Presenting your Research
Dr. CHLOE JOYNT
cjoynt@ualberta.ca
WCHRI Lunch and Learn
2014
Dr. SARAH CURTIS
s c u r t i s @ u a l b e r t a . ca
Today we will go over…
 What to remember when designing
 What to remember when presenting
 Oral presentation
 Oral Critique ( Interactive Exercise)
 Poster presentation and Interactive Exercise
Presenting …make it matter
 You worked really hard for these results!
 What main results do you want to emphasize
 What’s the one or two points you want them to remember
 Why should they care?
 How is it relevant to your audience - Story?
 How will YOU reach them
 Engage / incite/ educate/ entertain
Tell them what you’re going to tell them….
Tell them ….. Tell them what you told them
Earn their enthusiasm and trust
 Good research can be presented badly - or well
 However, you are not selling lawn furniture
 You are engaging thoughts...Don’t be too technical or flashy
 Genuine Enthusiasm is contagious – spark their enthusiasm
 Critical/ thoughtful appraisal of your work and
related work will earn trust of audience

Know your stuff (literature) and your slides/poster
Getting Started…
 Before you start THINK about






Your Audience
Creating your slides or poster
How you communicate your findings
What questions you will anticipate
How can they get a hold of me later?
Anticipate what could go wrong?
Do your background checks
 How Long Do you Have?
 Instructions for Presentation (declaration/subsections)
 Who is your audience?
 Specialized / General
 Moderators
 Judged
 PubMED your moderators/ judges

people ask questions on things they know
 Dress to respect your audience
 Facilities and A/V Connections
The Oral Research Presentation
Your Slides
 Use powerpoint/ prezie/keynote .. Be familiar
 You control the slide.... Not visa versa
 Make a PDF Version as a back up
 NO sound effects
 NO crazy fade in/ blinky blinky
 “Transparency” can be helpful to emphasize the slide
and not too distracting
 Use headings and transitions
 (oral/text/pics)
Your Slides
 Use headings and transitions
 Minimize Amount of Text but need main points

People need to read and LISTEN to you
 Pictures are worth more than words
 Don’t use graphics/ scanned results no one can read

Ie “I know this is hard to see but....”
This is scary…..
Catecholamines
Ca2+
Ca Channel
α -AR
Gs
Adenylyl Cyclase
ATP
Gs
β -AR
AMP
cAMP
PDE
PKA
X
PLAMB
SR
Ca2+
Lusitropy
PKA
cAMP
PDE
AMP
X
Troponin
complex
Milrinone
Inotropy
Maybe not so bad…
Catecholamines
Ca2+
Ca Channel
α -AR
Gs
Adenylyl Cyclase
ATP
Gs
β -AR
AMP
cAMP
PDE
PKA
X
cAMP
PLAMB
SR
Ca2+
Lusitropy
PKA
PDE
X
Troponin
complex
Milrinone
Inotropy
AMP
Your Slides
 White/ Black background is jarring for eyes
 Use High Contrast writing and slides
 Use 20-24 point (at least)
 Use Serif Fonts – “feet” create eyesight line
 Minimize ALL CAPS – use for rare emphasis
 No Mach 3 Slides - comfort /conversation pace
Talking the Talk (Poster or Oral)
 Voice and tone - MAKE IT CLEAR
 Talk WITH/TO your audience not AT your audience
 Not too fast SLOW DOWN – conversation
 Avoid monotone - controlled genuine enthusiasm
 Avoid Um, Uh.... Silent pause is better
 A Tasteful Joke or two is OK
 Eye contact
 Look up > slides or paper
 Pick a few interested/ known people to “talk with”
Talking the Talk (Poster or Oral)
 Start on time, finish on time
 Practice Practice Practice ...then relax
 Use clear, accurate descriptions
 Get honest feedback
 Mirror – Practice with a stopwatch
 If nervous or English is not your first language
 Write out your presentation and read SLOWLY - memorize
 Have notes on Powerpoint/ etc (presenter view)
 Practice with English speaker
 Let your graphs/pictures do the work
Gestures and Pointer
 Gestures
 Oak without roots NOT a tumbleweed
 Straight up but move occasionally
 Hands out of pockets, change out of pockets
 If have a pocket mic – avoid dress without pocket – pager rule
 The pointer
 Pointer to highlight ..not a light saber
 Bring water
 Bring a watch/phone clock
Presentation Organization
 Now you are psyched up/ informed/organized
 Need to organize your research into a logical
presentation

Confirm Meeting Expectations
 Organized talk implies organized, respectable research
The Oral Presentation
 Title Slide
 Declaration/ Conflict of Interest (if needed)
 Background
 Relevance / Clinical / NICU application
 Research Question (Hypothesis)
 Study Design
 Results
 Conclusions/ Summary
 Limitations/ Future Presentation
 Acknowledgments/ Funding
 Back up Slides
If you have 9-10 minutes
 Does that include question period?
