Projects

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The On-Going and Completed Scientific Projects of Dr Raywat Deonandan

NOTE: To co-investigators or potential co-investigators, I follow the International Committee of Medical Journal Editors‘ requirement that “an ‘author’ is generally considered to be someone who has made substantive intellectual contributions to a published study.” To ethically be included as a co-author on my studies, I require such substantial contributions.

1. Completed Projects

Writing Skills Enhancement for Public Health Professionals in Rwanda
In 2013, Canadian scholars delivered a one-week workshop to 30 junior public health professionals in Rwanda. The goal was to improve the Rwandans’ skills and confidence with respect to writing scientific papers for submission to international peer-reviewed global health journals. As a result of the workshop, there was a statistically significant improvement in participants’ reported confidence in many aspects of navigating the publishing process, but no improvement in confidence regarding statistically analyzing their data. Remarkably, as a group, participants were able to write an article for a leading international journal, which was subsequently published. Results indicate that similar interventions would be both successful and well received, especially if targeted to individuals at a similar stage of career progress.
Status: submitted to Advances in Medical Education and Practice
Co-authors: Nodine Sangwa, Steve Kanters, Sabin Nsanzimana

Bioterror…. From Space!
It is becoming increasingly evident that the genesis of life on Earth was sparked  –at least in some small way– by materials impacting our planet’s surface from outer space. Given our cosmic origins, there may be several shared characteristics between terrestrial and non-terrestrial biospheres, if the latter do exist. This suggests that our biosphere might be an amenable environment for extraterrestrial pathogens to flourish. Should a virulent alien organism enter our ecology, our ability to apply epidemiologic modelling techniques will depend upon certain key characteristics of the disease. By making educated assumptions about the nature of such an invader, we conclude that the S → E → I → S compartmentalization model is our best bet for predicting the spread of an extraterrestrial epidemic.
Status: Accepted to  Monster Math: Scientifically investigating imaginary foes, from zombies to vampires to Cybermen
Co-author: Stefan Litvinjenko

Factors Associated With BMI Among Slum Dwelling Women in India: An Analysis of the 2005-2006 Indian National Family Health Survey
Background: Urbanization is increasing around the world, and in India this trend has translated into an increase in the size of slum dwellings whose environments are suspected of being associated with poor health outcomes, particularly those relating to women’s nutritional status. With this study, we sought to determine factors associated with Indian women’s BMI in slum environments.
Methods: A multiple linear regression analysis was performed on data from the India National Family Health Survey (2005-2006), modelling demographic and behavioural factors suspected of being associated with BMI, with special attention paid to measures of social class, specifically caste and tribal status.
Results: Increasing BMI is significantly and positively associated with: frequency of watching television, having diabetes, age, wealth index, and residency status in the areas of New Delhi, Andhra Pradesh or Tamil Nadu.
Conclusion: While belonging to a scheduled tribe was not associated with changes in BMI, unadjusted rates suggest that tribal status may be worthy of deeper investigation. Among slum dwellers, there is a double-burden of under-nutrition and over-nutrition. Therefore a diverse set of interventions will be required to improve the health outcomes of these women.
Status: submitted to Global Journal of Health Science
Co-author: Maya Patel

The Public Health Implications of Assisted Reproduction Technology
The public health implications of Assisted Reproductive Technologies (ART) are typically unappreciated by researchers and policy makers alike. Short and long term health outcomes of women undergoing ART procedures, and of their offspring, need to be considered, as do the epidemiological risks associated with donated gametes and the health services impacts of multiple and preterm births, both produced in higher rates by ART. A national surveillance system and greater inter-jurisdictional communication are important strategies for addressing these evolving concerns.
Status: published in Chronic Diseases in Canada (2010)

The Mandatory Census: Tension Between Individual Rights and the Public Good
The discontinuation of the Canadian long-form mandatory census presents a crisis for data users. Examined as a tension between the needs to preserve individual civil liberties and the need to curtail those liberties for the public good, the census crisis presents an opportunity for a public discussion on the specifics of our national values, beliefs and expectations.
Status: Published in Canadian Journal of Public Health (2011)

Driving Deaths and Injuries Post-9/11
Objectives: In the days immediately following the terror attacks of 9/11, thousands of Americans chose to drive rather than to fly. We analyzed highway accident data to determine whether the number of fatalities and injuries following 9/11 were different from the same time period in 2000 and 2002. Methods: Motor crash data from the National Highway Traffic Administration’s Fatality Analysis Reporting System were analyzed to determine the numbers and rates of fatalities and injuries nationally and in selected states, for the 20 days after September 11, in each of 2000, 2001 and 2002. Results: While fatality rates did not change appreciably, the numbers of less severe injuries was statistically higher in 2001 than in 2000, both nationally and in the state of New York. Conclusions: The fear of terror attacks may have compelled Americans to drive instead of fly. They were thus exposed to the heightened risk of injury and death posed by driving. The need for public health to manage risk perception and communication is thus heightened in an era of global fear and terrorism.
Status: Published in International Journal of General Medicine (2011)
Co-authors: Amber Backwell

