of low back pain epidemiologically distinct? LAUREN DELLA MORA MPH Student, Dalla Lana School of Public Health

31 Impacts of Team-based Primary Care on Healthcare Access and Utilization for Adults with Intellectual and Developmental Disabilities in Ontario JEFF DIXON MSc Student, Queen’s University

34 A Comparison of Health Utility Scores in Alzheimer’s Disease Using the EQ-5D-3L and UK and Canadian Preference Weights MINGYING FANG Ph.D Candidate, University of Waterloo

36 Rotavirus Vaccine Safety Profile based on Reporting to the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS) MYLÈNE FRÉCHETTE Epidemiologist, Public Health Agency of Canada

37 Incidence of Diabetes in Older Adults with Co-Occurring Depressive Symptoms and Cardiometabolic Abnormalities CASSANDRA FREITAS MSc Epidemiology Candidate, McGill University

40 Quantifying the exposure to illicit “Canadian” online pharmacies dispensing oxycodone without prescription KIMMY CK FUNG MPH Graduate, Dalla Lana School of Public Health, University of Toronto

41 The association between self-reported depressive symptoms and risky sexual interactions in an injection drug using population in Winnipeg, Canada KARYN GABLER Master’s Student, University of Ottawa

42 HPV variants in Inuit women from Nunavik, Quebec BARBARA GAUTHIER MSc Student, McGill University, Department of Epidemiology, Biostatistics, and Occupational Health

43 Epidemiology of Booster Seat Use in Alberta RICHARD GOLONKA Evaluation Coordinator, Alberta Health Services

44 Child Restraint Information Sources Utilized by Parents of Booster Eligible Children RICHARD GOLONKA Evaluation Coordinator, Alberta Health Services

45 Job and Environmental Exposure Matrix (JEEM) : development of a concept for Prostate Cancer JAMES GOMES Assoc Prof, University of Ottawa

46 Analysis of the relationship between endocrine disrupting heavy metals and adverse infant-related and mother-related outcomes JAMES GOMES Assoc Prof, University of Ottawa

47 Cancer Incidence Attributable to Alcohol Consumption in Alberta, Canada in 2012 ANNE GRUNDY Research Scientist, Alberta Health Services

48 Cancer Incidence Attributable to Selected Dietary Factors in Alberta, Canada in 2012 ANNE GRUNDY Research Scientist, Alberta Health Services

49 Free-Roaming cats (FRC) and Public Health Risks IDIT GUNTHER DVM, Koret School of Veterinary Medicine, Hebrew University

50 Adolescent’s perspective on food insecurity and content validity analysis of a national survey item: A qualitative study FARZANA HAQ MSc. Candidate, Queen’s University

52 Quality of Secondary Health Data in Canada AYNSLIE HINDS PhD Student, University of Manitoba

53 Maternal lead exposure’s impact on infants’ blood lead levels in the first year after birth SIYING HUANG PhD, University of Toronto Dalla Lana School of Public Health

54 Best practices for publishing epidemiologic and biostatistical research PATRICIA HUSTON Scientific Editor, Canada Communicable Disease Report, Public Health Agency of Canada

60 56 Is educational attainment or high school academic performance a stronger predictor of dementia? MARYAM IRANIPARAST PhD student, University of Waterloo

57 PERSONALITY AND THE DIAGNOSIS OF CHRONIC CONDITIONS IN OLDER ADULTS JAMES IVENIUK University of Chicago

58 Cancer Risk Factors in Ontario First Nations SEHAR JAMAL Epidemiology Student, Cancer Care Ontario / Universty of Toronto

59 Urban-rural differences in the uptake of new osteoporosis drug formulations RACQUEL JANDOC Leslie Dan Faculty of Pharmacy, University of Toronto

60 The Effectiveness and Safety of Second-Line Therapy for Androgenetic Female Alopecia: A Multi Treatment Comparison Meta-Analysis ABBY RAMZI University of Ottawa

61 Educational interventions are the most promising for improving adherence to cardiovascular disease guidelines REBECCA JEFFERY Medical Student, Dalhousie University

62 Association between Neighbourhood walkability and Physical Activity among adults in Urban Canada ASHNA JINAH M.Sc. Candidate, Western University

63 STI (Sexually Transmitted Infections) Risk Misperception in the Maritime University Student Population LAURA KEELER Dalhousie University

64 A pragmatic overview of fetal macrosomia LOUAY KHIR Student, University of Ottawa

65 Methodological approaches for estimating the number of cancers caused by occupational exposure in Canada JOANNE KIM Research Associate, Occupational Cancer Research Centre

68 Comparison of Outcome Measures for Studying Mild Traumatic Brain Injury Prognosis in Older Adults VICKI KRISTMAN Associate Professor, Lakehead University

69 Safety of Statins as Secondary Prevention of Dyslipidemia: A Bayesian Network Meta-Analysis MELISSA LAVIGNE Student Researcher, University of Ottawa

70 The direct and indirect costs associated with one-month recovery following acute ankle sprains RAYMOND LEE Student, Queen’s University

71 Soil-transmitted helminth infections, anemia and child development: Addressing biases due to misclassification and decomposing effects in the presence of exposure-mediator interaction LAYLA MOFID Student, McGill University

72 Exposure to DDT following Indoor Residual Spraying and hypertensive disorders of pregnancy in South African women participating in the VHEMBE study JENNIFER MURRAY Student, McGill University

73 Cancer Incidence Attributable to Tobacco in Alberta, Canada in 2012 ABBEY POIRIER Research Scientist, Alberta Health Services

74 Tobacco Smoking and Passive Smoke Exposure Prevalence among Adult Albertans: Results from Alberta’s Tomorrow Project ABBEY PORIER Research Scientist, Alberta Health Services

75 A Cost-Effectiveness Analysis of Telemedicine for Glaucoma Screening SERA THOMAS MSc, Western University; Dept Epidemiology

61 Poster Presentations Wednesday, June 3, 2015 1 Examining the Relationship between Established Breast Cancer Risk Factors and Levels of DNA Methylation in Blood Leukocytes DEVON BOYNE MSc Candidate, Queen’s University

2 Evaluating the oral health status of Toronto children ANDREW LAM Student Epidemiologist, Toronto Public Health

3 Occupational exposure to polycyclic aromatic hydrocarbons is associated with increased breast cancer risk DERRICK LEE PhD Candidate, University of British Columbia

4 Carbohydrate intake and abdominal adiposity among postmenopausal women FELICIA LEUNG PhD Candidate, Dalla Lana School of Public Health, University of Toronto

5 Melatonin patterns among female hospital workers on day and night shifts MICHAEL LEUNG MSc., Queen’s University

6 Statistical Algorithm for Aberrant Event Detection Using an Interactive Web Application: The Data Driven Approach LENNON LI Biostatistical specialist, Public Health Ontario

7 Predictors of functional improvement in children and adolescents treated at Children’s Services (Saskatoon Health Region) (in progress) MUZI LI PhD student, University of Saskatchewan

8 High Temperature Effect on Mortality in Ontario, Canada QIONGSI LI Research Corrdinator, Public Health Ontario

9 Evaluating diagnostic characteristics and time to breast cancer diagnosis for women receiving organized breast assessment LEANNE LINDSAY Research Associate, Cancer Care Ontario

10 Exploring trajectories of diabetes distress in a community sample of adults with type 2 diabetes CARLA LIPSCOMBE Student, McGill University

11 Modeling the Ebola Outbreak in Bo, Sierra Leone, Using AnyLogic Software STEFAN LITVINJENKO University of Ottawa

12 Risk of adverse renal outcome following polyethylene glycol bowel preparation AIDEN LIU AL, Western University

13 The impact of education and apolipoprotein E on cognitive reserve is modified by late-life cortical atrophy MICHAEL MACKINLEY Graduate Student, University of Waterloo

14 Maternal Fat Intake during Pregnancy and Breastfeeding Initiation RACHEL MAN University of Western Ontario

15 The importance of the management of transitions in the neonatal intensive care unit MYURI MANOGARAN PhD Candidate, University of Ottawa

16 Limiting Lyme disease: using system dynamics simulation to target interventions SHILO MCBURNEY Student, Dalhousie University

17 Estimation of the mortality burden of influenza in India ASHLEIGH MCGIRR PhD Candidate, Dalla Lana School of Public Health, University of Toronto

20 Frailty in adults with intellectual & developmental disabilities and admission to long-term care KATHERINE MCKENZIE MSc Candidate, Queen’s University

21 Neighborhood Perception of Safety and the Mobility Gap between Women and Men in Old Age JUSTINE MCLEOD Graduate Student, Queen’s University

24 Patterns of Sugar Sweetened Beverage Consumption in Children Grades 6 to 10 in Northern Rural Canada LAURA DAVIS Queen’s University

25 Maternal Deworming Research Study (MADRES): generating empirical evidence to support global health policy on deworming LAYLA S. MOFID Student, McGill University

62 26 Trends & Associations of HIV-related admission and mortality proportions in Princess Marina Hospital, Gaborone from 2000-2006 MOOKETSI MOLEFI University of Botswana

27 Role of Omega-3 Fatty Acids in the Prevention and Treatment of Postpartum Depression FATIMA MOUGHARBEL Master student, University of Ottawa

29 What are the effects of high versus moderate exercise volume on insulin resistance indicators in postmenopausal women? HEATHER NEILSON Epidemiology Research Associate, Alberta Health Services

30 Physical activity and risk of breast cancer: protocol for a systematic review and meta-analysis HEATHER NEILSON Epidemiology Research Associate, Alberta Health Services

31 The Methodological Challenges of Identifying Multimorbidity in a Pan-Canadian Electronic Medical Record Database KATHRYN NICHOLSON PhD Candidate, Western University

32 Investigating in rural Indian women the acute effects of personal exposures to household air pollution on blood pressure CHRISTINA NORRIS MSc Candidate, McGill University

33 Health Care Satisfaction in Patients following Premature ACS: Determinants and Association with Adverse Outcomes MARISA OKANO M.Sc. Public Health Candidate, McGill University

35 Genetic Polymorphisms and Hair, Blood and Urine Mercury Levels: A Gene Environment Study of Mercury in the American Dental Association (ADA) Study RAJENDRA PARAJULI Environmental Health Sciences Lab, McGill University, Department of Natural Resource Science

36 Is finger length a predictor of prostate cancer risk? MARIE-ELISE PARENT Research Associate, INRS Institut Armand-Frappier

39 Sex, multiple painful joints and systemic inflammation in osteoarthritis ANTHONY PERRUCCIO Assoc. Scientist, University Health Network; University of Toronto

40 Maternal exposure to air pollution and adverse birth outcomes in Halifax, Nova Scotia ABBEY POIRIER Research Associate, Alberta Health Services

42 Ethnicity and Pain: An Exploration of the Expression of Pain among Four Ethnic Minority Groups in Canada PRINON RAHMAN Student, Dalhousie Univeristy

43 Correlates of human papillomavirus vaccine uptake among adolescent males in the United States: National Immunization Survey-Teen, 2013 MAHBUBUR RAHMAN Associate Professor, University of Texas Medical Branch

44 Alcohol as a risk factor for blood pressure in South Africa ABBY RAMZI University of Ottawa

45 The Evolving Risk Factor Profile of New-Onset Diabetes Mellitus After Renal Transplantation LAURA RIVERA Epidemiologist, Public Health Ontario

46 Pet ownership and asthma occurrence among Quebec children MARIE-CLAUDE ROUSEAU Professor, INRS-Institut Armand-Frappier

47 Evaluation of a Health Communications Initiative in Rwanda NODINE SANGWA Student, University of Ottawa

48 Factors Associated with Head Trauma Among Mixed Martial Arts Athletes PETER SCALIA Student, University of Ottawa

49 Genetic variants of vitamin D-related genes (GC and VDR) and breast cancer risk JOY SHI Queen’s University

50 Polymorphisms of insulin-like growth factor 1 pathway genes and breast cancer risk JOY SHI Queen’s University

51 An empirical comparison of methods to meta-analyze individual patient data of diagnostic accuracy GABRIELLE SIMONEAU Student, McGill University

52 Methodologic Issues in Pharmacoepidemiologic Studies of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Prostate Cancer (PC) Risk HASANTHA SINNOCK Graduate Student, University of Manitoba

53 Uptake of periodic health exams among adults with intellectual and developmental disabilities from 2009-2015 GLENYS SMITH Student, Queens University

63 54 A Meta Analysis of Tiffeneau-Pinelli Spirometric Index in Men and Women: Does Race Matter ? MOHSEN SOLTANIFAR Ph.D Student in Biostatistics, Dalla Lana School of Public Health - University of Toronto

55 The application of Canadian patient-reported health utility scores (HUS) derived from the EQ5D-3L questionnaire for metastatic non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations ERIN STEWART Graduate student, Princess Margaret Cancer Centre

56 Occupational stress and job characteristics among child care workers MARIAM STITOU Research assistant, University of Ottawa

57 Caring for LHBCC health MARIAM STITOU Student, University of Ottawa

58 Health and Well being among child care caregivers MARIAM STITOU Research assistant, University of Ottawa

59 Cross-Sectional Analysis of Linkages between Asthma and Anxiety DANIEL STOJANOVIC MD Candidate 2018, Schulich School of Medicine and Dentistry

60 Self-reported symptoms associated with ovarian cancer among peri- and postmenopausal women ZHUOYU SUN Department of Epidemiology, Biostatistics and Occupational Health, McGill University

61 Data Preprocessing and Quality Control Evaluation of Infinium HumanMethylation 450K DNA Methylation QI JING SUN Master of Public Health Epidemiology Student, Dalla Lana School of Public Health, University of Toronto

63 Is overall academic performance in high school associated with dementia and Alzheimer’s disease? GRACE TANG University of Waterloo

64 LENGTH OF STAY IN PATIENTS WHO HAVE SUSTAINED A TRAUMATIC BRAIN INJURY WITHIN AN INTEGRATED CANADIAN TRAUMA SYSTEM: A MULTICENTER COHORT STUDY PIER-ALEXANDRE TARDIF Université Laval

65 Corvid and mosquito pool surveillance data for the detection of West Nile virus in Ontario, 2002-2008: a comparison using survival analyses and spatial scan statistics ANDREA THOMAS-BACHLI PhD Candidate, Department of Population Medicine, University of Guelph

66 Developing an evidence framework for establishing treatment effectiveness in rare diseases KYLIE TINGLEY PhD Student, University of Ottawa

67 The validity of the 12-item Bem Sex Role Inventory in Older Spanish Population. An examination of the Androgyny Model AFSHIN VAFAEI Queen’s University

68 Change in risk factor status following incident diagnosis of cardiovascular disease in a Canadian cohort JACQUES VAN WIJK Graduate Student, Primary Healthcare Research Unit

69 Determining optimal fractional factorial designs of discrete choice experiments using d-efficiency THUVA VANNIYASINGAM PhD Candidate, McMaster University

70 A sensitivity analysis of the ranking of knowledge translation variables to differentiate methods of handling within-respondent variability: An application to addiction research THUVA VANNIYASINGAM PhD Candidate, McMaster University

71 Data synthesis methods can improve precision of survey-based prevalence estimates for Major Depression KATHRYN WIENS Student, University of Calgary

72 Trends and characteristics of response rates in case-control studies of cancer MENGTING XU Master’s Student (MScPH), University of Montreal

74 Risk Factors for Child Mortality in Bangladesh RIFAT ZAHAN Graduate Student, University of Saskatchewan

75 Spirometric Reference Equation for Aboriginal Children in Saskatchewan RIFAT ZAHAN Graduate Student, University of Saskatchewan

76 The association between maternity insurance, residence status and perinatal outcomes JING ZHANG MSc. Candidate, Brock University

77 Impact of diabetes and hypertension on overall and health-adjusted life expectancy in British Columbia LI RITA ZHANG Epidemiologist, Provincial Health Services Authority

78 The association between maternity insurance, residence status and selected perinatal outcomes among Chinese women JING ZHANG MSc. Candidate, Brock University

79 Evaluation of the Processing, Reading, and Interpretation of Malaria Rapid Diagnostic Tests NORA ZWINGERMAN PhD Student, University of Toronto

64 Poster Presentations Guide

65 Poster Presentations Tuesday, June 2, 2015 1 Diabetes And The Association Of Skin And Soft Tissue Infection: A Systematic Review Of Observational Studies WASEEM ABU-ASHOUR PharmaD, MSc. Student, Memorial University of Newfoundland To summarize and quantify the association between diabetes and the risk of skin and soft tissue infections (SSTIs) by conducting a systematic review and meta-analysis of the existing evidence. Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane library, IPA, and Web of Science databases. Studies evaluating the incidence of SSTIs in adults with diabetes using either a cohort (CS) or case-control (CCS) design were included. Study quality was assessed using the Newcastle-Ottawa Scale. Summary crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2-statistic and explored using subgroup analyses by type of surgery (cardiothoracic, general, orthopedic, skin, spinal, gastrointestinal, plastic and gynecology surgery). Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane library, IPA, and Web of Science databases. Studies evaluating the incidence of SSTIs in adults with diabetes using either a cohort (CS) or case-control (CCS) design were included. Study quality was assessed using the Newcastle-Ottawa Scale. Summary crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2-statistic and explored using subgroup analyses by type of surgery (cardiothoracic, general, orthopedic, skin, spinal, gastrointestinal, plastic and gynecology surgery). A total of 71 studies (43 CS and 28 CCS) were eligible to be included. Combining results from all cohort studies, diabetes was associated with an increased incidence of an SSTI (cOR 2.26, 95%CI 1.88-2.72; aOR 1.99, 95%CI 1.57- 2.52), albeit with considerable heterogeneity (I2=93.6% for crude and I2=84% for adjusted estimates). A stronger association was observed among case-control studies: cOR 3.10, 95%CI 2.34–4.12, I2=78.5%; aOR 2.44, 95%CI 2.16–2.76, I2=78.5%. Similar results were observed for total SSIs (CS: cOR 2.33, 95%CI 1.88–2.88, I2=93.4; aOR 2.04, 95%CI 1.59–2.62, I2= 84.4%; CCS: cOR 3.45, 95%CI 2.58–4.62, I2=74.4%; aOR 2.44, 95%CI 2.14–2.77, I2=0%). Heterogeneity was reduced within subgroups: cardiothoracic (I2=0%), general (I2=85.9%), orthopedic (I2=84.6%), skin (I2=43.3%), spinal (I2=0%), gastrointestinal (I2=0%) and plastic (I2=0%). Diabetes is associated with an approximately 2-fold increased risk of SSTI. The majority of the skin and soft tissue infections reported were due to surgical site infections. Results were generally consistent across types of surgeries with cardiothoracic, orthopedic and spinal surgery having the strongest associations. Co-Author(s): Amy Randell, Memorial University of Newfoundland/ Laurie Twells, Memorial University of Newfoundland/ James Valcour, Memorial University of Newfoundland/ Kelly Hatch, Memorial University of Newfoundland/ John-Michael Gamble, Memorial University of Newfoundland

2 Diabetes Is Associated With An Increased Risk of Respiratory Tract Infections: A Systematic Review Of Observational Studies WASEEM ABU-ASHOUR PharmaD, MSc. Student, Memorial University of Newfoundland To summarize and quantify the association between diabetes and the risk of respiratory tract infections (RTIs) by conducting a systematic review and meta-analysis of the existing evidence. Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane library, International Pharmaceutical Abstracts, and Web of Science databases. Studies evaluating the incidence of RTIs in adults with diabetes using either a cohort study (CS) or a case-control study (CCS) design were included. Study quality was assessed using the Newcastle-Ottawa Scale. Summary crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2-statistic and explored using subgroup analyses by 2 main categories of respiratory tract infection (pneumonia and tuberculosis). Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane library, International Pharmaceutical Abstracts, and Web of Science databases. Studies evaluating the incidence of RTIs in adults with diabetes using either a cohort study (CS) or a case-control study (CCS) design were included. Study quality was assessed using the Newcastle-Ottawa Scale. Summary crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2-statistic and explored using subgroup analyses by 2 main categories of respiratory tract infection (pneumonia and tuberculosis).A total of 24 studies (15 CS and 9 CCS) were eligible to be included. Combining results from all CS, diabetes was associated with an increased incidence of RTI (cOR 1.52, 95%CI 1.32-1.75; aOR 1.39, 95%CI 1.26-1.54), with considerable heterogeneity for crude estimate (I2=93.3%), and moderate heterogeneity for adjusted estimates (I2=49.7%). A stronger association was observed among CCS: cOR 2.09, 95%CI 1.66-2.64, I2=96.1%; aOR 1.62, 95%CI 1.33-1.96, I2=87.3%. Similar results were observed for the subcategories: A) Pneumonia, CS: cOR 2.09, 95%CI 1.24-3.52, I2=96.1%; aOR 2.2, 95%CI 1.23-3.63, I2= 20.8%; CCS: cOR 1.66, 95%CI 1.60-1.71, I2=0.0%; aOR 1.26, 95%CI 1.21-1.31, I2=0%; B) Tuberculosis, CS: cOR 1.24, 95%CI 1.10-1.40, I2=87.0%; aOR 1.36, 95%CI 1.24-1.49, I2= 45.5%; CCS: cOR 2.55, 95%CI 1.90-3.42, I2=95.2%; aOR 1.75, 95%CI 1.33-2.32, I2=88.8%.Diabetes is associated with an increased risk of respiratory tract infection. The results were comparable when further examining the subcategories, mainly including pneumonia and tuberculosis. More research is needed to explore the effects patient characteristics such as BMI and glycemic control on the risk of respiratory tract infections. Co-Author(s): Amy Randell, Memorial University of Newfoundland/ Laurie Twells, Memorial University of Newfoundland/ James Valcour, Memorial University of Newfoundland/ Kelly Hatch, Memorial University of Newfoundland/ John-Michael Gamble, Memorial University of Newfoundland

3 Canadian Ebola Perceptions: Responding to a Global Health Epidemic AMANDA ALBERGA St Michaels Hospital; ABTIN PARNIA University of Toronto; SHANNON BRENT Dalla Lana School of Public Health - University of Toronto The EVD perceptions pilot survey research aimed to describe, understand, and analyze the current state of EVD knowledge in relation to risk perceptions, identify key gaps in public EVD knowledge, and inform the development of a comprehensive public health strategy for future outbreak educational interventions. This research utilized a mixed methodology approach. Two pilot surveys were conducted, one qualitative (n=37), and one quantitative (n=167). Both surveys employed a cross-sectional design with a convenience sampling method. Participants were recruited via social media (Facebook). The qualitative survey posed open-ended questions, whereas the quantitative survey posed close-ended questions on EVD knowledge and perceptions. Data collection took place between November 26, 2014 and January 4, 2015. This research utilized a mixed methodology approach. Two pilot surveys were conducted, one qualitative (n=37), and one quantitative (n=167). Both surveys employed a cross-sectional design with a convenience sampling method. Participants were recruited via social media (Facebook). The qualitative survey posed open-ended questions, whereas the quantitative survey posed close-ended questions on EVD knowledge and perceptions. Data collection took place between November 26, 2014 and January 4, 2015. Approximately 86% of the quantitative survey respondents perceived the EVD outbreak to be an important public health issue. However, results indicated that young, educated North Americans lacked knowledge regarding basic treatment, modes of transmission, and their personal risk of contracting EVD in North America. A qualitative analysis revealed a majority of participants were unable to accurately name countries affected by EVD. Responses included: “Liberia”, “Africa”, “Canada”, “India”, and “US,” both countries and regions related and unrelated to the Ebola outbreak.Preliminary survey results demonstrated that young, North American participants are inadequately informed about EVD and tend to overestimate their personal risk of infection. A lack of accurate knowledge may be responsible for prevalent misperceptions and uninformed attitudes about the EVD epidemic. A cross-sectional research project, utilizing randomized sampling methods, to identify unbiased public risk perceptions and knowledge in the context of the 2014-2015 EVD epidemic is underway. The objective is to inform population-based approaches to public health knowledge-translation that can effectively influence and inform perceptions and attitudes in future outbreaks. Co-Author(s): Amanda Alberga, University of Toronto/ Abtin Parnia, University of Toronto/ Shannon Brent, University of Toronto/ Lindsey Falk, University of Toronto/ Yamna Ali, University of Toronto/ Mica Pereira Bajard, University of Toronto/ Amanda Manoharan, University of Toronto/ Senthuri Paramalingam

66 4 Disparities in childhood: examining the role of income, parental education and immigrant generational status across child health and achievement outcomes HUMNA AMJAD BHSc. Student, McMaster University The objectives of the present study are to examine (1) the association between socioeconomic status indicators (total household income and parental education) and child health and achievement outcomes; and (2) the extent to which immigrant generational status moderates these associations. Data for analyses come from the Hamilton Youth Study, a representative sample of 1,456 students in grades 5-8 attending 36 schools in Hamilton, Ontario. Structured, computer assisted interviews were conducted separately with students and their primary caregiver. Teachers completed self-administered surveys and school administrative data was accessed to ascertain levels of academic achievement. Students were classified as: 1st generation (foreign born), 2nd generation (Canadian born to at least one foreign born parent), and 3rd+ generation (Canadian born to Canadian born parents). Study measures were translated into the 8 most common home languages to include non-English speaking participants. Data for analyses come from the Hamilton Youth Study, a representative sample of 1,456 students in grades 5-8 attending 36 schools in Hamilton, Ontario. Structured, computer assisted interviews were conducted separately with students and their primary caregiver. Teachers completed self-administered surveys and school administrative data was accessed to ascertain levels of academic achievement. Students were classified as: 1st generation (foreign born), 2nd generation (Canadian born to at least one foreign born parent), and 3rd+ generation (Canadian born to Canadian born parents). Study measures were translated into the 8 most common home languages to include non- English speaking participants. Multivariate linear regression analyses were conducted to examine associations between immigrant generational status, total household income, parental education, and interactions between these terms, after controlling for age, sex, and family structure. The dependent variables were parent, teacher and youth reported emotional-behavioral problems, academic achievement, and parental report of child’s physical health. A strong negative association was found between income and levels of emotional-behavioral problems among 3rd+ generation students, however, these associations were weaker or non-existent among 1st and 2nd generation immigrant students. There was a strong positive association between academic achievement and income and parental education that was of similar magnitude across both immigrant and non-immigrant students. Parental education was not consistently associated with emotional-behavioral problems, nor was there a moderating effect of immigrant status. There was a strong and consistent negative association between household income and levels of emotional-behavioral problems only for non- immigrant students. These findings highlight the need for further research to identify family and individual level characteristics that may protect immigrant students against the negative effects of low income on mental health. Co-Author(s): Humna Amjad, BHSc, McMaster University, Offord Centre for Child Studies, Hamilton, Ontario/ Ahmad Qadeer, BSc, McMaster University, Offord Centre for Child Studies, Hamilton, Ontario/ Kathy Georgiades, PhD, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Offord Centre for Child Studies, Hamilton, Ontario

5 Brain Cancer Survival Rates in Canada: an analysis of Canadian Cancer Registry data by histology and province, 1992-2008 FAITH DAVIS Vice-Dean, School of Public Health, University of Alberta Cancer survival is an indicator of the effectiveness of healthcare systems. The comparison of survival rates across Canadian provinces can aid in identifying inequalities in cancer survival and lead to public health action. Population-based data from the Canadian Cancer Registry was obtained for 38,095 patients with primary malignant brain tumors diagnosed between 1992 and 2008 across provinces. One-year, two-year, and five-year Kaplan-Meier survival rate estimates were determined for all brain cancer patients, and by histology, province, and sex. To investigate provincial differences, Cox Proportional Hazards models were used to estimate the adjusted hazard ratios for provinces in 8 selected histology types. Numbers reported were rounded as necessary in accordance with Statistics Canada requirements. Population-based data from the Canadian Cancer Registry was obtained for 38,095 patients with primary malignant brain tumors diagnosed between 1992 and 2008 across provinces. One-year, two-year, and five-year Kaplan-Meier survival rate estimates were determined for all brain cancer patients, and by histology, province, and sex. To investigate provincial differences, Cox Proportional Hazards models were used to estimate the adjusted hazard ratios for provinces in 8 selected histology types. Numbers reported were rounded as necessary in accordance with Statistics Canada requirements. Overall brain cancer survival is higher in females than males (P<0.01) and lower in older age groups than younger age groups (P<0.01). Five-year survival rates by selected histology types are provided in descending order: 89.9% (95% CI: 88.0-91.6%) for pilocytic astrocytomas, 65% (95% CI: 62.5-67.4%) for oligodendrogliomas, 46.% (95% CI: 42.6-49.3%) for oligoastrocytic tumors, 26.6% (95% CI: 25.4-27.8%) for diffuse astrocytomas, 19.2% (95% CI: 16.2-22.4%) for lymphomas, and 4% (95% CI: 3.7-4.3%) glioblastomas (GBM). A sample of adjusted hazard ratios for provinces that are significantly different than Ontario in selected histology types include 0.801 (P<0.03) in Quebec for anaplastic oligodendrogliomas, 1.373 (P<0.05) in British Columbia for oligoastrocytic tumors, and 1.875 (P<0.01) in Alberta, 2.071 (P<0.01) in British Columbia, 2.375 (P<0.01) in maritime provinces, 4.473 (P<0.01) in Quebec, and 2.715 (P<0.01) in prairie provinces for lymphomas. As expected, brain cancer survival rate is higher in females than males, is lower with older age at diagnosis, and differs by histology. We also observed significantly different survival rates across provinces. Preliminary analyses show that survival inequality exists after adjusting for age, gender and histology type, which warrants further investigation. Co-Author(s): Ellie Andres, University of Alberta/ Yan Yuan, University of Alberta/ Maoji Li, University of Alberta/ Chenthila Nagamuthu, Toronto Western Research Institute/ Jordan Ross, University of Alberta/ Faith Davis, University of Alberta

6 Multistate Markov Models for Longitudinal and Event-Time Data ESHETU ATENAFU Senior Biostatistician, University Health Network Recent medical researches generate both longitudinal measures and survival data. Multi-state-modeling approach is useful in dealing with limited longitudinal measures and to correlate with survival endpoint. The aim of this study is to assess the recently available MSM package, point out the limitations and to propose Markov adjusted (MC-Adjusted) method. Disease activity states were defined by discretizing the longitudinal data as well as using survival endpoint. A Multi-state-modeling (MSM), which generalizes classic time-to-event to multiple outcomes, as suggested by Jackson (2011) was used for analysis. MC-adjusted approach was also proposed to use disease states as internal time dependent covariates and the absorbing death state as event of interest while stratifying by baseline states and implementing COX model. A simulation study was also conducted to compare results obtained from the different approaches including to the usual survival analysis that ignores the longitudinal information. Disease activity states were defined by discretizing the longitudinal data as well as using survival endpoint. A Multi-state-modeling (MSM), which generalizes classic time-to-event to multiple outcomes, as suggested by Jackson (2011) was used for analysis. MC-adjusted approach was also proposed to use disease states as internal time dependent covariates and the absorbing death state as event of interest while stratifying by baseline states and implementing COX model. A simulation study was also conducted to compare results obtained from the different approaches including to the usual survival analysis that ignores the longitudinal information.It is important to realize that there are several modeling strategies for incorporating the effect of longitudinal data on survival analysis. However, in the absence of enough repeated measures of the longitudinal data, MSM will play a great role. Including longitudinal data as in multi-state outcome as transient states and survival endpoint as non-transient state in the analysis adds information whereas estimation and uncertainty depends on initial parameters used. The use of MC-adjusted on the other hand provided less biased estimate compared to the other approach as seen on the simulation study and doesn’t require initial estimates. The results contribute to the use of longitudinal data & correlate it with survival endpoint by discretizing into recurrent states and using survival endpoint as absorbing state.Whereas MSM package requires careful specification of initial transition matrix to guarantee convergence and consistent estimate, MC-adjusted approach doesn’t require one and provides less biased, consistent and stable estimation and can be implemented the already existing software with minimal effort of modifications. Co-Author(s): Wendy Lou, University of Toronto

67 7 Sex differences in the prevalence and incidence of mild cognitive impairment: a systematic review and meta-analysis BONNIE AU Research Associate, Sunnybrook Health Sciences Centre Epidemiological studies report conflicting findings whether males or females have higher prevalence or incidence of mild cognitive impairment (MCI), an intermediate stage between normal aging and dementia. The aim of this systematic review and meta-analysis is to examine sex differences and present sex-specific pooled estimates of MCI prevalence and incidence. We performed a systematic search in 4 databases (PubMed, Scopus, PsycINFO, and Medline) for cross-sectional and longitudinal community- based studies reporting prevalence or incidence of MCI in males and females. Our search strategy consisted of combining the following groups of search terms using “AND” relations: MCI and related terminology as well as epidemiological measurement terminologies. Search terms within each category were combined using “OR” relations. Two independent reviewers will review abstracts and retrieve full-texts articles for detailed assessments. Publications meeting eligibility criteria will be analyzed in the meta- analysis using a random-effects model. We performed a systematic search in 4 databases (PubMed, Scopus, PsycINFO, and Medline) for cross-sectional and longitudinal community-based studies reporting prevalence or incidence of MCI in males and females. Our search strategy consisted of combining the following groups of search terms using “AND” relations: MCI and related terminology as well as epidemiological measurement terminologies. Search terms within each category were combined using “OR” relations. Two independent reviewers will review abstracts and retrieve full-texts articles for detailed assessments. Publications meeting eligibility criteria will be analyzed in the meta-analysis using a random-effects model. Our initial search yielded a total of 6921 studies from the search criteria (3208 in Pubmed, 1921 in Scopus, 662 in PsycINFO, and 1130 in Medline). A total of 2905 duplicates were identified, resulting in 4016 article titles to be systematically screened in the first round. The final numbers of included studies along with the meta-analytical results of sex-specific pooled estimates for prevalence and incidence will be presented at the conference. Our review will help clarify the inconsistent sex-specific prevalence and incidence of MCI. Findings will foster discussions for further research on the role of sex in MCI, advance our understanding in identifying certain populations at risk, and potentially influence sex-specific preventative strategies for MCI and its progression to dementia. Co-Author(s): Sydney Dale-McGrath, Sunnybrook Health Sciences Centre/ Jocelyn Charles, University of Toronto, Sunnybrook Health Sciences Centre/ Mary Tierney, University of Toronto, Sunnybrook Health Sciences Centre

9 The Influence of Satisfaction with Pre and Postnatal Healthcare Encounters on Postpartum Weight Retention ANDREEA BENTE Master’s Student, Western University The primary aim is to identify whether satisfaction with perinatal healthcare encounters influences maternal lifestyle, and leads to lower postpartum weight retention (PPWR). To accomplish the primary objective, an overall summed satisfaction scale was created, and interactions between the association of healthcare satisfaction and PPWR will be identified. A weighted analysis of 4 110 recently pregnant women from the 2006-2007 Canadian Maternity Experiences Survey (MES) was analyzed using SAS 9.3. Principal components analysis confirmed the validity of using a summed satisfaction score (score range: 6-30) to represent six dimensions of satisfaction: information, compassion, competency, privacy, respect and decision-making. PPWR is the difference in postpartum and pre-pregnancy weight. Descriptive statistics were conducted for sociodemographic factors, satisfaction with care and PPWR. Potential confounders were identified using a directed acyclic graph (DAG). Multivariable linear regression analysis was conducted to identify the association between healthcare satisfaction and PPWR. A weighted analysis of 4 110 recently pregnant women from the 2006-2007 Canadian Maternity Experiences Survey (MES) was analyzed using SAS 9.3. Principal components analysis confirmed the validity of using a summed satisfaction score (score range: 6-30) to represent six dimensions of satisfaction: information, compassion, competency, privacy, respect and decision-making. PPWR is the difference in postpartum and pre-pregnancy weight. Descriptive statistics were conducted for sociodemographic factors, satisfaction with care and PPWR. Potential confounders were identified using a directed acyclic graph (DAG). Multivariable linear regression analysis was conducted to identify the association between healthcare satisfaction and PPWR. The average time at assessment was 7 months (range: 6 to 15 months), and mean PPWR was 2.5 kg. 11% of participants were at a normal BMI before pregnancy, and transferred to the overweight BMI category postpartum. There was little variation in satisfaction levels, 49% of respondents were very satisfied (score of 30) on all dimensions. Univariable analyses between overall satisfaction and PPWR show a negative association. On average, for every one-unit increase in overall satisfaction score, there is a significant 0.065 kg (95% CI: 0.014-0.116) reduction in PPWR. Multivariable analysis including all potential confounders resulted in an attenuation of this relationship, a one-point increase in overall satisfaction decreased PPWR by 0.049 kg, although this association was not statistically significant. These findings are based on a national survey, adding to the broader literature that satisfaction with healthcare may have a small, but potentially important, effect on PPWR. Further assessment of the DAG to guide multivariable model building will provide insight for interpreting the results and their public health implications. Co-Author(s): Neil Klar, Western University/ Renato Natale, Western University/ Karen Campbell, Western University

10 In My Time of Dying: John Graunt’s Observations about the Bills of Mortality Revisited from a Spatial Point of View OLAF BERKE Associate Professor of Statistical Epidemiology, Population Medicine, U of Guelph John Graunt laid the foundations for statistical epidemiology when he reported about the London Bills of Mortality in 1662. One of his objectives was a spatial analysis of the plague mortality. Here, modern spatial epidemiological methods are applied to his data to reveal further insight. Numbers of burials and deaths by plague are used to estimate the proportional mortality for each of the 97 parishes in London within the wall of 1625. Disease mapping to visualize the spatial distribution of plague is based on a choropleth map of the empirical Bayesian smoothed proportional mortality ratio. Moran’s I index of spatial association is used to detect disease clustering. Disease clusters are identified by the spatial scan test. Spatial regression modeling is used to link the plague mortality to socio-economic data from 1638. Numbers of burials and deaths by plague are used to estimate the proportional mortality for each of the 97 parishes in London within the wall of 1625. Disease mapping to visualize the spatial distribution of plague is based on a choropleth map of the empirical Bayesian smoothed proportional mortality ratio. Moran’s I index of spatial association is used to detect disease clustering. Disease clusters are identified by the spatial scan test. Spatial regression modeling is used to link the plague mortality to socio-economic data from 1638. Moran’s I index indicates significant clustering in the proportional mortality (p<0.01). Negative clusters in the spatial distribution of proportional mortality are detected by the spatial scan test (p<0.01). Spatial linear regression modeling finds the proportional mortality ratio to be negatively correlated with the “percentage of rich households” in each parish. But “household density” was not related to the proportional plague mortality. Household density is used as an indicator for crowding, but more so for the number of fireplaces and their related smoke. Graunt discussed smoke as a major indicator for the healthfulness of an area – pertinent to the miasma paradigm. Graunt also mentioned how the rich remove outside a plague-ridden London. The socio-economic dimension of disease was otherwise not recognized. Since Graunt’s times of great mortality statistical epidemiology has evolved and provides now methods for advanced data analysis. Plague occurrence in medieval London parishes was associated with socio-economic indicators, but although Graunt saw the signs he could not draw respective conclusions under the prevailing epidemiological paradigm, i.e. miasma. Co-Author(s): Olaf Berke, Population Medicine, University of Guelph