 Title/Introduction/Question should be 2-3 minutes
 Methods and Results – 5-6 minutes
 Conclusion/Further Directions 1-2 minutes
 Number of Slides
 How clearly you speak
 How quickly you speak
 Content of slides
Title Slide
 Large, “Easy to Read” Title - Informative
 Names of all Authors
 Affiliations, Positions, Institutions
 Event and Date
 +/- Granting Agencies (begin or end)
 First Impression - Something a little “exciting”
 Tailor for the audience
 Thank the Chair/audience for opportunity to present
 Introduce yourself, institution and your Title
Comparing the Hemodynamic Effects
of Milrinone, Epinephrine and
Dobutamine in a Swine Model of
Neonatal Asphyxia-Reoxygenation
Joynt CA*, Bigam D#, Cheung PY*.
Departments of Pediatrics* and Surgery#,
University of Alberta
Canadian Paediatric Society 84th Annual Conference
June 28, 2007
Jaime Blackwood
PGY 5 PICU Fellow
Dr Jon Duff
Dr Terry Klassen
Dr Chloe Joynt
Declaration Slide
 Check to see if required by the audience/ conference
 Any “competing interests”
 Ties to industry
 Also note that you may need permission to
reproduce other’s graphs and to display photos
Background – ZOOMING IN
 Start: General Description of the Important Principle
 Focus in on your area of research for that principle
 why your research bears importance in grand scheme of things
 Let’s audience know the scientific borders of your research
 Summarize BRIEFLY work done in area
 Illustrates work is relevant
 Demonstrates a hole in the literature that you are trying to fill
 Give credit where it is due – know the studies you quote
Relevance or Application
 Transition to Hypothesis or Research Question
 Tell a FOCUSED story (no more than 20-30 sec)
 Useful if it has basis in truth
 Tie it to clinical or interesting applicability
 Demonstrate one important message – Your Question
 Lack of research or resource you are going to provide
 Bench to bedside
 Clinical Query
Hanging out before rounds
Research Question and Hypothesis
 State it simply
 One Slide for Question
 One slide for Hypothesis (if needed)
 Don’t try to validate your hypothesis in gory detail at
this point ..that is what the rest of your presentation
is for
Clinical Question
Can milrinone treat a stunned heart, increased
vascular resistance and pulmonary
hypertension found in an asphyxiated
newborn… better/worse than epinephrine or
dobutamine?