Implications and Reflections on the 2010 Supreme Court Ruling on Canada’s AHR Act
In December, 2010, Canada’s 6 year old Assisted Human Reproduction Act was successfully challenged in the Supreme Court. There may be important implications for public health and the evolution of reproductive technologies in this country. As well, this decision may reflect on the values and influences of Canadian society.
Status: Published in International Journal of Women’s Health (2011)
Co-author: Tarun Rahman

A Student-Run Peer-Reviewed Journal- An Educational Tool for Health Sciences students
Students at the University of Ottawa, a plurality of whom were targeting a career in Medicine, were surveyed to determine their attitudes and expectations regarding a new student-run peer-reviewed journal for the health sciences. A plurality reported that the existence of the journal would make them more likely to take a class with a written component, while a majority would work harder on that assignment. Those intending to pursue post-graduate or professional studies were most likely to recognize the value to their careers of having a publication history. We argue that student-run medical communications endeavours such as this are beneficial both for enhancing student careers and for contributing to a more thorough educational experience.
Status: Published in Advances in Medical Education and Practice (2012)
Co-authors: Premal Patel & Robyn Winterbottom

Ethical Concerns for Maternal Surrogacy and Reproductive Tourism
Reproductive medical tourism is by some accounts a multibillion dollar industry globally. The seeking by clients in high income nations of surrogate mothers in low income nations, particularly India, presents a set of largely unexamined ethical challenges. In this paper, 8 such challenges are elucidated to spur discussion and eventual policy development towards protecting the rights and health of vulnerable women of the Global South.
Status: Published in BMJ Journal of Medical Ethics (2012)
Co-authors: Samantha Green, Amanda van Beinum

Ethics Education for Pediatric Residents: A Literature Review
We conducted a structured literature review to explore the extent of ethics education in pediatric residency programs. Twelve relevant studies were found. The studies suggest that existing training regimens are insufficient to meet the real life ethical challenges experienced in actual practice, particularly with respect to palliative care and the commission of clinical errors. The increasing diversity of culture and beliefs in the clinical workplace is also serving to complicate educational needs. An interdisciplinary approach, spread over the entirety of a physician’s training, is a proposed solution worthy of more attention.
Status: Published in Canadian Medical Education Journal (2015)
Co-author: Hafsa Khan

The Arab Uprising: Indicators of Female Health, Development and Empowerment
Objectives: Our objective was to explore whether traditional measurements of female empowerment used in population health and development studies could detect a role played by women in the 2011 Arab Spring revolutions. Methods: State-level indicators of health, development and female empowerment were extracted form public databases maintained by the World Bank, UNDP and CIA World Factbook and compared between the six so-called Arab Spring nations, as well as eleven Middle Eastern nations deemed to be at risk for revolution. Results: The ratio of women to men was more egalitarian in countries that had already revolted, as compared to those deemed to be at risk for revolution. No other indicators showed a significant difference between the groups analyzed. Conclusions: Traditional health and development indicators ostensibly showing female social, legal and economic engagement failed to show an association between women’s empowerment and Arab Spring revolution. However, given the documented role of women in the Egyptian uprising, this may be an indication of the insufficiency of existing indicators to detect the subtle and multifactorial role of women in dramatic political change.
Status: Published in The Internet Journal of World Health and Societal Politics (2012)
Co-authors: Charmaine Stanley, Tania El-Hindi

The Killing of bin Laden and the Undermining of Public Health
The military raid in Abbottabad, Pakistan, that resulted in the killing of Osama bin Laden was preceded by a fake childhood immunization campaign meant to collect DNA samples for confirming the bin Laden family’s presence. This use of a public health activity under false pretences undermines the validity and effectiveness of international public health endeavours, and may put workers in danger. It is time for agencies and governments to declare that health and development programs will no longer be used as cover for violent or subversive adventures.
Status: Published in The Internet Journal of Public Health (2012)