11 Updated non-malignant mortality experience of Ontario uranium miners COLIN BERRIAULT Research Associate, Occupational Cancer Research Centre Uranium mines and mills operated in Ontario from 1954 to 1996. Previous studies of these miners focused primarily on cancer risks associated with radon exposure, though non-cancer mortality outcomes were also provided. This study sub-analysis will provide updated risk estimates and potential context for any observed non-cancer mortality excesses. Data from the Ontario Mining Master File (containing work history information collected during annual medical exams) and Canada’s National Dose Registry were combined to create the cohort consisting of mine and mill workers who worked for one or more weeks in the uranium industry. End of follow-up for the cohort has been extended from 1986 to 2007. The cohort was linked by Statistics Canada and compared to national mortality rates. 95% confidence intervals were calculated assuming deaths and cancers followed a Poisson distribution. The cohort was examined overall, by period of cohort entry, mining region, and other mining experience. Data from the Ontario Mining Master File (containing work history information collected during annual medical exams) and Canada’s National Dose Registry were combined to create the cohort consisting of mine and mill workers who worked for one or more weeks in the uranium industry. End of follow-up for the cohort has been extended from 1986 to 2007. The cohort was linked by Statistics Canada and compared to national mortality rates. 95% confidence intervals were calculated assuming deaths and cancers followed a Poisson distribution. The cohort was examined overall, by period of cohort entry, mining region, and other mining experience.Overall few mortality excesses were observed in the present cohort of 28,546 male miners with a total of 8,318 deaths. Standardized mortality ratio (SMR) excesses were observed for accidents, poisoning and violence (SMR= 1.43; 95% CI: 1.35-1.51), and pneumoconioses (SMR= 8.98; 95% CI: 6.69-11.81). Silicosis mortality excesses stood out in particular with an SMR of 19.68 (95% CI: 14.46-26.18). Pneumoconioses varied between Elliot Lake (SMR=10.03; 95% CI: 7.34-13.37) and Bancroft (SMR=3.74; 95% CI: 0.75-10.93) regions, while general respiratory disease deaths varied by ore experience (e.g., gold SMR=1.14; 95% CI: 1.03-1.27 versus no gold SMR=0.88; 95% CI: 0.77-0.99), and injury fatalities varied primarily by time period.Understanding the context of the mortality experience of Ontario uranium miners who worked during an era of rapid expansion through to the end of this Ontario mining sector is important. Updated mortality estimates for this cohort provide context for past and present outcomes such as injury and silicosis deaths. Co-Author(s): Colin Berriault, Occupational Cancer Research Centre, Toronto/ Garthika Navaranjan, Occupational Cancer Research Centre, Toronto/ Minh Do, Occupational Cancer Research Centre, Toronto/ Paul Villeneuve, Occupational Cancer Research Centre, Toronto and the Department of Health Sciences, Carleton University, Ottawa/ Paul Demers, Occupational Cancer Research Centre, Toronto and the Dalla Lana School of Public Health, University of Toronto, Toronto

68 12 What Really Happens to Women After They Have a Low-grade Abnormal Cervical Smear? ABHI BHANDARI Master’s Student, University of Ottawa A conservative strategy for screened women found to have a low-grade abnormal smear recommended in many jurisdictions is cytological surveillance in the community, but there is surprisingly little information on the outcomes of such follow-up. Our objectives were to investigate such outcomes, their determinants, and psychological consequences. Secondary analysis of data will be conducted from TOMBOLA (Trial of Management of Borderline and Other Low-grade Abnormal smears), a pragmatic randomized-controlled trial nested within the Cervical Screening Programmes in Scotland (Grampian and Tayside) and England (Nottingham), in which women were followed for three years after receipt of low-grade abnormal cytology. The patterns of testing will be examined, overall and within subgroups defined by HPV (Human Papillomavirus) test results, and in relation to psychosocial outcomes. This study was a secondary analysis of data from TOMBOLA (Trial of Management of Borderline and Other Low-grade Abnormal smears), a pragmatic randomized-controlled trial nested within the Cervical Screening Programmes in the United Kingdom. The trajectories of testing and sequences of test results were identified for women in the cytological surveillance arm of the trial, who were assigned to have follow-up Pap tests in primary care for up to three years. These were classified into outcomes, and associations with risk factors were analysed by multinomial logistic regression modelling. Associations between outcomes and reported psychological distress were analysed by longitudinal methods. This study was a secondary analysis of data from TOMBOLA (Trial of Management of Borderline and Other Low-grade Abnormal smears), a pragmatic randomized-controlled trial nested within the Cervical Screening Programmes in the United Kingdom. The trajectories of testing and sequences of test results were identified for women in the cytological surveillance arm of the trial, who were assigned to have follow-up Pap tests in primary care for up to three years. These were classified into outcomes, and associations with risk factors were analysed by multinomial logistic regression modelling. Associations between outcomes and reported psychological distress were analysed by longitudinal methods. All women who had at least one smear (n=2115) were categorized into one of three mutually exclusive outcomes: 1) Eligible for «return to routine recall» (n=873; 41.3%, 95% CI: 39.2%-43.4%). 2) Eligible for colposcopy referral (n=338; 16.0%, 95% CI: 14.4%-17.6%). 3)»Unresolved» (n=904; 42.7%, 95% CI: 40.6%-44.8%). In addition to high-risk Human Papillomavirus (HPV) status at recruitment, smoking status, age group and trial centre were significantly associated with these outcomes. Although a high proportion of women had clinically significant anxiety over a 30-month period, this proportion did not differ significantly across the outcomes. Further, there were no significant effects of the outcomes on repeated measures of anxiety or depression over the 30-month period, adjusting for socio-demographic and lifestyle characteristics. Documenting these outcomes will inform health planning for women with low-grade abnormal cervical cytology following the path of cytological surveillance; contribute to decisions about which women could be referred for more colposcopy at an early stage; and raise awareness about the psychological impact of follow-up in the longer-term. Co-Author(s): Julian Little, University of Ottawa/ Beth Potter, University of Ottawa/ Monica Taljaard

13 THE CURRENT STATE OF AND GAPS IN PUBLIC HEALTH INFORMATICS RESEARCH: A SCOPING REVIEW IN MEDLINE ARJUN BHATTARAI University of Waterloo To examine the extent and nature of existing Public Health Informatics (PHI) studies and identify gaps in research and practice of PHI on MEDLINE. The papers has adopted the scientific scoping review methodology recommended by Arksey and O’Malley in 2005 and refined by Levac and colleagues in 2010 and in 2013. It has proceeded with the main five stages which are: Stage I-Identifying the research question, Stage II-Identifying relevant studies, Stage III-Study selection, Stage IV-Charting the data and Collating, Stage V-summarizing and reporting the results. Each methodological stages has been carried out with close collaboration with academic supervisor and is being completed soon. The papers has adopted the scientific scoping review methodology recommended by Arksey and O’Malley in 2005 and refined by Levac and colleagues in 2010 and in 2013. It has proceeded with the main five stages which are: Stage I-Identifying the research question, Stage II-Identifying relevant studies, Stage III-Study selection, Stage IV-Charting the data and Collating, Stage V-summarizing and reporting the results. Each methodological stages has been carried out with close collaboration with academic supervisor and is being completed soon. The preliminary result of the study shows that there are a total number of 491 articles in MEDLINE which have used/discussed public health informatics concepts and information technologies in them. Out of these 491 articles, majority of them belong to USA followed by UK, Australia and Canada. Only about one fifth of the articles are from rest of the world. Further, About 60% of the papers belong to Infectious disease monitoring, Outbreak detection and Bio-terrorism surveillance. About 10% belong to chronic disease monitoring and about 40% belong to Public health policy system and research. The most frequently used information technology is electronic registry, website, and GIS. Mass media and mobile phones are among the least used technologies, the result highlights. It is concluded that there is very little use of very promising modern age technologies for e.g. mobile phones, E-mail and statistical/analytical software in public health practice and research. A further systematic study is required to inquire about why there is very few use of such technologies in PHI. Co-Author(s): Dr Joon Lee, University of Waterloo

14 Development of a national study on the health and wellness of Canadian commercial motor vehicle (CMV) drivers PHIL BIGELOW Associate Professor, Universtiy of Waterloo CMV drivers are recognized as a vulnerable population and many countries, including the US, have developed comprehensive research programs to understand the problem and recommend solutions. Our research addresses the paucity of research on CMV drivers in Canada through a systematic review of the relevant literature on the risks, exposures, and health of drivers along with the development of a protocol to conduct a national survey of Canadian CMV drivers. Co-Author(s): Philip Bigelow, Univerrsity of Waterloo/ Alex Cirzzle, University of Waterloo/ Anita Myers, University of Waterloo/ Cassondra McCrory, University of Waterloo/ Mamdouh Subair, Univeristy of Northern BC/ Martin Cooke, University of Waterloo

15 Assessing the intrepretability of different pooling methods that can be used within a systematic review for a meta-analysis VICTORIA BORG DEBONO Graduate Student, McMaster University The objective of this project is to compare five different ways of pooling and presenting a continuous outcome within a meta-analysis and do a comparative study to understand how the results of each method can be interpreted to aid with clinical decisions. Data from randomized controlled trials that investigated the use low level laser therapy compared to placebo, in alleviating pain with those with facial pain related to the temporal-mandibular joint, was systematically extracted. The primary outcome of interest was overall pain, which is a patient important outcome. Once all the pain data was extracted from each study, we pooled the data in four different ways for the purpose a planned meta-analysis within our systematic review. A theoretical comparison based on the current literature on pooling methods will be made based on this real trial data. Data from randomized controlled trials that investigated the use low level laser therapy compared to placebo, in alleviating pain with those with facial pain related to the temporal-mandibular joint, was systematically extracted. The primary outcome of interest was overall pain, which is a patient important outcome. Once all the pain data was extracted from each study, we pooled the data in four different ways for the purpose a planned meta-analysis within our systematic review. A theoretical comparison based on the current literature on pooling methods will be made based on this real trial data. The patient important outcome (overall pain) was pooled in the following ways: standardized mean difference, weighted mean difference, ratio of mean and relative risk. Minimally Important Difference units will also be considered where possible. From here we will, based on the current literature, create a discussion around the statistical properties and interpretation of the results generated from each pooling method using the pain result data collected and pooled. Each method has its benefits and limitations, however it is hypothesized that one of these pooling methods will produce a pooled result that will help best with interpreting the results of a meta-analysis conducted within a systematic review, and will best help those who use such results to aid with clinical decision making. The next step for this project will be to do a comparison between the four different pooling methods by presenting how results generated from each method can be interpreted, and the benefits/limitations of each method used. An assessment will be made as to which method helps best with interpretation. Co-Author(s): Victoria Borg Debono, McMaster University/ Jason Busse, McMaster University/ Li Wang, McMaster University/ Lehana Thabane, McMaster University

16 Routine follow-up care after curative treatment of head and neck cancer from the perspective of the patient KELLY BRENNAN Graduate Student, Queen’s University Current evidence suggests that cancer patients’ follow-up needs vary widely and are better suited to a personalized medicine approach. This study aims to describe the attitudes, needs, and fears toward routine follow-up appointments, and patients’ quality of life after curative treatment for head and neck cancer on one and two year anniversaries after treatment. This will allow for the identification of subgroups of patients with specific preferences to generate hypotheses for redesigning follow-up care. Co-Author(s): Stephen F Hall MSc MD FRCSC, Queen’s University

69 17 Measures of Excess Body Weight and Anthropometry among Adult Albertans: Results from Alberta’s Tomorrow Project DARREN BRENNER Research Scientist, Alberta Health Services Excess body weight in adulthood has been consistently associated with all-cause mortality, cardiovascular disease, and multiple cancer sites among other chronic diseases. We estimated the prevalence of excess body weight (Body Mass Index (BMI)) and abdominal obesity (Waist Circumference (WC)) reported by participants enrolled in Alberta’s Tomorrow Project (ATP). The ATP is a population-based cohort conducted among adults aged 35-69 across the province of Alberta. Participants were recruited by random digit dialling, and were invited to complete a series of questionnaires concerning lifestyle, diet and physical activity. Participants were asked to measure their height and waist circumference using a provided tape measure and to use a scale for body weight. BMI was derived from height and weight measurements (kg/m2). Individuals with a BMI of >25-<30 and ≥30 were categorized as overweight and obese respectively. For WC, excess abdominal adiposity was categorized using cut-offs of >94cm for men and >80cm for women. The ATP is a population-based cohort conducted among adults aged 35-69 across the province of Alberta. Participants were recruited by random digit dialling, and were invited to complete a series of questionnaires concerning lifestyle, diet and physical activity. Participants were asked to measure their height and waist circumference using a provided tape measure and to use a scale for body weight. BMI was derived from height and weight measurements (kg/m2). Individuals with a BMI of >25-<30 and ≥30 were categorized as overweight and obese respectively. For WC, excess abdominal adiposity was categorized using cut-offs of >94cm for men and >80cm for women. BMI and WC data were obtained from 12,062 men and 18,853 women participants who were enrolled between 2000 and 2008. Overall, 76.8% of men and 59.5% of women reported a BMI >25 (overweight or obese. The proportions of men and women in the overweight and obese categories were significantly higher in older age groups (p<0.0001). In addition, the proportion of participants reporting being overweight and obese was higher among lower education (26.7% in those not completing high school, 6.2% among those completing high school, p<0.0001) in and income groups (25.1% in the lowest income group, 10.3% in the highest education group, p<0.0001). Overall, approximately two thirds of men and women in the ATP cohort reported excess abdominal adiposity. Despite the use of self-reported measurements, a large majority of ATP participants were found to be overweight and carry excess abdominal fat. Strategies to improve energy imbalance among Albertans are encouraged and may have a notable impact on future chronic disease burden. Co-Author(s): Darren Brenner, Alberta Health Services, University of Calgary/ Alianu Akawung, Alberta Health Services/ Tiffany Hiag, Alberta Health Services/ Christine Friedenreich, Alberta Health Services, University of Calgary/ Paula Robson, Alberta Health Services, University of Alberta

18 Does Physical Activity Impact Breast Cancer Risk through Changes in Levels of Anti-Inflammatory Cytokines? Results from two Randomized Intervention Trials DARREN BRENNER Research Scientist, Alberta Health Services The mechanisms whereby regular exercise reduces breast cancer risk remain unclear. We investigated whether or not aerobic exercise alters anti-inflammatory cytokine levels in two randomized trials of physical activity (The Alberta Physical Activity and Breast Cancer Prevention Trial (ALPHA) and The Breast Cancer and Exercise Trial in Alberta (BETA)). ALPHA and BETA were two-center, two-armed randomized trials in inactive, healthy, postmenopausal women. Both trials included an exercise intervention done five times/week with no dietary changes. In ALPHA, the exercise group (EX) were asked to do 225 minutes/week versus no activity in the control group (CTRL). BETA examined dose-response effects comparing two levels of aerobic activity: HIGH (300 minutes/week) versus MODERATE (150 minutes/week). Plasma concentrations of Interleukin-4 (IL-4) and Interleukin-10 (IL-10) were measured using Luminex® assays at baseline, six, and 12-months. Intention-to-treat analyses were done using linear mixed models adjusted for baseline biomarker concentrations. Analyses based on adherence were done using linear models. ALPHA and BETA were two-center, two-armed randomized trials in inactive, healthy, postmenopausal women. Both trials included an exercise intervention done five times/week with no dietary changes. In ALPHA, the exercise group (EX) were asked to do 225 minutes/week versus no activity in the control group (CTRL). BETA examined dose-response effects comparing two levels of aerobic activity: HIGH (300 minutes/week) versus MODERATE (150 minutes/week). Plasma concentrations of Interleukin-4 (IL-4) and Interleukin-10 (IL-10) were measured using Luminex® assays at baseline, six, and 12-months. Intention-to-treat analyses were done using linear mixed models adjusted for baseline biomarker concentrations. Analyses based on adherence were done using linear models. Average cytokine changes [12-months-baseline] in ALPHA – EX and CTRL groups were: -8.39% and -1.45% for IL-4 and 0.04% and -1.68% for IL-10. Average cytokine changes [12-months-baseline] in BETA – HIGH and MODERATE groups were: -7.02% and -6.30% for IL-4 and -8.28% and -5.43% for IL-10. In intention-to-treat analyses, no significant group differences were found for IL-4 or IL-10 in ALPHA or BETA respectively (IL-4: ALPHA P-value=0.55; BETA P-value=0.27) (IL-10: ALPHA P-value=0.98; IL-10 BETA P-value=0.76). In analyses based on self-selected adherence (average minutes/week), no significant trends were found between 12-month cytokine percent changes and adherence groups in ALPHA or BETA (IL-4: ALPHA P-value=0.64; BETA P-value=0.24) (IL-10: ALPHA P-value=0.58; IL-10 BETA P-value=0.80). Preliminary results from these randomized exercise intervention trials suggest that changes in anti-inflammatory cytokines are not one of the major mechanisms of breast cancer prevention. These results were observed across vigorous activity doses ranging from 150, 225 and 300 minutes per week. Co-Author(s): Darren Brenner, Alberta Health Services, University of Calgary/ Heather Neilson, Alberta Health Services/ Qinggang Wang, Alberta Health Services/ Rachel O’Reilly, Alberta Health Services/ Shannon Conroy, University of California at Davis, USA/ Don Morris, University of Calgary/ Yutaka Yasui, University of Alberta/ Christy Woolcott, Dalhousie University/ Kerry Courneya, University of Alberta/ Christine Friedenreich, Alberta Health Services, University of Calgary

19 Cancer Incidence Attributable to Excess Body Weight in Alberta, Canada in 2012 DARREN BRENNER Research Scientist, Alberta Health Services Excess body weight (overweight (Body Mass Index (BMI) >25-<30) and obesity (BMI ≥30) has been consistently associated with colorectal, breast, endometrial, esophagus, gallbladder, pancreas and kidney cancers. The objective of this analysis was to estimate the proportion of total and site-specific cancers attributable to excess body weight in Alberta. Proportions of attributable cancers were estimated using the population attributable risk (PAR). Risk estimates were obtained from recent meta-analyses and population exposure prevalence estimates obtained from the Canadian Community Health Survey (cycles 1.1-2.1 2000-2003). Individuals with a BMI (kg/m2) of >25-<30 and ≥30 were categorized as overweight and obese, respectively. Age-sex-site-specific cancer incidence data were obtained from the Alberta Cancer Registry for the year 2012. Proportions of attributable cancers were estimated using the population attributable risk (PAR). Risk estimates were obtained from recent meta-analyses and population exposure prevalence estimates obtained from the Canadian Community Health Survey (cycles 1.1-2.1 2000-2003). Individuals with a BMI (kg/m2) of >25-<30 and ≥30 were categorized as overweight and obese, respectively. Age-sex-site-specific cancer incidence data were obtained from the Alberta Cancer Registry for the year 2012. Approximately 48 – 64% of men and 27 – 55% of women in Alberta were classified as either overweight or obese, where these proportions increased with age in both sexes. We estimate that approximately 17% and 11% of obesity-related cancers among men and women respectively can be attributed to excess body weight in Alberta in 2012. Site-specific results suggest that the heaviest absolute burden in terms of number of cases is seen for breast cancer among women and for colorectal cancer among men. Overall, approximately 5% of all cancers in Alberta in 2012 were attributable to excess body weight among adult Albertans in 2000-2003. Excess body weight contributes to a substantial proportion of cases of colorectal, breast, endometrial, esophageal, gallbladder, pancreatic and kidney cancers annually in Alberta. Strategies to improve energy imbalance and reduce the proportion of obese and overweight Canadians may have a notable impact on cancer incidence in the future. Co-Author(s): Darren Brenner, Alberta Health Services, University of Calgary/ Anne Grundy, Alberta Health Services/ Abbey Poirier, Alberta Health Services/ Farah Khandwala, Alberta Health Services/ Alison McFadden, Alberta Health Services/ Laura McDougall, Alberta Health Services/ Christine Friedenreich, Alberta Health Services, University of Calgary

20 Cancer Incidence Attributable to Physical inactivity in Alberta Canada in 2012 DARREN BRENNER Research Scientist, Alberta Health Services Physical inactivity in adulthood has been consistently associated with breast, colon, endometrial, prostate, ovarian and lung cancers. The objective of this analysis was to estimate the proportion of total and site-specific cancers attributable to physical inactivity in Alberta. The proportion of attributable cancers were estimated using the population attributable risk (PAR). Risk estimates from recent meta-analyses and population exposure prevalence estimates obtained from the Canadian Community Health Survey (cycles 1.1-2.1 2000-2003) were used. Inactivity was defined as someone expending less than 3.0 kcal/kg body weight/day in non-occupational activities. Age-sex-site-specific cancer incidence was obtained from the Alberta Cancer Registry for the year 2012. The proportion of attributable cancers were estimated using the population attributable risk (PAR). Risk estimates from recent meta-analyses and population exposure prevalence estimates obtained from the Canadian Community Health Survey (cycles 1.1-2.1 2000-2003) were used. Inactivity was defined as someone expending less than 3.0 kcal/kg body weight/day in non-occupational activities. Age- sex-site-specific cancer incidence was obtained from the Alberta Cancer Registry for the year 2012. Approximately 60 – 75% of men and 69 – 78% of women in Alberta were classified as moderately inactive or inactive. We estimate that approximately 10% and 18% of inactivity-related cancers among men and women respectively could be attributed to sub-optimal physical activity levels in Alberta in 2012. Site-specific results suggest that the heaviest absolute burden in terms of number of cancer cases is seen for breast among women and for lung and colorectal among men. Overall, approximately 8% of all cancers in Alberta in 2012 were attributable to physical inactivity among adult Albertans in 2000-2003. Physical inactivity contributes to a substantial proportion of cases of colorectal, breast, endometrial, prostate, ovarian and lung cancers annually in Alberta. Strategies to increase physical activity levels in Alberta may have a notable impact on cancer incidence in the future. Co-Author(s): Darren Brenner, Alberta Health Services, University of Calgary/ Anne Grundy, Alberta Health Services/ Abbey Poirier, Alberta Health Services/ Farah Khandwala, Alberta Health Services/ Alison McFadden, Alberta Health Services/ Laura McDougall, Alberta Health Services/ Christine Friedenreich, Alberta Health Services, University of Calgary

70 21 Incidence rates of lymphoma and leukemia in rheumatoid arthritis patients using adalimumab: a literature review AUDREY CARON Student, University of Ottawa Through a structured literature review, we will examine the association between anti-TNF-α (tumor necrosis factor alpha antagonist) drugs (most commonly adalimumab) and leukemia and lymphoma. We will review quantitative studies, published between 2000 and 2015 in North America in both English and French, considering only research using rheumatoid arthritis patients, for instances of observed increased incidences of leukemia and lymphoma. Included studies will be selected from two databases: MEDLINE and EMBASE, using keywords: rheumatoid arthritis, Humira, anti-TNF-α, adalimumab, leukemia and lymphoma. We will review quantitative studies, published between 2000 and 2015 in North America in both English and French, considering only research using rheumatoid arthritis patients, for instances of observed increased incidences of leukemia and lymphoma. Included studies will be selected from two databases: MEDLINE and EMBASE, using keywords: rheumatoid arthritis, Humira, anti-TNF-α, adalimumab, leukemia and lymphoma. An initial overview of the literature has shown that there is a positive relationship between the use of adalimumab and lymphoma or leukemia. If the relationship between adalimumab and the development of lymphoma or leukemia is observed, these results could be used in clinical settings to optimize the screening protocols for leukemia and lymphoma in rheumatoid arthritis patients. Co-Author(s): Alexandra Dussault, University of Ottawa

22 The Healthy Pregnancy Strategy: Establishing a Baseline ADELE CARTY M.Sc. Student, University of Guelph 1. To Establish baseline levels of perinatal weight gain to estimate the absolute risk of gestational diabetes mellitus (GDM) and gestational hypertension (GH) by pre- pregnancy body mass index (BMI) 2. Predict the adjusted absolute risk of GDM and GH by ascending pre-pregnancy BMI. The population for this cohort study was obtained from Ontario’s Better Outcomes Registry and Network. Maternal and prenatal data was extracted for all singleton pregnancies from a rural Southern Ontario community hospital between January 1, 2010 and December 31, 2014, restricting analysis to women without pre-GDM or chronic hypertension (n=824). Maternal descriptive statistics were computed by pre-pregnancy BMI categories, defined by the World Health Organization. Multiple logistic regression models will be built to assess the relationship between pre-pregnancy BMI and both GDM and GH. Models will be adjusted for age, pregnancy smoking status, parity, gravida and percent change in BMI. The population for this cohort study was obtained from Ontario’s Better Outcomes Registry and Network. Maternal and prenatal data was extracted for all singleton pregnancies from a rural Southern Ontario community hospital between January 1, 2010 and December 31, 2014, restricting analysis to women without pre-GDM or chronic hypertension (n=824). Maternal descriptive statistics were computed by pre-pregnancy BMI categories, defined by the World Health Organization. Multiple logistic regression models will be built to assess the relationship between pre-pregnancy BMI and both GDM and GH. Models will be adjusted for age, pregnancy smoking status, parity, gravida and percent change in BMI. Gestational weight gain ranged from -5kg to 37.1kg in the study cohort, with 11 women having lost weight while 2 reported no change in weight. Descriptive statistics revealed that a pre-pregnancy BMI of 27.5 kg/m^2 appears to be a threshold for a significant increase in GDM and GH, with the prevalence increasing by 8.8% and 5.0% respectively compared to the preceding pre-pregnancy BMI category. In the univariable analysis for GDM, pre-pregnancy BMI is significantly associated with the odds of having GDM (OR=1.1, p<0.001) and percent change in BMI having a significant sparring effect (OR=0.93, p<0.001). Primigravida (OR=3.5, p=0.002) and pre-pregnancy BMI (OR=1.1, p<0.001) are both significantly associated with the odds of having gestational hypertension and parity having a significant sparring effect (OR=0.6, p=0.03). Pre- pregnancy BMI was found to be significantly associated with GDM and GH. Multiple logistic regression analysis will be conducted for each outcome and absolute adjusted risk will be predicted by ascending pre-pregnancy BMI. This study can promote interventions to optimize effective prenatal and postnatal maternal care in the community. Co-Author(s): Dr. Sarah Gower, Groves Memorial Community Hospital/ Dr. Jan Sargeant, University of Guelph/ Dr. Andrew Papadopoulos, University of Guelph

23 Implantable Cardioverter Defibrillator activity sensors overestimate activity at time of shock HARPREET CHAHAL Master’s student, University of Western Ontario Implantable Cardioverter Defibrillator (ICD) activity sensors are often used clinically to assess a patient’s activity level at time of therapy. Several studies have relied on data from ICD sensors to infer patient activity habits. We aim to assess the reliability of this metric as a valid measure of physical activity. Patients receiving an ICD for primary prevention were enrolled at the time of implant. Patients underwent a detailed assessment of their baseline functional status and level of physical activity. Physical activity at the time of ICD shock was the primary measure investigated. Within 72 hours of ICD discharge, patients completed a thorough survey via telephone or clinic visit regarding their activity at the time of shock. At a follow-up clinic visit, device interrogation was performed to collect physical activity level during shock measured by the ICD accelerometer. The accelerometer data was compared to self-reported activity level to assess correlation. Patients receiving an ICD for primary prevention were enrolled at the time of implant. Patients underwent a detailed assessment of their baseline functional status and level of physical activity. Physical activity at the time of ICD shock was the primary measure investigated. Within 72 hours of ICD discharge, patients completed a thorough survey via telephone or clinic visit regarding their activity at the time of shock. At a follow-up clinic visit, device interrogation was performed to collect physical activity level during shock measured by the ICD accelerometer. The accelerometer data was compared to self-reported activity level to assess correlation. 97 patients were enrolled in the study (80% male, mean age 61 ± 9 years). The mean ejection fraction was 26.2 ± 9.0% and mean MVO2 was 1.57 ± 0.50 L/min. After a mean follow-up of 1058 ± 549 days, shock therapy was delivered 42 times in 21 patients. According to ICD device, the accelerometer reported ‘active’ status during 18 shocks. Meanwhile, by patient report, activity occurred during 11 shocks. The device performed with 91% sensitivity [95% CI 59% - 100%] and 56% specificity [95% CI 33% - 79%] to reported patient activity. The kappa coefficient assessing reliability of the ICD physical activity sensor was 0.41 [95% CI 0.13 - 0.70]. The ICD may lack specificity such that patients who reported being inactive at the time of shock are often assessed as active by the accelerometer. It may be prudent to consider the impact of this discrepancy in both clinical decision-making and in the design and advancement of activity sensor technology. Co-Author(s): Mark Speechley, University of Western Ontario/ Allan Skanes, London Health Sciences Centre/ Peter Leong-Sit, London Health Sciences Centre/ George Klein, London Health Sciences Centre/ Raymond Yee, London Health Sciences Centre/ Jaimie Manlucu, London Health Sciences Centre/ Anthony Tang, London Health Sciences Centre/ Lorne Gula, London Health Sciences Centre

24 The association of hyperhomocysteinemia with preeclampsia and other placenta-mediated outcomes: Assumptions underlying causal analytic approaches SHAZIA HIRA CHAUDHRY Graduate student, University of Ottawa Preeclampsia, placental abruption, fetal growth restriction, and fetal loss are pregnancy complications linked to placental vascular pathology that can have serious consequences for maternal and infant well-being. The etiology remains unknown, but elevated homocysteine levels, termed hyperhomocysteinemia, have been postulated to play a role. Hyperhomocysteinemia is associated with a number of factors including the Methylenetetrahydrofolate reductase (MTHFR) enzyme polymorphism C677T, which is relatively common worldwide and renders MTHFR thermolabile, with activity reduced by half. Co-Author(s): Shi-Wu Wen, Ottawa Hospital Research Institute/ Monica Taljaard, Ottawa Hospital Research Institute/ Mark Walker, Ottawa Hospital Research Institute

71 25 Variation in MMR Immunization Rates Across Calgary Zone Community Health Centres MONICA CHAWLA MPH Student, Alberta Health Services & University of Alberta Immunizations for infectious diseases have been below-target in Alberta, impacting herd immunity and increasing the potential for infectious disease outbreaks. The purpose of this project was to determine the effects of socioeconomic status, proximity to clinic, and having a non-official mother tongue on MMR immunization status in Calgary Zone. MMR (measles, mumps, rubella) immunization data was obtained from public health databases pertaining to children aged 2-6 years who accessed public health care in one of the 19 community health centres (CHCs) comprising the Calgary Zone. It was found that there was a large variation in MMR immunization status between different CHCs; thus, statistical analysis was stratified by the CHC. SES (estimated by the Pampalon Deprivation Index), distance from residence to the assigned CHC, and having a non-official mother tongue were predictor variables used to build a multivariable logistic regression model with MMR immunization status as the outcome. MMR (measles, mumps, rubella) immunization data was obtained from public health databases pertaining to children aged 2-6 years who accessed public health care in one of the 19 community health centres (CHCs) comprising the Calgary Zone. It was found that there was a large variation in MMR immunization status between different CHCs; thus, statistical analysis was stratified by the CHC. SES (estimated by the Pampalon Deprivation Index), distance from residence to the assigned CHC, and having a non-official mother tongue were predictor variables used to build a multivariable logistic regression model with MMR immunization status as the outcome. As the levels of MMR immunization varied greatly across the 19 CHCs, further analysis was stratified by CHC in order to prevent confounding of overall results. The effects of each predictor variable being considered (SES, proximity of residence to clinic, and having a non-official mother tongue) had different effects in different CHCs. Some covariates had significant interaction effects with others in some CHCs, some covariates were confounders of others in some CHCs, and the association of the covariates with MMR immunization status followed different trends across the different CHCs. These results are being taken together to understand the factors associated with MMR immunization among Calgary Zone CHCs in order to improve vaccine uptake and strengthen levels of herd immunity. Alberta Health Services produces immunization strategies in order to maximize vaccine coverage across populations, and the results found from this study can be used to design immunization programs that target those with lower rates of vaccination. Co-Author(s): Vineet Saini, Alberta Health Services/ Deborah McNeil, Alberta Health Services/ Jodi Siever, Alberta Health Services/ Ambikaipakan Senthilselvan, University of Alberta

26 Knowledge, Attitudes and Practices about Hepatitis B among Adolescents in the Upper West Region of Ghana: The Rural-Urban Gradient BATHOLOMEW CHIREH Graduate Student, University of Saskatchewan The threat posed by the global Hepatitis B (HBV) epidemic continues to increase and affects public health systems in developing countries. Improvements in vaccine uptake and advocacy can help reduce HBV disease spread. This study assesses the knowledge, attitudes and practices about HBV among adolescents in Ghana. A cross-sectional survey was conducted among in-school adolescents in grades 7 and 8 between the ages of 10 and 18 years living in rural and urban districts of the Upper West Region of Ghana. A structured paper-based questionnaire designed to cover major content areas of respondent’s demographics, knowledge, attitudes and practices was developed. A four-stage cluster sampling technique was used to select a representative sample of 408 adolescents (equal numbers of rural and urban respondents) in twelve junior high schools. The analyses focused on comparing rural and urban adolescents using Pearson chi-square tests. A cross-sectional survey was conducted among in-school adolescents in grades 7 and 8 between the ages of 10 and 18 years living in rural and urban districts of the Upper West Region of Ghana. A structured paper- based questionnaire designed to cover major content areas of respondent’s demographics, knowledge, attitudes and practices was developed. A four-stage cluster sampling technique was used to select a representative sample of 408 adolescents (equal numbers of rural and urban respondents) in twelve junior high schools. The analyses focused on comparing rural and urban adolescents using Pearson chi-square tests. Slightly more than half of the respondents (52%) were males. Age ranges (rural-urban) were: 10-12 years: 11%/6%, 13-15 years: 46%/61%, 16-18 years: 43%/33%. Almost all urban adolescents (91%) had heard about HBV, compared to only 74% of rural adolescents (p<0.001). More rural (57%) than urban (41%) adolescents were aware that HBV causes cancer (p<0.001). The majority of rural adolescents (74%) knew HBV primarily affects the liver, compared to 63% of urban respondents (p=0.03). Urban adolescents (59%) were more likely to associate with infected persons than rural (34%). Urban adolescents (78%) were more likely to ask for blood screening before transfusion compared to rural (68%). Half of urban adolescents have asked medical staff to use new syringes when seeking health care compared to one-third of rural. HBV is a serious but manageable disease which can be treated to delay progression to liver diseases (cirrhosis and hepatocellular carcinoma). HBV prevalence in developing countries is due to lack of access to preventive vaccines, low level of knowledge about the disease, stigmatization and lack of access to effective treatments. Co-Author(s): Lennarth Nyström, Department of Public Health and Clinical Medicine, Umeå University, Sweden/ Kenneth Carl D’Arcy, Department of Psychiatry and School of Public Health, University of Saskatchewan, Saskatoon, SK Canada

27 Prevalence Estimates of Five Mental Health Conditions: A Comparison of Approaches LUC CLAIR PhD Candidate, McMaster University Determining the prevalence rates for childhood mental illness is important for estimating current and future need for mental health services. This paper reviews the relevant literature on the prevalence rates for anxiety, depression, conduct disorder, eating disorders, and autism spectrum disorders in Canada and populations similar to Canada. Articles from peer-reviewed journals were selected from Medline and Pubmed searches using keywords prevalence, children, youth, school-aged, elementary, student, the illnesses listed, and combinations of these. These searches yielded 7,630 results. We focused on studies with populations similar to Canada with at least 1000 participants aged 0-25 years. The studies had to clearly define their diagnostic criteria (e.g., DSM or ICD) for evaluating symptoms and if diagnoses were based on algorithms or clinical diagnosis. The countries of interest were: Canada, United States, Great Britain, Australia, and Northern European countries. Articles from peer-reviewed journals were selected from Medline and Pubmed searches using keywords prevalence, children, youth, school-aged, elementary, student, the illnesses listed, and combinations of these. These searches yielded 7,630 results. We focused on studies with populations similar to Canada with at least 1000 participants aged 0-25 years. The studies had to clearly define their diagnostic criteria (e.g., DSM or ICD) for evaluating symptoms and if diagnoses were based on algorithms or clinical diagnosis. The countries of interest were: Canada, United States, Great Britain, Australia, and Northern European countries. A total of sixteen papers were reviewed. The literature on anxiety, depression, conduct disorder, and eating disorders predominantly uses algorithm-based diagnoses for calculating prevalence rates. In contrast, the autism literature strictly uses clinical diagnoses. For each mental illness considered, the relevant papers unanimously showed a dominance of prevalence of one gender (e.g., each paper on the prevalence of autism reported that males were more likely than women to have autism). The prevalence rates also demonstrate that the estimates tend to vary widely depending on the method chosen with self-reported prevalence rates of these conditions tending to be higher than algorithm based approaches or clinical diagnoses. The next step is to synthesize the literature and extract information on comorbidity, which further complicates the estimation of prevalence rates and creates heterogeneity between cases. Co-Author(s): Rick Audas

28 Effects of school and home neighbourhood food outlets on junk food consumption among elementary school children in a mid-size Canadian city KRISTA COOK Student, Western University Diet is implicated in the childhood obesity epidemic in Canada. Prevention strategies focused on individuals’ behaviours have been ineffectual, driving a shift towards examining the role contextual factors play in child weight gain. Our main objective is to assess the association between environmental food accessibility around children’s homes and schools and the frequency of unhealthy food consumption. Additionally, we plan to assess whether this association differs for different types of food outlets. Co-Author(s): Piotr Wilk, Western University/ Jason Gilliland, Western University

72 30 Are primary care patients with different patterns of low back pain epidemiologically distinct? LAUREN DELLA MORA MPH Student, Dalla Lana School of Public Health A classification system has been proposed for the purpose of treating ‘non-specific’ low back pain (LBP) based on dominant clinical pain pattern (back dominant pain aggravated by flexion (P1) or extension (P2), or leg dominant constant (P3) or intermittent (P4) pain). We examined whether these subgroups are epidemiologically distinct. This was a cross-sectional study of patients from 220 primary care practitioners across three cities in Ontario seeking care for LBP of 6 weeks to 12 months duration, aged 18+ years, and referred to the Inter-professional Spine Assessment and Education Clinics (ISAEC) program. Exclusions included back pain as a result of injury, pregnancy or other major pain-related conditions. Age, sex, body mass index, comorbidity count and general health status (EuroQol-5D) were compared across the four LBP pattern subgroups. Multinomial logistic regression analysis investigated adjusted associations between these epidemiological factors and LBP pattern subgroup (reference group: P1). This was a cross-sectional study of patients from 220 primary care practitioners across three cities in Ontario seeking care for LBP of 6 weeks to 12 months duration, aged 18+ years, and referred to the Inter-professional Spine Assessment and Education Clinics (ISAEC) program. Exclusions included back pain as a result of injury, pregnancy or other major pain-related conditions. Age, sex, body mass index, comorbidity count and general health status (EuroQol-5D) were compared across the four LBP pattern subgroups. Multinomial logistic regression analysis investigated adjusted associations between these epidemiological factors and LBP pattern subgroup (reference group: P1). N=1,020: 42% ‘P1’, 31% ‘P2’, 17% ‘P3’, 10% ‘P4’. Proportion of females was highest in the P1 and P2 groups. P2 and P4 groups had higher mean ages and mean comorbidity counts. The P3 and P4 groups had higher proportions of overweight/obese individuals, and general health status was poorer for these groups. From adjusted models, increasing age increased the odds of being in P2 and P4 (odds ratio (OR): 1.02 and 1.06; p<0.01). Being male or overweight/obese was associated with nearly 2 times greater odds of being in P3 and P4 (OR: 1.6-1.9; p≤0.03). Increasing comorbidity count increased the odds of being in P2 (OR: 1.14; p=0.045), and higher EuroQol-5D score (better health) was associated with decreased odds of being in P3 (OR: 0.40; p=0.033). Subgroups classified according to dominant clinical LBP pattern appear to have distinct epidemiological profiles, suggesting potentially unique risk factors and different underlying etiologies. Further research is needed to better characterize these subgroups and to investigate overlap with other musculoskeletal conditions such as osteoarthritis. Co-Author(s): Lauren S. Della Mora, Dalla Lana School of Public Health, University of Toronto; Toronto Western Hospital, University Health Network/ Anthony V. Perruccio, Toronto Western Hospital, University Health Network; Dalla Lana School of Public Health, University of Toronto/ Elizabeth M. Badley, Dalla Lana School of Public Health, University of Toronto; Division of Health Care and Outcomes Research, Toronto Western Research Institute/ Y. Raja Rampersaud, Toronto Western Hospital, University Health Network

31 Impacts of Team-based Primary Care on Healthcare Access and Utilization for Adults with Intellectual and Developmental Disabilities in Ontario JEFF DIXON MSc Student, Queen’s University This study evaluates impacts of integrated care on healthcare access and utilization indicators among adults with intellectual and developmental disabilities (IDD). It compares uptake of the periodic health exam and three cancer screens amongst Ontarians with IDD aged 18-64 years while under traditional primary care models and the new Family Health Team model. It also assesses how this policy shift impacts healthcare system utilization by this population group. Co-Author(s): Helene Ouellette-Kuntz, Queen’s University/ Michael Green, Queen’s University