Primary Research Question/
(can change easily to Hypothesis)
In a swine model of neonatal asphyxia-reoxygenation
will…
Epinephrine, dobutamine, and milrinone
Increase cardiac output
Increase systemic oxygen delivery
Have vasopressor effects with epinephrine & dobutamine
Have Less PHT aggravation with dobutamine and milrinone
Due to vasodilatory properties, will milrinoneDecrease vascular resistance
Increase regional flow and oxygen delivery
Study Design
 Detail is dependant on audience
 Keep it simple but informative
 In your head but not necessarily on a slide
Know how all the tests/procedures / process were done
 Know limitations of study design/methodology

 Simple, animated pictures with some text is easiest
 Talk around them
 Highlight (not light saber) important points of picture
 Dont gross out your audience with pics or “descriptive” words
 Don’t belabour this... “RESULTS” is what people want
Study Design – MED Trial
SHAM
CONTROL
6
EPINEPHRINE DOBUTAMINE
6
MILRINONE
6
6
Anesthesia and Instrumentation and Stabilize
Hypoxia – FiO2 0.08-0.15 (2h)
Reoxygenation – 100% (1h), 21% (3h)
Normal
Saline
infusion
Epinephrine
0.5
mcg/kg/min
Dobutamine
20
mcg/kg/min
2h
Milrinone
0.75
mcg/kg/min
Results
 Work through your results on piece at a time
 Summarize results of “section/question” before next results
 Don’t show “not relevant” results
 Leading them to your final conclusion
 You know the lingo and cerebral shortcut of your
research area and work ..... The audience does not


No shop talk
Clear explanation of what you are showing them
 Discuss YOUR results...don’t speculate or deviate
Pictures and Graphs
 Worth multiple pages of text
 Make it large, easy to see colors, SIMPLE
 Consistency – use same colors for same groups as you
go through graphs/charts


If using same figure multiple times – multiple slides/highlight
Don’t flip back and forth in presentation
 Remove information from figure not relevant to
presentation
Graphs- Pictures- Charts
 Orientate the audience – explain what’s measured,
groups, axis
 Well LARGE labelled axis or categories
 Summarize the main point of the graph – simple
steps not exquisite detail - verbal or written
 They can SEE the detail... They HEAR the main point
C a rd ia c In d e x
C o n tro l
240
E p in e p h rin e
D o b u ta m in e
220
M ilrin o n e
200
m l/kg /m in
180
end of
hypoxia
160
*
140
120
100
80
60
Treatment
40
0
100
Hypoxia
200
100% 02
300
21% 02
T im e (m in )
P< 0.05
M,E, D increased cardiac index vs control – ANOVA
S y s te m ic V a s c u la r R e s is ta n c e
0 .5
m m H g /m L /kg /m in
0 .4
*
0 .3
0 .2
0 .1
0 .0
C o n tro l
M ilrin o n e
D o b u ta m in e
E p in e p h rin e
Milrinone decreases SVRI compared to control * p <0.09
Stats
 Understand the stats that you used
 In case of questions
 Interpret the data correctly
 Highlight significant finds

Define significance
 Talk or show to statistician/ supervisor before
presenting
Summary and Conclusion
 Brief, concrete and to the point
 Simply state a concise major conclusion
 Decisive
 Keep less than three major points
 Should be derived from the data SHOWN
 Should directly address your previously stated research question
 CHECK back against your RESEARCH QUESTION SLIDE
 Zoom out
 Remind audience of how your research relates to a greater area

Limitations
 Demonstrate you know the scope of applicability
 Demonstrates situations were your work is valid
 (or may not be)
 Demonstrates insight and honesty
 Earns respect of audience
 Decreases number of questions
 If “Limitations” not part of the suggested format –
“back up slides”
Future Directions
 Where and why this can this be looked at further
 Demonstrate you can think of the next step
 May interest others to join you or contribute
suggestions to better your research
 Decreases number of questions
 If not part of the suggested format – “back up slides”
Acknowledgements
 List of names and granting agencies = BORING
so use….
 Pictures – you can generalize


Lab staff or colleagues
Granting agencies that made this work possible
 Thank your supervisor(s)
Thank you
DR. BIGAM
DR. CHEUNG
JUDI
Dennis and Elle
CORINNE
Zak, Mohammed, Grace
Thanks/Invite Questions
 Opportunity for one last impact picture
 Thank the audience for their time/attention
 Invite Questions
 Don’t step on moderator toes if there is one
Why we do all this stuff….
Questions
Answering Questions
 +/- moderator
 Repeat or summarize the question
 Audience can hear, clarify question for yourself, time to think
 Politely interrupt the “expert”/ don’t pick a fight
 “May I clarify... Are you asking...”
 “Perhaps we can agree to disagree on this point- discuss later”
 Break up the “2 part” question
 Answer the question concisely, politely with grace
 Acknowledge a good question or thought
 Admit graciously if you don’t know – “interesting concept”
“Back Up Slides- Example Topics”
 Anticipate Questions you will receive
 Know your audience
 Mechanism of drugs
 Unshown related data
 Quoted studies - summary
 Applicability to medicine
 Relevance of technique or model used
 Limitations/future directions
In summary
 Do your homework/ read instructions/ be prepared
 Practice and speak slowly
 Plan it out ahead
 What is your main point
 How will you get the audience to your point
 Keep things simple and relevant
 Be enthusiastic, polite and knowledgeable
Thank you!!