An Approach to Comparing Nations for Inclusion of Studies in Health-based Systematic Literature Reviews
To develop a systematic approach for comparing nations, for the purpose of deciding whether to include studies in a systematic review, a process was employed to identify criteria for describing a population. Nine criteria were chosen, both systemic and sociodemographic, and tested against 68 jurisdictions within a systematic review on mental illness prevalence. This method should be applied with indicators specific to the research questions, to control for political, economic, historical or ethnic biases.
Status: Published in Internet Journal of Epidemiology (2012)
Co-authors: Mylan Ly, Howard Schachter, Alberta Girardi, Nicholas Barrowman, Denise Lynch, Ceri Moore, Idil Abdulkadir

The Global Decline in Semen Quality: Ignoring the Developing World Introduces Selection Bias
Multiple studies from around the world have suggested that global semen quality is declining. However, all studies suffer from variable semen sampling criteria, selection bias with respect to the types of men volunteering to participate, and a bias with respect to a tendency to examine only samples from high income countries. This heterogeneity in approaches, especially given the under-sampling of rural and less affluent men from low income countries, calls into question researchers’ claims of universally declining semen norms. Multiple studies from around the world have suggested that global semen quality is declining. However, all studies suffer from variable semen sampling criteria, selection bias with respect to the types of men volunteering to participate, and a bias with respect to a tendency to examine only samples from high income countries. This heterogeneity in approaches, especially given the under-sampling of rural and less affluent men from low income countries, calls into question researchers’ claims of universally declining semen norms.
Status: Published in International Journal of General Medicine (2012)
Co-author: Marya Jaleel

Pre-Departure Global Health Ethics Training for Medical Volunteers: One Strategy
Short-term global health volunteerism is on the rise, as students and health care professionals seek short-duration volunteer experiences in low income settings. Given the potential for ethical transgressions in such situations, pre-departure ethics training is essential. We have developed a very short ethics training regimen with four dimensions: (1) an overview of the history and major challenges with respect to global health and ethics; (2) a simplified global health ethics framework for the non-specialist; (3) examples of ethical crises experienced in the field; (4) a proposed simple strategy for addressing new crises as they arise. We feel our training model can be modified and replicated for other groups in need of basic and brief pre-departure ethics training.
Status: Published in International Review of Social Sciences and Humanities (2012)
Co-authors: Bekkie Vineberg, Sarah Zelcer

Implications of India’s Skewed Sex Ratio
Recent studies have confirmed that India’s millions of missing girls are the result of selective abortion, resulting in a skewed sex ratio. This paper explores some of the possible consequences of the unbalanced sex ratio, and discusses the barriers to addressing the issue.
Status: Published in The Internet Journal of Public Health (2012)

Website describing the history of the female contraceptive pill
Status: website completed: HistoryOfThePill.ca (2011) –currently offline
Co-authors: Christabelle Sethna, Amanda Watson, Adam Barrowman

A Pilot Study for Case-Based Learning Among Undergraduate Students in Global Health
In this pilot study, students in a 4th year undergraduate course in Global Health at the University of Ottawa were exposed to Case-Based Learning (CBL) for the first time; and their experiences were assessed via an online survey. Though the response rate was poor (21%), respondents indicated overwhelmingly that the CBL experience was enjoyable, educational and appropriate for the subject. Aside from cost, the major challenge was harmonizing student experiences across the discussion groups, which may be addressed by better leader training. Given its innate opinion-based and interdisciplinary nature, Global Health is an appropriate subject area for the application of CBL to undergraduate teaching, and expansion of this intervention must include a wider selection of cases and greater harmonization of facilitation methods and leader training across groups.
Status: Published in Internet Journal of Medical Education (2012)
Co-authors: Arif Jinha, Jason Benovoy, Michelle Meilleur Sarazin, Jenny Doswell

Interdisciplinary Journal of the Health Sciences
The IJHS/RISS was founded in 2009-2010 as a student-run peer-reviewed journal for undergraduate-level scholarly manuscripts. It is on ongoing endeavour.
Status: journal accessible online at www.RISS-IJHS.ca

Strategies for Addressing Poor Statistical Literacy Among Scientists and Science Communicators
Statistical literacy (SL) is an aspect of numeracy and a core educational competency. Overall levels of SL in North America may be in decline, while evidence abounds of poor SL among researchers. Three strategies are recommended to help address poor SL among scholars and science communicators, with a particular focus on the health and medical sciences: (1) mandatory inclusion of computerized statistical platforms in undergraduate statistics classes; (2) requirement for statistical review in peer-reviewed paper submissions; and (3) the exploration of novel methods of results communication.
Status: Published in International Journal of Medical and Health Sciences Research