32 Impact of trauma center designation levels on surgical delay, mortality, complications and length of stay in patients with hemorrhagic shock: a multicenter cohort study PHILIPPE DUFRESNE B Sc, Université Laval The goal of integrated trauma systems is to rapidly transport gravely injured patients to a hospital with surgical capacity. We aimed to describe the trajectories of patients in hemorrhagic shock and to verify the effect of trauma center designation level on surgical delays, mortality, length of stay (LOS) and complications. We performed a retrospective cohort study with data extracted from the provincial trauma registry (1999 – 2012). We included adults from the 57 provincial trauma centers of Quebec (level I to IV) with SBP < 90 mm Hg who required urgent surgical care (<6h) for hemorrhage control. Logistic regression was used to examine surgical delays (arrival in the emergency room to the operating table), mortality and complications based on level of care. LOS was examined using linear regression. We performed a retrospective cohort study with data extracted from the provincial trauma registry (1999 – 2012). We included adults from the 57 provincial trauma centers of Quebec (level I to IV) with SBP < 90 mm Hg who required urgent surgical care (<6h) for hemorrhage control. Logistic regression was used to examine surgical delays (arrival in the emergency room to the operating table), mortality and complications based on level of care. LOS was examined using linear regression. Of 668 patients in the study population, 221 (33.1%) were transported directly to a level IV/III center, 340 (50.9%) directly to a level II/I center and 104 (15.6%) were transferred without having received surgery to a level II/I center. 172 patients (26%) had surgical delays of <1h. There were no differences in surgical delay (OR = 0.96; 95% CI: 0.44 – 2.11), a higher mortality which did not reach statistical significance (OR = 1.76; 95% CI: 0.87 – 3.57), a lesser incidence of complications (OR = 0.58; 95% CI: 0.27 – 1.22) and a shorter LOS (RR = 0.41; 95% CI: 0.29 – 0.57) in level IV centers when compared to level II/I centers. 25% of patients had an operation in the first hour and 15% were transferred without receiving surgery. Level IV centers may have higher mortality, similar surgical delays, less complications and a shorter LOS. Results suggest configuration of injury care in Quebec may not be optimal for patients in hemorrhagic shock. Co-Author(s): Julien Clément, Royal College of Physicians and Surgeons of Canada (FRSCS); Service de Chirurgie Générale, Centre Hospitalier Universitaire de Québec (CHUQ)/ Lynne Moore, Département de Médecine Sociale et Préventive, Université Laval; Axe Santé des Populations - Pratiques Optimales en Santé, Traumatologie - Urgence - Soins Intensifs, CHU de Québec - Hôpital de l’Enfant-Jésus/ Pier-Alexandre Tardif, Département de Médecine Sociale et Préventive, Université Laval; Axe Santé des Populations - Pratiques Optimales en Santé, Traumatologie - Urgence - Soins Intensifs, CHU de Québec - Hôpital de l’Enfant-Jésus/ Madiba Omar, Département de Médecine Sociale et Préventive, Université Laval; Axe Santé des Populations - Pratiques Optimales en Santé, Traumatologie - Urgence - Soins Intensifs, CHU de Québec - Hôpital de l’Enfant-Jésus

34 A Comparison of Health Utility Scores in Alzheimer’s Disease Using the EQ-5D-3L and UK and Canadian Preference Weights MINGYING FANG Ph.D Candidate, University of Waterloo The purpose of this study is to investigate whether the use of United Kingdom (UK) and Canadian preference weights will lead to different health utility scores in a sample of persons with Alzheimer’s disease (AD) and their primary informal caregivers. We recruited 216 patient-caregiver dyads from nine clinics across Canada. Participants used the EQ-5D-3L to rate their health-related quality-of-life (HRQoL). EQ-5D-3L responses were transformed into health utility scores using UK and Canadian preference weights. The levels of agreement between the two sets of scores were assessed by employing intraclass correlation coefficients (ICCs). Bland-Altman plots were introduced to depict individual-level differences. Differences in EO-5D scores between the two sets of scores were tested by using the Wilcoxon signed rank sum test. We recruited 216 patient-caregiver dyads from nine clinics across Canada. Participants used the EQ-5D-3L to rate their health-related quality-of-life (HRQoL). EQ-5D-3L responses were transformed into health utility scores using UK and Canadian preference weights. The levels of agreement between the two sets of scores were assessed by employing intraclass correlation coefficients (ICCs). Bland-Altman plots were introduced to depict individual-level differences. Differences in EO-5D scores between the two sets of scores were tested by using the Wilcoxon signed rank sum test. The distributions of EQ-5D-3L scores derived from the UK and Canadian preference weights were skewed to the left. The Canadian weights yielded higher scores than those of the UK weights in both persons with AD (0.265(0.259, 0.271)) and their caregivers (0.277(0.271, 0.283)). The results did not differ by severity of AD. The intraclass correlation coefficient (95% confidence interval) was 0.928 (0.906, 0.944) in the persons with AD and 0.938 (0.919, 0.952) in the caregivers. Over 95% of the individual differences in health utility scores fell between -0.348 and -0.192 for persons with AD and -0.358 and -0.202 for caregivers. Health utility scores differed when calculated with UK versus Canadian preference weights. This finding could be attributed to substantive differences in how people from the UK and Canada value the same health states. If available, researchers should use preference weights calculated for their specific population of interest. Co-Author(s): Mingying Fang, University of Waterloo/ Mark Oremus, University of Waterloo

35 Impact of a Recent Diagnosis of Cancer on Mental Health and Use of Psychoactive Drugs: A Canadian Retrospective Cohort Study SAMANTHA FOSTER Master’s Student Candidate, Memorial University of Newfoundland The purpose of this study is to examine the difference between an individual’s mental health during the year before and the year after an initial diagnosis of cancer. Mental health will be assessed based on DSM diagnoses and use of psychoactive drugs. The hypothesis is that individuals will experience more mental health conditions and use more psychotropic drugs in the year after a cancer diagnosis compared to before. Co-Author(s): Samantha Foster, Faculty of Medicine, Memorial University of Newfoundland/ Marshall Godwin, Primary Healthcare Research Unit, Memorial University of Newfoundland

73 36 Rotavirus Vaccine Safety Profile based on Reporting to the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS) MYLÈNE FRÉCHETTE Epidemiologist, Public Health Agency of Canada To summarize case reports of Adverse Events Following Immunization (AEFI) following rotavirus vaccine, submitted to the CAEFISS and administered between January 1, 2006 to December 31, 2014. Data were extracted from CAEFISS and analyzed using SAS® EG 5.1. Variables pertaining to patient demographics, vaccines (doses in series), the AEFI, and medical outcomes at time of reporting were obtained. AEFI were classified using the Medical Dictionary for Regulatory Activities (MedDRA) and by main reason for reporting (primary AEFI), severity, System Organ Class and Preferred Terms (PT). Data were extracted from CAEFISS and analyzed using SAS® EG 5.1. Variables pertaining to patient demographics, vaccines (doses in series), the AEFI, and medical outcomes at time of reporting were obtained. AEFI were classified using the Medical Dictionary for Regulatory Activities (MedDRA) and by main reason for reporting (primary AEFI), severity, System Organ Class and Preferred Terms (PT). A total of 695 AEFI reports were extracted and the reporting rate per 100,000 doses distributed was 30.3/100,000 overall, 117 (5.1/100,000) for serious reports and 26 (1.1/100,000) for intussusception cases(of which 52.4% followed the first dose). Male to female ratio was 1:0.98 and vaccinee age ranged from 4 weeks to 2 years old. The most frequent primary AEFI were GI (32.5%), Rash (20%) and Infection/Syndrome/Systemic (ISS) Infection (9.2%). The most frequent PTs were diarrhoea (8.7%), fever (8.5%), vomiting (6.1%) and crying (5.2%). Report distribution by dose: 41.4% dose-1, 22.0% dose-2, 0.1% dose-3 (when applicable) and 34.1% no information. In 74.1% of reports, rotavirus was administered concomitantly with other vaccines. With almost 2.3 million doses of rotavirus vaccine distributed in Canada since 2006, the safety profile is good and similar to what has been reported in other countries. No new safety signals have been detected but surveillance is ongoing. Co-Author(s): Barbara Law, Public Health Agency of Canada/ Robert Pless, Public Health Agency of Canada/ Helen Anyoti, Public Health Agency of Canada/ Nooshin Ahmandipour, Public Health Agency of Canada

37 Incidence of Diabetes in Older Adults with Co-Occurring Depressive Symptoms and Cardiometabolic Abnormalities CASSANDRA FREITAS MSc Epidemiology Candidate, McGill University High depressive symptoms and cardiometabolic abnormalities are independently associated with an increased risk of diabetes. The purpose of this study is to assess the association of co-occurring depressive symptoms and cardiometabolic abnormalities on risk of diabetes in a representative sample of the English population aged 50 years and older. Data were from the English Longitudinal Study of Ageing. The sample comprised of 4454 participants without diabetes at baseline. High depressive symptoms were based on a score of 4 or more on the 8-item Centre for Epidemiologic Studies – Depression scale. Cardiometabolic abnormalities were defined as 3 or more cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, high triglycerides, and central obesity). Cox proportional hazards regressions assessed the association between co-occurring depressive symptoms and cardiometabolic abnormalities with incidence of diabetes. Covariates included age, sex, education, income, smoking status, physical activity, and alcohol consumption. Data were from the English Longitudinal Study of Ageing. The sample comprised of 4454 participants without diabetes at baseline. High depressive symptoms were based on a score of 4 or more on the 8-item Centre for Epidemiologic Studies – Depression scale. Cardiometabolic abnormalities were defined as 3 or more cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, high triglycerides, and central obesity). Cox proportional hazards regressions assessed the association between co-occurring depressive symptoms and cardiometabolic abnormalities with incidence of diabetes. Covariates included age, sex, education, income, smoking status, physical activity, and alcohol consumption. The follow-up period consisted of 106 months, during which 193 participants reported a diagnosis of diabetes. Diabetes incidence rates were compared across the following four groups: 1) low depressive symptoms and no cardiometabolic abnormalities (reference group, n = 2717); 2) low depressive symptoms only (n = 338); 3) cardiometabolic abnormalities only (n = 1180); and 4) high depressive symptoms and cardiometabolic abnormalities (n = 219). Compared to the reference group, the hazard ratio for diabetes was 1.44 (95% CI 0.68, 3.08) for those with high depressive symptoms only, 4.31 (95% CI 3.02, 6.16) for those with cardiometabolic abnormalities only, and 7.00 (95% CI 4.24, 11.55) for those with both high depressive symptoms and cardiometabolic abnormalities, after adjusting for socio-demographic and lifestyle-related factors. These findings suggest that those with high depressive symptoms and cardiometabolic abnormalities have a 7-fold increased risk of diabetes. Co-occurring depressive symptoms might amplify the impact of cardiometabolic abnormalities on risk of diabetes. Co-Author(s): Eva Graham, McGill University/ Sonya Deschenes, McGill University/ Bonnie Au, McGill University/ Kimberley Smith, Brunel University London/ Norbert Schmitz, McGill University

39 Characteristics associated with prospective follow-up of children from a pregnancy cohort study; a pilot study linking the Ontario Birth Study and TARGet Kids! KIMMY CK FUNG MPH Graduate, Dalla Lana School of Public Health, University of Toronto The Ontario Birth Study (OBS) and TARGet Kids! are longitudinal cohort studies running concurrently to study maternal and child health, respectively. This study evaluates the feasibility of linking the studies for longitudinal follow-up and describes differences between OBS mothers who enroll in TARGet Kids! and those who do not. OBS is a prospective cohort study that currently recruits mothers <17 weeks gestational age at Mount Sinai Hospital, Toronto. TARGet Kids! is a practice-based research network that recruits and follows children 0-5 years of age in primary care paediatric and family medicine clinics. For our primary analysis, we examined characteristics of OBS mothers who enrolled their child in TARGet Kids!. We used chi-square tests for categorical variables and t-tests for continuous variables to analyze the statistical significance (p<0.05) between the two groups. OBS is a prospective cohort study that currently recruits mothers <17 weeks gestational age at Mount Sinai Hospital, Toronto. TARGet Kids! is a practice-based research network that recruits and follows children 0-5 years of age in primary care paediatric and family medicine clinics. For our primary analysis, we examined characteristics of OBS mothers who enrolled their child in TARGet Kids!. We used chi-square tests for categorical variables and t-tests for continuous variables to analyze the statistical significance (p<0.05) between the two groups. From the OBS pilot of nearly 1000 participants, 448 had delivered and had complete data from the first OBS questionnaire. For the pilot study, the researchers explored different methods for recruiting OBS mothers into TARGet Kids!. Fifty mothers have enrolled in TARGet Kids!, and 14 have expressed interest. Nulliparity (p=0.02), being married (p=0.01), and having no other children in the household (p=0.002) were statistically significant predictors of enrollment in TARGet Kids!. No statistically significant associations were observed for maternal age, pre-pregnancy BMI, education, ethnicity, whether the pregnancy was planned, current employment status or number of adults in household. Our preliminary results suggested mothers who participated in a healthcare-based pregnancy cohort study were also interested in a healthcare-based childhood cohort study, suggesting linking the cohorts at birth is feasible. Factors influencing transition between studies included parity, marital status and previous children, possibly reflecting pre-existing plans for childhood primary healthcare. Co-Author(s): Kimmy CK Fung, Dalla Lana School of Public Health, University of Toronto/ Laura N Anderson, Pediatrics, Hospital for Sick Children/ Julia A Knight, Lunenfeld- Tanenbaum Research Institute, Mount Sinai Hospital/ Sheryl Hewko, Obstetrics & Gynaecology, Mount Sinai Hospital/ Ryan Seeto, Obstetrics & Gynaecology, Mount Sinai Hospital/ Catherine Birken, Pediatrics, Hospital for Sick Children/ Patricia Parkin, Pediatrics, Hospital for Sick Children/ Jonathon Maguire, Li Ka Shing Knowledge Institute, St. Michael’s Hospital/ Stephen Lye, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital/ Alan Bocking, Obstetrics & Gynaecology, Mount Sinai Hospital

40 Quantifying the exposure to illicit “Canadian” online pharmacies dispensing oxycodone without prescription KIMMY CK FUNG MPH Graduate, Dalla Lana School of Public Health, University of Toronto An increasing number of websites claim to sell prescription medication without prescription over the internet. This study aims to simulate the Internet search results an average Canadian consumer experiences and assess the risk of exposure to no-prescription online pharmacies (NPOPs) as a proxy for falsified medications. We used oxycodone, a commonly abused and highly addictive prescription-only pain medication, to identify NPOPs in this study. We examined the availability of oxycodone from online pharmacies through 25 search term combinations in Google.ca, Bing.com and Google.com. We extracted the first 50 results from each search for a total of 3750 websites. The websites were classified as: legitimate pharmacies, NPOPs, portals, informational, forums and unrelated. The cost of oxycodone from legitimate and NPOPs was recorded and compared. We compared search result ranks between categories using the Kruskal-Wallis test, and pairwise test between categories at a significance level of p<0.05. We used oxycodone, a commonly abused and highly addictive prescription-only pain medication, to identify NPOPs in this study. We examined the availability of oxycodone from online pharmacies through 25 search term combinations in Google.ca, Bing.com and Google.com. We extracted the first 50 results from each search for a total of 3750 websites. The websites were classified as: legitimate pharmacies, NPOPs, portals, informational, forums and unrelated. The cost of oxycodone from legitimate and NPOPs was recorded and compared. We compared search result ranks between categories using the Kruskal-Wallis test, and pairwise test between categories at a significance level of p<0.05. Of the 3750 website links reviewed, 1499 unique websites were found. Only 1.60% of the 3750 links were legitimate pharmacies, 10.67% were NPOPs, 25.92% were portals, 31.49% were informational, 15.36% were forums and 14.96% were unrelated websites. After de-duplicating, none of the eight unique legitimate pharmacies reported prices for oxycodone. Of the 58 unique NPOPs, only 9 reported prices for oxycontin 80mg, and the average cost per pill was $12.31 CAD with prices ranging from $3.26 to $30.00. Search result order and categories were statistically different when using Google.ca (p=0.033), Google.com (p=0.018), but not Bing (p=0.599). The average legitimate website appeared around 7 ranks below the average portal or illicit website using Google.ca, and 2 ranks below using Google. com, however, pairwise-testing indicated no statistical significance. Internet users are much more likely to encounter NPOPs relative to legitimate pharmacies. Since many NPOPs price oxycodone similar to legal prices, using price alone is insufficient to identify NPOPs. Public health education campaigns designed to increase awareness of NPOPs can protect consumers against potential harm associated with falsified medicines. Co-Author(s): Kimmy CK Fung, Dalla Lana School of Public Health, University of Toronto/ Nicholas Mitsakakis, Toronto Health Economics and Technology Assessment Collaborative; Leslie Dan Faculty of Pharmacy/ Jillian C Kohler, Leslie Dan Faculty of Pharmacy & Munk School of Global Affairs; Collaborative Doctoral Program on Global Health, Dalla Lana School of Public Health

74 41 The association between self-reported depressive symptoms and risky sexual interactions in an injection drug using population in Winnipeg, Canada KARYN GABLER Master’s Student, University of Ottawa The aim of this study is to understand the correlates and moderators of sexual risk interactions in a vulnerable population. The objective focuses on the association between depressive symptoms and sexual risk-taking as well as the moderating effect of social support. The data were collected from a population of injection drug users between 2003 and 2004 in Winnipeg using mixed method sampling (card system, personal enrollment system and observational system). First, demographic and social behaviors will be analyzed to characterize the population. Logistic regression will be used to determine if there is an association between depressive symptoms and sexual risk interactions. Second, social network metrics (cohesion, dimension and centrality) will be used to characterize components within the population. A second logistic regression model will be built to determine if social support within one’s egocentric social network and if the type of social support available moderates the relationship between depressive symptoms and sexual risk interactions in this population. The data were collected from a population of injection drug users between 2003 and 2004 in Winnipeg using mixed method sampling (card system, personal enrollment system and observational system). First, demographic and social behaviors will be analyzed to characterize the population. Logistic regression will be used to determine if there is an association between depressive symptoms and sexual risk interactions. Second, social network metrics (cohesion, dimension and centrality) will be used to characterize components within the population. A second logistic regression model will be built to determine if social support within one’s egocentric social network and if the type of social support available moderates the relationship between depressive symptoms and sexual risk interactions in this population. There was an association between depressive symptoms, and number of sexual partners as well ass depressive symptoms and engaging in selling sex. There does not appear to be an association between depressive symptoms and condom usage. The complete regression analysis and the social network analysis have not yet been completed. The next steps of this project will be to complete the analysis and assess the limitations of this project.

42 HPV variants in Inuit women from Nunavik, Quebec BARBARA GAUTHIER MSc Student, McGill University, Department of Epidemiology, Biostatistics, and Occupational Health Inuit communities in Northern Quebec have high rates of human papillomavirus (HPV) infection and cervical cancer as compared to the Canadian population. There is limited information on which variants are found in circumpolar areas so this will be described and any association between infection clearance and each variant will be assessed. 629 Inuit women between the ages of 15- 69 years from Nunavik had HPV DNA collected along with Pap smear samples opportunistically between the years 2002-2010. High risk (HR)-HPV samples were sequenced to determine the intratypic variant. The different variants and variant lineages present are described and compared to similar circumpolar populations. Logistic regression and Cox proportional hazards models will be used to assess the association between viral clearance and HPV variant. 629 Inuit women between the ages of 15- 69 years from Nunavik had HPV DNA collected along with Pap smear samples opportunistically between the years 2002-2010. High risk (HR)-HPV samples were sequenced to determine the intratypic variant. The different variants and variant lineages present are described and compared to similar circumpolar populations. Logistic regression and Cox proportional hazards models will be used to assess the association between viral clearance and HPV variant. There were 174 women that were positive for HPV – 16, 18, 31, 33, 35, 45, 52, 56, or 58 during follow-up. There were 5 different variants, all of which were of European lineage, amongst the 57 women positive for HPV-16. The majority (n=31, 54%) were prototypic. There were 8 different variants HPV-18 present. All were non-prototypic and of European lineage (n=21). There was one woman who tested positive for a prototypic lineage A variant of HPV-31, but the majority of samples (n=52) were from lineage B. Prototypic samples were also rare for HPV- 45, and 56. All HPV-58 samples were in lineage A, and none were prototypic. Overall there are several oncogenic HPV types within this community and the intratypic diversity is low. These trends are similar to what was seen in other circumpolar regions of Canada, although there appears to be less diversity as no non-European variants were present. This study shows that most variants were clustered in one lineage for each HPV type. We are currently exploring associations of HR-HPV variant with infection persistence. Co-Author(s): Francois Coutlée, Centre Hospitalier de l’Université de Montréal, Département de Microbiologie et Infectiologie/ Eduardo Franco, McGill University, Division of Cancer Epidemiology/ Paul Brassard, McGill University, Department of Epidemiology, Biostatistics, and Occupational Health

43 Epidemiology of Booster Seat Use in Alberta RICHARD GOLONKA Evaluation Coordinator, Alberta Health Services To determine the prevalence of booster seat misuse within the province of Alberta, to describe the common ways booster seats are misused and identify risk factors of both improper seat choice and improper seat use or installation when a booster seat has been chosen correctly based on the child’s age and/or weight. Between May 1st and August 31st, 2008 at 67 randomly selected Alberta childcare centers, drivers picking up their children between 3pm and 6pm were approached while and asked to participate in a five minute survey and in-vehicle restraint inspection. Inspections were conducted on all children in the vehicle under the age of nine years, however only booster eligible children are considered in this analysis (n=330). Information on child restraint knowledge and associated behaviours were collected from the driver along with relevant demographic information. In-vehicle child restraint inspections collected information on child age and estimated weight, along with seat used and observed errors (if any). Between May 1st and August 31st, 2008 at 67 randomly selected Alberta childcare centers, drivers picking up their children between 3pm and 6pm were approached while and asked to participate in a five minute survey and in-vehicle restraint inspection. Inspections were conducted on all children in the vehicle under the age of nine years, however only booster eligible children are considered in this analysis (n=330). Information on child restraint knowledge and associated behaviours were collected from the driver along with relevant demographic information. In-vehicle child restraint inspections collected information on child age and estimated weight, along with seat used and observed errors (if any). Overall, 31.8% of booster eligible children were improperly restrained. Additionally, 11.4% of booster eligible children were improperly restrained even though they were in the correct seat. While the prevalence of improper seat choice was low as children first became eligible for booster seats (~15%), rates of premature graduation increased to ~50% and higher as the child neared the adult seatbelt transition point boundary of 80lbs. Children at low risk of being seated in the wrong seat included those riding with drivers that were able to successfully recall any child restraint transition point (OR: 0.27; 95%CI: 0.14-0.50; p<0.0001), while children at high risk of being seated in wrong seat included those riding in vehicles with three children (OR: 2.67; 95%CI: 1.2-6.06; p=0.020). Steps need to be taken in Alberta to increase the awareness of child restraint transition points as this knowledge is correlated with decreased odds of booster seat misuse. Other Canadian provinces have enacted booster seat legislation that mandates usage for children between 40lbs and 80lbs and this would be an essential step in Alberta to increase both booster seat compliance and awareness. Co-Author(s): Richard Golonka, University of Alberta/ Brian Rowe, University of Alberta/ Bonnie Dobbs, University of Alberta/ Don Voaklander, University of Alberta

44 Child Restraint Information Sources Utilized by Parents of Booster Eligible Children RICHARD GOLONKA Evaluation Coordinator, Alberta Health Services To identify where parents of booster eligible children in Alberta are obtaining information on child restraints in addition to where they would prefer to obtain their information in the future. Between May 1st and August 31st, 2008 at 67 randomly selected Alberta childcare centres, drivers picking up their children between 3pm and 6pm were approached while and asked to participate in a five minute survey and in-vehicle restraint inspection. Inspections were conducted on all children in the vehicle under the age of nine years, however only booster eligible children are considered in this analysis (n=330). Information on child restraint information source utilization and preferences were collected from the driver along with relevant demographic information. In-vehicle child restraint inspections collected information on child age and estimated weight, along with seat used and observed errors (if any). Between May 1st and August 31st, 2008 at 67 randomly selected Alberta childcare centres, drivers picking up their children between 3pm and 6pm were approached while and asked to participate in a five minute survey and in-vehicle restraint inspection. Inspections were conducted on all children in the vehicle under the age of nine years, however only booster eligible children are considered in this analysis (n=330). Information on child restraint information source utilization and preferences were collected from the driver along with relevant demographic information. In-vehicle child restraint inspections collected information on child age and estimated weight, along with seat used and observed errors (if any). Nearly half of all parents of booster eligible children had used a printed resource or a non-physician health professional to obtain information on child restraints, with the non-physician health professional being the most preferred source overall in the survey. By sex, males both utilized and preferred the use of non-health professionals to obtain information while females both utilized and preferred the use of non-physician health professionals. The lowest rates of misuse were seen among drivers who had utilized a physician as an information source, who were also among the most underutilized sources in the survey. Drivers able to use their preferred information source exhibited lower rates of booster seat misuse, regardless of which source was used. Avenues for parents to consult with non-physician health professionals must remain accessible as this was the most common pathway for obtaining information. Less common sources however, must not be overlooked, as nearly all sources exhibited the potential to be correlated with proper use as long as it was also preferred by the parent. Co-Author(s): Richard Golonka, University of Alberta/ Brian Rowe, University of Alberta/ Bonnie Dobbs, University of Alberta/ Don Voaklander, University of Alberta

75 45 Job and Environmental Exposure Matrix (JEEM) : development of a concept for Prostate Cancer JAMES GOMES Assoc Prof, University of Ottawa Job Exposure matrices (JEM), while often used as methods of assessing proxy measures in occupational epidemiology, carry limitations in measuring exposures outside of work, collectively the environment. Development of a new exposure matrix which allows for estimation of lifetime occupational and environmental exposures; the JEEM, may provide an intricate solution. The Job and Environmental Exposure Matrix (JEEM), exists as a sum of refined occupational and environmental exposure indices, which collectively measures the risk of prostate cancer. Following a retrospective case-control design with recently diagnosed male prostate cancer patients set against undiagnosed males of similar age (median 67). Data collection follow a combination of self-reports and expert assessments with a specifically designed questionnaires and interviews obtaining information on the job and environment, including employment profile, diet history, and chemical exposures. The proposed method shows a conceptual model for using questionnaire data to formulate JEEM. The Job and Environmental Exposure Matrix (JEEM), exists as a sum of refined occupational and environmental exposure indices, which collectively measures the risk of prostate cancer. Following a retrospective case-control design with recently diagnosed male prostate cancer patients set against undiagnosed males of similar age (median 67). Data collection follow a combination of self-reports and expert assessments with a specifically designed questionnaires and interviews obtaining information on the job and environment, including employment profile, diet history, and chemical exposures. The proposed method shows a conceptual model for using questionnaire data to formulate JEEM. The data collected from the cases and controls was converted into a numerical format weighted for intensity of exposure, duration of exposure, type of exposure, quality of exposure and the time-period of exposure. This data was transcribed using a statistical program into three-dimensional axis to assess the risk of exposure and disease development. High sensitivity, specificity, and predictive values are predicted as with assessments of the new matrix. Exposure parameters will form a three dimensional model with axes corresponding to National Occupational Classification [NOC] based coded occupation, North American Industry Classification System [NAICS], and the duration of exposure. Environmental exposure matrix followed a similar model. Development of the axes and their parameters are described. The JEEM will form a 3-D model, creating a unified risk estimate with potential applicability as a comprehensive alternative to its precursor. Currently, the model is at the stage of being fitted to evaluate the right selection of the parameters for the different axes, with calculations in works. Co-Author(s): Sung Lee, University of Ottawa/ James Gomes, University of Ottawa

46 Analysis of the relationship between endocrine disrupting heavy metals and adverse infant-related and mother-related outcomes JAMES GOMES Assoc Prof, University of Ottawa Some heavy metals exhibit endocrine disrupting properties. Scientific literature suggests that heavy metals pose a significant health risk during pregnancy. The objectives of this study was to evaluate the association between maternal exposure to mercury, lead, arsenic and cadmium, and adverse reproductive outcomes during pregnancy. Five databases (PubMed, Medline (Ovid), EMBASE, HealthStar, and Toxline) were searched for original research and review articles that assessed the association between maternal exposure to heavy metals and adverse mother- and infant-related outcomes. After all screening processes, 46 articles, 31 observational studies and 15 reviews, were retained for data extraction. The methodological quality of observational studies was assessed and scored using a modified version of the Downs and Black checklist. AMSTAR scoring was employed for assessing review studies. Five databases (PubMed, Medline (Ovid), EMBASE, HealthStar, and Toxline) were searched for original research and review articles that assessed the association between maternal exposure to heavy metals and adverse mother- and infant-related outcomes. After all screening processes, 46 articles, 31 observational studies and 15 reviews, were retained for data extraction. The methodological quality of observational studies was assessed and scored using a modified version of the Downs and Black checklist. AMSTAR scoring was employed for assessing review studies. Lead and arsenic exposure were found to be associated with fetal loss outcomes such as spontaneous abortion, stillbirth, and neonatal death. In addition, exposure to higher levels of cadmium and mercury also suggested risk of impaired fetal growth. This reinforced the findings from previous reviews assessing the risk of adverse infant-related outcomes. Novel findings were identified with respect to mother-related outcomes. The evidence demonstrated a significant association between low levels of lead exposure and gestational hypertension. An association between arsenic exposure and impaired glucose tolerance was also observed. Finally, exposure to trace elements such as copper was identified to have an association with gestational diabetes and fetal growth. The results suggested that exposure to endocrine disrupting chemicals during pregnancy adversely affected both the mother and the infant. Gestational diabetes, fetal growth effects were observed. Developmental issues were also suggested but this requires further investigation. Additional research is needed to further understand the effect of exposures to heavy metals during pregnancy. Co-Author(s): Alvi Rahman, University of Ottawa/ James Gomes, University of Ottawa

47 Cancer Incidence Attributable to Alcohol Consumption in Alberta, Canada in 2012 ANNE GRUNDY Research Scientist, Alberta Health Services Alcohol consumption has been linked with risk of oral cavity/pharyngeal, laryngeal, esophageal, liver, colorectal and breast cancers. The objective of this study was to quantify the proportion and total number of these cancers in Alberta in 2012 attributable to alcohol consumption. Cancers attributable to alcohol consumption in Alberta were estimated using population attributable risk (PAR) calculations. Relative risks were obtained from recent meta-analyses and alcohol consumption in Alberta was quantified using data from the Canadian Community Health Survey (CCHS; Cycles 1.1 – 2.1, 2000 – 2003). Age-site-sex-specific cancer incidence data for 2012 were obtained from the Alberta Cancer Registry. The impact of potential underestimation of alcohol consumption in CCHS data was evaluated using per capita alcohol sales data from Statistics Canada. Cancers attributable to alcohol consumption in Alberta were estimated using population attributable risk (PAR) calculations. Relative risks were obtained from recent meta-analyses and alcohol consumption in Alberta was quantified using data from the Canadian Community Health Survey (CCHS; Cycles 1.1 – 2.1, 2000 – 2003). Age-site-sex-specific cancer incidence data for 2012 were obtained from the Alberta Cancer Registry. The impact of potential underestimation of alcohol consumption in CCHS data was evaluated using per capita alcohol sales data from Statistics Canada. PARs for alcohol-related cancers ranged from 5% (liver) to 20% (oral cavity/pharynx) among men and 1% (liver) to 8% (oral cavity/pharynx and larynx) among women in Alberta. While the total number of attributable cancer cases was highest among common cancers (colorectal, female breast), at individual cancer sites PARs were highest for upper aerodigestive tract (oral cavity/pharynx, larynx, esophagus) cancers. Overall 5% of alcohol-associated cancers and 2% of cancers overall in Alberta were attributable to alcohol consumption in 2012. When results were adjusted for recorded alcohol consumption based on Statistics Canada sales data, these proportions rose to 12% for alcohol-associated cancers and 4% of cancers in Alberta overall. Overall, alcohol consumption accounts for 2 – 4% of total cancer cases in Alberta. As no level of alcohol consumption is considered safe with respect to cancer risk, strategies to reduce alcohol consumption have the potential to reduce Alberta’s cancer burden. Co-Author(s): Anne Grundy, Alberta Health Services/ Abbey Poirier, Alberta Health Services/ Farah Khandwala, Alberta Health Services/ Alison McFadden, Alberta Health Services/ Laura McDougall, Alberta Health Services/ Christine Friedenreich, Alberta Health Services, University of Calgary/ Darren Brenner, Alberta Health Services, University of Calgary

48 Cancer Incidence Attributable to Selected Dietary Factors in Alberta, Canada in 2012 ANNE GRUNDY Research Scientist, Alberta Health Services Insufficient fruit and vegetable intake is associated with oral cavity/pharynx, laryngeal, esophageal, stomach and lung cancers. Red and processed meat and fibre consumption are associated with increased and decreased risks of colorectal cancer respectively. This study aimed to quantify the attributable burden cancer due to these dietary factors in Alberta. The proportions of cancer in Alberta attributable to red and processed meat consumption and insufficient fruit and vegetable and fibre consumption were estimated using population attributable risk (PAR) calculations. Relative risks were obtained from recent meta-analyses and the WCRF 2011 Continuous Update Project on colorectal cancer. Fruit and vegetable consumption data was obtained from the Canadian Community Health Survey (CCHS, 2003 – 2008), while baseline data from Alberta’s Tomorrow Project (ATP) cohort were used to estimate intakes of red and processed meat and fibre. Age-site-sex-specific cancer incidence data for 2012 were obtained from the Alberta Cancer Registry. The proportions of cancer in Alberta attributable to red and processed meat consumption and insufficient fruit and vegetable and fibre consumption were estimated using population attributable risk (PAR) calculations. Relative risks were obtained from recent meta-analyses and the WCRF 2011 Continuous Update Project on colorectal cancer. Fruit and vegetable consumption data was obtained from the Canadian Community Health Survey (CCHS, 2003 – 2008), while baseline data from Alberta’s Tomorrow Project (ATP) cohort were used to estimate intakes of red and processed meat and fibre. Age-site-sex-specific cancer incidence data for 2012 were obtained from the Alberta Cancer Registry. Approximately 70-75% of men and 48-53% of women in Alberta did not meet cancer prevention guidelines for fruit and vegetable consumption. Approximately 10% of fruit and vegetable-associated cancers and 2% of cancers overall in Alberta were attributable to insufficient fruit and vegetable consumption. In ATP participants, reported intake of red and processed meat was substantially higher among men, where approximately 40-60% of men across age groups consumed greater than 500g per week, while these proportions ranged from approximately 15-25% among women. About 12% of colorectal cancers and 2% of all cancers in Alberta in 2012 were attributable to red and processed meat consumption. Proportions attributable to insufficient fibre consumption were slightly lower, at approximately 6% of colorectal cancers and 1% of all cancers in Alberta. The proportions of cancer attributable to insufficient fruit and vegetable consumption, red/processed meat consumption and insufficient fibre consumption in Alberta are similar to comparable estimates for the United Kingdom. The dietary factors investigated here represent modifiable cancer risk factors where changes in consumption patterns could reduce Alberta’s cancer burden. Co-Author(s): Anne Grundy, Alberta Health Services/ Abbey Poirier, Alberta Health Services/ Farah Khandwala, Alberta Health Services/ Alison McFadden, Alberta Health Services/ Paula Robson, Alberta Health Services, University of Alberta/ Laura McDougall, Alberta Health Services/ Christine Friedenreich, Alberta Health Services, University of Calgary/ Darren Brenner, Alberta Health Services, University of Calgary

76 49 Free-Roaming cats (FRC) and Public Health Risks IDIT GUNTHER DVM, Koret School of Veterinary Medicine, Hebrew University The aims of this study were: (i) to describe animal-related injuries and FRC-related nuisances to the human population. (ii) To determine the temporal distribution of FRC- related injuries and nuisances, and (iii) to examine their association with FRC population dynamics. Animal-related injuries data were obtained from the ministry of health in Israel. Nuisances data were obtained from a database of citizens’ telephone complaints registered in five cities in Israel (total human population of 1.42 million residents) for the years 2007-2011. Animal-related injuries database were classified according to the attacking animal: dogs, FRC and other animals. Nuisances’ data were classified to the following categories: cat’s carcasses, kittens, parturition, aggressive behavior toward people, invasion to human facilities, and cat injuries and distress. Temporal distributions and correlations between the various complaints were calculated. The same correlations were again calculated after controlling for seasonality. Animal-related injuries data were obtained from the ministry of health in Israel. Nuisances data were obtained from a database of citizens’ telephone complaints registered in five cities in Israel (total human population of 1.42 million residents) for the years 2007-2011. Animal-related injuries database were classified according to the attacking animal: dogs, FRC and other animals. Nuisances’ data were classified to the following categories: cat’s carcasses, kittens, parturition, aggressive behavior toward people, invasion to human facilities, and cat injuries and distress. Temporal distributions and correlations between the various complaints were calculated. The same correlations were again calculated after controlling for seasonality. Overall, 2,640 events of animal-related human injuries and 87,764 FRC-related complaint s were registered. Dogs were involved in 54%, FRC in 33% and other animals in 13% of animal related human reported injuries. FRC-related human injuries showed significant seasonality and were significantly correlated with kitten and parturition related complaints. Within the complaints issued by citizens to the municipalities ‘Kittens’ or ‘parturition’ were explicitly mentioned in 38%, 39% and 19%, respectively, of the complaints regarding cat aggressiveness toward people, cat invasion to human facilities and cat injuries and distress. These complaints were still associated after omission of the joint complaints and after controlling for seasonality. The current study revealed the high rate of potential public health hazards and nuisances related to FRC. Its findings imply an association of FRC-related public health hazards and nuisances with FRC reproduction intensity. Co-Author(s): Eyal Klement, Koret School of Veterinary Medicine, Hebrew University, Israel/ Tal Raz, Koret School of Veterinary Medicine, Hebrew University, Israel/ Olaf Berke, Department of Population Medicine, Ontario Veterinary College, University of Guelph, Ontario, CANADA

50 Adolescent’s perspective on food insecurity and content validity analysis of a national survey item: A qualitative study FARZANA HAQ MSc. Candidate, Queen’s University This qualitative exploratory study aims: i) To understand Canadian adolescents’ perspectives on hunger and food insecurity (FI); ii) To qualitatively assess content validity of the hunger item on the Canadian Health Behaviour in School-aged Children (HBSC) survey. Seven focus groups were undertaken with youth aged 11-15 across Ontario as part of a larger qualitative study on the health of Canadian adolescents. Youth were asked to respond to and discuss their interpretation and understanding of the HBSC question “Some children go to school or bed hungry because there is not enough food at home, how often does this happen to you?” The transcripts were analysed first with a template consisting of the four pillars of FI (i.e., food quality, quantity, consistency and preference). Any material that did not fit within these categories was open coded for emergent themes. Seven focus groups were undertaken with youth aged 11-15 across Ontario as part of a larger qualitative study on the health of Canadian adolescents. Youth were asked to respond to and discuss their interpretation and understanding of the HBSC question “Some children go to school or bed hungry because there is not enough food at home, how often does this happen to you?” The transcripts were analysed first with a template consisting of the four pillars of FI (i.e., food quality, quantity, consistency and preference). Any material that did not fit within these categories was open coded for emergent themes. Quantity and consistent access to food were most frequently mentioned, while food quality was less consistently explored. During discussions we found that some young people maybe hungry because there is not enough food that they like to eat, at home. In addition to concepts within the four FI pillars, participants were also considering the student’s level of affluence and their ability (or inability) to control their own hunger or access to food. A follow-up survey with a small group of former participants confirmed these interpretations. The content validity assessment of this question revealed that it could be used to consider general aspects of hunger, particularly the physical or economic ones. The content validity analysis confirmed adolescents currently interpret the HBSC hunger item as FI, however not all pillars are strongly represented. We recommend specific questions regarding the four pillars of FI in future studies to build a more detailed understanding of it and potential identification of specific points for intervention. Co-Author(s): Colleen Davison, Queen’s University