Questions
Now that you are experts…
Let’s Practice….
Please evaluate the following Speaker ……….
Producing an
Academic Poster
An Effective Poster:
 Visual logic
 Graphical
 The message – title, headings and
graphics
 Relative importance of elements
graphically
An Effective Poster:
 Shows & guides
 Reader gravity
 Readable 6 feet
 Avoids visual chaos
An Effective Poster:
 Minimizes text - use images and graphs instead
 Use phrases rather than full sentences
 Keep text elements to 50 words or fewer
 Use an active voice
 Avoid jargon
 Left-justify text; avoid centering/right justify
Please note: This slide has too much text! I
could have been more brief and made the exact
same points with better overall effect!
Simple messages are more
memorable
Preparation
 Design
 Content
 Delivery
Design: Planning
 Look up the poster format AHEAD of time
 Allowed poster size
 Printer/program format
 Borders and/or colors – institution template?
 When do you have to send to printer ?
Design: Print Layout
 Design your poster at the actual size that it going to be
printed.
 42”or 60” max width
 300 ppi resolution
 Go to printing website to get the scope.
 AICT: https://lfp.srv.ualberta.ca/login.php
 SUBPrint:
http://www.su.ualberta.ca/businesses/subprint/printing/
Design: Poster Templates
• Through WCHRI
• AICT: https://lfp.srv.ualberta.ca/login.php
• http://www.toolkit.ualberta.ca/Toolkit%20Downloa
ds/Templates/PosterPresentations.aspx
Content
 Title
 Background
 Research Question
 Methods
 Results
 Discussion
 Conclusion
 How can you most
clearly convey your
results?
Most people will only read the title!
Give the key message in the title!
 The Effect of Substance A on Protein B
OR
 Substance A Inhibits Production of Protein B
Content: Title
Most people will only read
the title!
Pose a question ?
 The effect of interval simulation exercises on
clinician performance.
OR
 Can interval simulation exercises improve
clinician performance?
Content: Graphics
 Flow diagrams
 Charts & Graphs
 Tables - last resort!
 Clear title
 Label the axes
 Units
http://www.smashingmagazine.com/2007/08/02/data-visualization-modernapproaches/
Content: Font Style
 This sentence is typed in Times New Roman
 This sentence is typed in Arial
Use sans serif: Arial, Helvetica or Calibri
Consider bold, bold italics for occasional effect
Avoid too many underlines
Content: Font Size
Title:
85-120 pt
 Subheadings: 30-32 pt
 Body: 24-28 pt
 Captions
18 pt
Content: Colors
 Contrast light background & dark text
 Avoid dark background & light text
 Theme of 2-3 colours maximum!
 Use consistent pattern
 Avoid tricky color combinations – red/greenespecially on graphics
 Use color wheels- http://kuler.adobe.com
Delivery
 Set up early (pushpins?)
 Poster canister
 Business cards & mini posters
 Supplementary information
 Plan a 2-5 minute tour; Q & A time
 Body language and dress neatly
Delivery:
 Is there a formal oral presentation?
 Practice
 Know your audience
 Be enthusiastic, polite and knowledgeable
 Speak slowly
Delivery:
 Face your audience
 Tell them the context
 Identify the big problem
 Explain why the problem is important
 Tell them:
 What you did to answer it
 What the answer is
 What the answer means
Poster Critiques
CHILDHOOD FRACTURES APPEAR TO BE HERITABLE:
A Genetic Epidemiology Study
Sarah Curtis1
MD, FRCPC •
1Dept.
Pat Parfrey2
MD, FRCPC •
Tracey Bridger2
MD, FRCPC •
Ben Vandermeer1
INTRODUCTION:
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p
a
r
e
d
u
s
in
g
t
h
e
s
t
u
d
e
n
tT
t
e
s
t!
!C
a
t
e
g
o
r
ic
a
lv
a
r
ia
b
le
sa
s
s
e
s
s
e
d
u
s
in
g
F
is
h
e
r
's
e
x
a
c
tt
e
s
t
!
!T
h
e
K
r
u
s
k
a
lW
a
llis
t
e
s
tw
a
s
u
s
e
d
f
o
ro
r
d
in
a
ld
a
t
a
.!