A Pilot Study: Research Poster Presentations as an Educational Tool for Undergraduate Epidemiology Students
Students in a 4th year Epidemiology course were surveyed after participating in a formal Science Research Day in which they presented original research, in poster form, to be judged by scientists from the community. As a result, 19% of respondents are more likely to pursue a career in science, and 27.5% are more likely to pursue a career in Epidemiology. Only one respondent reported being less likely to pursue a science career, while 7 were less likely to pursue Epidemiology. A majority of respondents felt that the poster experience was on par with, or superior to, a comparable research paper, in terms of both educational appeal and enjoyableness. Mandatory, formal poster presentations are an innovative format for teaching advanced health sciences, and may more accurately reflect the realities of a science career than do more traditional educational formats.
Status: Published in Advances in Medical Education and Practice
Co-authors: James Gomes, Eric Lavigne, Thy Dinh, Robert Blanchard

Factors Associated With Staff and Physician Influenza Immunization at a Children’s Hospital in Ontario, Canada
In 2005, employees of the Children’s Hospital of Eastern Ontario were surveyed about their experiences with, and receipt of, the 2003-4 influenza vaccination. With a 29% success rate, 91% of respondents claimed to have received the 2003-4 vaccine, with physicians being the most likely to have done so (97.2%). With covariates controlled via logistic regression, the only factor significantly predictive of whether an employee received the vaccine was whether they had memory of a formal vaccination awareness campaign.
Status: Published in International Journal of General Medicine
Co-authors: Ghada Al Sulaiti, Asha Gajaria, Kathryn Suh

Book: Traveling Well: Essays in Medical Tourism
A collection of essays, studies and presentations on the emerging issue of medical tourism.
Published: Transdisciplinary Studies in Population Health Series, University of Ottawa
Editors: Ronald Labonte, Vivien Runnels, Corinne Packer, Raywat Deonandan

India’s Assisted Reproduction Bill and the Maternal Surrogacy Industry
The latest version of India’s assisted reproduction bill addresses many of the shortfalls of the previous draft. In this paper, we examine the latest draft’s failure to address the most preponderant ethical issues affecting the burgeoning reproductive tourism industry.
Status: Published in International Review of Social Sciences and Humanities (2012)
Co-author: Andreea Bente

Health Questions Posed by Amerindians in Guyana’s Deep Interior
Background: The forest-dwelling Amerindian peoples of Guyana are among that nation’s most impoverished, vulnerable and least served. Health promotion messaging has been informed in large part by nation-level health indicators that may not be well targeted to this group. Our study sought to identify local health education needs, and to identify factors preventing proper uptake of health messaging. Methods: As part of medical missions to the interior, we asked patients waiting for care to anonymously submit their health questions in writing. Conventional content analysis was employed to identify prevalent themes in their responses. Findings: Sexual health (63.6%) and nutrition (17.4%) were the most popular themes asked about. Within the former, the science of sexual maturation and reproduction (31.4%) and HIV/AIDS (28.8%) were the most common sub-themes, with the pathophysiology and etiology of HIV/AIDS being the most common sub-theme within the latter. Interpretation: Within Guyana’s Amerindian community, there exists is a prevalent curiosity about the basic science of both sexual reproduction and the transmission of sexual disease.
Status: Published in Global Journal of Health Science
Co-authors: Bekkie Vineberg,Rebecca Stulberg, Marya Jaleel, Nicholar Szecket, Sheila Dunn, Mary Ann Hamelin, Margaret Van der Kuur, Sarah Zelcer

Measuring Reproductive Tourism Through an Analysis of Indian ART Clinics’ Websites
Objectives: India is fast becoming the most prominent player in the global industry of reproductive tourism (RT), in which infertile people cross international borders to seek assisted reproduction technologies (ARTs). This study was conducted to better understand the extent and manner in which Indian clinics seek foreign clients. Methods: A systematic search of official Indian ART websites was undertaken, and instances noted wherein foreign clients were overtly targeted, and maternal surrogacy overtly offered. Results: A total of 159 clinics with web addresses were identified, though only 78 had functioning websites. All were published in English, with the majority clustered in the states of Maharashtra (14) and Gujarat (9); 53 (68%) featured some mention of maternal surrogacy services, and 42 (54%) made overt overtures to foreign clients. Qualitative appeals to foreigners included instructions for international adoption, visa application, and the legal parental disposition of the surrogate. All Maharashtran clinics’ websites that mention surrogacy also feature RT overtly. Pre-implantation diagnosis (PGD) services were not offered disproportionately by clinics mentioning RT. Conclusions: Based upon clinics’ online profiles, RT comprises a substantial fraction of India’s ART business focus, clustering around its most tourist-friendly locales, and with a sense that surrogacy is a strong motivator for international clientele.
Status: Published in International Journal of General Medicine
Co-authors: Mirhad Loncar, Prinon Rahman, Sabrina Omar