51 Maternal vitamin D supplementation during pregnancy and fracture risk in early childhood: a case-control study SZE WING (WENDY) HEONG Master of Public Health Epidemiology Student, University of Toronto To evaluate whether maternal vitamin D supplementation during pregnancy, including single product vitamin D supplements and multivitamins, are associated with fracture risk in early childhood. A case-control study was conducted. Fracture cases between 1 and 6 years of age were recruited from the fracture clinic at the Hospital for Sick Children and healthy controls of the same age without fracture were identified through the TARGet Kids! primary care research network. Controls were matched to cases on age, sex, height and season. Maternal recall of vitamin D supplement use and multivitamin use during pregnancy were obtained through parent questionnaires. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained from conditional logistic regression with adjustment for the child’s skin type, waist circumference, outdoor free play time, neighbourhood income, soda consumption and child birth weight. A case-control study was conducted. Fracture cases between 1 and 6 years of age were recruited from the fracture clinic at the Hospital for Sick Children and healthy controls of the same age without fracture were identified through the TARGet Kids! primary care research network. Controls were matched to cases on age, sex, height and season. Maternal recall of vitamin D supplement use and multivitamin use during pregnancy were obtained through parent questionnaires. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained from conditional logistic regression with adjustment for the child’s skin type, waist circumference, outdoor free play time, neighbourhood income, soda consumption and child birth weight. A total of 206 fracture cases were recruited from 2009-2013 and were matched to 343 healthy controls. 56% of fractures occurred in upper extremities and 36% in the lower extremities. Vitamin D supplement use during pregnancy was reported by 7% of mothers of fracture cases, versus 11% of controls. Maternal multivitamin use during pregnancy was reported by 85% of fracture cases versus 86% of controls. Neither vitamin D supplement use during pregnancy (yes vs. no, aOR=0.64; 95% CI: 0.32, 1.26) nor multivitamin use during pregnancy (yes vs. no, aOR=0.61; 95% CI: 0.31, 1.19) were statistically significantly associated with child fracture risk in the adjusted model. Vitamin D exposure during pregnancy was not significantly associated with decreased risk of fractures in early childhood, although the results may suggest a possible inverse association that warrants further investigation. Future studies are needed to understand the relationship between vitamin D exposure in utero and fracture risk in early childhood. Co-Author(s): Laura N. Anderson, Sick Kids Hospital/ Yang Chen, St. Michael’s Hospital/ Khosrow Adeli, St. Michael’s Hospital/ Andrew Howard, St. Michael’s Hospital/ Catherine S. Birken, Sick Kids Hospital/ Patricia C. Parkin, Sick Kids Hospital/ Jonathon L. Maguire, St. Michael’s Hospital

52 Quality of Secondary Health Data in Canada AYNSLIE HINDS PhD Student, University of Manitoba Use of secondary data is increasing as a resource for health research and surveillance, and there has been a corresponding growth in the number of data quality studies. The research objective was to review published Canadian research on secondary data quality to determine what characteristics and methods have been investigated. Articles were obtained from electronic searches of PubMed, Scopus, and Google Advanced using different combinations of data quality keywords. All articles from 2004 to 2014 were systematically examined, as were reports from key national and provincial organizations. All studies that evaluated the quality of administrative database were included. The following study attributes were abstracted using a standardized form: data quality concept (e.g., validity, completeness, accuracy), publication year, type of publication, geographic origin of the data, type of administrative database(s), measures validated, measures of validity, and investigated health condition(s). Descriptive statistics were used to analyze the data. Articles were obtained from electronic searches of PubMed, Scopus, and Google Advanced using different combinations of data quality keywords. All articles from 2004 to 2014 were systematically examined, as were reports from key national and provincial organizations. All studies that evaluated the quality of administrative database were included. The following study attributes were abstracted using a standardized form: data quality concept (e.g., validity, completeness, accuracy), publication year, type of publication, geographic origin of the data, type of administrative database(s), measures validated, measures of validity, and investigated health condition(s). Descriptive statistics were used to analyze the data. A total of 111 peer-reviewed publications and 12 reports were reviewed. The number of publications increased over time. The majority of peer-reviewed publications were based on data from Ontario and Alberta. Almost all (96.7%) of the publications were validation studies; the majority (79.0%) of these used a reference standard study design. The majority (75.0%) of the non-peer reviewed publications were re-abstraction studies that examined elements of the Discharge Abstract Database. Hospital discharge abstracts, physician billing claims, and emergency department records were the most frequently validated databases. Medical records were the most common reference data source. Almost half of the studies validated case definitions based on diagnoses identified in multiple data sources. Sensitivity (63.9%) and positive predictive value (62.2%) were the most common measures of validity. Numerous Canadian validation studies have assessed diagnosis code accuracy. Methods to explore other quality concepts are needed to provide a comprehensive perspective on data quality. Since decisions about population health and healthcare are frequently based on secondary data, it is critical to identify opportunities to enhance and improve these data. Co-Author(s): Aynslie Hinds, Department of Community Health Sciences, University of Manitoba/ Lisa Lix, Department of Community Health Sciences, University of Manitoba

77 53 Maternal lead exposure’s impact on infants’ blood lead levels in the first year after birth SIYING HUANG PhD, University of Toronto Dalla Lana School of Public Health Maternal blood lead level is highly reflective of fetal lead exposure during gestation but less related to infant lead exposure level. We aimed to quantify the impact of maternal lead exposure levels on infants’ lead exposure levels from birth to 12 month using data from a longitudinal birth cohort study. Blood samples from 360 mother-infant pairs from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort study were collected. Lead exposure were measured from venous blood in mothers at delivery, 3 or 4,7 and 12 months and in infants at birth from cord blood as well as from peripheral blood at 3,6,12 months. We used linear mixed effect models to examine the effects of maternal blood lead levels (BLL) at delivery and BLL after delivery on infant BLL adjusting for children’s birth dates and breastfeeding. Additionally, we examined the effect of maternal delivery BLL over time. Blood samples from 360 mother-infant pairs from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort study were collected. Lead exposure were measured from venous blood in mothers at delivery, 3 or 4,7 and 12 months and in infants at birth from cord blood as well as from peripheral blood at 3,6,12 months. We used linear mixed effect models to examine the effects of maternal blood lead levels (BLL) at delivery and BLL after delivery on infant BLL adjusting for children’s birth dates and breastfeeding. Additionally, we examined the effect of maternal delivery BLL over time. The average of infant BLL showed a non-linear (declining from birth to 3 months then increasing from 6 to 12 months) trend. The average maternal BLL showed increasing trend from delivery to 3 /4 month then gradually decreased. The mothers’ BLL at delivery had a much stronger positive effect (beta=0.64, p<0.001) on infants’ BLL than the effect of subsequent maternal BLL (beta=0.08, p=0.06). However, the effect of maternal delivery BLL gradually reduced over time (beta=-0.03, p<0.001). Additionally, breastfeeding during the first year on average significantly contributed to infant lead exposure (beta= 0.49, p=0.04). Maternal lead exposures are positively associated with infant BLL in the first year with the strongest and long-lasting impact from delivery. However this relationship decrease over time. This implies the transitioning of lead exposure sources from fetal/maternal influence to environment as infants gaining mobility and becoming independent from mothers. Co-Author(s): Siying Huang, University of Toronto School of Public Health/ Howard Hu, University of Toronto School of Public Health/ Brisa Sánchez, University of Michigan School of Public Health/ Adrienne Ettinger, Yale Schools of Public Health and Medicine/ Karen Peterson, University of Michigan School of Public Health/ Mauricio Hernandez- Avila, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México/ Maritsa Solano-González, Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública/ Martha María Téllez- Rojo, Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública

54 Best practices for publishing epidemiologic and biostatistical research PATRICIA HUSTON Scientific Editor, Canada Communicable Disease Report, Public Health Agency of Canada Much epidemiologic and biostatistical research never gets published due to a lack of awareness and use of best practices in scientific writing and manuscript preparation. To identify useful resources for epidemiologists and biostatisticians on best practices in scientific writing and manuscript preparation for peer-reviewed journals. Best practices in scientific writing and manuscript preparation were culled from the literature and, following a review of relevant articles, books and web-based resources, were summarized for the Canadian context. Key resources for epidemiologists/biostatisticians who want to write for a peer reviewed journal include: Best reference text: Lang TA, Secic M. How to Report Statistics in Medicine: Annotated guidelines for authors, editors and reviewers. American College of Physicians. 2nd ed. Philadelphia: American College of Physicians; 2006. 490p. Described as: «an excellent resource guide to best practices in statistical reporting in medical literature» — British Medical Journal https:// store.acponline.org/ebizatpro/ProductsandServices/Products/ProductDetail/tabid/202/Default.aspx?ProductId=17152 Best website for reporting checklists: The EQUATOR Network: Enhancing the QUAlity and Transparency of health Research: The resource centre for good reporting practices for health research studies: www.equator-ntework. org Key resources for epidemiologists/biostatisticians who want to write for a peer reviewed journal include: Best reference text: Lang TA, Secic M. How to Report Statistics in Medicine: Annotated guidelines for authors, editors and reviewers. American College of Physicians. 2nd ed. Philadelphia: American College of Physicians; 2006. 490p. Described as: «an excellent resource guide to best practices in statistical reporting in medical literature» — British Medical Journal https://store.acponline.org/ebizatpro/ ProductsandServices/Products/ProductDetail/tabid/202/Default.aspx?ProductId=17152 Best website for reporting checklists: The EQUATOR Network: Enhancing the QUAlity and Transparency of health Research: The resource centre for good reporting practices for health research studies: www.equator-ntework.org. First surveillance summary reporting guide: Surveillance summary reporting guide CCDR 2015;41:76-78. Based on EQUATOR practices, this includes a 20-item checklist that identifies what should be included in the Introduction, Methods, Results and Conclusion (see handout) http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/15vol41/dr-rm41-04/surv-3-eng. php Best overall information on manuscript submission requirements: International Committee of Medical Journal Editors. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. Updated December 2014 http://www.icmje.org/icmje-recommendations.pdf. Awareness and adoption of best practices in scientific writing and manuscript preparation can increase the probability of getting an epidemiologic or biostatistical manuscript published in a peer-reviewed journal.

55 Does high educational attainment and academic performance contribute to shorter survival in individuals with Alzheimer neuropathology? A test of the cerebral reserve hypothesis MUSHAAL IJAZ University of Waterloo Individuals with high cerebral reserve tolerate more Alzheimer neuropathology before symptom onset, show greater neuropathology at time of onset, and experience shorter survival post onset. This study assessed the association of educational attainment and academic performance, variables influencing reserve, with overall survival and examined whether Alzheimer neuropathology modified this association. Analyses were based on the Nun Study, a longitudinal study of aging in 678 participants aged 75+ years at baseline. Data on highest level of educational attainment and high school grades in English, Latin, Algebra, and Geometry, available from the convent archives, were used as measures of education and academic performance, respectively. Alzheimer neuropathology was assessed in postmortem autopsies according to standard diagnostic criteria (CERAD, NIA-RI). Cox proportional hazard regression models included cognitive function as a time-dependent covariate, age and apolipoprotein E (a genetic risk factor for Alzheimer’s disease) as time-independent covariates, and Alzheimer neuropathology as an effect modifier. Analyses were based on the Nun Study, a longitudinal study of aging in 678 participants aged 75+ years at baseline. Data on highest level of educational attainment and high school grades in English, Latin, Algebra, and Geometry, available from the convent archives, were used as measures of education and academic performance, respectively. Alzheimer neuropathology was assessed in postmortem autopsies according to standard diagnostic criteria (CERAD, NIA-RI). Cox proportional hazard regression models included cognitive function as a time-dependent covariate, age and apolipoprotein E (a genetic risk factor for Alzheimer’s disease) as time-independent covariates, and Alzheimer neuropathology as an effect modifier. Expected within the next month. In individuals with Alzheimer neuropathology, an inverse association between high educational factors and survival will support the cerebral reserve hypothesis. For these individuals, higher education and academic performance could contribute to a compression of cognitive morbidity (i.e., delayed onset but shorter survival), thus reducing the global burden of Alzheimer’s disease. Co-Author(s): Mushaal Ijaz, University of Waterloo/ Joel Dubin, University of Waterloo/ Maryam Iraniparast, University of Waterloo/ Michael L. MacKinley, University of Waterloo/ Sanduni M. Costa, University of Waterloo/ Suzanne L. Tyas, University of Waterloo

78 56 Is educational attainment or high school academic performance a stronger predictor of dementia? MARYAM IRANIPARAST PhD student, University of Waterloo Low educational attainment is an established risk factor for dementia. However, the impact on dementia of other characteristics of education is less well understood. Our objective was to compare the relative importance of educational attainment and high school academic performance on the development of dementia. The Nun Study, a longitudinal study in 678 religious sisters aged 75+, includes access to archival records with final grades for first-year high school courses in English, Latin, algebra and geometry. Low academic performance was defined as <80% (i.e., below an ‘A’). Education was categorized as <=high school, Bachelor’s degree, and Master’s degree or above. Dementia was diagnosed based on DSM-IV criteria. The association of dementia with education and academic performance was assessed in logistic regression models adjusted for age and apolipoprotein E (a genetic risk factor) in separate models for English (n=454), Latin (n=416), algebra (n=451), and geometry (n=435). The Nun Study, a longitudinal study in 678 religious sisters aged 75+, includes access to archival records with final grades for first-year high school courses in English, Latin, algebra and geometry. Low academic performance was defined as <80% (i.e., below an ‘A’). Education was categorized as <=high school, Bachelor’s degree, and Master’s degree or above. Dementia was diagnosed based on DSM-IV criteria. The association of dementia with education and academic performance was assessed in logistic regression models adjusted for age and apolipoprotein E (a genetic risk factor) in separate models for English (n=454), Latin (n=416), algebra (n=451), and geometry (n=435). Low academic performance increased the odds of dementia, with the strongest and only statistically significant association found for English in unadjusted models (odds ratio [OR]=1.87, 95% confidence interval [CI]=1.17-2.99). Education was a significant predictor in unadjusted models and remained so in fully adjusted models (including education, academic performance, age, and apolipoprotein E) when academic performance weakened to nonsignificance for all courses. Compared to educational attainment of Master’s+, the ORs for dementia in individuals with high school education increased from three to four-fold across courses. A more modest effect was found in these models for Bachelor’s education, with ORs ranging from 1.49 to 1.63: all except the model for English showed a statistically significant association (English OR=1.61, 95% CI=0.97-2.67; education: Bachelor’s vs. Master’s+ OR=1.49, 95% CI=0.99-2.26). Educational attainment is a stronger predictor of dementia than academic performance in first-year high school English, Latin, algebra or geometry courses. If academic performance has an impact on dementia, it may act primarily through increasing the likelihood of attaining higher levels of education. Co-Author(s): Maryam Iraniparast, University of Waterloo/ Grace H. Tang, University of Waterloo/ Mushaal Ijaz, University of Waterloo/ Michael L. MacKinley, University of Waterloo/ Sanduni M. Costa, University of Waterloo/ Suzanne L. Tyas, University of Waterloo

57 PERSONALITY AND THE DIAGNOSIS OF CHRONIC CONDITIONS IN OLDER ADULTS JAMES IVENIUK University of Chicago In this paper, I examine how personality characteristics are implicated in the diagnosis of hyperglycemia and hypertension. I employ data from a nationally representative, longitudinal survey of older adults (N=2261; wave one in 2005/2006; wave two in 2010/2011). This dataset includes biomeasures, and dyadic data, which allows me to measure the characteristics of respondents and their matched spouses. Using these data, I model the risk of being undiagnosed for hyperglycemia, and also hypertension, using multinomial logistic regression. I employ data from a nationally representative, longitudinal survey of older adults (N=2261; wave one in 2005/2006; wave two in 2010/2011). This dataset includes biomeasures, and dyadic data, which allows me to measure the characteristics of respondents and their matched spouses. Using these data, I model the risk of being undiagnosed for hyperglycemia, and also hypertension, using multinomial logistic regression. I find that individuals who are more extraverted are more likely to be undiagnosed for hyperglycemia, even when controlling for diagnosis status in previous waves. Moreover, regardless of the focal person’s personality traits, if that person’s spouse is more extraverted, then he or she is also more likely to be undiagnosed. Individuals who have spouses in worse physical health are also more likely to remain undiagnosed for hyperglycemia. Respondents’ personality traits were not associated with diagnosis of hypertension, but those with more agreeable spouses were more likely to be undiagnosed for hypertension. There were no interactions between spouses’ personality and gender. Individual differences may increase individual risk of remaining undiagnosed for specific chronic conditions, and the personality of key confidants (e.g. spouses) may be similarly important.

58 Cancer Risk Factors in Ontario First Nations SEHAR JAMAL Epidemiology Student, Cancer Care Ontario / Universty of Toronto Ontario First Nations people are experiencing more rapidly increasing cancer incidence with worse cancer survival, compared to other Ontarians. Our objective is to estimate the prevalence of cancer-related risk factors in the Ontario First Nations population. Determining areas of high risk for cancer for this population may inform prevention strategies. Canadian Community Health Survey data for the years 2007-2013 were combined to produce indicators for cancer-related risk factors (including tobacco use, alcohol consumption, overweight and obesity, physical activity, and diet) in the off-reserve First Nations (n=2,119) and non-Aboriginal (n=123,105) Ontario adult population, aged 18 years or older. Prevalence estimates were age-standardized to the 2006 Ontario Aboriginal identity population, and stratified by sex, age-group, and education. Indicators were defined to best align with the data available in the First Nations Regional Health Survey (RHS) Phase 2 (2008/10), to enable future comparison with on-reserve First Nations. Canadian Community Health Survey data for the years 2007-2013 were combined to produce indicators for cancer-related risk factors (including tobacco use, alcohol consumption, overweight and obesity, physical activity, and diet) in the off-reserve First Nations (n=2,119) and non-Aboriginal (n=123,105) Ontario adult population, aged 18 years or older. Prevalence estimates were age-standardized to the 2006 Ontario Aboriginal identity population, and stratified by sex, age-group, and education. Indicators were defined to best align with the data available in the First Nations Regional Health Survey (RHS) Phase 2 (2008/10), to enable future comparison with on-reserve First Nations. Significantly more First Nation adults reported being current smokers (43%) compared to non-Aboriginal adults (22%); a trend common across all age groups and education levels. Additionally, heavy drinking episodes (5 or more drinks at least once a month) were significantly more common among First Nations (33%) than non-Aboriginals (23%), in particular among males and females and individuals with higher levels of education (secondary school degree or greater). Over 50% of First Nations and non-Aboriginals were at least moderately active (54% and 51% respectively). Obesity was almost two times more common in First Nations (30%) than non-Aboriginals (17%). Higher obesity levels were observed across all age groups and education levels. Adequate vegetables and fruit consumption was significantly lower in First Nations (22%) compared to non-Aboriginals (29%). High prevalence of current smokers, heavy drinking episodes, obesity, and low prevalence of adequate consumption of vegetables and fruit may increase the risk of cancer in off-reserve First Nations. Future comparison to on-reserve data in the RHS will provide a more comprehensive representation of cancer risk in Ontario First Nations. Co-Author(s): Maegan Prummel, Cancer Care Ontario/ Abigail Amartey, Cancer Care Ontario/ Loraine Marrett, Cancer Care Ontario and University of Toronto

59 Urban-rural differences in the uptake of new osteoporosis drug formulations RACQUEL JANDOC Leslie Dan Faculty of Pharmacy, University of Toronto Rural physicians may be less aware of drug formulary changes due to their isolated practice and less exposure to specialists and pharmaceutical promotion. We examined urban-rural differences in the uptake of new osteoporosis drug formulations: alendronate + vitamin D3 (listed: 2007/01), monthly risedronate (listed: 2009/06), and risedronate delayed-release (listed: 2012/02). We used Ontario healthcare data to identify osteoporosis drug claims dispensed to community-dwelling seniors aged ≥65 years. We plotted the monthly proportion of new formulations (proportion of new formulation claims of all claims with the same drug molecule) from their formulary listing date until 2014/03. Results were stratified by urban, nonmajor urban, and rural regions as defined by the Rurality Index of Ontario; a rurality score that considers population size and local access to healthcare services. Differences in proportions (chi-square) and trends of dispensing over time (regression) were compared between regions. We used Ontario healthcare data to identify osteoporosis drug claims dispensed to community-dwelling seniors aged ≥65 years. We plotted the monthly proportion of new formulations (proportion of new formulation claims of all claims with the same drug molecule) from their formulary listing date until 2014/03. Results were stratified by urban, nonmajor urban, and rural regions as defined by the Rurality Index of Ontario; a rurality score that considers population size and local access to healthcare services. Differences in proportions (chi-square) and trends of dispensing over time (regression) were compared between regions. We identified 16,367,752 eligible osteoporosis drug claims (77% urban, 18% nonmajor urban, 5% rural). Rural regions dispensed lower proportions of new formulation claims compared to urban regions. For instance, 18% of alendronate + vitamin D3 claims of all alendronate claims were dispensed in rural regions compared to 31% in nonmajor urban and 44% in urban regions. Similar differences were identified for monthly risedronate (26% rural, 32% nonmajor urban, 39% urban), and risedronate delayed-release (15% rural, 22% nonmajor urban, 22% urban). Rural regions also had slower monthly uptake of new formulations over time as identified by their regression slope compared to urban regions (0.24% vs 0.58% for alendronate + vitamin D3, 0.33% vs 0.42%, for monthly risedronate, 1.11% vs 1.46% for risedronate delayed-release). We identified significantly slower uptake and lower overall proportions of new osteoporosis drug formulations dispensed in rural regions compared to urban regions. Further research examining whether urban-rural differences in prescribing translates into regional differences in adherence to therapy and clinical outcomes is warranted. Co-Author(s): Muhammad Mamdani, La Ka Shing Knowledge Institute, St. Michael’s Hospital/ Linda E Lévesque, Department of Public Health Sciences, Queen’s University/ Suzanne M Cadarette, Leslie Dan Faculty of Pharmacy, University of Toronto

79 60 The Effectiveness and Safety of Second-Line Therapy for Androgenetic Female Alopecia: A Multi Treatment Comparison Meta-Analysis ABBY RAMZI University of Ottawa Female pattern hair loss (androgenetic alopecia in women) is a common dermatological problem that can start at any point in life. The condition leaves patients with strong negative psychological effects regarding that affects their everyday life. We aim to perform a systematic review and multi-treatment comparison meta-analysis on all double- blind randomized clinical trials assessing the effectiveness and safety of spironolactone, cyproterone acetate, 5-alpha reductase inhibitors, and flutamide for the treatment of female pattern hair loss. Co-Author(s): Ghayath Janoudi, uOttawa/ Laura Mesana, uOttawa/ Nour Matar, uOttawa/ Abby Ramzi, uOttawa

61 Educational interventions are the most promising for improving adherence to cardiovascular disease guidelines REBECCA JEFFERY Medical Student, Dalhousie University Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize the evidence about the effectiveness of interventions that target healthcare professionals to improve adherence to CVD guidelines and patient outcomes. We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials (RCTs) testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome. We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials (RCTs) testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome. We identified 38 RCTs to be included in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were completed for several outcomes by intervention. Many comparisons favoured the intervention, although only the adherence outcome for education intervention was statistically significant (standard mean difference=0.58 [95% confidence interval 0.35 to 0.8]). Many interventions show promise to improve healthcare provider adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions. Co-Author(s): Matthew To, Dalhousie University/ Gabrielle Hayduk-Costa, Dalhousie University/ Adam Cameron, Dalhousie University/ Colin Van Zoost, Dalhousie University/ Jill Hayden, Dalhousie University

62 Association between Neighbourhood walkability and Physical Activity among adults in Urban Canada ASHNA JINAH M.Sc. Candidate, Western University The objective of this study is to investigate the association between neighbourhood walkability and physical activity among adults in Urban Canada. We hypothesize that less walkable neighbourhoods may be associated with lower levels of walking and/or physical activity by adults. Three walkability measures (street connectivity, population density, and land use entropy index) were constructed from Census and DMTI Spatial Inc. at the dissemination area (DA) level, and arranged in quintiles representing less walkable to more walkable DA’s. Individual physical activity was represented by walking and physical activity levels from the National Population Health Survey (NPHS) 2000/01 to 2010/11, indicated by the frequency of participation in walking for exercise, energy expenditure, and proportions of active, moderately active and inactive individuals. To test the association between walkability measures, walking, and physical activity, both descriptive and regression analyses were conducted. Three walkability measures (street connectivity, population density, and land use entropy index) were constructed from Census and DMTI Spatial Inc. at the dissemination area (DA) level, and arranged in quintiles representing less walkable to more walkable DA’s. Individual physical activity was represented by walking and physical activity levels from the National Population Health Survey (NPHS) 2000/01 to 2010/11, indicated by the frequency of participation in walking for exercise, energy expenditure, and proportions of active, moderately active and inactive individuals. To test the association between walkability measures, walking, and physical activity, both descriptive and regression analyses were conducted. Preliminary univariable findings revealed no significant associations between street connectivity, land use entropy index and frequency of walking for exercise, energy expenditure, and the physical activity index. The only significant associations found were between population density and all physical activity variables, and between the land entropy index and frequency of participation in walking for exercise for most NPHS cycles. A multivariable longitudinal analysis assessing the association between walkability measures and walking and other physical activity measures is currently in progress. Many of the hypothesized associations were not found. Our findings of univariable associations between population density and outcome variables were consistent with previous cross-sectional findings. Co-Author(s): Sisira Sarma, Western University/ Karen Campbell, Western University/ Jason Gilliland, Western University

63 STI (Sexually Transmitted Infections) Risk Misperception in the Maritime University Student Population LAURA KEELER Dalhousie University In the Maritime Provinces, STIs (sexually transmitted infections) account for the majority of reported cases of notifiable diseases in ages 15-24. A contributing factor to sexual risk-taking in this population is that many do not perceive their sexual behaviour as risky. We aim to determine what is driving the misperception between sexual risk behaviour and perception of risk and whether or not risk perception is a predicting factor of STI testing in Maritime university students. Co-Author(s): Laura Keeler, Dalhousie University/ Donald Langille, Dalhousie University

64 A pragmatic overview of fetal macrosomia LOUAY KHIR Student, University of Ottawa We seek to examine the spectrum of health, societal, and economic implications behind rising rates of fetal macrosomia (high birth weight). Trend analysis was performed to ecologically compare rates of fetal macrosomia with proxy measurement of maternal socioeconomic status, primarily rates of health insurance and other selected indicators of population health investment in US states. Natality data were drawn from the Center for Disease Control’s Wide-ranging Online Data for Epidemiologic Research (WONDER). Data on health insurance rates was collected from the Current Population Survey of the United States Census Bureau. Economic data were collected through the Centers for Medicare and Medicaid Services (CMS). Trend analysis was performed to ecologically compare rates of fetal macrosomia with proxy measurement of maternal socioeconomic status, primarily rates of health insurance and other selected indicators of population health investment in US states. Natality data were drawn from the Center for Disease Control’s Wide-ranging Online Data for Epidemiologic Research (WONDER). Data on health insurance rates was collected from the Current Population Survey of the United States Census Bureau. Economic data were collected through the Centers for Medicare and Medicaid Services (CMS). Rates of macrosomia correlate strongly and inversely with health insurance rates. Literature sources confirm that fetal macrosomia is associated with long-term risks for obesity, diabetes, and reduced cognitive development. Societal impacts include decreased health capital in childhood, reduced educational attainment, and worse labor market and health outcomes in adulthood. While there are currently no cost impact studies for fetal macrosomia, when compared to delivery of a normal weight fetus, macrosomic births present the potential for 100% increase in costs. Applied to nearly 10% of total births, these increases represent a substantial rise in overall health care spending. Greater consideration must be made for probable impacts of macrosomal births, projected to further rise over the next several decades. This must include a shift in the current birth weight paradigm, which focuses on low birth weight. Future studies will examine non-American populations and use individual, rather than ecological, data. Co-Author(s): Raywat Deonandan, University of Ottawa

80 65 Methodological approaches for estimating the number of cancers caused by occupational exposure in Canada JOANNE KIM Research Associate, Occupational Cancer Research Centre In recent years, several projects quantifying the burden of occupational cancer have been conducted with increased methodological sophistication. We present the methods for incorporating more detailed exposure assessments and risk-relationships in the estimation of the attributable fraction (AF), developed as part of the Canadian Burden of Occupational Cancer project. This project builds upon methods from a recent UK burden study to derive AFs using: relative risks (RR) from review of the literature, detailed assessment of exposure developed by the CAREX Canada project, and a population model constructed from Canadian data. The methodological approach for each exposure-cancer site pair is adapted according to the level of detail in the available epidemiology and exposure data. We have developed a framework that results in three possible approaches: scenario A (overall RR, exposed/unexposed), scenario B (categorical exposure-response, ordinal exposure categories) and scenario C (quantitative exposure-response, quantitative exposure levels). This project builds upon methods from a recent UK burden study to derive AFs using: relative risks (RR) from review of the literature, detailed assessment of exposure developed by the CAREX Canada project, and a population model constructed from Canadian data. The methodological approach for each exposure-cancer site pair is adapted according to the level of detail in the available epidemiology and exposure data. We have developed a framework that results in three possible approaches: scenario A (overall RR, exposed/unexposed), scenario B (categorical exposure-response, ordinal exposure categories) and scenario C (quantitative exposure-response, quantitative exposure levels). The simplest burden calculation approach is applied to exposure circumstances. Due to exposure to welding fumes, welders have an elevated risk of lung cancer (overall RR = 1.44). We estimate that 260 lung cancers are diagnosed among current or former welders in Canada each year (AF overall = 1.1%, AF males = 2.0%). Exposures that have been well characterized in the literature permit more sophisticated modelling of burden. For example, the risk of lung cancer associated with diesel engine exhaust exposure has been summarized in a meta-regression. Calculating risk based on the modelled cumulative exposure of our exposed cohort, we estimate that 550 new lung cancers are caused each year in Canada by this exposure (AF overall = 2.4%, AF males = 4.3%). We sought to increase the validity of the burden estimates by using Canadian exposure and population data. The methodological enhancements in incorporating detailed epidemiology and exposure assessment further increases the validity of estimates for specific industries and occupations, facilitating targeted risk reduction strategies to prevent occupational cancers. Co-Author(s): Chris McLeod, School of Population and Public Health, University of British Columbia/ Victoria Arrandale, Occupational Cancer Research Centre; Dalla Lana School of Public Health, University of Toronto/ Daniel Song, Occupational Cancer Research Centre/ Cheryl Peters, CAREX Canada; School of Population and Public Health, University of British Columbia/ Hugh Davies, School of Population and Public Health, University of British Columbia/ France Labrèche, Chemical and Biological Hazards Prevention, IRSST; Department of Environmental and Occupational Health, University of Montreal/ Anne-Marie Nicol, Faculty of Health Sciences, Simon Fraser University/ Jérôme Lavoué, Department of Environmental and Occupational Health, University of Montreal/ Manisha Pahwa, Occupational Cancer Research Centre/ Sally Hutchings, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London/ Lesley Rushton, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London/ Paul Demers, Occupational Cancer Research Centre; Dalla Lana School of Public Health, University of Toronto

68 Comparison of Outcome Measures for Studying Mild Traumatic Brain Injury Prognosis in Older Adults VICKI KRISTMAN Associate Professor, Lakehead University Despite high rates of mild traumatic brain injury (MTBI) in the older adult population, no study has described MTBI outcome measures specifically for this population. We conducted a pilot study to identify clinically meaningful measures of recovery for older adults with MTBI. At three Ontario general hospitals, we screened for patients aged 65 and older visiting the Emergency Departments (ED) for MTBI. Measures were assessed by telephone shortly after ED visits (baseline) and six months after ED visits. Recovery measures included the Glasgow Outcome Scale (Extended) (GOSE), Medical Outcomes Study 12-Item Short Form Health Survey (SF-12), Rivermead Post Concussion Symptom Questionnaire (RPQ), and one question on self-rated recovery. Sensitivity, specificity, and responsiveness were determined using the RPQ as the comparator. At three Ontario general hospitals, we screened for patients aged 65 and older visiting the Emergency Departments (ED) for MTBI. Measures were assessed by telephone shortly after ED visits (baseline) and six months after ED visits. Recovery measures included the Glasgow Outcome Scale (Extended) (GOSE), Medical Outcomes Study 12-Item Short Form Health Survey (SF-12), Rivermead Post Concussion Symptom Questionnaire (RPQ), and one question on self-rated recovery. Sensitivity, specificity, and responsiveness were determined using the RPQ as the comparator. Forty-nine of 54 people enrolled completed the follow-up interview. The results suggested the SF-12 mental component score (MCS) had good sensitivity at baseline (93.3% (95% CI: 77.9, 99.2)) and follow-up (100% (95% CI: 91.6, 100)). The GOSE and self-rated question had good specificity at baseline (GOSE: 78.9% (95% CI: 54.4, 93.9), self-rated: 100% (82.3, 100)) and follow-up (GOSE: 85.7% (95% CI: 42.1, 99.6), self-rated: 100% (95% CI: 59.0, 100)). The MCS and RPQ identified most as early recovery. The GOSE, SF-12 MCS and self-rated question identified participants with deterioration and also reported less early recovery. There is no single best measure to assess recovery from MTBI in older adults. MTBI-specific and generic tools reported varying results and the measures use varying concepts of recovery. Further confirmatory longitudinal research is needed. Co-Author(s): Robert Brison, Queen’s University/ Michel Bedard, Lakehead University/ Paula Reguly, Lakehead University/ Shelley Chisholm, Thunder Bay Regional Health Sciences Centre

69 Safety of Statins as Secondary Prevention of Dyslipidemia: A Bayesian Network Meta-Analysis MELISSA LAVIGNE Student Researcher, University of Ottawa Statins are considered to be the most widely prescribed drugs in the world. However, there is a lot of discordance in the literature about their safety. Despite the overwhelming evidence for the efficacy of statins, many clinicians are reluctant to prescribe them because they fear an increased incidence in serious adverse events. This study aims to synthesize the evidence for the safety of statins as lipid-lowering therapies given for the secondary prevention of dyslipidemia. Statins are considered to be the most widely prescribed drugs in theworld. However, there is a lot of discordance in the literature about their safety. Despite the overwhelming evidence for the efficacy of statins, many clinicians are reluctant to prescribe them because they fear an increased incidence in serious adverse events. This study aims to synthesize the evidence for the safety of statins as lipid-lowering therapies given for the secondary prevention of dyslipidemia. Co-Author(s): Laura Mesana, University of Ottawa/ Melissa Lavigne, University of Ottawa/ Jehan Kho, University of Ottawa/ Ghayath Janoudi, University of Ottawa

70 The direct and indirect costs associated with one-month recovery following acute ankle sprains RAYMOND LEE Student, Queen’s University The primary objective of this analysis was to compare the direct and indirect costs between three recovery levels among patients who suffered from ankle sprains. The secondary objective was to compare the demographic characteristics by recovery status of patients at 1 month following injury. This study used data from a randomized controlled trial of a physiotherapy regimen on 503 patients with grade 1 and 2 ankle sprains. The Foot and Ankle Outcome Score (FAOS) and a productivity questionnaire were completed at baseline and 1 month post-injury. FAOS was used to defined recovery status and the scores were divided into low, partial, and full recovery. Direct costs consisted of health care visits and imaging. Indirect costs comprised of lost income from missed work days, paid and unpaid assistance, travel, medication, and support treatments. One-way ANOVA and a Kruskal-Wallis test were used to analyze direct and indirect costs. This study used data from a randomized controlled trial of a physiotherapy regimen on 503 patients with grade 1 and 2 ankle sprains. The Foot and Ankle Outcome Score (FAOS) and a productivity questionnaire were completed at baseline and 1 month post-injury. FAOS was used to defined recovery status and the scores were divided into low, partial, and full recovery. Direct costs consisted of health care visits and imaging. Indirect costs comprised of lost income from missed work days, paid and unpaid assistance, travel, medication, and support treatments. One-way ANOVA and a Kruskal-Wallis test were used to analyze direct and indirect costs. Direct costs were not significantly different by FAOS tertile (p<0.27) and the overall direct cost mean was slightly higher than the reported lowest indirect cost in full recovery ($210 vs. $201). Indirect costs showed a significant downward trend among fully recovered patients compared to patients with a poor recovery ($282 ± 227, CL 95%), partial recovery ($235 ± 224.69, CL 95%) and good recovery ($201 ± 227, CL 95%) 1 month post-injury (p<0.0001). Age, sex, sprain grade, and occupation status were significantly different by recovery status. Participants with poor recovery tended to have grade II ankle sprains, be female, age>30 years, and unemployed. This cost study was the first to describe the direct and indirect costs of a physiotherapy regimen for patients with ankle sprains by recovery status. Policy changes directed at implementing financial support is evident from indirect cost discrepancies in ankle sprain patients. Co-Author(s): Raymond Lee, Queen’s University/ Iwona Bielska, Queen’s University/ Raymond Fong, Queen’s University/ Rob Brison, Kingston General Hospital/ Brenda Brouwer, Queen’s University/ Ana Johnson, Queen’s University

81 71 Soil-transmitted helminth infections, anemia and child development: Addressing biases due to misclassification and decomposing effects in the presence of exposure-mediator interaction LAYLA MOFID Student, McGill University The objectives of the present research were developed to address an important knowledge gap in parasite epidemiology, using rigorous epidemiological methods and analyses. Objectives include: 1) To determine the effect of chronic soil-transmitted helminth (STH) infection (i.e. intestinal parasites) on child development at five years of age; and, 2) To investigate the mechanism by which STH infections affect child development by considering anemia as a mediator and effect measure modifier of this relationship. Co-Author(s): Theresa Gyorkos, McGill University Health Centre

72 Exposure to DDT following Indoor Residual Spraying and hypertensive disorders of pregnancy in South African women participating in the VHEMBE study JENNIFER MURRAY Student, McGill University Indoor Residual Spraying (IRS) for malaria control exposes 120 million people to high levels of insecticides such as DDT (dichlorodiphenyltrichloroethane). Evidence suggests DDT exposure may increase blood pressure but no study has investigated associations with hypertensive disorders of pregnancy (HDP) in an IRS area. We used data from the NIEHS-funded Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a birth cohort study evaluating the health impact of exposure to IRS insecticides among 751 mother-infant pairs in South Africa. Serum concentrations of DDT and its breakdown product, DDE, and protein in urine were measured in pregnant women at delivery. HDP diagnostic (preeclampsia, eclampsia or gestational hypertension) was collected by questionnaire and gestational blood pressure (BP) was abstracted from medical records. We used multiple logistic and linear regression models to examine the relation between DDT, DDE and HDP. We used data from the NIEHS-funded Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a birth cohort study evaluating the health impact of exposure to IRS insecticides among 751 mother-infant pairs in South Africa. Serum concentrations of DDT and its breakdown product, DDE, and protein in urine were measured in pregnant women at delivery. HDP diagnostic (preeclampsia, eclampsia or gestational hypertension) was collected by questionnaire and gestational blood pressure (BP) was abstracted from medical records. We used multiple logistic and linear regression models to examine the relation between DDT, DDE and HDP. Geometric mean (GM) concentrations of DDT and DDE in maternal serum were 76.32 ng/g lipid [geometric standard deviation (GSD): 6.02] and 91.66 ng/g lipid (GSD: 4.71), respectively. Current Canadian concentrations measured in an adult population are lower for DDT (GM

73 Cancer Incidence Attributable to Tobacco in Alberta, Canada in 2012 ABBEY POIRIER Research Scientist, Alberta Health Services Evidence from the epidemiologic literature concludes that tobacco smoking causes cancers of the lung, larynx, oral cavity and pharynx, esophagus, stomach, pancreas, liver, kidney, bladder, cervix, bone marrow (myeloid leukemia), ovary and colon-rectum. This study aimed to quantify the proportion of cancers attributable to tobacco exposure in Alberta. Population attributable risk (PAR) calculations were used to estimate the proportion of incident cancer cases attributable to active and passive tobacco exposure in Alberta. Data from the Canadian Community Health Survey (CCHS, years 2000-2007) were used to estimate prevalence of active (current or former smoker) and passive (second-hand smoke) tobacco exposure in Alberta. These, along with relative risk estimates from recent meta-analyses, were used for the PAR calculations. Age-sex-site specific cancer incidence data were obtained from the Alberta Cancer Registry for 2012. Population attributable risk (PAR) calculations were used to estimate the proportion of incident cancer cases attributable to active and passive tobacco exposure in Alberta. Data from the Canadian Community Health Survey (CCHS, years 2000-2007) were used to estimate prevalence of active (current or former smoker) and passive (second-hand smoke) tobacco exposure in Alberta. These, along with relative risk estimates from recent meta-analyses, were used for the PAR calculations. Age-sex-site specific cancer incidence data were obtained from the Alberta Cancer Registry for 2012. Prevalence of current or former smokers ranged from 68% - 82% in men and 51% - 66% in women. Approximately 78% and 73% of lung cancer in men and women, respectively could be attributed to current or former active tobacco smoking. PAR estimates for the other active tobacco-related cancer sites ranged from approximately 4% for ovarian cancer to 74 %for laryngeal cancer. Approximately 5% of incident lung cancers in never smoking men and women could be attributed to passive tobacco exposure at home, in a vehicle or in a public place. Overall, approximately 37% of tobacco-related cancers in Alberta in 2012 were attributable to active tobacco smoking. This equates to 16% of all incident cancers in Alberta in 2012. A notable proportion of cancers at sites linked to tobacco use can be attributed to active smoking in Alberta. Passive exposure remains an important risk factor for lung cancer. Strategies to reduce the prevalence of active tobacco smokers in Alberta could have a considerable impact on future cancer incidence. Co-Author(s): Abbey Poirier, Alberta Health Services/ Anne Grundy, Alberta Health Services/ Farah Khandwala, Alberta Health Services/ Sierra Tamminen, Alberta Health Services/ Laura McDougall, Alberta Health Services/ Christine Friedenreich, Alberta Health Services, University of Calgary/ Darren Brenner, Alberta Health Services, University of Calgary