!M
u
lt
iv
a
r
ia
t
e
lo
g
is
t
ic
r
e
g
r
e
s
s
io
n
u
s
e
d
t
o
e
v
a
lu
a
t
e
m
u
lt
ip
le
v
a
r
ia
b
le
s
a
n
d
e
f
f
e
c
to
n
p
r
o
b
a
b
ilit
y
o
ff
r
a
c
t
u
r
e
!
!O
d
d
s
R
is
k
o
ff
r
a
c
t
u
r
in
g
w
a
s
c
a
lc
u
la
t
e
d
!
!
RESULTS:
Overview of Enrollment and Results
Overview
184
Report Forms
Distributed
(90 % Return)
Cases: H
e
a
lt
h
y
c
h
ild
r
e
n
p
r
e
s
e
n
t
in
g
w
it
h
f
r
a
c
t
u
r
e
Controls: F
r
a
c
t
u
r
e
f
r
e
e
h
e
a
lt
h
y
c
h
ild
r
e
n
!
!
Intervention: P
a
r
t
ic
ip
a
n
t
s
a
n
d
p
a
r
e
n
t
s
w
e
r
e
a
s
k
e
d
t
o
c
o
m
p
le
t
e
a
r
e
p
o
r
tf
o
r
m
Not Returned
19
a
b
o
u
tt
h
e
irm
e
d
ic
a
la
n
d
f
r
a
c
t
u
r
e
h
is
t
o
r
y
in
c
lu
d
in
g
in
f
o
r
m
a
t
io
n
r
e
le
v
a
n
tt
o
r
is
k
f
a
c
t
o
r
s
f
o
rf
r
a
c
t
u
r
e
.
!
Incomplete
15
Sampling methods:
Fractures
79
Controls
71
47 % Parents Fractured
74/158
31% Parents Fractured
44/142
Exclusion Criteria
C
h
r
o
n
ic
d
is
e
a
s
e
!
M
e
d
ic
a
t
io
n
s
s
u
c
h
a
s
O
C
P
,S
t
e
r
o
id
s
!
S
m
o
k
in
g
/A
lc
o
h
o
l!
P
r
e
v
io
u
s
h
is
t
o
r
y
o
ff
r
a
c
t
u
r
e
f
o
rc
o
n
t
r
o
lg
r
o
u
p
!
J
u
ly
&
A
u
g
u
s
to
f2
0
0
1
2
0
0
4
(t
o
t
a
l6
m
o
n
t
h
s
)
!
Ethical Approval: T
h
e
H
u
m
a
n
I
n
v
e
s
t
ig
a
t
io
n
C
o
m
m
it
t
e
e
(
M
U
N
)
!
If Father
Fractured
2.1
1.03 - 4.32
0.036
1.8
0.96 - 3.5
0.46
If Both Parents
Fractured
Mother
Fractured
30/79 (38 %)
Father
Fractured
43/79 (54%)
If Either Parent
Fractured
3.0
1.1 - 8.02
0.020
2.1
0.99 - 4.8
0.05
If Neither Parent
Fractured
0.5
0.24 – 0.93
0.0 4
Percentage of Parents Fractured for Cases vs. Controls
Mothers Fractured
Fathers Fractured
Both Parents Fractured
Either Parent Fractured
Neither P arent Fractured
Cases
Controls
38 %
54%
22%
71%
29%
23%
39%
9%
54%
46%
Baseline Characteristics and Risk Factor Comparisons
Age (years)
Activity (hrs/day)
Sleep (hrs /day)
Sunlight (hrs/week)
Calcium (mg/day)
Cola (drink/day)
Force estimate (0 -3)
Male
Cases
Controls
9.1
10.1
9.1
24.2
1550
0.4
2
63%
8.5
10.3
8.5
23.7
1559
0.3
2
52%
SUMMARY
! This study provides important evidence supporting the need to further
investigate the genetic basis of common childhood fractures.
Inclusion Criteria
! C
h
ild
r
e
n
a
g
e
d
0
1
6
y
r
s
!
! C
lin
ic
a
lly
d
o
c
u
m
e
n
t
e
d
f
r
a
c
t
u
r
e
f
o
rc
a
s
e
s
!
!
If Mother
Fractured
! Childhood fractures appear to be heritable, a feature which is
independent of the environmental risk factors for fracture.
Complete Report Forms
150
!