Clinical Complaints Amongst Patients in a Guyanese Prison
Background: Incarcerated populations are at particular risk for developing specific health conditions. Prior studies of prisons in developing countries have focused on the threat of communicable diseases, though anecdotal evidence suggests that chronic conditions are of particular concern. This study constitutes the first published investigation of health complaints offered by residents of a prison in the South American nation of Guyana. Method: In 2010, a medical team sent by the Toronto non-governmental organization Ve’ahavta visited the Mazaruni prison in the interior of Guyana. Data on patient encounters was collected as part of the triage activity. Results: Care was given to 108 patients, staff and family members. Contrary to literature expectations, 50% of complaints concerned musculoskeletal issues, while only 11% were genitor-reproductive. Upon examination, 30.6% of patients were experiencing musculoskeletal problems, most commonly back pain. Conclusion: Future medical interventions to this and comparable low- and middle-income country prisons should more vigorously consider physiotherapeutic interventions, in addition to the expected addressing of infectious diseases.
Status: Published in Global Journal of Health Science
Co-authors: Jessica Lockhart, Brenna Mahony, Glenda Mindlin, Joanne Laine-Gossin, Nazmoon Audam, Louis Rel, Melissa Sissons, Bekkie Vineberg

Family physicians’ sharing of personal information on Facebook
Background: Online social networks, such as Facebook, are growing in popularity amongst physicians, and represent a potential avenue for the compromising of their privacy. To better gauge the potential for privacy violations, we sought to determine the extent to which Canadian doctors are sharing personal information on Facebook. Methods: From the website of the College of Physicians and Surgeons of Ontario, all 1000 family physicians active in the Ottawa region were identified. A catalogue was then created of subjects’ publicly shared information for those with accessible profiles on Facebook. Chi square and t-tests were performed to explore demographic patterns for those with viewable profiles, and a binary logistic regression was used to identify factors associated with Facebook visibility. Results: While only 10.2% of physicians had viewable profiles, 81.4% of those featured a visible profile photo; 91.2% could be messaged directly by any member of the public; a majority shared limited personal information, including recent online activities and place of education; 24% shared their place of work; 15% had visible lists of family members; and 14% disclosed their relationship status. From our regression analysis, there were no significant factors associated with whether a physician was viewable on Facebook. Interpretation: While a minority of physicians have a publicly accessible Facebook profile, those that do are sharing personal information that may expose them to fraud, identity theft, unwanted intrusions into their personal lives, and unexpected patient interactions outside of the office. Physicians should be aware of options for making their online information less publicly accessible.
Status: Published in British Journal of Medicine and Medical Research
Co-authors: Kamila Premji, Andrea Nwsou

Assisted Reproduction and Cross-Border Maternal Surrogacy Regulations in Selected Nations
Aims: To ascertain the laws and policies of selected high income countries, with respect to the disposition of their citizens seeking assisted reproductive technologies (ARTs) internationally. Study design: Literature review. Methodology: PubMed and Google of various ART terms with terms relating to regulations in the selected nations of Australia, Canada, New Zealand, the UK, the USA, and Israel. Results: All nations except the USA have a federal ART regulatory presence, distinguish between gestational and traditional surrogacy, and between paid and unpaid surrogacy. Policies concerning the repatriation of children produced by ART abroad vary widely. Conclusions: Heterogeneous regulations are one of the drivers of the global reproductive tourism industry. Domestic regulations are likely affected by both the values of a specific population and the needs of the industry.
Status: Published in British Journal of Medicine and Medical Research
Co-author: Andreea Bente

An analysis of Village Health Worker training for postpartum hemorrhage in rural Maharashtra
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide and accounts for significant postpartum mortality in Indian hospitals. The PPH mortality rate is likely greater among rural Indian populations where most women deliver at home accompanied by unskilled birth attendants or family members unless a Village Health Worker is available. Village Health Workers both receive and facilitate training at a Comprehensive Rural Health Project in Maharashtra, India. By analyzing the perspectives of Village Health Worker/Trainers, we aimed to assess Village Health Worker knowledge and generate recommendations to guide the creation of similar programs in other low-resource areas. Responses from three focus groups of six Village Health Worker/Trainers each were examined using content analysis. Participants displayed strong content retention with respect to clinically relevant knowledge. Village Health Workers experienced barriers, including lack of education and casteism, which affected their ability to establish trust in the community. Clinical observation was identified as the most effective teaching method and is thus recommended to teach PPH-related topics to Village Health Workers. When implementing this training model in comparable communities, local culture and its impact on establishing trust is an important factor to consider.
Status: Published in International Journal of General Medicine
Co-authors: Wynn Peterson,Shoba Arole, Ramaswamy Premkumar