74 Tobacco Smoking and Passive Smoke Exposure Prevalence among Adult Albertans: Results from Alberta’s Tomorrow Project ABBEY PORIER Research Scientist, Alberta Health Services Tobacco consumption has been clearly associated with all-cause mortality, cardiovascular disease, and multiple cancer sites among other chronic diseases. The objective of this analysis was to estimate the prevalence of active tobacco consumption and passive tobacco exposure (second hand smoke) in participants enrolled in the Alberta Tomorrow Project (ATP). The ATP is a population-based cohort conducted among adults aged 35-69 years across Alberta that began recruitment in 2000. Participants were recruited by random digit dialling, and upon enrollment, participants were invited to complete self-administered health and lifestyle questionnaires. As part of the initial baseline assessment, participants reported their smoking status and habits and were categorized into different groups: former occasional, former daily, current daily, current occasionally, or never smokers. Never smokers were also asked to report on passive tobacco exposure in the home and/or workplace. The ATP is a population-based cohort conducted among adults aged 35-69 years across Alberta that began recruitment in 2000. Participants were recruited by random digit dialling, and upon enrollment, participants were invited to complete self-administered health and lifestyle questionnaires. As part of the initial baseline assessment, participants reported their smoking status and habits and were categorized into different groups: former occasional, former daily, current daily, current occasionally, or never smokers. Never smokers were also asked to report on passive tobacco exposure in the home and/or workplace. Data concerning tobacco exposure were obtained from 31,038 participants who were enrolled between 2000-2008. Overall, 16.0% of men and 15% of women reported smoking daily, 3.5% and 2.9% reported smoking occasionally, and 39.2% of men and 36.0% of women were classified as former daily or former occasional smokers. The proportion of participants who reported current smoking was significantly lower in older age groups (p<.0001). The proportion of current smoking decreased across increasing education and income levels (p<.0001). Among self-reported never smokers, 84.1% of men and 80.3% women reported exposure to passive tobacco in the home and/or the workplace. Despite clear messages concerning the adverse impact of tobacco exposure, a large proportion of Tomorrow Project participants were using tobacco regularly at the time of enrollment into this cohort, and consequentially, exposed others to second hand smoke. Continued strategies to reduce all forms of tobacco consumption and exposure will impact future chronic disease burden in this population. Co-Author(s): Darren Brenner, Alberta Health Services, University of Calgary/ Alianu Akawung, Alberta Health Services/ Tiffany Hiag, Alberta Health Services/ Abbey Poirier, Alberta Health Services/ Christine Friedenreich, Alberta Health Services, University of Calgary/ Paula Robson, Alberta Health Services, University and Alberta

82 75 A Cost-Effectiveness Analysis of Telemedicine for Glaucoma Screening SERA THOMAS MSc, Western University; Dept Epidemiology Glaucoma is the leading cause of irreversible vision loss. The study objective is to determine the cost-effectiveness of teleglaucoma, an innovative glaucoma screening device. The study will determine if teleglaucoma can improve access to ophthalmic care specifically in rural areas and reduce patient wait times, travel times, and healthcare costs. A cost-effectiveness analysis was conducted using societal, patient, and healthcare provider perspectives within rural Canada. The study population are patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states (mild, moderate, severe, and blind). Effectiveness was measured in QALYs and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. A cost-effectiveness analysis was conducted using societal, patient, and healthcare provider perspectives within rural Canada. The study population are patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states (mild, moderate, severe, and blind). Effectiveness was measured in QALYs and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61.23 hours and physician wait times by 30% in comparison to in-patient examination (standard of care). Teleglaucoma costs $871.51 per patient screened which was 80% less than in-patient examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-patient examination. Teleglaucoma was more cost-effective than in-patient examination with an ICER of -$27,460/QALY. This indicates that teleglaucoma will save $27, 460 for each addition QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma can accurately discriminate negative glaucoma cases and can detect glaucoma at earlier stages. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective than current in-patient examination and can improve the quality of life in glaucoma patients. Co-Author(s): Monali Malvankar-Mehta, Western University, Dept. Epidemiology/ William Hodge M.D., Western University, Medicine & Epidemiology; Ivey Eye Institute/ Cindy Hutnik M.D., Western University, Medicine (Ophthalmology & Pathology); Ivey Eye Institute

76 Molecular and statistical analysis of Campylobacter and antimicrobial resistant Campylobacter carriage in mammalian wildlife and livestock species from Ontario farms (2010) MYTHRI VISWANATHAN Graduate Student, University of Guelph The objectives of this study were to assess risk factors for the carriage of Campylobacter and antimicrobial resistant Campylobacter among livestock and mammalian wildlife on farms in Ontario, and to determine if Campylobacter subtypes are exchanged between wildlife and livestock based on molecular subtyping results. Using data collected from a cross-sectional study of 25 farms in 2010, we assessed associations between Campylobacter and antimicrobial resistant Campylobacter carriage and the following explanatory variables using mixed logistic regression models: animal species, farm type, type of sample (livestock or wildlife), and Campylobacter species; the model included a random intercept to account for the farm where samples were collected. Isolates were subtyped using a Campylobacter-specific 40 gene comparative fingerprinting assay. Using data collected from a cross-sectional study of 25 farms in 2010, we assessed associations between Campylobacter and antimicrobial resistant Campylobacter carriage and the following explanatory variables using mixed logistic regression models: animal species, farm type, type of sample (livestock or wildlife), and Campylobacter species; the model included a random intercept to account for the farm where samples were collected. Isolates were subtyped using a Campylobacter- specific 40 gene comparative fingerprinting assay. Ninety-two livestock samples and 49 raccoon samples were collected with 72% (66 livestock) and 41% (20 raccoons) testing Campylobacter positive, respectively. Livestock Campylobacter isolates were significantly more likely to exhibit antimicrobial resistance (AMR) to ≥1 antimicrobial tested compared to wildlife Campylobacter isolates. Campylobacter jejuni was significantly more likely to exhibit AMR ) to ≥1 antimicrobial tested compared to C. coli. Fecal samples from livestock were significantly more likely to test positive for Campylobacter than wildlife samples. Relative to dairy cattle, swine had significantly higher odds of testing positive for Campylobacter. The odds of shedding Campylobacter jejuni was significantly greater in beef cattle compared to dairy cattle and raccoons. Fifty unique subtypes of Campylobacter were identified, with one subtype found in both wildlife and livestock. The sharing of Campylobacter species between livestock and wildlife was uncommon based on identical subtype similarity and AMR patterns. Future research, using various cluster analysis techniques, will explore if the molecular subtypes circulating in wildlife and livestock form distinct groups/clades and whether similar strains have been isolated in humans. Co-Author(s): Mythri Viswanathan, University of Guelph, Department of Population Medicine/ David Pearl, University of Guelph, Department of Population Medicine/ Eduardo Taboada, Public Health Agency of Canada, Laboratory for Foodborne Zoonoses/ Jane Parmley, Public Health Agency of Canada, Laboratory for Foodborne Zoonoses & Canadian Cooperative Wildlife Health Centre/ Claire Jardine, University of Guelph, Department of Pathobiology

83 Poster Presentations Wednesday, June 3, 2015 1 Examining the Relationship between Established Breast Cancer Risk Factors and Levels of DNA Methylation in Blood Leukocytes DEVON BOYNE MSc Candidate, Queen’s University Objective 1: To determine the relationship between adiposity, hormonal factors, and global DNA methylation. Objective 2: To determine the relationship between adiposity, hormonal factors, BRCA1 methylation, and RASSF1A methylation. Objective 1: To determine the relationship between adiposity, hormonal factors, and global DNA methylation. Hypothesis: Increased adiposity and increased exposure to sex hormones will be associated with lower levels of global DNA methylation. Objective 2: To determine the relationship between adiposity, hormonal factors, BRCA1 methylation, and RASSF1A methylation. Hypothesis: Increased adiposity and exposure to sex hormones will be associated with higher levels of BRCA1 and RASSF1A methylation. The current cross-sectional study is nested within an ancillary study of the Alberta Physical Activity and Breast Cancer Prevention Trial. Participants consisted of 320 inactive, post-menopausal women aged 50 to 74 years who were not current smokers or excessive drinkers and had no prior diagnosis of cancer or major co-morbidities. This study will make use of exposure measures and exposure history assessed at baseline. Ordinary least squares regression models will be used to investigate the association between the exposures and the outcomes of interest while controlling for potential confounders (i.e. age, sex, ethnicity, diet, smoking history, and physical activity). The current cross-sectional study is nested within an ancillary study of the Alberta Physical Activity and Breast Cancer Prevention Trial. Participants consisted of 320 inactive, post-menopausal women aged 50 to 74 years who were not current smokers or excessive drinkers and had no prior diagnosis of cancer or major co-morbidities. This study will make use of exposure measures and exposure history assessed at baseline. Ordinary least squares regression models will be used to investigate the association between the exposures and the outcomes of interest while controlling for potential confounders (i.e. age, sex, ethnicity, diet, smoking history, and physical activity). Results are not available at this time. Preliminary analyses of the relationship between LINE-1 methylation and hormonal factors (i.e. serum levels of endogenous sex hormones, reproductive history, menopausal history, and exogenous hormone use) are currently in progress and will be presented at the conference. The next steps of this project are the examination of gene-specific measures of methylation and incorporation of measures of adiposity into the analyses. Co-Author(s): Will King, Queen’s University/ Christine Friedenreich, Alberta Health Services

2 Evaluating the oral health status of Toronto children ANDREW LAM Student Epidemiologist, Toronto Public Health Introduction overall health of children. Oral diseases such as tooth decay and gum disease can lead to lower self-esteem, eating difficulties and speech problems; therefore, having healthy teeth enables children to thrive. This work evaluated the oral health status of Toronto children. Oral health data were abstracted from Toronto Public Health’s internal data between September 1st 2004 and June 30th 2014. Data were collected each school year from the dental screening program for children in Junior Kindergarten to Grade 8. Oral health status was evaluated for the proportion of children with untreated caries and the proportion of children with d+D ≥ 2 (2 or more caries). The percent of children with untreated caries was the proportion of total children screened who had caries. The proportion of children with d+D ≥ 2 was analysed and mapped according to Ontario’s screening intensity guidelines. Oral health data were abstracted from Toronto Public Health’s internal data between September 1st 2004 and June 30th 2014. Data were collected each school year from the dental screening program for children in Junior Kindergarten to Grade 8. Oral health status was evaluated for the proportion of children with untreated caries and the proportion of children with d+D ≥ 2 (2 or more caries). The percent of children with untreated caries was the proportion of total children screened who had caries. The proportion of children with d+D ≥ 2 was analysed and mapped according to Ontario’s screening intensity guidelines. The proportion of untreated caries among Toronto children has increased from 13.5% in the 2004 to 2005 school year to 14.6% in 2013 to 2014. Untreated caries among children was higher in Northeastern and Northwestern Toronto and lower near Central Toronto. Dental screening intensity among children was higher in wards of Northern Toronto, Davenport, and Parkdale-High Park compared to other Toronto wards. However, no wards had a high screening intensity level. There has been an increasing trend of untreated caries among school-aged children in Toronto. Future investigations of caries status should be assessed with consideration of immigrant status and socioeconomic status to better understand the demographics of populations requiring dental care. Co-Author(s): Andrew Lam, Toronto Public Health/ Shirley Woods, Prince Albert Grand Council/ Nnamdi Ndubuka, Northern Inter-Tribal Health Authority

3 Occupational exposure to polycyclic aromatic hydrocarbons is associated with increased breast cancer risk DERRICK LEE PhD Candidate, University of British Columbia Polycyclic aromatic hydrocarbons (PAH) are a group of chemicals that include carcinogenic variants. Although environmental exposure to PAH is ubiquitous, occupational exposure yields the highest intensity levels. A population-based case-control study was undertaken in British Columbia and Ontario to examine the role occupational PAH exposure has on breast cancer risk. Lifestyle data and work histories were collected on 1132 cases and 1178 controls, frequency-matched by age and location, in Vancouver, BC and Kingston, ON. Lifetime occupational histories were assessed for PAH exposure using three job-exposure matrices (JEMs). Two JEMs were previously developed in the United States and Europe using expert judgements, while the third was based on compliance measurements of coal tar pitch volatiles from workplace safety inspections collected by the U.S. Occupational Safety and Health Administration between 1979 and 2010. Odds ratios (ORs) were estimated after adjusting for age, BMI, education, ethnicity, and centre. Lifestyle data and work histories were collected on 1132 cases and 1178 controls, frequency-matched by age and location, in Vancouver, BC and Kingston, ON. Lifetime occupational histories were assessed for PAH exposure using three job-exposure matrices (JEMs). Two JEMs were previously developed in the United States and Europe using expert judgements, while the third was based on compliance measurements of coal tar pitch volatiles from workplace safety inspections collected by the U.S. Occupational Safety and Health Administration between 1979 and 2010. Odds ratios (ORs) were estimated after adjusting for age, BMI, education, ethnicity, and centre. The expert-based JEMs indicated a quarter of the subjects were exposed occupationally to PAH, whereas measurement-based JEM indicated that approximately 60% were exposed, which is based on the likelihood of exceeding the permissible exposure level (PEL = 0.2 mg/m3). Applying expert-based JEMs yielded non-significantly elevated point estimates of the adjusted ORs for having ever been exposed. The measurement-based JEM revealed an increased risk for ever being exposed to a “high” exposure level (probability of exposure exceeding the PEL >10%) (OR=1.37, 95% CI: 1.14-1.64). An increased risk with duration at “high” exposure was also observed (p-trend < 0.01) (OR = 1.38, 95% CI: 1.11-1.72; OR = 1.16, 95% CI: 0.82-1.64; OR = 1.44, 95% CI: 1.07-1.94; for 0-5, 5-10, and ≥ 10 years respectively). The risk of breast cancer was found to be associated with occupational PAH exposure. The risk increased with length of employment in occupations with likelihood of exposure above PEL being greater than 10%. Our results strengthen evidence for PAH exposure as a modifiable risk factor for breast cancer. Co-Author(s): John Spinelli, British Columbia Cancer Research Centre/ Igor Burstyn, Drexel University/ Kristan Aronson, Queen’s University/ Jerome Lavoué, Université de Montréal/ Melissa Friesen, National Cancer Insititute/ Hans Kromhout, Utrecht University

84 4 Carbohydrate intake and abdominal adiposity among postmenopausal women FELICIA LEUNG PhD Candidate, Dalla Lana School of Public Health, University of Toronto Limited existing research on macronutrients, foods, and dietary patterns in relation to abdominal adiposity measures suggest the importance of carbohydrate quality. Thus, the objective was to examine the associations between carbohydrate and dietary fibre intake and abdominal adiposity among postmenopausal women, and determine whether the associations vary by food source. A cross-sectional study of 348 postmenopausal women, aged 50-69 years was conducted. Past year dietary intake was assessed using a comprehensive food frequency questionnaire. In addition to total carbohydrate and dietary fibre intake, macronutrient food sources that were considered included grains, fruits, vegetables, legumes, dairy, and sweetened products. The measure of abdominal adiposity was trunk fat mass, as measured using dual energy x-ray absorptiometry. Associations of carbohydrate and dietary fibre intake with trunk fat mass were evaluated using multivariate linear regression analyses. The analyses included adjustment for potential confounders, including total energy intake, age, ethnicity, physical activity, and alcohol use. A cross-sectional study of 348 postmenopausal women, aged 50-69 years was conducted. Past year dietary intake was assessed using a comprehensive food frequency questionnaire. In addition to total carbohydrate and dietary fibre intake, macronutrient food sources that were considered included grains, fruits, vegetables, legumes, dairy, and sweetened products. The measure of abdominal adiposity was trunk fat mass, as measured using dual energy x-ray absorptiometry. Associations of carbohydrate and dietary fibre intake with trunk fat mass were evaluated using multivariate linear regression analyses. The analyses included adjustment for potential confounders, including total energy intake, age, ethnicity, physical activity, and alcohol use. Total dietary fibre intake was inversely associated with trunk fat mass, but there was no association with total carbohydrate intake. A 1-g/d increase in dietary fibre intake was associated with -127.10 g (95% confidence interval: -210.47, -43.73 g) change in trunk fat mass. Carbohydrate and dietary fibre intake from grains were inversely associated with trunk fat mass, while there were positive associations for carbohydrate and dietary fibre intake from potatoes. Carbohydrate intake from fruit was associated with a decrease in trunk fat mass. However, the association between dietary fibre intake from fruit and trunk fat mass was not significant. There were no associations for either carbohydrate or dietary fibre intake from cereals and baked products, legumes, dairy products, and sweetened products. The varied associations between dietary fibre intake from grains and potatoes with trunk fat mass support the importance of carbohydrate quality in abdominal adiposity. Further research is needed to understand the role of carbohydrate quality in the accumulation of abdominal adipose tissue. Co-Author(s): Felicia Leung, Dalla Lana School of Public Health, University of Toronto/ Anthony J. Hanley, Department of Nutritional Sciences, University of Toronto/ Victoria A. Kirsh, Prevention and Cancer Control, Cancer Care Ontario/ Ilona Csizmadi, Department of Preventive Oncology, Faculty of Medicine, University of Calgary/ Julia A. Knight, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital

5 Melatonin patterns among female hospital workers on day and night shifts MICHAEL LEUNG MSc., Queen’s University To determine the circadian melatonin pattern according to current shiftwork status (day only, or rotating day and night) of female workers in terms of mesor (average concentration over a 24-hour period), amplitude (difference between peak and mesor concentrations) and acrophase time (time of peak concentration), and to determine the association with past shiftwork experience. Female hospital workers volunteered for a cross-sectional study in 2012-2014, with two 24-hour periods of biospecimen collection (n=331). Lifetime shiftwork duration and other variables were collected by in-person interview. 24-hour Melatonin profiles are examined by cosinor analysis using a mixed model with first-order autoregressive covariance structure. The cosinor parameters – mesor, amplitude and acrophase time are compared between day and shift workers. Female hospital workers volunteered for a cross-sectional study in 2012-2014, with two 24-hour periods of biospecimen collection (n=331). Lifetime shiftwork duration and other variables were collected by in-person interview. 24-hour Melatonin profiles are examined by cosinor analysis using a mixed model with first-order autoregressive covariance structure. The cosinor parameters – mesor, amplitude and acrophase time are compared between day and shift workers. Those currently working rotating shifts exhibited decreased mean melatonin production (p-value=0.03) and an earlier phase shift of the melatonin production rhythm (p-value=0.01) compared to day workers. However, there was no difference in the amplitude of melatonin between the two groups. Re-categorizing participants according to duration of past shift work regardless of current work status, there is no apparent difference in the mesor, amplitude or acrophase time for participants with greater than 6 years of shiftwork experience compared to those with less than 6 years. Further analyses adjusted for cofounders will be conducted and presented. This study is large, conducted while participants are at work and home, and one of the few that considers both current and past exposure to shiftwork as potential risk factors for circadian disruption. Co-Author(s): Kristan Aronson, Queen’s University/ Joan Tranmer, Queen’s University/ Renee Corbin, Queen’s University/ Andrew Day, Queen’s University

6 Statistical Algorithm for Aberrant Event Detection Using an Interactive Web Application: The Data Driven Approach LENNON LI Biostatistical specialist, Public Health Ontario To improve the sensitivity and specificity of aberrant event detection procedures applied on a daily basis to Ontario’s reportable infectious disease data from the integrated Public Health Information System (iPHIS). To develop software and tools that improves the process of statistical model development using a data driven approach. For seven reportable diseases, seasonality, time trend and day of week effects were modeled on historical data using Poisson regression. Internal facing interactive web applications were built allowing internal users to visualize data aggregated by different levels of time and space. Cumulative Sums (CUSUM) were run prospectively on the difference between observed and expected counts. The web application also allowed users to change parameters of CUSUM to maximize the sensitivity and specificity on historical data aggregated at different levels. Alerts were compared to those from the Early Aberration Reporting System (EARS), which was being run concurrently For seven reportable diseases, seasonality, time trend and day of week effects were modeled on historical data using Poisson regression. Internal facing interactive web applications were built allowing internal users to visualize data aggregated by different levels of time and space. Cumulative Sums (CUSUM) were run prospectively on the difference between observed and expected counts. The web application also allowed users to change parameters of CUSUM to maximize the sensitivity and specificity on historical data aggregated at different levels. Alerts were compared to those from the Early Aberration Reporting System (EARS), which was being run concurrently. Algorithms were built for giardiasis, cyclosporiasis, influenza A, influenza B, mumps, pertussis, and invasive pneumococcal disease. Choices of time and space aggregation, seasonality, time trend and day of week effects were disease-specific. After making decisions on the parameters of CUSUM using the interactive web application, the algorithms were run prospectively and the results were monitored. Compared to EARS, the interim results, obtained over a 3 month test period, showed that the CUSUM models performed better in terms of both sensitivity and specificity. For cyclosporiasis, an outbreak was detected sooner using the CUSUM approach. Similarly for Influenza A, the onset of the influenza season was identified more precisely. The CUSUM algorithms developed by this process appear to operate more effectively than off-the-shelf programs such as EARS. Using an interactive web-based application allowed internal staff to interact with the data and develop the best CUSUM detection model. This process will be expanded and applied to other reportable infectious diseases. Co-Author(s): Lennon Li, Public Health Ontario, University of Toronto/ ian Johnson, Public Health Ontario, University of Toronto/ Tina Badiani, Public Health Ontario

7 Predictors of functional improvement in children and adolescents treated at Children’s Services (Saskatoon Health Region) (in progress) MUZI LI PhD student, University of Saskatchewan Children’s mental health problems substantially impact their functioning in various aspects. The primary objectives of this project are to identify predictors of functional improvement in clients who received services from Children’s Services, Mental Health and Addictions Services, Saskatoon Health Region and to make recommendations regarding improving the effectiveness of services. This is a secondary analysis of routinely collected, anonymized clinical assessment data for a prospective case cohort. The established measure of client functioning used includes a global measure of impairment/functioning and subscales on school/work, home, and community performance, behavior towards others, moods/emotions, self-harmful behavior, substance use, and thinking as dependent variables. Clients’ socio-demographic characteristics, initial presenting problem(s), referral source, and caregiver/parental involvement are independent variables. Descriptive statistics are used to document changes in the clinic’s clients over time and to assess improvements in individual client’s functioning. Univariate and multivariate statistics are used to examine potential factors that influence functioning improvement. This is a secondary analysis of routinely collected, anonymized clinical assessment data for a prospective case cohort. The established measure of client functioning used includes a global measure of impairment/functioning and subscales on school/work, home, and community performance, behavior towards others, moods/emotions, self-harmful behavior, substance use, and thinking as dependent variables. Clients’ socio-demographic characteristics, initial presenting problem(s), referral source, and caregiver/parental involvement are independent variables. Descriptive statistics are used to document changes in the clinic’s clients over time and to assess improvements in individual client’s functioning. Univariate and multivariate statistics are used to examine potential factors that influence functioning improvement. The research will provide significant information to clinicians and health region managers by: 1) describing changes in clientele overtime; 2) providing information on the overall effectiveness of services provided to children and adolescents and families in improving function; 3) identifying specific factors, including parental involvement that influence functional outcome; and 4) providing a basis for recommending ways to make the services provided by Children’s Services more effective. This analysis will provide robust evidence about some of the factors involved in functional improvement in children (especially caregiver/parental involvement) and the effectiveness of current services. The results of this analysis will be used to guide managers and supervisors in improving the mental health services provided to children in Saskatoon. Co-Author(s): Muzi Li, University of Saskatchewan/ Carl D’Arcy, University of Saskatchewan

85 8 High Temperature Effect on Mortality in Ontario, Canada QIONGSI LI Research Corrdinator, Public Health Ontario The association between high temperature and daily mortality has been examined in many countries. However, few studies have examined this relationship in Canada. Hence, we examined to what extent the intensity and duration of high temperatures affected daily mortality rates in Ontario, the most populous province in Canada. We obtained daily non-accidental mortality across Ontario from June through August each year from 1996 to 2010 by Public Health Unit region. We a priori selected daily maximum ambient temperature as temperature metric. We assessed the effect of heat intensity on mortality by using a distributed lag non-linear model, adjusted for influenza, seasonal and time trends, day of the week, holidays, and the air pollutants NO2 and O3. We estimated the effect of heat duration by using two methods: a heat wave indicator and a spline function of heat duration. We obtained daily non-accidental mortality across Ontario from June through August each year from 1996 to 2010 by Public Health Unit region. We a priori selected daily maximum ambient temperature as temperature metric. We assessed the effect of heat intensity on mortality by using a distributed lag non-linear model, adjusted for influenza, seasonal and time trends, day of the week, holidays, and the air pollutants NO2 and O3. We estimated the effect of heat duration by using two methods: a heat wave indicator and a spline function of heat duration. We observed increases in daily mortality as temperature increased. There was also an important spatial heterogeneity of the relationship of heat intensity and mortality in Ontario. For example, in the Central Ontario, there was a 3.3% (95% CI: 1.1, 5.4) and 4.6% (95% CI: 1.4, 8.0) increase in mortality when temperature was 31℃ and 33℃ compared to 25℃, respectively. In contrast, the corresponding increase was 5.9% (95% CI: -0.6, 12.8) and 9.0% (95% CI: -0.5, 19.3) in the Western Ontario. In addition, we estimated that independent of heat intensity, prolonged exposure to high temperatures led to additional 7.6% (95% CI: -1.4, 17.5) increase in mortality across Ontario, when daily maximum temperature exceeded 30℃ and daily minimum temperature exceeded 19℃ persisted ≥ 3 consecutive days. These results show that both temperature intensity and duration have an effect on daily mortality rates. The risk of mortality due to heatwave seems noticeable when high temperature continued over three or more days. These findings provide important empirical data to support the development of evidence-based heat warning system in Ontario, Canada. Co-Author(s): John Wang, Public Health Ontario/ Abderrahmane Yagouti, Health Canada/ Hong Chen, Public Health Ontario

9 Evaluating diagnostic characteristics and time to breast cancer diagnosis for women receiving organized breast assessment LEANNE LINDSAY Research Associate, Cancer Care Ontario Breast Assessment Centres (BAC) provide organized workup of an abnormal screening mammogram through a formal defined pathway. This study aims to evaluate differences in time to breast cancer diagnosis for women undergoing assessment through a BAC compared to outside a BAC and diagnostic characteristics which may contribute to this difference. This retrospective cohort design identified two concurrent cohorts of women age 50 to 69 screened within the OBSP between January 1, 2002 and December 31, 2009 and diagnosed with ductal carcinoma in-situ (DCIS) or invasive breast cancer. A delay in diagnosis was classified as being diagnosed more than 7 weeks following an abnormal screening mammogram. Diagnostic characteristics evaluated included time to first assessment following an abnormal screening mammogram and total number of diagnostic assessment procedures performed. Odds ratios and corresponding 95% confidence intervals were calculated for delay to diagnosis and diagnostic characteristics by assessment centre type. This retrospective cohort design identified two concurrent cohorts of women age 50 to 69 screened within the OBSP between January 1, 2002 and December 31, 2009 and diagnosed with ductal carcinoma in-situ (DCIS) or invasive breast cancer. A delay in diagnosis was classified as being diagnosed more than 7 weeks following an abnormal screening mammogram. Diagnostic characteristics evaluated included time to first assessment following an abnormal screening mammogram and total number of diagnostic assessment procedures performed. Odds ratios and corresponding 95% confidence intervals were calculated for delay to diagnosis and diagnostic characteristics by assessment centre type. A total of 7,703 women screened in the OBSP and diagnosed with breast cancer were included in the study. Forty-seven percent of women were assessed through a BAC and 53% were assessed outside a BAC. Women were almost two times more likely to be diagnosed within 7 weeks if they were assessed through a BAC compared to outside of a BAC (OR: 1.84, 95%CI 1.66, 2.03). Women assessed in a BAC were 4.86 (95%CI 4.13, 5.72) times more likely to be diagnosed in 7 weeks if they had 3 or less diagnostic assessment procedures while women assessed outside of a BAC were 3.02 (95%CI 2.65, 3.45) times more likely. Women assessed at a BAC are less likely to experience a diagnostic delay compared to women assessed outside of a BAC. Further analyses will evaluate the influence of diagnostic characteristics on diagnostic delay. Co-Author(s): Anna Chiarelli, Cancer Care Ontario/University of Toronto/ Claire Holloway, Sunnybrook Health Sciences/University of Toronto/ Lucia Mirea, University of Toronto/Mount Sinai Hospital/ Derek Muradali, Cancer Care Ontario/ Frances O’Malley, St. Michael’s Hospital/ May Lynn Quan, University of Calgary

10 Exploring trajectories of diabetes distress in a community sample of adults with type 2 diabetes CARLA LIPSCOMBE Student, McGill University In adults with type 2 diabetes, moderate to severe diabetes distress (DD) is correlated with poorer disease management and worse diabetes health outcomes, however little is known about the progression or pattern of change of DD over time. We used 4 years of data derived from the Evaluation of Diabetes Treatment study (2011-2014), a longitudinal community-based survey of Canadian adults with type 2 diabetes (n=1,135). A latent class growth modelling approach was used to determine the number and shape of trajectories. Additionally, we used a multinomial regression analysis to investigate the degree to which various sample characteristics altered the probability of membership in a particular trajectory. We used 4 years of data derived from the Evaluation of Diabetes Treatment study (2011-2014), a longitudinal community-based survey of Canadian adults with type 2 diabetes (n=1,135). A latent class growth modelling approach was used to determine the number and shape of trajectories. Additionally, we used a multinomial regression analysis to investigate the degree to which various sample characteristics altered the probability of membership in a particular trajectory. Five distinct trajectories of DD were identified. Trajectories 1 and 2 described participants with persistently low distress (60% of sample) or persistent at risk levels of distress (24% of sample). Trajectory 3 (7.5% of sample) included participants with moderate levels of distress at baseline that decreased to sub-threshold levels by 3 years of follow-up. Trajectory 4 (6.3% of sample) consisted of participants with moderate, but increasing levels of distress. Trajectory 5 (2.5% of sample) included participants with persistently high (severe) levels of distress. A multinomial regression identified several factors associated with an increased probability of membership in trajectories 4 and 5 (vs trajectory 1); including having more diabetes complications, low social support, being physically inactive, being a current smoker, younger age and being female. These results suggest that DD follows a dynamic process and, for a subset of individuals, DD appears to be a fairly stable condition over time. Medical health professionals might consider screening for risk factors of high levels of DD in this population. Co-Author(s): Norbert Schmitz, McGill University

11 Modeling the Ebola Outbreak in Bo, Sierra Leone, Using AnyLogic Software STEFAN LITVINJENKO University of Ottawa Given existing pandemic modelling techniques, the timing and effectiveness of interventions in Ebola hemorrhagic fever will be manipulated to determine their influence on epidemic prognosis, in comparison to real-world 2014/2015 data. The county of Bo, Sierra Leone is selected as a case population to conceptualize the transmission dynamics of Ebola. The peer-reviewed scientific literature was reviewed to (1) identify the S.E.I.R. infectious disease model appropriate to characterize Ebola hemorrhagic fever and 2) estimate the model parameters of Ebola that are representative of the Bo county in Sierra Leone. The S.E.I.R model was then developed under AnyLogic software to simulate the progression of infectious activity, and to identify when and how strong a response is needed to achieve a controlled epidemic (when R0= <1). The peer-reviewed scientific literature was reviewed to (1) identify the S.E.I.R. infectious disease model appropriate to characterize Ebola hemorrhagic fever and 2) estimate the model parameters of Ebola that are representative of the Bo county in Sierra Leone. The S.E.I.R model was then developed under AnyLogic software to simulate the progression of infectious activity, and to identify when and how strong a response is needed to achieve a controlled epidemic (when R0= <1). Under tailored parameters, the S.E.I.R. model was able to produce results with reasonable precision in comparison to cumulative case counts and deaths observed in the 2014 Ebola pandemic, specifically Bo region, Sierra Leone. Adjusting values of intervention time and effectiveness allowed users to visualize impacts on prevalence and incidence of Ebola in real-time. Under several simplifying assumptions, AnyLogic was a powerful computational tool for infectious disease modeling. The rigidity of implementing a reduced reproductive number at an instantaneous rate does not reflect the fluid decline in transmission rates as observed in real-world scenarios. Next steps are to develop a complex model which encompasses the continuous reduction in basic reproductive number, over time, as a result of intervention. Co-Author(s): Stefan Litvinjenko, University of Ottawa, Interdisciplinary School of Health Sciences/ Dr. Raywat Deonandan, University of Ottawa, Interdisciplinary School of Health Sciences

86 12 Risk of adverse renal outcome following polyethylene glycol bowel preparation AIDEN LIU AL, Western University To investigate whether patients prescribed sodium picosulfate would be at a higher risk for hospital admission with acute kidney injury compared to patients prescribed polyethlyene glycol as bowel preparation for colonoscopy examination. We conducted a retrospective population-based cohort study using health administrative data from Ontario, Canada. Datasets were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences. A cohort of elderly patients was assembled from a previous study by Weir et al using Ontario Drug Benefit Database. Primary outcome, secondary outcomes, and baseline covariates were identified using Canadian Institute for Health Information Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Health Insurance Plan Database. Logistic regression models were constructed for analysis. We conducted a retrospective population-based cohort study using health administrative data from Ontario, Canada. Datasets were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences. A cohort of elderly patients was assembled from a previous study by Weir et al using Ontario Drug Benefit Database. Primary outcome, secondary outcomes, and baseline covariates were identified using Canadian Institute for Health Information Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Health Insurance Plan Database. Logistic regression models were constructed for analysis. Risk of admission with AKI was not significantly different between groups (RR 0.9, 95% CI, 0.6-1.2), patients prescribed sodium picosulfate compared to polyethlyene glycol were significantly less likely to be admitted with hypotension (RR 0.6, 95% CI, 0.5 – 0.9) and less likely to receive acute hemodialysis (RR 0.4, 95% CI, 0.2 – 0.8). The risk of death was not significantly different between groups. Our findings reflect an increased risk of hypotension and receipt of acute dialysis associated with Polyethlyene glycol. Low sensitivity of diagnostic codes contributed to lower event rate and potentially inadequate statistical power. Our findings should cast doubts on perceived safety profile of polyethlyene glycol for bowel preparation. Co-Author(s): Amit Garg, London Health Sciences Centre/ Kuan Liu, ICES-Western/ Salimah Shariff, ICES-Western/ Arsh Jain, London Health Sciences Centre/ Matthew Weir, London Health Sciences Centre

13 The impact of education and apolipoprotein E on cognitive reserve is modified by late-life cortical atrophy MICHAEL MACKINLEY Graduate Student, University of Waterloo While education and apolipoprotein E (APOE), a genetic risk factor for dementia, have shown strong theoretical links with cognitive reserve, little research has investigated their interaction with cortical atrophy. Our study examined whether the impact of education and APOE on cognitive reserve was modified by cortical atrophy in late life. The Nun Study is a longitudinal study of 678 religious sisters aged 75+ at baseline. Cognitive reserve was defined as the absence of dementia despite Alzheimer neuropathology. Alzheimer neuropathology (CERAD criteria) and cortical atrophy were determined by microscopic and gross post-mortem examinations, respectively. Dementia status (DSM-IV criteria) was based on the last cognitive assessment before death, and highest level of education was ascertained from archival data. After excluding participants with missing APOE and cortical atrophy data, the analytic sample included 234 participants (142 demented, 92 not demented). Logistic regression models were adjusted for age at death, education and APOE. The Nun Study is a longitudinal study of 678 religious sisters aged 75+ at baseline. Cognitive reserve was defined as the absence of dementia despite Alzheimer neuropathology. Alzheimer neuropathology (CERAD criteria) and cortical atrophy were determined by microscopic and gross post-mortem examinations, respectively. Dementia status (DSM-IV criteria) was based on the last cognitive assessment before death, and highest level of education was ascertained from archival data. After excluding participants with missing APOE and cortical atrophy data, the analytic sample included 234 participants (142 demented, 92 not demented). Logistic regression models were adjusted for age at death, education and APOE. The odds of cognitive reserve were reduced two-fold in carriers of the APOE*E4 allele (vs. noncarriers: OR=0.46, 95% CI=0.24-0.84) and three-fold in individuals with low education (<=high school vs. Masters+: OR=0.30, 95% CI=0.10-0.78). A marginally significant interaction was found between APOE and cortical atrophy (p=0.07). When the sample was stratified by cortical atrophy (n=177 with cortical atrophy, n=57 without cortical atrophy), APOE*E4 remained significantly associated with cognitive reserve only among participants where cortical atrophy was present (OR=0.40, 95% CI=0.18-0.81). Although there was no significant interaction between education and cortical atrophy, low education (<=high school vs. Masters+) was significantly associated with cognitive reserve only for participants with cortical atrophy (OR=0.26, 95% CI=0.07-0.81). Educational attainment and APOE were only significantly associated with cognitive reserve among participants with cortical atrophy. While a smaller sample may have impacted models assessing participants without atrophy, this finding suggests that these early-life factors may influence cognitive reserve by increasing resistance to the deleterious effects of cortical atrophy. Co-Author(s): Michael L. MacKinley, The University of Waterloo/ Mushaal Ijaz, The University of Waterloo/ Maryam Iraniparast, The University of Waterloo/ Grace H. Tang, The University of Waterloo/ Sanduni M. Costa, The University of Waterloo/ Suzanne L. Tyas, The University of Waterloo

14 Maternal Fat Intake during Pregnancy and Breastfeeding Initiation RACHEL MAN University of Western Ontario The objective of this study is to examine the association between maternal total fat intake and EPA+DHA intake during pregnancy and breastfeeding initiation. We also wish to explore whether maternal EPA+DHA intake modifies the relationship between total fat intake during pregnancy and breastfeeding initiation. The data for this study are taken from the Prenatal Health Project, a longitudinal cohort study based in London, Ontario. Women 10-22 weeks’ gestation were recruited from ultrasound clinics and completed a telephone interview. Participants were followed-up at the perinatal, infant (<1 yr) and toddler (2-5 yrs) stage. To conceptualize the relationship of maternal fat intake and covariates with breastfeeding initiation, a directed acyclic graph (DAG) was created. Backward elimination was conducted to build the final model ( p-value=0.20 for cut-off). Variables were entered temporally in a block-wise manner. Multivariable logistic regression was performed for the final analysis. The data for this study are taken from the Prenatal Health Project, a longitudinal cohort study based in London, Ontario. Women 10-22 weeks’ gestation were recruited from ultrasound clinics and completed a telephone interview. Participants were followed-up at the perinatal, infant (<1 yr) and toddler (2-5 yrs) stage. To conceptualize the relationship of maternal fat intake and covariates with breastfeeding initiation, a directed acyclic graph (DAG) was created. Backward elimination was conducted to build the final model ( p-value=0.20 for cut-off). Variables were entered temporally in a block-wise manner. Multivariable logistic regression was performed for the final analysis. Contrary to our hypothesis, higher maternal fat intake during pregnancy was significantly associated with breastfeeding initiation. The odds of initiating breastfeeding for mothers whose diets were composed of >35% fat, compared to ≤35% fat, was 2.014 (95% CI: 1.002, 4.045). EPA+DHA intake (meeting recommendations of >115mg/day vs. not meeting them) was not significantly associated with breastfeeding initiation. We also found the following to be significantly associated with breastfeeding initiation in our sample: higher education, higher income, higher caloric intake, being a non-smoker and giving birth vaginally. Explanations for the association between higher fat intake and breastfeeding initiation may be biological, such as the importance of fat in lactation. There are also social considerations – mothers who place more importance on the baby’s health, rather than self-image, may have higher fat intake and are more likely to breastfeed. Co-Author(s): Colleen O’Connor, Brescia University College/ Kathy Speechley, University of Western Ontario/ Karen Campbell, University of Western Ontario