! P
o
t
e
n
t
ia
ls
t
u
d
y
s
u
b
je
c
t
s
w
e
r
e
id
e
n
t
ifi
e
d
b
y
t
h
e
e
m
e
r
g
e
n
c
y
n
u
r
s
e
s
!
! R
e
s
e
a
r
c
h
e
rn
o
t
ifi
e
d
!
! C
o
n
s
e
n
ts
ig
n
e
d
,in
f
o
r
m
a
t
io
n
p
a
c
k
a
g
e
a
n
d
r
e
p
o
r
tf
o
r
m
g
iv
e
n
t
o
c
o
m
p
le
t
e
/p
o
s
t
b
a
c
k
!
!
Odds Ratios
95 % CI
P Value
!D
a
t
a
e
x
t
r
a
c
t
e
d
f
r
o
m
r
e
p
o
r
tf
o
r
m
s
-e
n
t
e
r
e
d
in
t
o
M
S
A
c
c
e
s
s
d
a
t
a
b
a
s
e
b
y
r
e
s
e
a
r
c
h
e
r
!
!
!
MD M.Sc. FRCPC
Odds Ratios for Fracture Based on Parental History of Fracture
7
1
in
e
a
c
h
g
r
o
u
p
!
Study Population: C
h
ild
r
e
n
(
0
1
6
y
e
a
r
s
)
;n
o
c
h
r
o
n
ic
d
is
e
a
s
e
;N
L
!
Study Dates:
and Proton Rahman2
!
S
t
.J
o
h
n
s
,N
L
!
!
!
!
!
!
M.Sc.
of Pediatrics, Stollery Children s Hospital • 2Dept. of Pediatrics, Janeway Children's Hospital, Memorial University of Newfoundland, St. John's, NL, Canada
Mother
Fractured
16/71(23%)
Father
Fractured
28/71 (39%)
FUTURE CONSIDERATIONS
! Further expansion of this study with increased sample size, the addition
of bone mineral density tests and serum markers of bone metabolism is
warranted.
! This may also provide important evidence supporting the undertaking of
genetic linkage studies to further understand fracture susceptibility.
ACKNOWLEDGEMENTS
Janeway Research Foundation for financial support
Samra Mian & Sarah Matheson for data entry
RP Evans for technical support
!
Positives: Fairly easy on text with bulleted methods section. Title is big and tells the main point of the research. Has a flow
diagram. Has logos and authors.
Negatives: The ‘reader gravity’ could be improved by using same sized background boxes- top to bottom and left to right
reading. Number the order of sections. The last 3 sections are hard to see clearly- better placed in similar background box. Cut
out some of the introducion text further. Change to a more sensible font. Graphics for results would have been easier for the
reader.
Positives: Fairly easy on text with bulleted methods section. Title is big and tells the main point of the
research. Has a flow diagram. Has logos and authors. Nice colors.
Negatives: The ‘reader gravity’ could be improved by using same sized background boxes- top to bottom
and left to right reading. Number the order of sections for correct flow. The last 3 sections are hard to see
clearly- better placed in similar background box. Cut out some of the introducion text further. Change to a
more sensible font.
Positives: Title is big and tells the main point of the research. Section titles are clear. Pictures create
interest. Logos present. Nice colours.
Negatives: A bit jarring visually! The ‘reader gravity’ needs improvement- same sized background
boxes- top to bottom and left to right reading. Number the order of sections as it is difficult to know which
way to read for this story. Cut out lots of text! Use bulleted points more.
Giving an Effective Poster Presentation
http://www.youtube.com/watch?v=vMSaFUrk-FA
CONSORT 2010 Flow Diagram
Enrollment
Assessed for eligibility (n= )
Excluded (n= )
Not meeting inclusion criteria (n= )
Declined to participate (n= )
Other reasons (n= )
Randomized (n= )
Allocation
Allocated to intervention (n= )
Received allocated intervention (n= )
Allocated to intervention (n= )
Received allocated intervention (n= )
Did not receive allocated intervention (give
reasons) (n= )
Did not receive allocated intervention (give
reasons) (n= )
Follow-Up
Lost to follow-up (give reasons) (n= )
Lost to follow-up (give reasons) (n= )
Discontinued intervention (give reasons) (n= )
Discontinued intervention (give reasons) (n= )
Analysis
Analysed (n= )
Excluded from analysis (give reasons) (n= )
Analysed (n= )
Excluded from analysis (give reasons) (n= )
CHILDHOOD FRACTURES APPEAR TO BE HERITABLE:
A Genetic Epidemiology Study
Sarah Curtis1 MD, FRCPC • Pat Parfrey2 MD, FRCPC • Tracey Bridger2 MD, FRCPC • Ben Vandermeer1 M.Sc. and Proton Rahman2 MD
1Dept.