28. Characteristics of a transcultural ethical framework for cross-border reproductive tourism: insights from existing studies
Reproductive tourism is the act of crossing an international border to seek assisted reproductive services, which can include maternal surrogacy. Ethical analyses of this phenomenon may be poorly served by considering the Western liberal framework alone. In previous studies, we identified 16 domains of ethical interest arising from this industry. In this paper, we sought perspectives in the scholarly literature that inform the development of an alternative to the Western liberal framework, incorporating more communalistic values that were then applied to the pre-identified domains. We concluded that a hybrid Western-communalistic framework, appropriate for helping to guide ethical analyses of reproductive tourism, incorporates an encouragement of third-party advocates to overcome power gaps between pertinent actors, and assumes the existence of a universal morality, such that a uniform standard of care can be expected regardless of cultural context.
Co-author: Sarah Taber
Status: Published in British Journal of Medicine and Medical Research

Factors Influencing Guyanese Health Worker Migration to Canada
Background: For years, Canada has benefited from the immigration of health care workers from Caribbean nations, which may have resulted in a service deficit in the source country, in terms of both economy and the presence of human capital ; this is known as the medical brain drain. Objectives: We sought to identify experiences, attitudes, and push and pull factors pertaining to Guyanese health care workers who migrated to, and studied and/or worked in Canada. Methods: A purposeful sample of 7 Guyanese health care worker expatriates now living in Canada was drawn from private networks. In-person and phone interviews were conducted with respondents. We applied content analysis to identify themes relating to respondents’ motivations and experiences in migrating, with two raters independently identifying relevant themes. Results: Push and pull themes identified include the existence of a champion who encouraged migration and/or retention, family connections, perceived responsibilities to the country left behind, remuneration, opportunities for self and children, and most commonly opportunities for further education and career advancement based upon merit. Conclusion: The desire of migrants to maintain constructive contact with the source country might be leveraged to Co-author: Helena Bleekerempower capacity-building enterprises.
Status: Published in University of Toronto Medical Journal

A Piece of the Pie: An Analysis of Canadian Federal Funding for Research on Autism Spectrum Disorder
Background: The objective of this study was to examine the nature of Canadian public funding, in terms of dollars expended by the Canadian Institute for Health Research (CIHR), for Autism Spectrum Disorder (ASD) research. We analyzed expenditures by theme, geographical region (country and province-level), research institution, CIHR Institute, and fiscal year in terms of both the total number and the dollar amount of grants. Methods: We searched the CIHR Funded Decisions database to identify federal-funded grants with a direct focus on ASD research. Data from the search results were exported to Microsoft Excel for analysis. Two reviewers independently assessed the titles and abstracts of each funded project for relevance. Of the initial 329 research grants, 139 were excluded. The remaining 190 grants were examined for topic, funding category, dollar amount, geographical location, and payee institution. Results: From 1999 – 2012, 186 ASD research grants wort $36, 515,109 were funded by CIHR. A plurality was allocated to biomedical research (43% of grants, 46% of dollars), followed by clinical research (27% and 41%), social/cultural/environmental/population health research (12% and 3%), and health systems/services research (10% and 7%). Foreign countries (USA and UK) received 8% of the grants. Provincial distribution revealed that Ontario, Quebec and British Columbia received a disproportionate amount of grants (77% of total). Of the 57 research institutions that were awarded funding, McMaster University and the University of British Columbia received the most dollars (10% and 9%, respectively). Temporal trends showed that while the most number of grants were awarded in fiscal year 2009, the highest amount of ASD funding was given in 2003. Conclusions: ASD research funding in Canada is clustered in a handful of provinces and institutions, and disproportionately favours basic biomedical research, while disfavouring programs and projects focused on social and behavioural interventions, adaptation, and institutional response. Temporal trends suggest that the preference for funding biomedical research has been to the detriment of clinical research funding. A reassessment of funding priorities may be in order to better balance Canada’s ASD research profile.
Status: Published in Autism Research and Treatment
Co-authors: Erin Liu, Ben Kolisnyk, Anne Konkle

Demographic Profile of Travellers Seeking Reproductive Tourism Services
Reproductive medical tourism is by some accounts a multibillion dollar industry globally. Transnationally, it involves the travel between nations of individuals seeking assisted reproductive technologies in foreign countries. Through a structured literature review, we identified the demographic characteristics of those seeking these services. Data from 14 peer-reviewed studies were synthesized. Most studies described travel within Europe, with Belgium being the destination most often cited. Key findings include that those travelling for reproductive purposes are typically over 35 years of age, likely to self-identify as homosexual, bisexual or transgendered. The most frequently mentioned reason for travel was the lack of appropriate services in the home country.
Status: Published in British Journal of Medicine and Medical Research
Co-author: Samantha DiRaimo