15 The importance of the management of transitions in the neonatal intensive care unit MYURI MANOGARAN PhD Candidate, University of Ottawa Inappropriate transitions of care (e.g., early discharge) for a high-risk neonatal population can lead to negative outcomes for patients and their families, health professionals, and the health system, such as readmission. This research examines how interprofessional collaboration can act as a catalyst for efficient and effective discharge planning. Six cases will be observed from admission to the neonatal intensive care unit (NICU) until their discharge to home. Document analysis of all discharge-related documents passed to the family members of the cases and between health care professionals will be conducted. The documents will be scanned with a focus on content for analysis of the data to categorize the recurrent or common themes. How the documents collected came into being, how it is being used, how the health care professionals and the parents interpret them will also be analysed. This analysis is the first in a series of four stages. Six cases will be observed from admission to the neonatal intensive care unit (NICU) until their discharge to home. Document analysis of all discharge-related documents passed to the family members of the cases and between health care professionals will be conducted. The documents will be scanned with a focus on content for analysis of the data to categorize the recurrent or common themes. How the documents collected came into being, how it is being used, how the health care professionals and the parents interpret them will also be analysed. This analysis is the first in a series of four stages. Review of the literature indicates that few studies have been conducted to examine the impact of IPC for the discharge planning of neonates. In order for a proper transfer of care to be carried out, the discharge planning team needs to collaborate with health care professionals, community resources outside of the NICU, and the patient’s family, thus increasing the need for IPC in discharge planning. Each health care professional has the best knowledge on resources available in their field, and thus would play a huge role in making sure the patient is well connected. It is anticipated that the document analysis will assist in identifying how documents are used in the discharge of neonates and how they can be used to facilitate the discharge process. It is believed that a model of discharge planning that incorporates IPC is more successful than one that relies on the independent input of each healthcare worker. Co-Author(s): Ivy Bourgeault, University of Ottawa

87 16 Limiting Lyme disease: using system dynamics simulation to target interventions SHILO MCBURNEY Student, Dalhousie University Lyme disease is the most common vector-borne infection in North America. My study objectives are: 1. To explore ways patient and physician knowledge, beliefs and behavior surrounding Lyme disease evolve with increasing disease incidence, and how this affects incidence, diagnosis, progression to treatment, and patient outcomes. 2. To apply an understanding of how these factors interact to determine the best strategies for targeting the public and physicians with interventions to minimize negative health outcomes. Co-Author(s): George Kephart, Dalhousie University/ Shelly Sarwal, Public Health Agency of Canada

17 Estimation of the mortality burden of influenza in India ASHLEIGH MCGIRR PhD Candidate, Dalla Lana School of Public Health, University of Toronto Influenza virus is one of the most deadly infectious diseases in high-income countries; however, little is known about the mortality burden from influenza in India. Our primary objective is to estimate influenza mortality in India. Secondary objectives include understanding temporal trends and identifying high-risk age groups for influenza immunization prioritization. Weekly pneumonia deaths were obtained from the Million Deaths Study, a verbal autopsy based study of over 120,000 deaths from a representative sample of India’s population. Quasi-Poisson regression was used to estimate the proportion of pneumonia deaths attributable to influenza. The final model included 14 parameters: week, average weekly temperature, average weekly relative humidity, year of observation, percentage of positive influenza tests, and 8 seasonal terms. Influenza-specific mortality fraction was extrapolated to the population to approximate the influenza mortality rate. 95% confidence intervals were estimated using standard error of the fitted model and assuming no additional variability of the multipliers. Weekly pneumonia deaths were obtained from the Million Deaths Study, a verbal autopsy based study of over 120,000 deaths from a representative sample of India’s population. Quasi-Poisson regression was used to estimate the proportion of pneumonia deaths attributable to influenza. The final model included 14 parameters: week, average weekly temperature, average weekly relative humidity, year of observation, percentage of positive influenza tests, and 8 seasonal terms. Influenza-specific mortality fraction was extrapolated to the population to approximate the influenza mortality rate. 95% confidence intervals were estimated using standard error of the fitted model and assuming no additional variability of the multipliers. Both the crude and age-specific Poisson regression models were found to be a good fit to the data, although not all included terms in the model were statistically significant. Estimated influenza mortality rates decreased throughout the study period with estimates of 7.55 (95%CI: 3.11 – 14.81) and 5.05 (95%CI: 2.24 – 11.17) influenza deaths per 100,000 population in 2001 and 2003 respectively. Using the most recent data, the burden of influenza mortality in 2003 was found to be greatest among children ≤4 years old (49.38 per 100,000 population) and the adults ≥65 years old (21.47 per 100,000 population). Contrary to high-income countries where influenza burden is high in children but associated with low mortality, young children were found to have the highest influenza mortality burden in India, followed by older adults. As such, these are high-risk groups that should be considered for priority influenza immunization in India. Co-Author(s): Cindy Gauvreau, Centre for Global Health Research, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada/ Yurie Maher, Centre for Global Health Research, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada/ Mark Jit, Public Health England, London, United Kingdom. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom/ Shaun Morris, Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada. Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada/ Prabhat Jha, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. Centre for Global Health Research, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada

18 Disability management policies are associated with supervisors’ likelihood to accommodate back injured workers CONNOR MCGUIRE Master of Health Science Candidate, Lakehead University Department of Health Sciences To determine the association between supervisors’ perceptions of global work safety culture, disability management policies and practices and the likelihood of supporting job accommodations for back-injured workers. We conducted a cross-sectional study of supervisors from a non-random, convenience sample of Canadian and US employers. Supervisors’ likeliness to support job accommodation was measured using the Job Accommodation Scale (JAS). Global work safety culture was measured using the 6-item Global Work Safety Climate (GWSC) scale. Disability management policies and practices were measured using 13-items from the Organizational Policies and Practices (OPP) instrument. Multivariable modeling was used to determine the association between supervisors’ decision to support workplace accommodation and exposures. Final reduced models were determined after evaluating several supervisor characteristics and job factors as potential confounders and effect modifiers. We conducted a cross-sectional study of supervisors from a non-random, convenience sample of Canadian and US employers. Supervisors’ likeliness to support job accommodation was measured using the Job Accommodation Scale (JAS). Global work safety culture was measured using the 6-item Global Work Safety Climate (GWSC) scale. Disability management policies and practices were measured using 13-items from the Organizational Policies and Practices (OPP) instrument. Multivariable modeling was used to determine the association between supervisors’ decision to support workplace accommodation and exposures. Final reduced models were determined after evaluating several supervisor characteristics and job factors as potential confounders and effect modifiers. A total of 796 eligible supervisors from 19 employers participated. OPP was positively associated with a supervisors’ likeliness to accommodate (β= .19; 95% CI: .13; .24) and GWSC was not associated with supervisors’ likeliness to accommodate (β= -.084; 95% CI: -.19; .027). There were three important confounders for the association between OPP and JAS: social capital, country of residence and LBDQ C. There were also three important confounders for the association between GWSC and JAS: supervisor autonomy, vignette absences and long lasting postures and repetitive movements physical work score. Self-perceived OPP was positively associated with a supervisors’ likelihood to accommodate while GWSC was not associated with likelihood to accommodate. Future application of these findings may involve modifying disability management policies to improve the return to work process and using real world scenarios to investigate how changing disability management policies affects RTW accommodation. Co-Author(s): Vicki L Kristman, Department of Health Sciences, Lakehead University, Thunder Bay, ON, CANADA; Institute for Work & Health, Toronto, ON, CANADA; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, CANADA; Northern Ontario Scho/ William Shaw, Center for Disability Research, Liberty Mutual Research Institute for Safety, Boston, MA, USA / Paula Reguly, Department of Health Sciences, Lakehead University, Thunder Bay, ON, CANADA

19 Supervisors autonomy and considerate leadership style are associated with supervisors likelihood to accommodate back injured workers CONNOR MCGUIRE Master of Health Science Candidate, Lakehead University Department of Health Sciences To determine the association between supervisors’ leadership style and self-perceived autonomy and their likelihood of supporting job accommodations for back-injured workers. We conducted a cross-sectional study of supervisors from a non-random, convenience sample of Canadian and US employers. Supervisors’ likeliness to support job accommodation was measured using the Job Accommodation Scale (JAS). Leadership style (Initiating Structure and Consideration) was measured using the Leader Behavior Description Questionnaire (LBDQ). Self-perceived autonomy was measured using questions from the Job Content Questionnaire. Multivariable modeling was used to determine the association between supervisors’ decision to support workplace accommodation and exposures. Final reduced models were obtained after assessing several supervisor characteristics and organizations/job factors as potential effect modifiers and confounders. We conducted a cross-sectional study of supervisors from a non-random, convenience sample of Canadian and US employers. Supervisors’ likeliness to support job accommodation was measured using the Job Accommodation Scale (JAS). Leadership style (Initiating Structure and Consideration) was measured using the Leader Behavior Description Questionnaire (LBDQ). Self-perceived autonomy was measured using questions from the Job Content Questionnaire. Multivariable modeling was used to determine the association between supervisors’ decision to support workplace accommodation and exposures. Final reduced models were obtained after assessing several supervisor characteristics and organizations/job factors as potential effect modifiers and confounders. A total of 796 eligible supervisors from 19 employers participated. LBDQ Consideration β( = .012; 95% CI: .009; .016) and autonomy (β= .065; 95% CI: .024; .111) were positively associated with supervisors’ likeliness to accommodate. We found no significant association between LBDQ Initiating Structure and supervisors’ likeliness to accommodate (β = .002; 95% CI: -.001; .006). There were three important confounders for the association between LBDQ C and JAS: disability management policies, country of residence, and LBDQ IS. Important confounders for LBDQ IS included LBDQ C, heavy physical work score, long lasting postures and repetitive movements, and education. Important confounders for autonomy included workplace social capital and country of residence. Self-perceived autonomy and a considerate leadership style were positively associated with supervisors’ likeliness to accommodate back-injured workers. Providing supervisors with more autonomy over decisions regarding workplace accommodation and developing their considerate leadership style may aid in increasing work accommodation for back-injured workers and preventing prolonged work disability. Co-Author(s): Vicki L Kristman, Department of Health Sciences, Lakehead University, Thunder Bay, ON, CANADA ; Institute for Work & Health, Toronto, ON, CANADA; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, CANADA; Northern Ontario Scho/ William Shaw, Center for Disability Research, Liberty Mutual Research Institute for Safety, Boston, MA, USA / Kelly Williams-Whitt, Faculty of Management, University of Lethbridge, Calgary, AB, CANADA / Paula Reguly, Department of Health Sciences, Lakehead University, Thunder Bay, ON, CANADA/ Sophie Soklaridis, Department of Health Sciences, Lakehead University, Thunder Bay, ON, CANADA; Centre for Addiction and Mental Health, Toronto, ON, CANADA ; Department of Psychiatry, University of Toronto, Toronto, ON, CANADA

88 20 Frailty in adults with intellectual & developmental disabilities and admission to long-term care KATHERINE MCKENZIE MSc Candidate, Queen’s University Persons with intellectual and developmental disabilities (IDD) face an increased risk for negative health outcomes compared to the general population. Using a measure of frailty, this study predicts the time to admission to long-term care, and compares it to a similar measure. Identifying frail individuals could improve care practices. Adults with IDD (aged 18-99 years) living in the community and receiving home care between 2007 and 2013, identified through various Ontario health data sources, were included (n=8,337). To measure health instability, the Changes in Health, End Stage disease, Signs and Symptoms (CHESS) scale, embedded in the Resident Assessment Instrument- Home Care (RAI-HC) was used. To measure frailty, a frailty index that captures the accumulation of health deficits, adapted for the IDD population, was developed using well-established criteria. A modified Cox proportional hazards model will be used to find the association with time to admission to long-term care. Adults with IDD (aged 18-99 years) living in the community and receiving home care between 2007 and 2013, identified through various Ontario health data sources, were included (n=8,337). To measure health instability, the Changes in Health, End Stage disease, Signs and Symptoms (CHESS) scale, embedded in the Resident Assessment Instrument- Home Care (RAI-HC) was used. To measure frailty, a frailty index that captures the accumulation of health deficits, adapted for the IDD population, was developed using well-established criteria. A modified Cox proportional hazards model will be used to find the association with time to admission to long-term care. It is hypothesized that frailty (as measured by the frailty index) will be more prevalent than health instability (as measured by the CHESS) among home care recipients with IDD. It is also hypothesized that frailty will be a stronger predictor of admission to a long-term care facility than health instability. It is well-reported that adults with IDD experience aging earlier than the general population, and this may be attributable to early frailty. A frailty measure specific for an IDD population has not been created using Canadian healthcare data. Future research should continue to identify potential risk factors for long-term care. Co-Author(s): Katherine McKenzie, Queen’s University/ Helene Ouellette-Kuntz, Queen’s University/ Lynn Martin, Lakehead University

21 Neighborhood Perception of Safety and the Mobility Gap between Women and Men in Old Age JUSTINE MCLEOD Graduate Student, Queen’s University Senior mobility is a good predictor of health outcomes. Neighborhood conditions are key determinants of mobility, but little research exists on the effects of perceived neighborhood safety. Elderly women may have more mobility limitations than elderly men, possibly due to gender inequity. This study will examine the relationship between neighborhood perception of safety and mobility in seniors from Canada, Colombia, and Brazil, and then explore if these effects vary by gender. Co-Author(s): Afshin Vafaei, Queen’s University/ Beatriz Alvarado, Queen’s University/ Maria Victoria Zunzunegui, Universite de Montreal/ Carmen Lucia Curcio, Universidad de Caldas/ Fernando Gomez, Universidad de Caldas/ Ricardo Guerra, Universidad Rio Grande du Nord

22 The Association of Specific Characteristics in Randomized Controlled Trials of SSRIs for depression to Placebo Outcome: A Systematic Review and a Meta- Regression Model MARIA CASSANDRE MEDOR Student, University of Ottawa To conduct a systematic review of the literature, retrieving all trials that have been published on the topic of Selective Serotonin Reuptake Inhibitors (SSRI) for the treatment of depression. Subsequently, we will perform a meta-regression for specific study and population characteristics to determine if they influence the placebo outcome. Co-Author(s): Jady Lubin, University of Ottawa/ Ghayath Janoudi, University of Ottawa/ Laura Mesana, University of Ottawa

23 Association between changes in quality of life and early treatment discontinuation among women participating in the MAP.3 breast cancer chemoprevention trial OLIVIA MEGGETTO MSc Epidemiology Candidate, Queen’s University MAP.3 was a randomized placebo-controlled trial evaluating exemestane for breast cancer prevention that demonstrated a 65% relative reduction in breast cancer incidence among post-menopausal women. This analysis aims to evaluate the association between changes in quality of life (QOL) and discontinuation of study treatment within the first year of randomization. All participants (independent of treatment group) were combined in this secondary analysis, based on a recent publication demonstrating limited effect of exemestane on QOL. QOL was assessed prior to randomization, 6 months and annually thereafter using the Menopause-Specific Quality of Life Questionnaire (MENQOL). A clinically meaningful decline (CMD) in each MENQOL domain was represented by a 5% change from baseline. Early treatment discontinuation was defined as discontinuing assigned therapy within 365 days of randomization. Multivariable log-binomial regression was used to evaluate the association between a CMD in QOL and early treatment discontinuation for each MENQOL domain. All participants (independent of treatment group) were combined in this secondary analysis, based on a recent publication demonstrating limited effect of exemestane on QOL. QOL was assessed prior to randomization, 6 months and annually thereafter using the Menopause-Specific Quality of Life Questionnaire (MENQOL). A clinically meaningful decline (CMD) in each MENQOL domain was represented by a 5% change from baseline. Early treatment discontinuation was defined as discontinuing assigned therapy within 365 days of randomization. Multivariable log-binomial regression was used to evaluate the association between a CMD in QOL and early treatment discontinuation for each MENQOL domain. Of the 4560 participants, 745 (16.3%) discontinued assigned treatment within the first year of randomization, representing 54.8% of those who ever discontinued. Main reasons for discontinuing within the first year included toxicity (58.8%) and refusal (26.2%). Approximately 34.8%, 18.7%, 28.1% and 27.3% of women experienced a CMD in QOL within 6 months of randomization in the vasomotor, sexual, physical and psychosocial domains of the MENQOL, respectively. After adjusting for treatment assignment and age, women who experienced a CMD in any of the MENQOL domains within 6 months of randomization were more likely to discontinue early than those who did not (vasomotor domain RR=1.52 95% CI: 1.30-1.78, sexual domain RR=1.42 95% CI: 1.19-1.71, physical domain RR=1.70 95% CI: 1.45-1.98 and psychosocial domain RR=1.71 95% CI: 1.47-2.01). The first year of treatment is a critical time for persistence with therapy in a breast cancer chemoprevention trial. Declines in QOL are important predictors of early discontinuation in this context. Future work will assess the impact of lifestyle, medical and sociodemographic factors on early discontinuation of treatment within MAP.3. Co-Author(s): Olivia Meggetto, Queen’s University, Department of Public Health Sciences/ Elizabeth Maunsell, Centre de recherche du Centre hospitalier universitaire (CHU) de Québec/ Paul E. Goss, Massachusetts General Hospital Cancer Center/ Rowan T. Chlebowski, University of California at Los Angeles Medical Centre/ Dongsheng Tu, National Cancer Institute of Canada Clinical Trials Group/ Harriet Richardson, Queen’s University, Department of Public Health Sciences

24 Patterns of Sugar Sweetened Beverage Consumption in Children Grades 6 to 10 in Northern Rural Canada LAURA DAVIS Queen’s University (1) To describe sugar sweetened beverage (SSB) consumption among school-aged children in Nunavut specifically, northern Canada as a complete region (combining all Territories) and Canada (by age, sex, family affluence, family composition, other unhealthy behaviours and remoteness of community). This will improve the understanding of SSB consumption and its related factors in the north of Canada. (2) To determine the relationship between community remoteness and SSB consumption in Canada.

25 Maternal Deworming Research Study (MADRES): generating empirical evidence to support global health policy on deworming LAYLA S. MOFID Student, McGill University The aim of this study is to contribute new knowledge to the evidence base on deworming in women of reproductive age (WRA). The objective is to determine the effectiveness of maternal postpartum deworming on infant growth and morbidity, maternal soil-transmitted helminth (STH) infection and intensity, anemia, fatigue, and breastfeeding practices. A randomized, placebo-controlled trial on maternal postpartum deworming with single-dose albendazole (ClinicalTrials.gov: NCT01748929) is currently being conducted in Iquitos, Peru, a highly STH-endemic region. From February to August 2014, a total of 1,010 mother-infant pairs were recruited into the trial following delivery at Hospital Iquitos. Participants were visited in the hospital at baseline, and are currently being visited in their homes at 1, 6, 12 and 24 months following delivery for outcome ascertainment. The primary outcome is infant mean weight gain between birth and six months of age. Secondary outcomes are assessed at each follow-up timepoint. A randomized, placebo-controlled trial on maternal postpartum deworming with single-dose albendazole (ClinicalTrials.gov: NCT01748929) is currently being conducted in Iquitos, Peru, a highly STH-endemic region. From February to August 2014, a total of 1,010 mother-infant pairs were recruited into the trial following delivery at Hospital Iquitos. Participants were visited in the hospital at baseline, and are currently being visited in their homes at 1, 6, 12 and 24 months following delivery for outcome ascertainment. The primary outcome is infant mean weight gain between birth and six months of age. Secondary outcomes are assessed at each follow-up timepoint. At recruitment, the mean age of mothers was 25.4 years (range 13-44); 88.2% were married or co-habiting; 53.9% had less than a secondary school education; and 20.2% were employed. A quarter of the mothers were primagravida and 76.3% had had a vaginal birth. The mean gestational age of infants was 38.6 weeks; 12 (1.2%) were premature; and 65 (6.4%) were low birth weight. Only 14 (1.4%) women had taken a deworming drug during their current pregnancy, and 942 (75.7%) had taken iron supplementation in the last 9 months. This trial will be the first to demonstrate the effectiveness of deworming mothers in the postpartum period. The results will provide key empirical evidence on a global deworming strategy targeting women of reproductive age in 114 worm-endemic countries globally. The trial is expected to be completed in August 2016. Co-Author(s): Martin Casapia, Asociación Civil Selva Amazónica/ Theresa W. Gyorkos, McGill University

89 26 Trends & Associations of HIV-related admission and mortality proportions in Princess Marina Hospital, Gaborone from 2000-2006 MOOKETSI MOLEFI University of Botswana To analyse the HIV-related admission and mortality proportions at Princess Marina Hospital in the years 2000, 2003 and 2006, compare and establish the trends To investigate factors associated with the risk of HIV-related admission or death, and their trend over time. Patient records for the years 2000, 2003and 2006 were reviewed. Cases were identified by documented HIV status or evidence of clinical immunosuppression by having any of the conditions in listed in section B20-B24 of the International Classification of Diseases (ICD 10 B20-B24) .HIV-related admission, HIV-related mortality proportion and HIV- Case fatality Rate were calculated for each of the specified periods. Chi-square test for linear using ptrend in STATA was used. A Log binomial regression method was used to identify important risk factors for HIV- associated mortality and admission Patient records for the years 2000, 2003and 2006 were reviewed. Cases were identified by documented HIV status or evidence of clinical immunosuppression by having any of the conditions in listed in section B20-B24 of the International Classification of Diseases (ICD 10 B20-B24) .HIV-related admission, HIV-related mortality proportion and HIV- Case fatality Rate were calculated for each of the specified periods. Chi-square test for linear using ptrend in STATA was used. A Log binomial regression method was used to identify important risk factors for HIV-associated mortality and admission. A total of (N= 24 541) records were reviewed from 2000-2006. The HIV-admission proportions were 10.1% (988/9748), 11.2% (868/7745) and 12.3% (754/6148) of all admissions for 2000 , 2003 and 2006, respectively. The HIV mortality proportions were 38.1% (289/759), 0.474(309/652) and 37.1% (252/680) of all deaths for 2000, 2003 and 2006, respectively. The HIV-Case Fatality Rates were 29.2% (289/988), 35.6% (309/868) and 33.4% (252/754) for 2000,2003 and 2006, respectively. Chi-square test for linear trend in STATA was only statistically significant for HIV-related admissions (p<0.05).The log binomial regression model showed a relative risks of both HIV-related admission and death to be lower in females (aRR 0.54 CI 0.32,0.93) and (aRR 0.53 CI 0.34,0.86), but increased in the age-group 14-49 years (aRR 2.08 CI 1.07,4.04) and (aRR 1.21 CI 1.12,3.94), respectively. A linear trend in the proportion of HIV-related admission was evident but none regarding HIV-related deaths and the HIV-Case Fatality Rate. Female gender and age group 14-49 years emerged the two most important determinants for HIV-related admissions and deaths. Future research focusing on recent trends and determinants for HIV- related admissions and deaths are required. Co-Author(s): JoseGaby Tshikuka, University of Botswana/ Tuduetso Monagen, University of Botswana/ Mgaywa Magafu, University of Botswana/ Tiny Masupe, University of Botswana/ Mpho Mogodi, University of Botswana/ Paul Rheeder, University of Pretoria

27 Role of Omega-3 Fatty Acids in the Prevention and Treatment of Postpartum Depression FATIMA MOUGHARBEL Master student, University of Ottawa To assess the best available evidence to date on the effect of omega-3 polyunsaturated fatty acid (n-3 PUFA) on the aetiology, prevention and treatment of postnatal depression. A systematic review and narrative synthesis was conducted in order to address the gaps in knowledge. A broad search of electronic databases of published quantitative literature has been conducted. Quality appraisal was performed using the tools produced by the effective public health practice project (EPHPP). The narrative synthesis was informed by Popay et al (2006) who have produced a guideline on the conduct of narrative synthesis which consists of four elements. A systematic review and narrative synthesis was conducted in order to address the gaps in knowledge. A broad search of electronic databases of published quantitative literature has been conducted. Quality appraisal was performed using the tools produced by the effective public health practice project (EPHPP). The narrative synthesis was informed by Popay et al (2006) who have produced a guideline on the conduct of narrative synthesis which consists of four elements. Out of 181 potential articles, a total of 17 studies met the inclusion criteria. Seven of eight experimental studies and four of nine observational studies failed to support a role of omega-3 for the prevention or treatment of postpartum depression. The heterogeneity of results can be explained by dissimilar study designs, including differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental PUFAs. Overall, the majority of studies found no relationship between omega-3 intake and postpartum depression. However further investigation of omega-3 fatty acids is warranted to determine the role of omega-3 fatty acids in the prevention and treatment of postpartum depression.

28 Strong association of alcohol use and unprotected anal sex in potential discordant gay couples is partly confounded by unmeasured sensation seeking covariate SOODABEH NAVADEH University of California, San Francisco Alcohol use has been reported unbelievably strong predictor (OR=9.9) for potential discordant unprotected anal intercourse (PDUAI) in men who have sex with men (MSM). Using expert opinion, we want to quantify how likely this association could be confounded by sensation seeking (SS). Using an online survey, we seek for expert’s input of 28 epidemiologist and behavioral scientists to quantify the following bias parameters in the population of HIV positive and HIV negative MSM: 1. Proportion of high SS among MSM stratified by low risk/heavy drinkers and 2.Risk ratio of the association between SS and PDUAI. We used Bootstrap estimation to summarize the findings. Using an online survey, we seek for expert’s input of 28 epidemiologist and behavioral scientists to quantify the following bias parameters in the population of HIV positive and HIV negative MSM: 1. Proportion of high SS among MSM stratified by low risk/heavy drinkers and 2.Risk ratio of the association between SS and PDUAI. We used Bootstrap estimation to summarize the findings. Eleven experts answered the survey. Among HIV+ heavy drinkers, the proportion of high SS was 53.5% (SI95% 45.2-61.9%), which decreased to 41.1% (SI95% 31.6-50.4%) in HIV- heavy drinkers. In non-heavy HIV+ drinkers, the high SS proportion was considerably low as 26.9% (SI955 17.8-35.9%), almost equal to the HIV- negative non-heavy drinkers (25.3%, SI95% 17.2-33.5%). The Risk Ratio for the association between SS and PDUAI was estimated as 2.6 (SI95 2.1 – 3.2) in HIV+ and 2.1 (SI95% 1.5 - 2.5) in HIV- MSM. We found that for unmeasured covariates in a causal inference exercise, expert opinion can yield sufficient information to further assess or adjust for confounding effects. In our case study, alcohol use observed association with unsafe anal sex confounded by sensation seeking based, and the effect is modified by HIV status. Co-Author(s): Ali Mirzazadeh, University of California, San Francisco/ Sarah Woolf-King, University of California, San Francisco/ Willi McFarland, University of California, San Francisco/ Mohammad Ali Mansournia, Tehran University of Medical Sciences

29 What are the effects of high versus moderate exercise volume on insulin resistance indicators in postmenopausal women? HEATHER NEILSON Epidemiology Research Associate, Alberta Health Services Objectives: Insulin resistance is a proposed risk factor for postmenopausal breast cancer. In clinical trials exercise improves insulin sensitivity compared with no exercise. Using a randomized dose comparison trial with biomarker outcomes, we aimed to identify if a higher exercise volume provided additional improvements in insulin sensitivity. Methods: The Breast Cancer and Exercise Trial in Alberta (BETA) was a two-center, two-armed randomized (1:1) trial in 400 inactive, non-diabetic, postmenopausal women, aged 50-74 years, body mass index 22-40 kg/m2. Participants were randomly assigned to a HIGH (300 minutes/week) or MODERATE (150 minutes/week) volume of aerobic exercise, achieving 65%-75% heart rate reserve five times per week while maintaining usual diet. Fasting blood concentrations of insulin and glucose, leptin, adiponectin and resistin were measured at baseline, six, and 12-months. Intention-to-treat analyses were based on linear mixed models adjusted for baseline biomarker concentrations. Methods: The Breast Cancer and Exercise Trial in Alberta (BETA) was a two-center, two-armed randomized (1:1) trial in 400 inactive, non-diabetic, postmenopausal women, aged 50-74 years, body mass index 22-40 kg/m2. Participants were randomly assigned to a HIGH (300 minutes/week) or MODERATE (150 minutes/week) volume of aerobic exercise, achieving 65%-75% heart rate reserve five times per week while maintaining usual diet. Fasting blood concentrations of insulin and glucose, leptin, adiponectin and resistin were measured at baseline, six, and 12-months. Intention-to-treat analyses were based on linear mixed models adjusted for baseline biomarker concentrations. Preliminary Results: Biomarker data were available at baseline, six and 12-months for n=386, n=384, and n=384, respectively. Average biomarker changes [12-months-baseline] for HIGH and MODERATE groups were: -11% and -10% for insulin, -25% and -21% for leptin, -3% and +3% for resistin and +2% and +1% for adiponectin. In intention-to-treat analyses, no significant group differences were found for changes in insulin, leptin, adiponectin, or resistin [treatment effect ratios (95% CI): 0.96 (0.90-1.03), 0.92 (0.83-1.02), 1.04 (0.95-1.13), 0.99 (0.95, 1.04), respectively, representing the HIGH:MODERATE ratio of geometric means for biomarker levels over 12 months. In analyses based on self-selected adherence (average minutes/week), favorable trends were found between biomarker changes (12-month versus baseline) and adherence quintiles for insulin (P-trend=0.0006), leptin (P-trend<0.0001) and resistin (P-trend=0.002). Next Steps: Preliminary results suggest little advantage, with respect to insulin resistance indicators, in prescribing 300 versus 150 minutes/week of moderate-vigorous aerobic exercise to inactive postmenopausal women. Further analyses are warranted to explain these findings, including a per-protocol analysis and tests for interaction by baseline biomarker levels and baseline adiposity. Co-Author(s): Heather K Neilson, Alberta Health Services/ Christine M Friedenreich, Alberta Health Services/ Qinggang Wang, Alberta Health Services/ Frank Z Stanczyk, University of Southern California/ Yutaka Yasui, University of Alberta/ Darren R Brenner, Alberta Health Services/ Scott C Adams, University of Alberta/ Andria R Morielli, University of Alberta/ Kerry S Courneya, University of Alberta

90 30 Physical activity and risk of breast cancer: protocol for a systematic review and meta-analysis HEATHER NEILSON Epidemiology Research Associate, Alberta Health Services Objectives: The biologic mechanisms relating physical activity to breast cancer risk may differ for premenopausal and postmenopausal women. Yet two recently published meta-analyses estimated the association between physical activity and pre- and postmenopausal breast cancers combined. This project aims to estimate the magnitude of risk reduction that is possible with moderate-vigorous recreational activity (discretionary behavior aligned with cancer prevention guidelines), separately for premenopausal and postmenopausal women, to inform policy makers, healthcare providers, and the public. Co-Author(s): Heather K Neilson, Alberta Health Services/ Darren R Brenner, Alberta Health Services/ Marcus M Vaska, Knowledge Resource Centre/ Christine M Friedenreich, Alberta Health Services

31 The Methodological Challenges of Identifying Multimorbidity in a Pan-Canadian Electronic Medical Record Database KATHRYN NICHOLSON PhD Candidate, Western University The objectives of this work are to highlight the methodological challenges of identifying patients with multimorbidity (two or more chronic diseases) in an electronic medical record database. This work will present approaches to overcome these challenges, as well as the first prevalence estimates of multimorbidity among adult patients in Canada. These electronic medical record data will be derived from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which was initially created in 2008. To date, more than 450,000 anonymized patient-level records have been collected. This research will assess the burden of multimorbidity among patients who are at least 18 years of age as of their first encounter date, producing a final sample size of 389,267 adult primary care patients. Descriptive analyses will be conducted to determine the prevalence estimates of multimorbidity among this sample of patients. These electronic medical record data will be derived from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which was initially created in 2008. To date, more than 450,000 anonymized patient-level records have been collected. This research will assess the burden of multimorbidity among patients who are at least 18 years of age as of their first encounter date, producing a final sample size of 389,267 adult primary care patients. Descriptive analyses will be conducted to determine the prevalence estimates of multimorbidity among this sample of patients. The key methodological challenges of identifying patients with multimorbidity in electronic medical records include: 1) creating a relevant “list” of chronic disease diagnoses; 2) establishing where the diagnostic information will be derived from; and 3) overcoming the variability in electronic medical record coding among the providers and sites that contribute clinical data. Proposed approaches to overcome these important challenges are presented, to create a cohesive approach to identifying patients with multimorbidity within the CPCSSN database. After applying these approaches, approximately 50% of adult primary care patients had two or more chronic diseases and 35% of adult patients had three or more chronic diseases. This research represents the first national prevalence estimates of multimorbidity in Canada, using a robust electronic medical record database. This work also highlights the methodological challenges, and proposed approaches, associated with identifying these complex patients. Future research should strive to enhance the epidemiological understanding of multimorbidity, within the Canadian context. Co-Author(s): Kathryn Nicholson, Western University/ Amanda Terry, Western University/ Martin Fortin, Universite de Sherbrooke/ Tyler Williamson, University of Calgary/ Amardeep Thind, Western University

32 Investigating in rural Indian women the acute effects of personal exposures to household air pollution on blood pressure CHRISTINA NORRIS MSc Candidate, McGill University We conducted a panel study in winter and summer among rural Indian women who cook with biomass fuels in traditional stoves. The objective was to determine whether personal exposures to black carbon, a marker of biomass smoke, were associated with minute-by-minute changes in blood pressure during a cooking session. We enrolled 45 women (ages 25-66 years) and simultaneously measured their personal real-time exposure to black carbon and ambulatory blood pressure at 10-minute intervals during a cooking session (durations <245 minutes). We recorded ambient temperature, participants’ activities during cooking, and assessed women’s body mass index, socioeconomic status, previous diagnosis of hypertension, and concurrent use of medication. We evaluated the association between concentrations of black carbon (e.g., integrated over time preceding the blood pressure measurement, lagged values from 1-20 min) and acute changes in blood pressure using multivariate linear mixed effects regression models with random intercepts to account for repeated measurements. We enrolled 45 women (ages 25-66 years) and simultaneously measured their personal real-time exposure to black carbon and ambulatory blood pressure at 10-minute intervals during a cooking session (durations <245 minutes). We recorded ambient temperature, participants’ activities during cooking, and assessed women’s body mass index, socioeconomic status, previous diagnosis of hypertension, and concurrent use of medication. We evaluated the association between concentrations of black carbon (e.g., integrated over time preceding the blood pressure measurement, lagged values from 1-20 min) and acute changes in blood pressure using multivariate linear mixed effects regression models with random intercepts to account for repeated measurements. Women’s average geometric mean black carbon exposure was lower in winter (43 μg/m3; SD: 9) than in summer (62 μg/m3; SD: 8). None of the indices of exposures to black carbon were associated with acute changes in systolic or diastolic blood pressure, after adjusting for age, ambient temperature, body mass index, activities during cooking, and time of day. The adjusted 1-unit increase in black carbon on a ln-scale integrated over the time prior to the blood pressure measurement was associated with a 0.23 mm Hg decrease in systolic blood pressure (95% CI: -1.25, 0.78) and a 0.25 mm Hg decrease in diastolic blood pressure (95% CI: -1.14, 0.64). We found associations of similar magnitudes and ranges of uncertainty when using other indices of black carbon. We did not find an association between personal exposures to black carbon and acute changes in blood pressure among Indian women cooking with biomass fuels. Future studies could be developed over a longer time frame (i.e., hours-days) to better understand the potential mechanisms linking household air pollution and blood pressure. Co-Author(s): Mark Goldberg, McGill University/ Jill Baumgartner, McGill University/ Julian Marshall, University of Minnesota/ Marie-France Valois, McGill University/ T Pradeep, SAMUHA/ Narayanswamy M, SAMUHA/ Grishma Jain, Independent (previously Resource Optimization Initiative)/ Karthik Sethuraman, Independent (previously Resource Optimization Initiative)

33 Health Care Satisfaction in Patients following Premature ACS: Determinants and Association with Adverse Outcomes MARISA OKANO M.Sc. Public Health Candidate, McGill University Patient satisfaction is an important indicator of health outcomes and may be differentially experienced among young (<55) individuals suffering from heart disease. The current study explored patient demographics and examined the relationship between patient satisfaction and health care service utilization and health outcomes, following premature acute coronary syndrome (ACS). We used data from 1213 patients (≤ 55 years) hospitalized for ACS and enrolled into the prospective multicenter cohort study, GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome). Participants were recruited between January 2009-April 2013, from 26 centres across Canada, the United States and Switzerland. Patient satisfaction with healthcare services received over the 12 months following the index ACS was measured via multiple facets including involvement in treatment planning and engagement in health discussion. Healthcare satisfaction, healthcare services utilization and clinical outcomes data were collected through self-reported questionnaires and medical chart review. We used data from 1213 patients (≤ 55 years) hospitalized for ACS and enrolled into the prospective multicenter cohort study, GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome). Participants were recruited between January 2009-April 2013, from 26 centres across Canada, the United States and Switzerland. Patient satisfaction with healthcare services received over the 12 months following the index ACS was measured via multiple facets including involvement in treatment planning and engagement in health discussion. Healthcare satisfaction, healthcare services utilization and clinical outcomes data were collected through self-reported questionnaires and medical chart review. The median age of our cohort was 48 years and 30% of participants were female. Patients with lower healthcare satisfaction over 12 months post initial cardiac event were more likely to be female (p=0.112), depressed (p< .01), anxious (p< .01), and to have diabetes (p< .05) and hypertension (p=.06 ) at baseline. Results of multivariable Cox regressions indicated that, after adjusting for sex, age, education, GRACE score and STEMI, patients with higher healthcare satisfaction were 53% less likely to be rehospitalised for cardiac causes than patients with low satisfaction (95% CI:0.25, 0.88). Consistent with this finding, a trend for decreased patient rehospitalisation for all causes was also observed (HR= 0.65, 95% CI:0.38, 1.12). Patient satisfaction was not associated with healthcare services utilization. Distinct differences in patient profiles was observed among those who report higher and lower satisfaction with their healthcare experience. Quantification of factors that lead to differential satisfaction among patients is important as it may reduce rehospitalisation rates and inform physician’s practices. Co-Author(s): Roxanne Pelletier, Research Institute of the McGill University Health Center/ Natalie Dayan, McGill University Health Centre/ Louise Pilote, Research Institute of the McGill University Health Center/ for the GENESIS-PRAXY Investigators

91 35 Genetic Polymorphisms and Hair, Blood and Urine Mercury Levels: A Gene Environment Study of Mercury in the American Dental Association (ADA) Study RAJENDRA PARAJULI Environmental Health Sciences Lab, McGill University, Department of Natural Resource Science Mercury (Hg) is a potent toxicant of concern to the general public. Recent studies suggest that several genes that mediate mercury metabolism are polymorphic. We hypothesize that single nucleotide polymorphisms (SNPs) in such genes may underline inter-individual differences in exposure biomarkers. Dental professionals (n =908) were recruited during the American Dental Association (ADA) 2012 Annual Meeting. Samples of hair, blood, and urine were collected for inorganic/organic mercury levels and genotyping (119 SNPs). Questionnaires were administrated for demographics and fish consumption. ANOVA and linear regressions were used for statistical analysis. Dental professionals (n =908) were recruited during the American Dental Association (ADA) 2012 Annual Meeting. Samples of hair, blood, and urine were collected for inorganic/organic mercury levels and genotyping (119 SNPs). Questionnaires were administrated for demographics and fish consumption. ANOVA and linear regressions were used for statistical analysis. Mean (geometric) mercury levels in hair (hHg), blood (bHg), urine (uHg) and the average mercury intake from fish were 0.62µg/g, 3.75µg/L, 1.32µg/L, and 0.12µg/kg/d, respectively. Out of 119 SNPs genotyped, 89 SNPs were eligible for further analysis after screening. Hg biomarker levels differed by genotype for 14 SNPs. Five SNPs, mostly in transporter genes, showed specific group differences for hHg and bHg ratio. When the associations between Hg contributors (base model) and biomarkers were analyzed with respect to SNPs, many main and gene-environment interactions were significant. Out of 89 SNPs evaluated, 21, 24, and 5 SNPs showed significant main effects for hHg, bHg and uHg level, respectively. Similarly, 20, 10, and 4 gene-environment interactions showed significant interaction effects for hHg, bHg and uHg level, respectively. The findings suggest that polymorphisms in environmentally-responsive genes can influence Hg biomarker levels. Hence, consideration of such gene-environment factors may improve our ability to assess the health risks of Hg more precisely. Co-Author(s): Rajendra Parajuli, Environmental Health Sciences Lab, McGill University, Department of Natural Resource Science/ Dr. Jaclyn Goodrich, Departments of Environmental Health Sciences, University of Michigan School of Public Health/ Al Franzblau, Departments of Environmental Health Sciences, University of Michigan School of Public Health/ Prof. Niladri Basu, Environmental Health Sciences Lab, McGill University, Department of Natural Resource Science