INTRODUCTION:
C
h
ild
h
o
o
d
fr
a
c
tu
r
e
s
a
r
e
c
o
m
m
o
n
,a
s
ig
n
ifi
c
a
n
tc
a
u
s
e
o
fm
o
r
b
id
ity
a
n
d
a
r
e
c
o
s
tly
to
s
o
c
ie
ty
.T
h
e
y
a
r
e
m
u
ltifa
c
to
r
ia
lin
o
r
ig
in
a
n
d
r
e
s
u
lt
fr
o
m
th
e
im
b
a
la
n
c
e
b
e
tw
e
e
n
c
o
m
p
le
x
itie
s
o
fb
o
n
e
s
tr
e
n
g
th
a
n
d
tr
a
u
m
a
.B
o
th
b
o
n
e
m
in
e
r
a
ld
e
n
s
ity
(
B
M
D
)a
n
d
th
e
c
o
m
p
le
x
m
ic
r
o
a
r
c
h
ite
c
tu
r
a
lp
r
o
p
e
r
tie
s
o
fb
o
n
e
d
e
te
r
m
in
e
b
o
n
e
s
tr
e
n
g
th
.A
d
u
lta
n
d
p
e
d
ia
tr
ic
s
tu
d
ie
s
h
a
v
e
n
o
te
d
th
a
tp
a
r
e
n
ta
lh
is
to
r
y
o
ffr
a
c
tu
r
e
a
n
d
p
r
e
v
io
u
s
fr
a
c
tu
r
e
c
o
n
fe
ra
n
in
c
r
e
a
s
e
d
r
is
k
o
ffr
a
c
tu
r
e
in
d
e
p
e
n
d
e
n
to
f
B
M
D
.T
h
e
im
p
o
r
ta
n
c
e
o
fg
e
n
e
tic
fa
c
to
r
s
in
c
h
ild
h
o
o
d
fr
a
c
tu
r
e
s
h
a
s
n
o
ty
e
tb
e
e
n
e
v
a
lu
a
te
d
.!
OBJECTIVES:
T
o
d
e
te
r
m
in
e
ifa
fa
m
ilia
lte
n
d
e
n
c
y
to
fr
a
c
tu
r
e
e
x
is
ts
.!
T
o
a
s
s
e
s
s
th
e
r
e
la
tiv
e
r
o
le
o
fe
n
v
ir
o
n
m
e
n
ta
lfa
c
to
r
s
in
d
e
te
r
m
in
a
tio
n
o
ffr
a
c
tu
r
e
r
is
k
.
METHODOLOGY:
Design: C
a
s
e
c
o
n
tr
o
ls
tu
d
y
!
Setting: P
e
d
ia
tr
ic
E
m
e
r
g
e
n
c
y
D
e
p
a
r
tm
e
n
t,J
a
n
e
w
a
y
C
h
ild
r
e
ns
H
o
s
p
ita
l,!
STUDY DATA:
Sample Size:
Odds Ratios for Fracture Based on Parental History of Fracture
7
1
in
e
a
c
h
g
r
o
u
p
!
!
Report Form:
!D
e
s
ig
n
e
d
b
y
p
r
im
a
r
y
r
e
s
e
a
r
c
h
e
r
!
! In
fo
r
m
a
tio
n
o
n
d
ie
t,a
c
tiv
ity
,s
le
e
p
s
u
n
lig
h
te
x
p
o
s
u
r
e
,s
ta
n
d
a
r
dm
e
d
ic
a
lin
fo
r
m
a
tio
n
!
!F
o
r
c
e
e
s
tim
a
te
d
o
n
a
3
p
o
in
ts
c
a
le
(
1
m
ild
,2
m
o
d
e
r
a
te
,3
s
e
v
e
r
e
)fr
o
m
d
e
s
c
r
ip
tio
n
o
fe
v
e
n
ts
!