Shifting The Birth Weight Paradigm
Birth weight is one of the most important indicators of overall infant health and likelihood of long-term survival. Traditionally, population health researchers have dichotomized this indicator, with the cut-off at so-called “low birth weight” (LBW), defined as those with less than 2,500 grams of mass, and “normal birth weight” for anything exceeding this cut-off.1 LBW has proven to be a useful statistic in a host of population health analyses, from indicating health system performance to predicting health trajectories for individual babies. But a focus on LBW may have taken our attention away from other health concerns associated with other points along the birth weight spectrum. In this paper, we argue that more attention should be paid to those births at the other end of the weight scale, now termed large for gestational age, or LGA, births, which are commonly the result of fetal macrosomia.
Status: Published in Health Science Enquiry
Co-author: Louay Khir

The epidemiology of ophthalmological disease among school age children in rural India
Preventable blindness is one of the primary health concerns in rural India, yet little is known about the prevalence of eye disease among India’s school-age children. The clinical database of the Srikiran Institute of Ophthalmology, which describes clinicians’ visits to schools in Kakinada, India, was analyzed retrospectively to determine the prevalence of eye disease among 8488 students aged 18 years and younger. Basic refractory impingement, including degrees of astigmatism, was most prevalent, followed by squinting. Vitamin A deficiency was not a factor in any of the tested subjects.
Status: Published in Interdisciplinary Journal of Health Sciences
Co-authors: Clive Velkers, MacKenzie Turpin

HSS Buddy Program: Evaluation of its First Year
In the 2011-2012 academic year, the HSS Buddy Program pilot project was implemented in the Interdisciplinary School of Health Sciences at the University of Ottawa. Intended to address rising student anxiety levels, the program teamed freshmen (first year) students with groups of older students to promote more instances of casual social interaction. Participants’ perceptions of the program were universally positive in terms of its enjoyability, usefulness, and relevance to student needs. Suggested improvements include recruiting of more male participants, liaising with school administrators to help avoid scheduling conflicts, starting the program earlier in the academic year, and forming social groups with fewer students. Overall, the approach undertaken by the Buddy Program was seen to be a valuable one worthy of continuation and growth.
Status: Published in Interdisciplinary Journal of Health Sciences
Co-authors: Mostafa Abdul-Fattah, Rita Hafizi, Hiba Abdul-Fattah, Sonia Gulati

Economic trends and organ donation rates in the USA: an ecological analysis
The ecological association between several economic indicators and organ donation rates in the USA were examined for the years 1998 to 2012.  A strong, positive correlation was identified between GDP per capita and all organ donation rates, except for heart donation, for which a strong, negative correlation was found.  These results suggest that economic downturns may be associated with reductions in organ availability.
Status: Submitted to Global Journal of Health Sciences
Co-authors: Margaret Frere

 

2. On-Going Projects

Trauma Among Child Survivors of The Sri Lankan Tsunami and Civil War
Co-authors: Suvendrini Lena, Rachael Braund

Computing the number of excess deaths avoided by vaccination in the past 100 years
Co-authors: Eric Ho, Emma Thurston

The Politicization of Science
Co-authors: Arif Jinha

Climate Change in Guyana
Objectives: It is known that climatic changes will affect vulnerable communities in differential manners, depending upon nations’ geography, population, infrastructural development and wealth. This study was conducted to determine the likely health effects of global Climate Change on the Caribbean nation of Guyana, which is known to be the second poorest country in the Western hemisphere. Methods: A structured literature review was conducted, using selected conjugated search terms. Results: Thirteen peer-reviewed studies satisfied our search criteria. The themes describing likely health impacts were: dengue and malaria, other infectious diseases (i.e., schistosomiasis, chagas, leishmaniasis, diarrheal diseases), flooding/waterborne illnesses, food and water shortage, and respiratory issues. Conclusions: Unlike other parts of the developing world, where Climate Change impact is effected through economic forces, water shortage and agriculture change, Guyana’s small population and high resource wealth makes it most vulnerable to direct effects and disease vectors. There is little to no publication activity around the potential for systemic and economic forces to also be affected.
Co-author: Nadine Overhoff, Karine Landry, Patrick Saunders-Hastings