36 Is finger length a predictor of prostate cancer risk? MARIE-ELISE PARENT Research Associate, INRS Institut Armand-Frappier The ratio of the lengths of the second to the fourth finger (2D:4D) has been linked to intrauterine testosterone levels and may relate to prostate cancer (PCa) development. We assessed the association between 2D:4D and PCa risk in a population-based case-control study in Montréal, Canada. Subjects included 1,937 incident PCa cases aged ≤ 75 years, histologically-confirmed, diagnosed across French hospitals in 2005-2009. Concurrently, 1,995 population controls from Montreal were randomly selected from the French electoral list and frequency-matched to cases by age (±5 years). In-person interviews elicited information on socio-demographic, lifestyle and environmental factors. The lengths of the 2nd (index) and 4th finger (ring) of subjects’ right hand were measured. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the association between 2D:4D and PCa risk, adjusting for age, ancestry, and a first-degree family history of PCa. Subjects included 1,937 incident PCa cases aged ≤ 75 years, histologically-confirmed, diagnosed across French hospitals in 2005-2009. Concurrently, 1,995 population controls from Montreal were randomly selected from the French electoral list and frequency-matched to cases by age (±5 years). In-person interviews elicited information on socio-demographic, lifestyle and environmental factors. The lengths of the 2nd (index) and 4th finger (ring) of subjects’ right hand were measured. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the association between 2D:4D and PCa risk, adjusting for age, ancestry, and a first-degree family history of PCa. The OR for each increment of 2D:4D, defined by one standard deviation, was 0.917 (95% CI: 0.857-0.981). Corresponding ORs were 0.931 (95% CI: 0.866-1.002) and 0.882 (95% CI: 0.796-0.976) for men diagnosed with less and more aggressive cancers, respectively. ORs stratified by age at diagnosis/interview (˂ 60, ≥ 60 years) did not differ. In analyses restricted to men of African descent, the OR for each increment of 2D:4D was 1.284 (95% CI: 0.989-1.665). Our findings suggest an inverse association between 2D:4D and PCa risk, particularly pronounced for aggressive cancers. Contrastingly, there was evidence of a positive association among men of African descent. Co-Author(s): Marie-Elise Parent, INRS-Institut Armand-Frappier/ Marie-Claude Rousseau, INRS-Institut Armand-Frappier/ Hugues Richard, INRS-Institut Armand- Frappier/ Pierre Karakiewicz, Université de Montréal

37 The association between occupational exposure to metals and metalloids and brain cancer risk ROMAIN PASQUET PhD student in public health, concentration in epidemiology, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada. Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada Metals and metalloids are potential carcinogens to which millions of workers worldwide are exposed daily. They may accumulate in the brain and thus contribute to brain cancer development. Exposure to electromagnetic fields (EMF) may further increase their accumulation in the brain. The objectives of this PhD project are 1) to examine the association between metals and metalloids and brain cancer risk, and 2) to examine if these associations are modified by exposure to EMF. Co-Author(s): Elisabeth Cardis, Centre for Research in Environmental Epidemiology (CREAL) Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain./ Lesley Richardson, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada./ Jérôme Lavoué, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada./ Jack Siemiatycki, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada. Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada./ Anita Koushik, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada. Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada

38 Consumer product and assistive device use related fall injuries among seniors in Canada: Preliminary analysis of data from the Canadian Longitudinal Study on Ageing PARTH PATEL Epidemiology Student, University of Toronto While assistive devices are vital to the prevention of falls in seniors, some studies have suggested that they may also contribute to an increased risk of fall. The purpose of this research is to document the prevalence of falls related to consumer products and assistive device use among senior adults in Canada and identify potential risk factors for falls associated with falls using assistive devices. Nationally representative weighted data from the Tracking Component of the Canadian Longitudinal Study on Ageing (CLSA) were analyzed to obtain information on the prevalence of fall-related injuries and consumer product use. Logistic regression models will be constructed to determine the role of consumer product and assistive device use on fall related injuries by sex, socio-demographic characteristics, biological, behavioural, frailty, and social factors. Nationally representative weighted data from the Tracking Component of the Canadian Longitudinal Study on Ageing (CLSA) were analyzed to obtain information on the prevalence of fall-related injuries and consumer product use. Logistic regression models will be constructed to determine the role of consumer product and assistive device use on fall related injuries by sex, socio-demographic characteristics, biological, behavioural, frailty, and social factors. Among seniors aged 65 years or older, 5.1% experienced fall-related injuries within the last 12 months, with a higher proportion of females compared to males (5.9% vs. 4.2%) experiencing a fall. Among those who fell, 65.0% received medical attention for the injury, 17.2% were hospitalized, and 17.3% received follow-up care from a health professional due to the injury. Majority of the falls (53.6%) occurred outdoors, 26.9% occurred inside the home, and 19.4% of the falls occurred outside home but inside a building. Most of the falls (51.4%) occurred while standing or walking. About 9.0% of the fallers reported using an assistive device at the time of the fall and among them, 12.3% reported that their assistive device contributed to the fall. This study provides an insight into the relationship between consumer products and assistive device use with fall-related injuries. Next steps involve the construction of logistic regression models to conduct a detailed analysis on the factors that affect this association. Co-Author(s): Parth Patel, University of Toronto/ Wendy Thompson, Public Health Agency of Canada/ Deepa Rao, Public Health Agency of Canada/ Lauren Griffith, McMaster University/ Parminder Raina, McMaster University/ Minh Do, Public Health Agency of Canada

92 39 Sex, multiple painful joints and systemic inflammation in osteoarthritis ANTHONY PERRUCCIO Assoc. Scientist, University Health Network; University of Toronto Among those with osteoarthritis (OA), women experience more pain than men. Pain is associated with inflammation. We investigated whether the association between inflammation (as measured by C-reactive protein (CRP)) and overall painful joint count was modified by sex in a hip/knee OA sample. Serum CRP and COMP (an indicator of OA severity) concentrations were determined (ELISA) in 115 women and 88 men with late-stage hip/knee OA. A painful joint count was obtained from a homunculus showing joints that were painful on most days for a month. Age, sex, body mass index (BMI) and comorbidities were recorded. The association between joint count and CRP, adjusting for age, sex, BMI, comorbidity and COMP, was investigated using negative-binomial regression, with risk as a count ratio (CR). A sex*CRP interaction was tested. In sensitivity analysis, individuals with metabolic syndrome-associated comorbidities (e.g. heart disease, diabetes) were excluded. Serum CRP and COMP (an indicator of OA severity) concentrations were determined (ELISA) in 115 women and 88 men with late-stage hip/knee OA. A painful joint count was obtained from a homunculus showing joints that were painful on most days for a month. Age, sex, body mass index (BMI) and comorbidities were recorded. The association between joint count and CRP, adjusting for age, sex, BMI, comorbidity and COMP, was investigated using negative-binomial regression, with risk as a count ratio (CR). A sex*CRP interaction was tested. In sensitivity analysis, individuals with metabolic syndrome-associated comorbidities (e.g. heart disease, diabetes) were excluded. Mean age: 64 years for men, 66 for women (>96% were ≥50 (i.e. post-menopausal)). Women had higher mean painful joint count (4.6 vs. 2.5, p<0.001; 4+ joints reported by 42% of women, 28% of men). More women were obese: 56% compared to 36% of men. Median CRP concentration was higher in women than men, 18.7 vs. 9.3 µg/ml (p<0.01). From adjusted analyses, the effect of CRP was modified by sex. The effect of increasing concentration of CRP on greater painful joint count was greater among women (CR for interaction term: 1.3; 95% CI (1.1, 1.6); main effect: CR=0.9; 95% CI (0.8, 1.1)). Results from the sensitivity analysis were similar (CR for interaction: 1.5; 95% CI (1.1, 1.9)). There appears to be a sex-dependent dose-response association between number of painful joints and systemic inflammation in OA. As systemic inflammation is a risk factor for metabolic syndrome-associated conditions, women with a higher number of painful joints may be a subgroup in OA at greater risk of these conditions. Co-Author(s): Anthony Perruccio, Toronto Western Research Institute, University Health Network; Dalla Lana School of Public Health, Univeristy of Toronto/ Elizabeth Badley, Toronto Western Research Institute, University Health Network; Dalla Lana School of Public Health, Univeristy of Toronto/ J Denise Power, Dalla Lana School of Public Health, Univeristy of Toronto/ Nizar Mahomed, Toronto Western Hospital, University Health Network; Dept. of Surgery, Faculty of Medicine, Univeristy of Toronto/ Rajiv Gandhi, Toronto Western Hospital, University Health Network; Dept. of Surgery, Faculty of Medicine, Univeristy of Toronto

40 Maternal exposure to air pollution and adverse birth outcomes in Halifax, Nova Scotia ABBEY POIRIER Research Associate, Alberta Health Services This study aimed to examine the associations between exposure to land-use regression (LUR)-modeled air pollution in a setting of relatively low ambient air pollution and the outcomes of pre-term birth (PTB), term low birth weight (TLBW) and small for gestational age (SGA). This population-based retrospective cohort study examined the relationship between maternal exposure to sulfur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM) of various fractions, benzene and toluene during pregnancy and PTB, TLBW and SGA. The Nova Scotia Atlee Perinatal Database was used to obtain information on birth outcomes and potential covariates. Spatial estimates of air pollution were determined from LUR models. Based on maternal postal code, individual-level maternal exposure estimate for each of the air pollutants measured using the LUR models were established. Multiple logistic regressions were conducted for each individual pollutant and outcome to assess the associations. This population- based retrospective cohort study examined the relationship between maternal exposure to sulfur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM) of various fractions, benzene and toluene during pregnancy and PTB, TLBW and SGA. The Nova Scotia Atlee Perinatal Database was used to obtain information on birth outcomes and potential covariates. Spatial estimates of air pollution were determined from LUR models. Based on maternal postal code, individual-level maternal exposure estimate for each of the air pollutants measured using the LUR models were established. Multiple logistic regressions were conducted for each individual pollutant and outcome to assess the associations. Smoking during pregnancy, low neighbourhood income, nulliparity and low pre-pregnancy weight were associated with a greater risk of all adverse birth outcomes of interest. After adjustment for maternal age, parity, smoking and neighbourhood income, no significant associations were observed between pollutant exposure and TLBW or SGA. Compared to women in the lowest quartile of toluene exposure, those in the second lowest showed a positive association with PTB (OR=1.35, 95% CI: 1.12, 1.63). Based on a piecewise logistic regression break-point analysis, a cut point of 0.36 µg/m3 (95% CI: 0.33, 0.40) was determined for toluene and the risk of PTB. Compared to mothers with exposures below the cut-point, those with exposure above the cut-point were at a higher risk of PTB (OR=1.19, 95% CI: 1.01, 1.39). This population-based cohort study suggests that in an area of relatively low air pollution concentration, maternal exposure to some air pollutants is associated with adverse birth outcomes. Using a novel statistical method, we determined an exposure cut-point for toluene where the risk of PTB no longer continued to increase. Co-Author(s): Abbey Poirier, Alberta Health Services/ Linda Dodds, Dalhousie University/ Trevor Dummer, University of British Columbia/ Daniel Rainham, Dalhousie University/ Markey Johnson, Health Canada

41 Screening for Nipah Virus Infections in Pigs of Kathmandu Valley and Chitwan District of Nepal MEERA PRAJAPATI Veterinary Scientist S1, Animal Health Research Division, Nepal Agricultural Research Council Nipah Virus (NiV) infection is an emerging infectious disease of public health importance in South East Asia affecting pigs and people. In Nepal, the status of NiV infection is unknown. Hence, this study aims to screen for Nipah virus antibody in sera of pigs. A descriptive cross sectional study was carried out in pigs of Kathmandu valley and Chitwan district where bats of the genus Pteropus sps (fruit bats) are also present. Blood samples of pigs from ear vein were collected and serum was separated and stored in deep freeze at -80C. These sera samples were dispatched to Animal and Plant Health Agency (APHA), UK and tested using Luminex binding multiplexed assay. A descriptive cross sectional study was carried out in pigs of Kathmandu valley and Chitwan district where bats of the genus Pteropus sps (fruit bats) are also present. Blood samples of pigs from ear vein were collected and serum was separated and stored in deep freeze at -80C. These sera samples were dispatched to Animal and Plant Health Agency (APHA), UK and tested using Luminex binding multiplexed assay. Out of 120 pig sera, 3 sera samples were found possible seropositive to Hendra virus and Nipah virus by Luminex binding assay. Those three samples did show levels of binding >500MFI and can be regarded as suspect positives. Though the results from duplicates are not identical, this is commonly seen with pig sera probably exhibiting a lot of nonspecific binding from other proteins or immunoglobulins in the sera. It was tried to reduce by using a higher dilution factor but there could still be nonspecific binding present, rather than a true “positive”. Therefore, confirmatory analysis should be carried out using a virus neutralization test. This study is a preliminary study against NiV infections in pigs of Nepal using Luminex binding multiplexed assay. The reservoir hosts of Henipaviruses, bats (Pteropus spp) are also present in Nepal. Hence further study on bats and pigs is very important for early detection, prevention and control. Co-Author(s): Andrew Breed, Animal Health and Veterinary Laboratories Agency (AHVLA), UK/ Doj Raj Khanal, Animal Health Research Division, Nepal Agricultural Research Council, Nepal/ Swoyam Prakash Shrestha, Animal Health Research Division, Nepal Agricultural Research Council, Nepal/ Madhav Prasad Acharya, Animal Health Research Division, Nepal Agricultural Research Council, Nepal/ Prazila Shrestha, Animal Health Research Division, Nepal Agricultural Research Council, Nepal/ Narayan Poudyal, Animal Health Research Division, Nepal Agricultural Research Council, Nepal/ Raju Prajapati, The Britain Nepal Medical Trust (BNMT), Nepal/ Richard Bowen, College of Veterinary Medicine and Biomedical Science, Colorado State University, USA/ E Wise, Animal and Plant Health Agency/ A Fooks, Animal and Plant Health Agency

42 Ethnicity and Pain: An Exploration of the Expression of Pain among Four Ethnic Minority Groups in Canada PRINON RAHMAN Student, Dalhousie Univeristy I propose to examine expression of pain and discomfort between the four largest ethnic minority groups in Canada using the Canadian Community Health Survey (CCHS) data collected from the years 2005 to 2012. The first objective of this study is to investigate if there is a difference in the prevalence of pain reporting among the four minorities groups of interest. The second objective is to explore the association between bio-psychosocial factors from a theoretical framework and expression of pain between the four ethnic groups, with and without chronic pain conditions. Co-Author(s): Swarna Weerasinghe, Dalhousie University/ Jill Hayden, Dalhousie University

93 43 Correlates of human papillomavirus vaccine uptake among adolescent males in the United States: National Immunization Survey-Teen, 2013 MAHBUBUR RAHMAN Associate Professor, University of Texas Medical Branch To examine the correlates of human papillomavirus (HPV) vaccine initiation and completion among a national sample of adolescent males two years after the routine recommendation that they receive the 3-dose HPV vaccine series. Provider-verified HPV vaccination information (N=9,554) among 13-17 year old males from the National Immunization Survey-Teen (NIS-Teen) 2013 study were analyzed. Weighted multivariable logistic regression analyses were performed to examine the correlates of HPV vaccine initiation (receipt of ≥1 dose) and completion (receipt of ≥3 doses). Provider-verified HPV vaccination information (N=9,554) among 13-17 year old males from the National Immunization Survey-Teen (NIS-Teen) 2013 study were analyzed. Weighted multivariable logistic regression analyses were performed to examine the correlates of HPV vaccine initiation (receipt of ≥1 dose) and completion (receipt of ≥3 doses). Overall, weighted HPV vaccine initiation and completion rates were 34.6% and 13.9% among 13-17 year old US males. Weighted multivariable analyses observed that black (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.49-2.64; OR 1.52, 95% CI 1.06-2.17) and Hispanic males (OR 2.42, 95% CI 1.83-3.20; OR 1.95, 95% CI 1.38-2.76), older age (OR 1.07, 95% CI 1.01-1.15; OR 1.10, 95% CI 1.01-1.20) and physician recommendation (8.71, 95% CI 7.20-10.55; OR 6.23, 95% CI 4.73-8.20) were associated with higher HPV vaccine initiation and completion. Further, adolescent males with household income below the poverty level, whose mother were not married, and who were residing in the Northeast and visited a health care provider in the past 12 months were more likely to initiate the vaccine. Provider recommendation was the strongest predictor for both HPV vaccine initiation and completion. Intervention programs targeted at physicians which focus on increasing their recommendations for the HPV vaccine may improve overall HPV vaccine uptake among US adolescent males. Racial disparities should be addressed as well. Co-Author(s): Mahbubur Rahman, University of Texas Medical Branch at Galveston, Texas, USA/ Tabassum Laz, University of Texas Medical Branch at Galveston, Texas, USA/ Abbey Berenson, University of Texas Medical Branch at Galveston, Texas, USA

44 Alcohol as a risk factor for blood pressure in South Africa ABBY RAMZI University of Ottawa This study is firstly inquiring about alcohol consumption within South Africa as being a risk factor for blood pressure. Furthermore, we aim to tease apart any demographic factors within the population of individuals who consume alcohol that might be influencing the aforementioned correlation. Using secondary data, provided by the South African Demographic and Health Surveys (SADHS), this study will mainly ascertain the severity of the impact of alcohol on high blood pressure. The population of interest will be that of individuals aged 18 to 49 years old residing in the Western Cape region in South Africa at the time of data collection in the year 2003. Sample size of the study population was 1914. IBM SPSS 20 will be used to run statistical analyses for the association between levels of alcohol consumption and levels of blood pressure. Using secondary data, provided by the South African Demographic and Health Surveys (SADHS), this study will mainly ascertain the severity of the impact of alcohol on high blood pressure. The population of interest will be that of individuals aged 18 to 49 years old residing in the Western Cape region in South Africa at the time of data collection in the year 2003. Sample size of the study population was 1914. IBM SPSS 20 will be used to run statistical analyses for the association between levels of alcohol consumption and levels of blood pressure. We expect to find a significant association between high blood pressure and high levels of alcohol consumption. This finding is expected to be magnified when dividing the population by gender as well as age. Men are expected to show a stronger association between levels of alcohol consumption and elevated blood pressure, furthermore, this trend is expected to be more prominent in older adults. We also predict to find a significant effect between education and income on blood pressure, partially mediated by BMI, heart rate, exercise frequency, alcohol use and smoking. We also predict that BMI is affected by alcohol use, smoking and exercise, and that resting heart rate is influenced by smoking and exercise frequency. Additional research will improve the current understanding of the epidemiology of alcohol consumption in relation to high blood pressure. Future studies would also help the development of successful and targeted community-based prevention programs that would disseminate knowledge to the population and reduce the numbers of cardiovascular disease in the country. Co-Author(s): Sanni Yaya, University of Ottawa

45 The Evolving Risk Factor Profile of New-Onset Diabetes Mellitus After Renal Transplantation LAURA RIVERA Epidemiologist, Public Health Ontario Incidence of new-onset diabetes after transplant (NODAT) in kidney transplant recipients is high immediately post-transplant, declining over time until approaching the rate of diabetes in the general population. This suggests differences in diabetogenesis mechanism. Understanding risk factors for early- and late-onset NODAT may inform strategies for prevention and early treatment. The study population is composed of individuals over the age of 18 who received a first kidney transplant between 1 Jan 2000 and 31 Dec 2012 at Toronto General Hospital and was free of diabetes mellitus at the time of transplant. Patients were considered to have early-onset NODAT if they developed diabetes between day 14 and day 90 post-transplant inclusive, and late-onset NODAT if they developed diabetes after 90 days. A multivariate Cox proportional hazards model was used to identify risk factors for early- and late-onset NODAT. The study population is composed of individuals over the age of 18 who received a first kidney transplant between 1 Jan 2000 and 31 Dec 2012 at Toronto General Hospital and was free of diabetes mellitus at the time of transplant. Patients were considered to have early-onset NODAT if they developed diabetes between day 14 and day 90 post-transplant inclusive, and late-onset NODAT if they developed diabetes after 90 days. A multivariate Cox proportional hazards model was used to identify risk factors for early- and late-onset NODAT. The study cohort was composed of 933 kidney transplant recipients, with a median follow-up of 3.46 years. Overall, 272 patients in the cohort developed early-onset diabetes, and 155 developed late-onset NODAT. Risk factors for early-onset NODAT were recipient age (HR 1.04, 95% CI 1.03-1.06) and BMI (HR 1.05, 95% CI 1.03-1.08), while transplant era 2009-2011 vs. 2000-2004 was protective (HR 0.39, 95% CI 0.22-0.67). Risk factors for late-onset NODAT were recipient age (HR 1.04, 95% CI 1.03-1.06), BMI (HR 1.08, 95% CI 1.04-1.12), time on dialysis pre-transplant (HR 1.07, 95% CI 1.03-1.11), recipient panel reactive antibody > 0% vs. = 0% (HR 1.76, 95% CI 1.13-2.61), and acute rejection (HR 2.15, 95% CI 1.33-3.48). The differential risk factor profiles for early- and late-onset NODAT suggest that they are likely the product of both shared and distinct mechanisms. Based on these results, the targets for diabetes risk reduction in kidney transplant recipients may partially depend on the timing of NODAT occurrence. Co-Author(s): Laura Rivera, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada/ Roman Zyla, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada/ Yanhong Li, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada/ Segun Famure, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada/ Joseph Kim, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

46 Pet ownership and asthma occurrence among Quebec children MARIE-CLAUDE ROUSEAU Professor, INRS-Institut Armand-Frappier Epidemiological studies on the association between early life exposure to pets and asthma development generated inconsistent findings. Few studies have addressed pet ownership and asthma risk in Canada. We determined whether exposure to dogs and cats was associated with asthma occurrence in the Quebec Birth Cohort on Immunity and Health. This cohort, originally designed to study bacillus Calmette-Guerin (BCG) vaccination in relation to asthma, comprises information from administrative databases and telephone interviews conducted with a subset of subjects (n=1643) using a two-stage sampling strategy (balanced design according to BCG vaccination and asthma status). Subjects were considered asthmatic if they had ≥2 physician claims or ≥1 hospitalization for asthma. They reported on pet ownership during two exposure time windows: infancy (

94 47 Evaluation of a Health Communications Initiative in Rwanda NODINE SANGWA Student, University of Ottawa A capacity building workshop was given in Rwanda in August of 2014 to teach health professionals how to write for academic journals. In this study, we assess whether the workshop was perceived to have met the skills-building expectations of the participants. A pre-session evaluation form was handed out at the start of the workshop and a post-session evaluation form was given to participants to fill out at the end of the workshop. Both forms contained qualitative and quantitative questions assessing participants’ research confidence levels. Paired t-tests were used to determine whether there was a significant change, either positively or negatively, in participants’ confidence in performing academic writing and statistics tasks. Theme analysis was applied to the qualitative data to determine an overall sense of participants’ reactions. A pre-session evaluation form was handed out at the start of the workshop and a post-session evaluation form was given to participants to fill out at the end of the workshop. Both forms contained qualitative and quantitative questions assessing participants’ research confidence levels. Paired t-tests were used to determine whether there was a significant change, either positively or negatively, in participants’ confidence in performing academic writing and statistics tasks. Theme analysis was applied to the qualitative data to determine an overall sense of participants’ reactions. There was a statistically significant (p<0.05) improvement in participants’ perception of their writing skills, but no change in their statistical analysis skills. Major themes arising from the pre-session evaluation were a desire to learn to write a proper manuscript, improve statistical knowledge, publish a paper, and improve overall writing skills. Post-session, respondents indicated a desire for more time in the workshop, particularly concerning learning deeper skills in statistics. The workshop was perceived to be an unqualified success, in terms of helping Rwandan health scholars publish in international journals. Future interventions should focus on biostatistics skills, and be of longer duration. Co-Author(s): Raywat Deonandan, University of Ottawa

48 Factors Associated with Head Trauma Among Mixed Martial Arts Athletes PETER SCALIA Student, University of Ottawa To determine the factors associated with being rendered unconscious in professional MMA fights. Among fighters rendered unconscious, the factors associated with receiving a diagnosed concussion, and formulating policy recommendations for addressing head injury in MMA. Question 1: Logistic regression analysis will be employed to model covariates against the dichotomous outcome “unconsciousness vs no unconsciousness”. SPSS version 20 will be employed to conduct the analysis, which will be performed on the data provided by Fightmetric. Question 2: Logistic regression analysis will be employed to model covariates against the dichotomous outcome “diagnoses concussion vs no concussion”. SPSS version 20 will be employed to conduct the analysis, which will be performed on the enriched subset of data. Question3: The results from the first two research questions and the literature sources will help us formulate policy recommendations for addressing head injury in MMA. Question 1: Logistic regression analysis will be employed to model covariates against the dichotomous outcome “unconsciousness vs no unconsciousness”. SPSS version 20 will be employed to conduct the analysis, which will be performed on the data provided by Fightmetric. Question 2: Logistic regression analysis will be employed to model covariates against the dichotomous outcome “diagnoses concussion vs no concussion”. SPSS version 20 will be employed to conduct the analysis, which will be performed on the enriched subset of data. Question3: The results from the first two research questions and the literature sources will help us formulate policy recommendations for addressing head injury in MMA. Preliminary results: Age, number of fights, and previous concussion are three variables that are associated with being diagnosed with a concussion. Impose retirement age, limit number of pro fights, and prevent fighters from fighting again if they have attained a certain number of concussions. Co-Author(s): Raywat Deonandan, University of Ottawa

49 Genetic variants of vitamin D-related genes (GC and VDR) and breast cancer risk JOY SHI Queen’s University To determine the associations of 21 vitamin D-related genetic polymorphisms with breast cancer risk among European and East Asian women and assess for potential interactions by tumour receptor subtypes, as defined by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) status. Data from a case-control study of 1,037 breast cancer cases and 1,050 age-frequency matched controls participating in Vancouver, British Columbia and Kingston, Ontario, were used. Biological samples were collected for genotyping and tumour pathology markers have been obtained for most cases. Stratified analyses among European and East Asian women were conducted to calculate age- and centre-adjusted odds ratios, using logistic regression and assuming an additive genetic model. Polytomous logistic regression was used to assess relationships by tumour subtype and heterogeneity of associations between subtypes. Corrections for multiple comparisons were completed using the false discovery rate adjustment. Data from a case-control study of 1,037 breast cancer cases and 1,050 age-frequency matched controls participating in Vancouver, British Columbia and Kingston, Ontario, were used. Biological samples were collected for genotyping and tumour pathology markers have been obtained for most cases. Stratified analyses among European and East Asian women were conducted to calculate age- and centre-adjusted odds ratios, using logistic regression and assuming an additive genetic model. Polytomous logistic regression was used to assess relationships by tumour subtype and heterogeneity of associations between subtypes. Corrections for multiple comparisons were completed using the false discovery rate adjustment. Associations between genetic variants in two vitamin D-related genes (GC and VDR) and breast cancer risk were not observed among European or East Asian women after false discovery rate adjustment. In addition, these relationships were not modified by menopausal status in either ethnic subgroup. However, among European women, two SNPs of the VDR gene showed significant heterogeneity among subtypes with the strongest associations observed with ER-/PR-/HER2+ breast tumours (based on 32 cases): rs1544410 (OR = 0.38, 95% CI: 0.21 – 0.70) and rs7967152 (OR = 2.80, 95% CI: 1.63 – 4.85). Our study did not observe any association between polymorphisms of vitamin D-related genes and breast cancer risk, although our results suggest that these relationships may be modified by breast tumour receptor status. These results provide evidence for distinct etiological profiles between breast tumour subtypes. Co-Author(s): Anne Grundy, Department of Cancer Epidemiology and Prevention Research, Alberta Health Services - Cancer Control Alberta/ Johanna Schuetz, Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada/ Harriet Richardson, Department of Public Health Sciences; and Cancer Research Institute Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada/ Igor Burstyn, Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA, United States/ Angela Brooks-Wilson, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada/ John Spinelli, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada/ Kristan Aronson, Department of Public Health Sciences; and Cancer Research Institute Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada

50 Polymorphisms of insulin-like growth factor 1 pathway genes and breast cancer risk JOY SHI Queen’s University To determine associations between genetic variations in insulin-like growth factor 1 (IGF-1) pathway genes with breast cancer risk among European and East Asian women, while assessing for potential interactions with menopausal status, body mass index (BMI) and family history of breast cancer. A population-based case-control study of breast cancer with 1,037 cases and 1,050 controls was conducted in Vancouver, British Columbia and Kingston, Ontario. Demographic, lifestyle and reproductive characteristics of study participants were collected via questionnaire, and DNA samples were obtained for genotyping. Age- and centre-adjusted odds ratios were calculated using logistic regression in an additive genetic model for 22 SNPs across five IGF-1 pathway genes. Stratified analyses were conducted in Europeans and East Asians, and interactions of polymorphisms with menopausal status, BMI and family history were assessed separately. A population-based case-control study of breast cancer with 1,037 cases and 1,050 controls was conducted in Vancouver, British Columbia and Kingston, Ontario. Demographic, lifestyle and reproductive characteristics of study participants were collected via questionnaire, and DNA samples were obtained for genotyping. Age- and centre-adjusted odds ratios were calculated using logistic regression in an additive genetic model for 22 SNPs across five IGF-1 pathway genes. Stratified analyses were conducted in Europeans and East Asians, and interactions of polymorphisms with menopausal status, BMI and family history were assessed separately. Two SNPs of the IGF1 gene appeared protective against breast cancer risk among European women: rs1019731 (OR = 0.67, 95% CI: 0.53-0.84) and rs12821878 (OR = 0.73, 95% CI = 0.61-0.88). Four different SNPs of the IGF1 gene were modified by menopausal status among East Asian women only and were protective against postmenopausal breast cancers: rs2288378 (OR = 0.43, 95% CI: 0.26-0.69); rs17727841 (OR = 0.44, 95% CI: 0.27-0.72); rs7136446 (OR = 0.45, 95% CI: 0.28-0.72); and rs7956547 (OR=0.45, 95% CI: 0.28-0.73). No association was observed for polymorphisms of IRS-1, PI3KCB, IGFBP3, IGF1R and breast cancer risk. We have identified several variants of the IGF1 gene that were associated with breast cancer risk. These relationships appear to be modified by menopausal status but not by BMI or family history of breast cancer. Co-Author(s): Kristan Aronson, Department of Public Health Sciences; and Cancer Research Institute Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada/ Anne Grundy, Department of Cancer Epidemiology and Prevention Research, Alberta Health Services - Cancer Control Alberta/ Johanna Schuetz, Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada/ Igor Burstyn, Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA, United States/ Angela Brooks-Wilson, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada/ John Spinelli, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada/ Harriet Richardson, Department of Public Health Sciences; and Cancer Research Institute Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada

95 51 An empirical comparison of methods to meta-analyze individual patient data of diagnostic accuracy GABRIELLE SIMONEAU Student, McGill University With individual patient data (IPD), pairs of sensitivity and specificity are available for all possible thresholds for each study. To meta-analyze such data, the bivariate random- effects model (BREM) can be applied threshold per threshold to obtain pooled estimates. The objective is to compare this method to two multivariate methods. We apply the three methods to the CAGE test and the PHQ-9 questionnaire to compare the bivariate model and the two multivariate methods, empirically. IPD are available for both datasets. The BREM requires conducting separate meta-analysis for each threshold to obtain pooled results for all possible thresholds. It doesn’t account for correlation across thresholds within study. The two multivariate methods, the ordinal mixed model and the normal mixed model, meta-analyze all thresholds simultaneously. We will compare resulting pooled estimates, standard errors and correlation obtained from the three methods. We will also compare applicability of the methods. We apply the three methods to the CAGE test and the PHQ-9 questionnaire to compare the bivariate model and the two multivariate methods, empirically. IPD are available for both datasets. The BREM requires conducting separate meta-analysis for each threshold to obtain pooled results for all possible thresholds. It doesn’t account for correlation across thresholds within study. The two multivariate methods, the ordinal mixed model and the normal mixed model, meta-analyze all thresholds simultaneously. We will compare resulting pooled estimates, standard errors and correlation obtained from the three methods. We will also compare applicability of the methods. Complete results are available for the CAGE dataset. The pooled estimates of sensitivity and specificity for all thresholds are very similar across methods. The two multivariate approaches produce smaller standard errors than the BREM. This difference is more striking for low or high thresholds. Partial results are available for the PHQ-9 dataset. The BREM and the ordinal mixed model are applied to a clinically relevant subset of all thresholds. The ordinal mixed model produces smaller pooled estimates and more stable standard errors than the BREM. The normal mixed model could not be applied yet due to convergence issues. Heterogeneity has not been explored yet for the two datasets. Accounting for correlation between thresholds seems to reduce standard errors of pooled estimates as shown by application of the ordinal mixed model. Further work in this area includesmodel checking and simulation studies. Co-Author(s): Andrea Benedetti, McGill University

52 Methodologic Issues in Pharmacoepidemiologic Studies of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Prostate Cancer (PC) Risk HASANTHA SINNOCK Graduate Student, University of Manitoba Over recent decades, several lines of evidence (including pre-clinical and animal studies) have converged to suggest that NSAIDs could prevent development of PC. However, pharmaco-epidemiologic studies on NSAIDs and PC have produced inconsistent results likely due to the challenging nature of designing and interpreting these types of studies. Here we discuss possible explanations for the discrepancies between epidemiologic findings from large observational studies and other evidence for the effectiveness of NSAIDs against PC. We explore common sources of error that afflict observational studies in general including confounding, bias, and reverse causality and describe these issues in the context of pharmaco-epidemiologic findings on NSAIDs use and PC risk. We reviewed the existing body of literature on PC and NSAIDs to cite specific examples and instances of these issues. Here we discuss possible explanations for the discrepancies between epidemiologic findings from large observational studies and other evidence for the effectiveness of NSAIDs against PC. We explore common sources of error that afflict observational studies in general including confounding, bias, and reverse causality and describe these issues in the context of pharmaco-epidemiologic findings on NSAIDs use and PC risk. We reviewed the existing body of literature on PC and NSAIDs to cite specific examples and instances of these issues. The growing use of health administrative databases has afforded us a greater opportunity to perform pharmacoepidemiological research. Large observational studies of NSAID use and PC demonstrate inconsistent results with cohort studies generally showing no association and case-control studies suggesting statistically significant inverse associations. We found that pharmaco-epidemiologic studies could be systematically distorted or misinterpreted in ways typical of all observational studies, but also in ways specific to cancer pharmaco-prevention. In our review, possible measurement errors resulting from differential misclassification of outcomes and exposures were identified. Types of selection bias, including differential loss to follow-up, screening bias, referral bias and protopathic bias were noted in some studies. Confounding by indication and by use of other medications are additional sources of error that may have led to misinterpretation of results in some studies. Although this article focuses on NSAIDs and PC, the challenges and methodologic issues described here are likely to be encountered in all pharmaco-prevention studies. It is hoped that this discussion clarifies existing evidence and aids in the design of future observational studies of drug use and PC. Co-Author(s): Karla Willows, University of Manitoba/ Salaheddin Mahmud, University of Manitoba

53 Uptake of periodic health exams among adults with intellectual and developmental disabilities from 2009-2015 GLENYS SMITH Student, Queens University 1) To determine if there has been an increase in the uptake of the periodic health exam (PHE) from 2009 to 2015 among adults with intellectual and developmental disabilities (IDD) and to compare the trend to that in the general population. 2) To identify physician characteristics that are associated with increased performance of the PHE for their patients with IDD in a two year period after controlling for patient characteristics and region. Co-Author(s): Helene Ouellette-Kuntz, Queen’s University

54 A Meta Analysis of Tiffeneau-Pinelli Spirometric Index in Men and Women: Does Race Matter ? MOHSEN SOLTANIFAR Ph.D Student in Biostatistics, Dalla Lana School of Public Health - University of Toronto Tiffeneau-Pinelli Index has been widely used to diagnose lung diseases especially COPD which has become prevalent.Our systematic review of the index differences showed an overall significantly lower index in men versus women and no significant association of Race to the index difference. -The data consisted of 20 studies, where each study included the sample size, standard deviation of the index and the mean index for both men and women -The Main Outcome being investigated was the difference in Index scores between Men and Women. Race was considered as the Main Predictor. -Analysis was carried using STATA and R and both software produced almost identical results. -Standard Forest and Funnel plots were generated to visualize the size and variability associated with each study, popular tests such as Egger and Begg were used to assess the prevalence of publication bias. -The data consisted of 20 studies, where each study included the sample size, standard deviation of the index and the mean index for both men and women -The Main Outcome being investigated was the difference in Index scores between Men and Women. Race was considered as the Main Predictor. -Analysis was carried using STATA and R and both software produced almost identical results. -Standard Forest and Funnel plots were generated to visualize the size and variability associated with each study, popular tests such as Egger and Begg were used to assess the prevalence of publication bias. -There was no publication bias. -High heterogeneity was observed via both statistical tests and its canonical measurement tools. -Different regression models to calculate mean differences could be a source of high heterogeneity. -Men had significantly lower standard mean FEV1/FVC(%) than women. -Between studies variance estimated to be high: T^2 = 1.409 -The covariate Race had no significant effect on the heterogeneity of the results. -Overall, men have significantly lower mean FEV1/FVC(%) than women. -Race is not significantly associated to the heterogeneity in the standardized mean differences of FEV1/FVC(%). Co-Author(s): Mohsen Soltanifar, University of Toronto/ Maheshan Indraligam, University of Toronto/ Jiandong Su, University of Toronto/ Abhishek Varu, University of Toronto/ Sudipta Saha, University of Toronto/ Bowei(Adam) Xiao, University of Toronto

96 55 The application of Canadian patient-reported health utility scores (HUS) derived from the EQ5D-3L questionnaire for metastatic non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations ERIN STEWART Graduate student, Princess Margaret Cancer Centre HUS help define quality-adjusted life years in pharmacoeconomic analyses. Several approved EGFR tyrosine kinase inhibitors (TKIs) are used worldwide for patients with NSCLC and more are in development. However, reference HUSs are lacking for these patients. Here, we present epidemiologically obtained patient-reported HUS in metastatic NSCLC patients with EGFR mutations. Using a cross-sectional epidemiology survey design, 55 consecutive metastatic NSCLC outpatients with EGFR mutations at the Princess Margaret Cancer Centre completed clinico-epidemiologic surveys (risk factors, demographics, health status) and the EQ5D-3L questionnaire. The EQ5D-3L is a 2-part (descriptive and visual) standardized self-administered instrument used to capture health status at the time of completion. Descriptive measurements were converted into HUS (0-1) using Canadian based preference weights. ECOG performance status (0-4) and a patient-reported health state over the last month from 1 (excellent) to 5(poor) were collected as well. Results were correlated with clinico-epidemiologic data. Using a cross-sectional epidemiology survey design, 55 consecutive metastatic NSCLC outpatients with EGFR mutations at the Princess Margaret Cancer Centre completed clinico-epidemiologic surveys (risk factors, demographics, health status) and the EQ5D-3L questionnaire. The EQ5D-3L is a 2-part (descriptive and visual) standardized self-administered instrument used to capture health status at the time of completion. Descriptive measurements were converted into HUS (0-1) using Canadian based preference weights. ECOG performance status (0-4) and a patient- reported health state over the last month from 1 (excellent) to 5(poor) were collected as well. Results were correlated with clinico-epidemiologic data. Median age was 60 yrs; 55% female; 55% Asian ancestry; 66% never-smokers; 80% stage IV at diagnosis but 100% stage IV at the time of survey (median = 29 months after diagnosis). Overall mean±SEM HUS=0.80±0.14. Eighty-four percent (n=46) were on EGFR-targeted therapy, of which 67% (n=31) had partial response or stable disease (PR/SD) with a mean HUS=0.82±0.16. In contrast, patients with progressive disease were associated with lower HUS=0.74±0.08. Race, gender, time since diagnosis, smoking status and number of lines of therapy were each unassociated with HUS. Patients responding to EGFR TKIs also reported higher EQ5D visual (VAS) scores, ECOG and health state scores compared to those with progressive disease (71±20.1 vs 59±21.1, p=0.13; 0.65±0.61 vs 1.27±1.03, p=0.11; and 3.00±1.03 vs 3. 87±0.64, p=0.052 respectively). While not significant, the HUS, VAS, ECOG and patient-reported health state between PR/SD and patients with progressive disease did trend towards significance. Thus, the EQ5D-3L may be a very useful tool for measuring NSCLC patients HUS as obtained through an epidemiological survey approach. Co-Author(s): Erin Stewart, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Catherine Labbe, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ M. Catherine Brown, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Andrea Perez- Cosio, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Ashlee Vennettilli, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Devalben Patel, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Nicholas Cheng, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Mindy Liang, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Gursharan Gill, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Yvonne Leung, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Nicole Mittmann, Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Sunnybrook Hospital/ Hiten Naik, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada/ Geoffrey Liu, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

56 Occupational stress and job characteristics among child care workers MARIAM STITOU Research assistant, University of Ottawa The purpose of this study is to examine the job characteristics factors of Licensed home based childcare caregivers (LHBCC) in two Canadian provinces (Quebec and Ontario) that may contribute to their decision to stay or leave their job.

57 Caring for LHBCC health MARIAM STITOU Student, University of Ottawa The purpose of this study is to compare self-perceived mental and physical health status of licensed home based childcare caregivers (LHBCC) in two Canadian provinces (Quebec and Ontario) and to identify if there are any differences for chronical disease, daily sleeping hours and work injuries outcomes measures.

58 Health and Well being among child care caregivers MARIAM STITOU Research assistant, University of Ottawa The purpose of this study is to compare self-perceived mental and physical health status of LHBCC in two Canadian provinces (Quebec and Ontario) to the Canadian population and to identify if there are any differences.

59 Cross-Sectional Analysis of Linkages between Asthma and Anxiety DANIEL STOJANOVIC MD Candidate 2018, Schulich School of Medicine and Dentistry This study aims to assess the association between anxiety disorders and asthma among the general Canadian population from 2011-2012. There was also an evaluation of the interaction between anxiety disorders and recent experience of asthmatic symptoms and the use of asthma medication. Data was from the Canadian Community Health Survey 2011-2012: Annual Component. This survey collected the necessary information on health status in the Canadian population to meet the project objectives. All data from the survey is self-reported. Two questions were utilized in determining the primary objective, “Do you have asthma?” and “Do you have an anxiety disorder?”. 124555 responses were collected. An odds ratio assessment was used to analyze the relationship between these variables. Further analysis involved odds ratios comparing anxiety disorders with asthma symptoms in the past year, and utilization of asthma medication in the past month. Data was from the Canadian Community Health Survey 2011-2012: Annual Component. This survey collected the necessary information on health status in the Canadian population to meet the project objectives. All data from the survey is self-reported. Two questions were utilized in determining the primary objective, “Do you have asthma?” and “Do you have an anxiety disorder?”. 124555 responses were collected. An odds ratio assessment was used to analyze the relationship between these variables. Further analysis involved odds ratios comparing anxiety disorders with asthma symptoms in the past year, and utilization of asthma medication in the past month. Anxiety and asthma are significantly co-morbid (OR= 2.1884; 95% CI [2.0566 - 2.3288], P < 0.0001) within the Canadian population. Furthermore, having an anxiety disorder would increase the likelihood of experiencing asthmatic symptoms / attacks within the past year among asthmatics (OR= 1.7507; 95% CI [1.552 - 1.9707], P < 0.0001) and of having taken asthma medication in the past month (OR= 2.1461; 95% CI [1.8455 - 2.4956], P<0.0001). Among Canadians Asthma and Anxiety disorders are highly co-morbid. However, this data does not provide a mechanism for such a relationship. In the past non-allergic asthma was believed to be a psychosomatic disorder. However, anxiety disorders have been linked to traumatic experiences, such as suffering an asthma attack.

60 Self-reported symptoms associated with ovarian cancer among peri- and postmenopausal women ZHUOYU SUN Department of Epidemiology, Biostatistics and Occupational Health, McGill University Women with pelvic or abdominal symptoms are advised to undergo assessment to rule out ovarian cancer (OC). However, little is known about the prevalence of these symptoms among peri- and postmenopausal women. This study aims to estimate the prevalence and distribution of OC symptoms among women over 50 in Montreal. We carried out a web +/- paper-based survey among 3000 women aged 50+ in Montreal, randomly sampled from those covered by Provincial Health Insurance. Women were asked about symptoms lasting for more than 2 weeks but less than 1 year. Binomial regression was used to assess associations between symptoms and socio-demographic characteristics and medical history. We carried out a web +/- paper-based survey among 3000 women aged 50+ in Montreal, randomly sampled from those covered by Provincial Health Insurance. Women were asked about symptoms lasting for more than 2 weeks but less than 1 year. Binomial regression was used to assess associations between symptoms and socio-demographic characteristics and medical history. Despite 2 reminders, only 823 women (27%) returned completed questionnaires. The response rate was similar between Anglophone and Francophone, but differed by age (<70 vs. 70+ years: 31% vs. 19%). Here, we present preliminary results based on 300 questionnaires from the 1st wave. Overall, about 50% of responders reported at least one symptom, and 30% reported 3+ symptoms. Experiencing symptoms was less frequent in the older age group, with 41.7% of women over 70 reporting 1+ symptom, compared with 54.4% in those aged 50-69 years. Having ever used hormone replacement therapy was associated with reporting symptoms (RR=1.3, 95%CI: 1.0-1.7). The symptoms considered as most commonly associated with OC-abdominal bloating, increased urinary frequency, and early satiety-were reported by 13.3%, 12.7%, and 6.3% of women, respectively. Symptoms that maybe associated with ovarian cancer are mostly frequent among women aged 50-69 years. Given the low response rate, the above figures most likely overestimate the prevalence of symptoms in this population-an issue that we will address in future analyses. Co-Author(s): Zhuoyu Sun, Department of Epidemiology, Biostatistics and Occupational Health, McGill University/ Lucy Gilbert, Department of Obstetrics and Gynecology, McGill University Health Center/ Antonio Ciampi, Department of Epidemiology, Biostatistics and Occupational Health, McGill University/ Olga Basso, Department of Epidemiology, Biostatistics and Occupational Health, McGill University

97 61 Data Preprocessing and Quality Control Evaluation of Infinium HumanMethylation 450K DNA Methylation QI JING SUN Master of Public Health Epidemiology Student, Dalla Lana School of Public Health, University of Toronto The Infinium HumanMethylation450 BeadChip is one of the most advanced technologies used to assess genome-wide DNA methylation. The primary objective of this study was to execute and evaluate preprocessing and quality control of the DNA methylation data, using a customized analysis pipeline adapted from the currently available packages. The Infinium 450K DNA methylation data acquired from the blood samples of 187 breast cancer patients were preprocessed and assessed using a custom- designed data analysis approach. Using the raw *.idat files as the input, the genome-wide methylation data was examined by boxplots and correlation analysis in the GenomeStudio Methylation Module. The files were subsequently loaded into the RnBeads package (version 0.99.13) in the R environment, where they were processed and evaluated for data quality control to account and adjust for the technical variabilities, probe design bias, and batch effects. The Infinium 450K DNA methylation data acquired from the blood samples of 187 breast cancer patients were preprocessed and assessed using a custom-designed data analysis approach. Using the raw *.idat files as the input, the genome-wide methylation data was examined by boxplots and correlation analysis in the GenomeStudio Methylation Module. The files were subsequently loaded into the RnBeads package (version 0.99.13) in the R environment, where they were processed and evaluated for data quality control to account and adjust for the technical variabilities, probe design bias, and batch effects. The preprocessing and quality control evaluation has consistently demonstrated high experimental quality data from the Infinium 450K assay. The SWAN normalization method minimized bias between probe types. Post-filtering revealed that most of the experimental measurements were reliable and thus were included in the data quality control evaluations downstream. The Infinium 450K control probes indicated that there was likely a problem with the biotin staining and extension for the G nucleotide hairpin probes. The negative control boxplots showed that the quality for all samples were acceptable, as over 0.9 percentiles of the probe intensities were less than 1000. No sample mix-ups were found by the SNP genotyping probes. The deviation plots suggested that the methylation profiles of the interrogated genomic regions were that of expected. This project had successfully executed the data preprocessing and quality control assessment of the genomic sites interrogated by the Illumina Infinium Human Methylation 450K BeadChip. The results indicated that samples were assayed with high experimental quality, and that the removal of poor quality data was minimal. Co-Author(s): Steven A. Narod, Dalla Lana School of Public Health, University of Toronto; Women’s College Research Institute/ Mohammad R. Akbari, Dalla Lana School of Public Health, University of Toronto; Women’s College Research Institute

62 Evidence Reversal: An Analysis of Contradicted Medical Practices DESIREE SUTTON Evidence Reversal: An Analysis of Contradicted Medical Practices, Epidemiology and Biostatistics Schulich Medicine & Dentistry, Western University Evidence Reversal occurs when new studies – better powered, controlled or designed than predecessors – contradict currently accepted practices and upset Evidence Based Medicine. Some standard treatments, surgeries, and drugs have been shown to be ineffective or even harmful as new evidence accrues. We will describe the characteristics of reversals, and develop taxonomy of Reasons for Evidence Reversal, followed by development and internal validation of a prediction tool for determining Evidence Maturity or Reversal. Co-Author(s): Janet Martin, Department of Epidemiology and Biostatistics and Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre/ Aiswaryna Pillai, London Health Sciences Centre/ Angel Zhu, London Health Sciences Centre

63 Is overall academic performance in high school associated with dementia and Alzheimer’s disease? GRACE TANG University of Waterloo While level of education has been extensively investigated as a risk factor for dementia and Alzheimer’s disease (AD), less is known about the influence of academic performance. The objective of this study was to determine if overall academic performance in high school was associated with dementia and AD. The Nun Study is a longitudinal study of 678 religious sisters aged 75+ at baseline. Academic performance was based on average grade (%) across first-year high school English, Latin, Algebra, and Geometry courses, and categorized by quartile. Low and high performance was defined as the lowest or highest quartile, respectively. Dementia was diagnosed based on DSM-IV criteria. AD was diagnosed based on meeting criteria for both dementia and AD neuropathology (CERAD criteria). The association of academic performance with dementia (n=383) and AD (n=133) was assessed using logistic regression models adjusted for age, education and a genetic risk factor, apolipoprotein E. The Nun Study is a longitudinal study of 678 religious sisters aged 75+ at baseline. Academic performance was based on average grade (%) across first-year high school English, Latin, Algebra, and Geometry courses, and categorized by quartile. Low and high performance was defined as the lowest or highest quartile, respectively. Dementia was diagnosed based on DSM-IV criteria. AD was diagnosed based on meeting criteria for both dementia and AD neuropathology (CERAD criteria). The association of academic performance with dementia (n=383) and AD (n=133) was assessed using logistic regression models adjusted for age, education and a genetic risk factor, apolipoprotein E. Academic performance was not significantly associated with dementia: compared to the lowest quartile, ORs were 0.72 (95% CI=0.39-1.35), 0.78 (95% CI=0.42-1.42) and 0.79 (95% CI=0.42-1.46) for the second, third and fourth quartiles, respectively. Parallel ORs for AD were 0.53 (95% CI=0.15-1.82), 0.63 (95% CI 0.19-2.02), and 0.62 (95% CI=0.19-1.92). Neither high nor low academic performance was significantly associated with dementia or AD. However, overall the detrimental impact of low performance on dementia (OR=1.31; 95% CI=0.80-2.16) and AD (OR=1.67; 95% CI=0.65-4.57) was greater than the beneficial impact of high performance on dementia (OR=0.96, 95% CI=0.58-1.58) and AD (OR=0.87; 95% CI=0.36-2.19). Academic performance in high school was not significantly associated with dementia or AD. However, stronger associations were found for low performance as a risk factor than for high performance as a protective factor. Associations were also stronger for AD, a subtype of dementia, than for all-cause dementia. Co-Author(s): Grace H. Tang, University of Waterloo/ Maryam Iraniparast, University of Waterloo/ Michael L. MacKinley, University of Waterloo/ Sanduni M. Costa, University of Waterloo/ Suzanne L. Tyas, University of Waterloo

64 LENGTH OF STAY IN PATIENTS WHO HAVE SUSTAINED A TRAUMATIC BRAIN INJURY WITHIN AN INTEGRATED CANADIAN TRAUMA SYSTEM: A MULTICENTER COHORT STUDY PIER-ALEXANDRE TARDIF Université Laval Comprehensive information on hospital resource use for traumatic brain injured (TBI) patients is needed. The objectives of this study were to compare acute care index LOS (in highest designated trauma center) to total LOS (all consecutive hospitalisations related to the injury) following a TBI and identify the determinants of LOS. Multicenter retrospective cohort study based on all adults (≥ 16 years) discharged alive following a TBI between 2007 and 2012. Data were extracted from the Quebec trauma registry linked to the hospital discharge database. Missing data for physiological variables was simulated with multiple imputation. Length of stay was defined as the number of days between admission and discharge and was described and modeled using a log-normal transformation. LOS determinants were identified using a hierarchical linear regression. Their relative importance was estimated with Cohen’s f^2, a local size effect measure suitable to hierarchical models. Multicenter retrospective cohort study based on all adults (≥ 16 years) discharged alive following a TBI between 2007 and 2012. Data were extracted from the Quebec trauma registry linked to the hospital discharge database. Missing data for physiological variables was simulated with multiple imputation. Length of stay was defined as the number of days between admission and discharge and was described and modeled using a log-normal transformation. LOS determinants were identified using a hierarchical linear regression. Their relative importance was estimated with Cohen’s f^2, a local size effect measure suitable to hierarchical models. Geometric mean total LOS (12.6 days [95% CI: 12.3-12.8]) was 1 day longer than geometric mean index LOS (11.7 days [95% CI: 11.5-11.9]; p < 0.0001). The proportions of index LOS spent in intensive care unit (ICU), intermediate care unit and general ward were 18.5%, 5.2%, and 76.3% respectively. Globally, determinants explained 45% and 36% of the variation in index and ICU LOS. The six most important determinants of LOS accounted for 80% of the explained variation in i) index and total LOS: discharge destination, severity of concomitant injuries, GCS, TBI severity, ICU mechanical ventilation, number of comorbidities; ii) ICU LOS: mechanical ventilation, severity of concomitant injuries, TBI severity, surgery. Acute care LOS for TBI admissions is slightly underestimated when only index LOS is considered and six variables account for 80% of the explained variation in LOS. This information should be taken into account when LOS is used to assess the efficiency and quality of acute care for TBI patients. Co-Author(s): Lynne Moore, Centre de recherche du CHU de Québec — Hôpital de l’Enfant-Jésus

98 65 Corvid and mosquito pool surveillance data for the detection of West Nile virus in Ontario, 2002-2008: a comparison using survival analyses and spatial scan statistics ANDREA THOMAS-BACHLI PhD Candidate, Department of Population Medicine, University of Guelph The objectives of this study were to determine whether the timing and location of clusters of first WNv-positive test results from dead corvid and mosquito pool tests within public health units are comparable, and to examine yearly trends and factors that may bias these surveillance modalities. Using survival analyses, we investigated the yearly trends, socio-demographic and geographic factors associated with the first WNV-positive dead birds and mosquito pools detected within public health units (PHUs). Spatial scan statistics were employed for spatio-temporal cluster detection of first-positive dead birds, mosquito pools and human cases within public health units (PHUs) across Ontario using raw and model-adjusted data. Using survival analyses, we investigated the yearly trends, socio-demographic and geographic factors associated with the first WNV-positive dead birds and mosquito pools detected within public health units (PHUs). Spatial scan statistics were employed for spatio-temporal cluster detection of first-positive dead birds, mosquito pools and human cases within public health units (PHUs) across Ontario using raw and model-adjusted data. WNv activity within a PHU generally was detected earlier using dead birds, although there was variation related to year, region, and whether the PHU was predominantly rural or urban. There was geographic overlap between statistically significant (p<0.05) space-time clusters of first-positive dead birds, mosquito pools and human cases during all years in which significant clusters were found. The mosquito pool clusters were always located in southwestern Ontario, but the dead bird and human model-adjusted cluster was located in northern Ontario during 2007. The dead corvid data outperformed the mosquito pool data stream in terms of timeliness. Survival model-adjusted space-time cluster analyses of first-positive dead corvids appeared to have greater ability than models based on mosquito pool data, in terms of timeliness and spatial location, to detect human case clusters during most surveillance years. Co-Author(s): David L. Pearl, Department of Population Medicine, University of Guelph/ Olaf Berke, Department of Population Medicine, University of Guelph/ Elizabeth Jane Parmley, Canadian Cooperative Health Centre, University of Guelph/ Ian K. Barker, Department of Pathobiology, University of Guelph

66 Developing an evidence framework for establishing treatment effectiveness in rare diseases KYLIE TINGLEY PhD Student, University of Ottawa Recognizing that few randomized controlled trials exist in rare disease research, our objective is to elaborate on the traditional evidence hierarchy in this context. We will conceptualize the potential value added to knowledge of treatment effectiveness from alternative study designs, while highlighting risks of bias for each design. We used a critical review of the literature to inform the development of an evidence framework for studying effectiveness of treatments for rare diseases. Seminal papers were identified in the following areas: evidence typologies for evaluating effectiveness; risk of bias assessment for observational studies; methods and any existing frameworks for evaluating treatments for rare diseases. Our literature search was designed to be iterative, with the study team meeting frequently to refine its direction. Selected papers were qualitatively synthesized to identify challenges specific to the rare disease context; ability of specific study designs to address these challenges; and risk of bias. We used a critical review of the literature to inform the development of an evidence framework for studying effectiveness of treatments for rare diseases. Seminal papers were identified in the following areas: evidence typologies for evaluating effectiveness; risk of bias assessment for observational studies; methods and any existing frameworks for evaluating treatments for rare diseases. Our literature search was designed to be iterative, with the study team meeting frequently to refine its direction. Selected papers were qualitatively synthesized to identify challenges specific to the rare disease context; ability of specific study designs to address these challenges; and risk of bias. From our literature search and consultation with members of the research team, we have identified six main challenges in generating evidence of treatment effectiveness for rare diseases: (1) power to detect treatment effects; (2) addressing heterogeneity in treatment effects; (3) ascertainment of relevant outcomes; (4) addressing confounding without randomization/blinding; (5) ability to determine long-term treatment effects; and (6) challenges in statistical analysis. We have also identified several alternative study designs for determining treatment effectiveness in rare diseases, including both quasi-experimental and observational designs, and have determined their ability to address the above challenges. We will use these results to further develop the framework to include guidance about when a particular study design is useful and about how to minimize bias for each. This work is on going and is expected to result in a framework that will provide insights into approaches for generating and synthesizing evidence about treatment effectiveness in the context of rare diseases. Co-Author(s): Beth Potter, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa/ Doug Coyle, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa/ Lindsey Sikora, Health Sciences Library, University of Ottawa

67 The validity of the 12-item Bem Sex Role Inventory in Older Spanish Population. An examination of the Androgyny Model AFSHIN VAFAEI Queen’s University Perceived gender role is a crucial part of a person’s identity and an established determinant of health.Our objectives were to explore the validity of Bem Sex Role Inventory (BSRI) in an older Spanish population, to compare different standard methods of measuring gender roles, and to examine their impact on health indicators. The BSRI and health indicator questions were completed by 120 community-dwelling adults aged 65+ living in Aragon, Spain. Exploratory factor analysis was performed to examine psychometric properties of the BSRI. Androgyny model suggests that those with high levels of both masculinity and femininity (androgynous) are more adaptive and hence have better health. We measured androgyny by three approaches: geometric mean, t-ratio, and traditional four gender groups classification and then explored the relationships between health indicators and gender roles. The BSRI and health indicator questions were completed by 120 community-dwelling adults aged 65+ living in Aragon, Spain. Exploratory factor analysis was performed to examine psychometric properties of the BSRI. Androgyny model suggests that those with high levels of both masculinity and femininity (androgynous) are more adaptive and hence have better health. We measured androgyny by three approaches: geometric mean, t-ratio, and traditional four gender groups classification and then explored the relationships between health indicators and gender roles. Factor analysis resulted in two factors solution consistent with the original masculine and feminine items with high loadings and good reliability. There were no associations between biological sex and gender roles. Different gender role measurement approaches classified participants differently into gender role groups. Overall, androgyny was associated with better mobility and physical and mental health. The traditional four groups approach showed higher compatibility with the androgyny model and was better able to disentangle the differential impact of gender roles on health. Co-Author(s): Beatriz E. Alvarado, Queen’s University/ Concepcion Tomás, University of Zaragoza/ Carmen Muro, University of Zaragoza/ Beatriz Martinez, University of Zaragoza/ Maria Victoria Zunzunegui, Université de Montréal

68 Change in risk factor status following incident diagnosis of cardiovascular disease in a Canadian cohort JACQUES VAN WIJK Graduate Student, Primary Healthcare Research Unit The aim of this study is to determine whether adults who are diagnosed with coronary artery disease were more likely to change their lifestyles compared to those who did not have these diagnoses. Proxies (Body Mass Index, cholesterol level, blood pressure level) will be used to assess likelihood of lifestyle change or at least change in emphasis on healthy living and attention to one’s health as these are not directly recorded in electronic medical records. Co-Author(s): Jacques Van Wijk, Faculty of Medicine, Memorial University of Newfoundland/ Marshall Godwin, Primary Healthcare Research Unit, Memorial University of Newfoundland

69 Determining optimal fractional factorial designs of discrete choice experiments using d-efficiency THUVA VANNIYASINGAM PhD Candidate, McMaster University Our objective is to determine how the optimality of the design, measured using d-efficiency, is affected by: the number of attributes, number of levels, number of scenarios, number of overlapping attributes between scenarios, and number per scenario. We will use simulations to create the fractional designs to evaluate the d-efficiency under the various conditions listed above. We will use simulations to create the fractional designs to evaluate the d-efficiency under the various conditions listed above. We will report our results using graphs to illustrate the change in d-efficiency as the number of attributes, number of levels, number of scenarios, number of overlapping attributes between scenarios, and number per scenario change. This simulation study is widely applicable for determining individual preferences on services, programs, and products. Co-Author(s): Thuva Vanniyasingam, McMaster University/ Charles Cunningham, McMaster University/ Gary Foster, McMaster University/ Lehana Thabane, McMaster University

99 70 A sensitivity analysis of the ranking of knowledge translation variables to differentiate methods of handling within-respondent variability: An application to addiction research THUVA VANNIYASINGAM PhD Candidate, McMaster University Our objective is i) to determine professional development preferences of service providers and administrators for the enhancement of addiction services and ii) to examine the effect of within participant clustering of responses on the ranking of attributes. A discrete choice experiment was conducted with 1379 service providers and administrators from 333 addiction agencies. Using a fractional factorial design, participants were presented with a set of scenarios presenting different combinations of attributes influencing the dissemination of evidence-based practices. We will first estimate the value of each attribute and rank them using a random effects multinomial logit model. We will then evaluate how sensitive these final ranks are to within-participant variability through an empirical comparison of random effects multinomial logit and probit models. A discrete choice experiment was conducted with 1379 service providers and administrators from 333 addiction agencies. Using a fractional factorial design, participants were presented with a set of scenarios presenting different combinations of attributes influencing the dissemination of evidence-based practices. We will first estimate the value of each attribute and rank them using a random effects multinomial logit model. We will then evaluate how sensitive these final ranks are to within-participant variability through an empirical comparison of random effects multinomial logit and probit models. We will report the relative importance (or ranking) of each attribute and level of attribute in determining participants’ preferences. This study will guide future discrete choice experiments in terms of which statistical method of analysis is most appropriate. Co-Author(s): Thuva Vanniyasingam, McMaster University/ Charles Cunningham, McMaster University/ Gary Foster, McMaster University/ Lehana Thabane, Foster

71 Data synthesis methods can improve precision of survey-based prevalence estimates for Major Depression KATHRYN WIENS Student, University of Calgary Descriptive epidemiology of major depression seeks to describe the distribution of illness for proper allocation of health services. In Canada, national surveys are important data sources, however, limited precision is often encountered in analyses of individual datasets. This paper explores quantitative data synthesis as a potential solution to this problem. Data synthesis methods will be examined by assessing the existence of urban-rural differences in major depression prevalence. The National Population Health Survey (NPHS) and Canadian Community Health Survey (CCHS) are a series of national cross-sectional datasets collected between 1996 and 2013. Survey specific prevalence estimates of major depression in urban versus rural areas have been inconsistent, with some confidence intervals for measures of association crossing the null value. Using a random effects approach, forest plots and meta-analysis are used to pool these estimates. Meta-regression analyses further assess the effect of survey type and year to ensure homogeneity between survey estimates. Data synthesis methods will be examined by assessing the existence of urban-rural differences in major depression prevalence. The National Population Health Survey (NPHS) and Canadian Community Health Survey (CCHS) are a series of national cross-sectional datasets collected between 1996 and 2013. Survey specific prevalence estimates of major depression in urban versus rural areas have been inconsistent, with some confidence intervals for measures of association crossing the null value. Using a random effects approach, forest plots and meta-analysis are used to pool these estimates. Meta-regression analyses further assess the effect of survey type and year to ensure homogeneity between survey estimates. There was no significant effect of diagnostic instrument or year of survey on variability between estimates. The I2 statistic of 13.3% indicates that minimal variability was due to methodological heterogeneity, providing justification for pooling. The pooled odds ratio from the random effects model revealed urban regions have a slightly higher prevalence of major depression with 1.19 (1.13, 1.25) times the odds of illness compared to rural regions. In comparison to a few survey specific estimates: 1.253 (1.033, 1.519) from NPHS-1996, 1.069 (0.931, 1.228) from CCHS-2.1 and 1.299 (1.042, 1.619) from CCHS-2012, the pooled estimate demonstrates improved precision and provides a definitive estimate of the difference in urban and rural prevalence of major depression. Data synthesis of national survey-based estimates is an effective method for deriving estimates of increased precision, and improving statistical power to detect a weak measure of association. Co-Author(s): Kathryn V Wiens, University of Calgary/ Jeanne VA Williams, University of Calgary/ Dina H Lavorato, University of Calgary/ Andrew GM Bulloch, University of Calgary, Mathison Centre for Research and Education, Hotchkiss Brain Institute/ Scott B Patten, University of Calgary, Mathison Centre for Research and Education, Hotchkiss Brain Institute

72 Trends and characteristics of response rates in case-control studies of cancer MENGTING XU Master’s Student (MScPH), University of Montreal It is suspected that response rates in case-control studies have declined, which threatens the validity of this body of work. Our objectives are 1) to describe the levels of response rates seen in recent studies, 2) to describe time trends, methods of calculation and patterns of reporting for response rates from 1984 to 2013, and 3) to analyse the determinants of response rates with respect to subject ascertainment, recruitment and interview methods. Co-Author(s): Jack Siemiatycki, CHUM Research Center / Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada

73 CSIH MentorNet: Exploring application of module-based curriculum for mentoring students and young professionals in global health JOANNES PAULUS YIMBESALU Steering Committee Member, Canadian Society of International Health In 2011, the Canadian Society of International Health created MentorNet, a national global health mentorship program connecting students and young professionals (SYPs) with global health experts. With long standing commitment to creating the next generation of leaders, the program aims to facilitate knowledge transfer between SYPs studying and working in global health, with Canadian global health. MentorNet is run by a volunteer Steering Committee of seven young global health students and professionals from across Canada. The Committee members manage all aspects of the program, including recruitment, selection and matching of SYPs with mentors. SYP admission is competitive and successful applicants are matched with a mentor based on their interests. Committee members also liaise SYP-mentor relationships, providing tailored monthly modules that prompt pairs to critically engage in discussions on global health issues, reflect on career goals and expand their professional networks. Three mentorship cohorts have completed the program to date (2011-12, 2012-13 and 2013-14), with a fourth cohort beginning in January 2015. MentorNet is run by a volunteer Steering Committee of seven young global health students and professionals from across Canada. The Committee members manage all aspects of the program, including recruitment, selection and matching of SYPs with mentors. SYP admission is competitive and successful applicants are matched with a mentor based on their interests. Committee members also liaise SYP-mentor relationships, providing tailored monthly modules that prompt pairs to critically engage in discussions on global health issues, reflect on career goals and expand their professional networks. Three mentorship cohorts have completed the program to date (2011-12, 2012-13 and 2013-14), with a fourth cohort beginning in January 2015. There were a total of 156 SYP (vs. 140 in 2011 and 70 in 2012) and 40 mentor (vs. 30 in 2011 and 22 in 2012) applications in Year 3 (2013). Program capacity increased to 29 matched pairs for cohort 1 lasting ten months and 8 matched pairs for cohort 2 lasting eight months. The geographic distribution of participants within Canada was primarily concentrated in Ontario. Mid and post program evaluation results indicate that participants were highly satisfied with the program, with the majority of SYPs reporting improved understanding of global health issues, expanded professional networks and increased interest in pursuing a career in global health. As the program continues to grow, we aim explore and evaluate the application of module-based mentorship curriculum on training students and young professionals in the field. MentorNet has proven to be a valuable initiative for supporting Canadian SYPs to become leaders in global health. Moving forward, MentorNet aims to continue fostering mentorship relationships that are beneficial to both mentors and SYPs. Limitations include small sample size and need for improved approach for pre- and post- test assessment in subsequent years. Co-Author(s): Joannes Paulus Yimbesalu, Canadian Society of International Health/ Shweta Dhawan, Canadian Society of International Health/ Amanda Frain, Canadian Society of International Health/ Shanna Sunley, Canadian Society of International Health/ Katia Wong, Canadian Society of International Health/ Caity Jackson, Canadian Society of International Health/ Ceilidh MacPhail, Canadian Society of International Health/ Larissa Naidu, Canadian Society of International Health

74 Risk Factors for Child Mortality in Bangladesh RIFAT ZAHAN Graduate Student, University of Saskatchewan Infant and child mortality is an important indicator of the social and economic well-being of a population. Bangladesh has traditionally had a high child mortality rate. The study objective was to test factors associated with mortality among children less than five years of age in Bangladesh. Study data were from the 2011 Bangladesh Demographic and Health Survey. Risk factors included birth order, birth spacing, mother’s education level, mother’s current age, age at delivery and residence. These variables were chosen using type-3 sum of squares. The data were analyzed using Cox’s Proportional Hazards model. The tied observations were handled using Efron approximation. Interaction terms were included for variables varying with time. Study data were from the 2011 Bangladesh Demographic and Health Survey. Risk factors included birth order, birth spacing, mother’s education level, mother’s current age, age at delivery and residence. These variables were chosen using type-3 sum of squares. The data were analyzed using Cox’s Proportional Hazards model. The tied observations were handled using Efron approximation. Interaction terms were included for variables varying with time. A total of 7,423 births (only the most recent birth of each mother) were recorded in the five years prior to the survey (i.e., 2007-2011), giving an under-five mortality rate of 27 per 1,000 live births, with 51.7% male and 68.14% from rural areas. The rate of child mortality decreases as mother’s education increases (No Education vs. Primary: HR = 1.25, 95% CI = 0.86-1.82, No Education vs. Secondary: HR = 1.61, 95% CI = 1.09-2.36 and No Education vs. Higher: HR = 0.30, 95% CI = 0.14-0.64). The survival rate for lower birth order was low compared to higher birth order (First vs. 2nd -4th: HR = 6.64, 95% CI = 2.37-18.61 and First vs. 4+: HR = 8.41, 95% CI = 2.65-26.76). Progress in education of women and smaller family size were associated with reduced mortality rate. Government and policy makers should focus on these two factors to achieve the Millennium Development Goal (MDG) 4: reduce child mortality. Co-Author(s): Cindy Feng, University of Saskatchewan

100 75 Spirometric Reference Equation for Aboriginal Children in Saskatchewan RIFAT ZAHAN Graduate Student, University of Saskatchewan Spirometric prediction equations are used to predict the lung function values for healthy individuals, which is based on individual’s anthropometric measurements. Extensive work for building reference equations for spirometric indices for certain ethnic groups can be found in the literature. The objective of this study is to identify appropriate spirometric reference equations for Canadian First Nations children. Co-Author(s): Rifat Zahan, University of Saskatchewan/ Shahedul Khan, University of Saskatchewan/ Donna Rennie, University of Saskatchewan/ Chandima Karunanayake, University of Saskatchewan/ James Dosman, University of Saskatchewan/ Jo-Ann Episkenew, University of Regina/ Sylvia Abonyi, University of Saskatchewan/ J. Seeseequasis, Beardy’s Okemasis Reserve/ D. Arnault, Willow Cree Health Centre/ J. Gardipy, Montreal Lake Cree Nation/ Dr Mark Fenton, University of Saskatchewan

76 The association between maternity insurance, residence status and perinatal outcomes JING ZHANG MSc. Candidate, Brock University To investigate the joint impact of maternity insurance and maternal residence on birth outcomes in a Chinese population. A perinatal cohort study was conducted in the Beichen District of the city of Tanjin, China. 2364 pregnancy women from this district were invited to participate this study at around 12-week gestation when they registered for receiving prenatal care services. After cleaning for missing information for related variables, a total of 2309 women with singleton birth were included in this analysis. a perinatal cohort study was conducted in the Beichen District of the city of Tanjin, China. 2364 pregnancy women from this district were invited to participate this study at around 12-week gestation when they registered for receiving prenatal care services. After cleaning for missing information for related variables, a total of 2309 women with singleton birth were included in this analysis. 1190 (51.5%) women reported having maternity insurance and 629 (27.2%) were rural residents. The abnormal birth outcomes were defined in this study as infant deaths (n=9), birth defects (n=51) including congenital heart defects (n=32). Maternal insurance and residence were not related to extreme birth weight (small for gestational age and large for gestational age). Compared to women who lived in urban areas with maternity insurance, the odds of infant mortality and defects was much higher for women who lived in rural areas with maternity insurance (Odds ratio (OR, 95% CI): 2.40 (1.02,5.63) p<0.05) as well as without maternity insurance (5.37, (1.32,21.87), p<0.02) after adjustment for the related covariates. Compared to Tianjin urban areas, its rural areas had a much higher prevalence of infant mortality and birth defects. It suggests that more effort is needed to reduce infant mortality and defects in rural areas through improving women’s health during their pregnancy.

77 Impact of diabetes and hypertension on overall and health-adjusted life expectancy in British Columbia LI RITA ZHANG Epidemiologist, Provincial Health Services Authority This study was aimed at estimating life expectancy (LE) and health-adjusted life expectancy (HALE) in British Columbia for all population as well as those with and without diabetes or hypertension to assess the impact of these chronic conditions that would inform chronic disease prevention efforts. Mortality data (2005-2010 total) was obtained from the B.C. Chronic Disease Registry. Health Utilities Index data (HUI3) and its variance were calculated using pooled 2005 and 2009/10 Canadian Community Health Survey master files. Life table analysis with 19 standard age groups was applied to calculate LE, HALE, and their confidence intervals (CIs) using the Chiang and the adapted Sullivan methods. For the latter, life-years lived variable was adjusted by HUI3 as a measure of health-related quality of life. The last open-ended age interval was addressed using the Gompertz function, and the variance of HALE was calculated using Mather’s method. Mortality data (2005-2010 total) was obtained from the B.C. Chronic Disease Registry. Health Utilities Index data (HUI3) and its variance were calculated using pooled 2005 and 2009/10 Canadian Community Health Survey master files. Life table analysis with 19 standard age groups was applied to calculate LE, HALE, and their confidence intervals (CIs) using the Chiang and the adapted Sullivan methods. For the latter, life-years lived variable was adjusted by HUI3 as a measure of health-related quality of life. The last open-ended age interval was addressed using the Gompertz function, and the variance of HALE was calculated using Mather’s method. Regardless of age and sex, HALE was lower than LE, and a diagnosis of diabetes or hypertension lowered both measures. For the overall population at birth, a 10.1-year difference was seen between HALE (72.5 years, 95% CI: 72.3-72.7) and LE (82.6 years, 95% CI: 82.6-82.7). Significantly different compared to those without a diagnosis, a 65-year-old with diabetes were expected to lose 3.8 (females: 3.9, males: 3.2) years LE and 3.7 (females: 4.2, males: 3.0) years HALE, and one with hypertension were expected to lose 1.5 (females: 1.3, males: 1.7) years HALE. Eliminating either condition from the population would result in significant gains in HALE (diabetes: 1.2 years at birth, 0.9 years at 65 years; hypertension: 1.2 years at 20 years, 0.9 years at 65 years). Associated with significant losses in LE and HALE for both males and females and for all age groups, diabetes and hypertension have discernible impact on overall population health status of British Columbians. Co-Author(s): Li Rita Zhang, Provincial Health Services Authority/ Drona Rasali, Provincial Health Services Authority/ Jenny Sutherland, BC Ministry of Health/ Mike Pennock, BC Ministry of Health

78 The association between maternity insurance, residence status and selected perinatal outcomes among Chinese women JING ZHANG MSc. Candidate, Brock University The main purpose of this study is to investigate the single and joint impact of maternity health insurance especially during pregnancy and residence on infant extreme birth weight, birth defects in Chinese population.

79 Evaluation of the Processing, Reading, and Interpretation of Malaria Rapid Diagnostic Tests NORA ZWINGERMAN PhD Student, University of Toronto The accuracy of malaria rapid diagnostic tests (RDTs) depends on whether end users properly perform the tests. This study evaluates the proportion of RDTs with processing (e.g. delayed reading, incorrect volume or placement of solutions) and reading (e.g. not recognizing invalid tests, disregarding faint test lines) errors. Data was ascertained from 9 implementation studies of Fionet system. In each study, healthcare workers received training on processing RDTs and integrated an automated RDT reader (Deki Reader) into their point-of-care case management. The reader features in-process quality control and automated test interpretation for malaria RDTs. Descriptive statistics of the prevalence of each error type was calculated for each study. A random-effects meta-analysis, using Freeman-Tukey transformation, was used to estimate the average proportion of errors across individual users and studies. Secondary analyses include the examination of RDT brands (3), changes in the proportion of errors overtime, and agreement between results. Data was ascertained from 9 implementation studies of Fionet system. In each study, healthcare workers received training on processing RDTs and integrated an automated RDT reader (Deki Reader) into their point-of-care case management. The reader features in-process quality control and automated test interpretation for malaria RDTs. Descriptive statistics of the prevalence of each error type was calculated for each study. A random-effects meta- analysis, using Freeman-Tukey transformation, was used to estimate the average proportion of errors across individual users and studies. Secondary analyses include the examination of RDT brands (3), changes in the proportion of errors overtime, and agreement between results. In total, 147 healthcare workers processed 32,067 malaria RDTs (with a minimum of 30 RDTs processed by each worker) had an estimated average of 10.72% (CI: 9.78,12.05) errors across all studies and users. The most frequent errors were: blood already added, too late for analysis, and too much blood added. The proportion of errors significantly varied between studies, ranging from 5.40% (CI: 2.76,8.87) to 16.81% (CI: 14.10, 19.75). The RDT brand was significantly associated with the prevalence of errors, with estimated average error rates of: 7.01% (CI: 4.85, 9.54), 11.31% (CI: 9.13,13.72) and 12.08% (CI: 10.47, 13.76). Additional results to be presented. Sensitivity and specificity of malaria RDT are high, however in the field there are a significant amount of processing and reading errors. These errors can jeopardize the accuracy of the results. Quality assurance devices would help prevent the use of compromised test results. Co-Author(s): Nora Zwingerman, University of Toronto/ Marcela Cancino, Fio Corporation/ Santiago Ferro, Fio Corporation

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