Ethics Education for OB-GYN Residents
Co-author: Jessica Chippior

Ecological Comparison of Temporal Trends in Edentulism and GDP in Selected US Regions, 1997-2011
Co-author: Carissa DuPuis

Comparison of Economic and Health Trajectories of BRIC Nations
Co-authors: Zing-Wae Wong, Saurav Barua, Sarah Bowers, Iryna Borzilova

Modelling the Threat of an Extraterrestrial Epidemic
Co-author: Stefan Litvenjenko

Can India Sustain an Emergency 911 Service?
An emerging economic force, India is yet unable to organize its emergency response process well enough to service large numbers of neighbourhoods. This paper attempts to explore factors that impede such a process, and makes recommendations of how to proceed.
Co-authors: Setareh Rouhani

Moralism in Public Health
The extent to which public agencies issue behavioural recommendations in the wake of medical threats does not appear to be evidence based, but varies with public perception of risk and with lobbying efforts. Case studies include safe sex messaging versus safe driving messaging.

Dating Site Stats
Free online dating sites, such as plentyoffish.com, represent a trove of epidemiological data. Using the sites’ own public search engines, demographic comparisons can be made between the online dating population and the actual base population.
Co-authors: Myriam Saboui

Economic Analysis of the Burden of Preventable Blindness in India
Co-author: Amal Popat

Ethics Education Among Oncology Residents
Co-author: Jessica Silva

Peer-Reviewed Publishing Activity in Selected Nations
Co-author: Ghayath Janoudi

Can We Predict the Winner of “The Biggest Loser”?
Co-author: Daniella Kachur

Literature Review of Barriers fo Implementing Contraception Programs in India
Co-author: Vanora D’Sa, Katherine LeMay

The Future of Global Health
Co-author: Nicole Haywood, Sarah Newell

 

3. Stalled or Abandoned Projects

Folding Health Into Canada’s Official Climate Change Agenda
Increasingly, Canadian policymakers are recognizing that Climate Change must take a central seat in almost every electoral and policy platform emerging in the new century. The November 2006 paper in Policy Options magazine, by Liberal Party strategist John Duffy, titled “Climate change – the great national governance issue of the 21st century“, underlined this truth. The extent to which health must be closely integrated into such policies must now be considered and advocated.
Co-authors: Nerehis Tzivanopoulos, Jan Jablonski, Lauren Easton

Family Doctors Engaged in Reproductive Technology
Funded by AHRC, a survey of Canadian family doctors was undertaken to determine their activities that might be considered “artificial reproductive technology”. A regression analysis was performed to determine which factors doctors are most likley to engage in.
Status: grounded due to legal restrictions
Co-authors: Nicholas Barrowman, Ed Hughes

Training Program on Infectious Diseases for Medical Students at University of Guyana
Co-authors: Bill Cameron, Karam Ramotar, Paul MacPherson, Mark Tyndell

Contaminants in Water Supply of Residents of Upper Mazaruni in Guyana
Water samples taken from four locations in the upper Mazaruni were tested for heavy metal contamination.
Co-authors: James Gomes, Anne Konkle, Glenda Mindlin, Nazmoon Audam, Melissa Sissons, Louis Rel, Jessica Lockhart, Joanne Laine-Gossin

Barriers Faced by Refugee and Immigrants to Accessing Child Health Services in Ontario
Co-authors: Nicholas Barrowman

The Impact of the 2009 Global Economic Crisis on International Health
Media focus on the GEC has predominantly focused on the plight of developed nations, primarily home owners and certain manufacturing industries. There is an increasing appreciation for the specific and dramatic impacts of the crisis on the health of the world’s most vulnerable populations. This paper attempts to itemize those impacts and projects short- and longterm developments.

Factors Associated With Seeking Reproductive Tourism Services

Factors associated with positive ophthalmological outcome among mobile care patients in Andrah Pradesh, India
Co-authors: Asha Gajaria, Jessica Silva
Follow-up: Revised CIHR operation grant submitted (March, 2011). Co-authors: Nick Barrowman

Computing Excess Deaths Saved by Investing Public Health Monies in Traffic Control
Every year Canada invests millions of dollars in public health projects in key nations, often with poor outcome analysis. If the desired outcome can be reduced to the minimization of excess deaths, then would the re-tasking of all those funds toward traffic control result in greater performance? A case study is needed, probably in a Caribbean locale, like Trinidad.

Book: Health and Development in the New India
Co-authors: Sonia Gulati, Sanni Yaya

Developing Video-Based Skills Enhancement Products for Clinicians in the Caribbean
Co-authors: Paul McPherson, Karam Ramotar, Louise Balfour, Sabrina Persaud

Barriers to addressing child/youth mental health issues in LMICs

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