!
Handling:
!
Analysis:
!U
n
iv
a
r
ia
te
a
n
a
ly
s
is
c
o
m
p
a
r
e
d
g
r
o
u
p
s
o
nd
e
m
o
g
r
a
p
h
ic
s
,g
e
n
e
tic
a
n
d
e
n
v
ir
o
n
m
e
n
ta
lr
is
k
fa
c
to
r
s
!
!C
o
n
tin
u
o
u
s
v
a
r
ia
b
le
sc
o
m
p
a
r
e
d
u
s
in
g
th
e
s
tu
d
e
n
tT
te
s
t!
!C
a
te
g
o
r
ic
a
lv
a
r
ia
b
le
sa
s
s
e
s
s
e
d
u
s
in
g
F
is
h
e
r
's
e
x
a
c
tte
s
t!
!T
h
e
K
r
u
s
k
a
lW
a
llis
te
s
tw
a
s
u
s
e
d
fo
ro
r
d
in
a
ld
a
ta
.!
!M
u
ltiv
a
r
ia
te
lo
g
is
tic
r
e
g
r
e
s
s
io
n
u
s
e
d
to
e
v
a
lu
a
te
m
u
ltip
le
v
a
r
ia
b
le
s
a
n
d
e
ffe
c
to
n
p
r
o
b
a
b
ility
o
ffr
a
c
tu
r
e
!
!O
d
d
s
R
is
k
o
ffr
a
c
tu
r
in
g
w
a
s
c
a
lc
u
la
te
d
!
!
RESULTS:
Overview of Enrollment and Results
Overview
184
Report Forms
Distributed
(90 % Return)
Study Population: C
h
ild
r
e
n
(
0
1
6
y
e
a
r
s
)
;n
o
c
h
r
o
n
ic
d
is
e
a
s
e
;N
L
!
!
Cases: H
e
a
lth
y
c
h
ild
r
e
n
p
r
e
s
e
n
tin
g
w
ith
fr
a
c
tu
r
e
Controls: F
r
a
c
tu
r
e
fr
e
e
h
e
a
lth
y
c
h
ild
r
e
n
!
!
Intervention: P
a
r
tic
ip
a
n
ts
a
n
d
p
a
r
e
n
ts
w
e
r
e
a
s
k
e
d
to
c
o
m
p
le
te
a
r
e
p
o
r
tfo
r
m
Not Returned
19
a
b
o
u
tth
e
irm
e
d
ic
a
la
n
d
fr
a
c
tu
r
e
h
is
to
r
y
in
c
lu
d
in
g
in
fo
r
m
a
tio
n
r
e
le
v
a
n
tto
r
is
k
fa
c
to
r
s
fo
rfr
a
c
tu
r
e
.!
Incomplete
15
Sampling methods:
Fractures
79
Controls
71
47 % Parents Fractured
74/158
31% Parents Fractured
44/142
Exclusion Criteria
C
h
r
o
n
ic
d
is
e
a
s
e
!
M
e
d
ic
a
tio
n
s
s
u
c
h
a
s
O
C
P
,S
te
r
o
id
s
!
S
m
o
k
in
g
/A
lc
o
h
o
l!
P
r
e
v
io
u
s
h
is
to
r
y
o
ffr
a
c
tu
r
e
fo
rc
o
n
tr
o
lg
r
o
u
p
!
Study Dates:
!
J
u
ly
&
A
u
g
u
s
to
f2
0
0
1
2
0
0
4
(to
ta
l6
m
o
n
th
s
)
!
Ethical Approval: T
h
e
H
u
m
a
n
In
v
e
s
tig
a
tio
n
C
o
m
m
itte
e
(
M
U
N
)
!
!
If Father
Fractured
If Both Parents
Fractured
If Either Parent
Fractured
2.1
1.03 - 4.32
0.036
1.8
0.96 - 3.5
0.46
3.0
1.1 - 8.02
0.020
2.1
0.99 - 4.8
0.05
Mother
Fractured
30/79 (38 %)
Father
Fractured
43/79 (54%)
If Neither Parent
Fractured
0.5
0.24 – 0.93
0.0 4
Percentage of Parents Fractured for Cases vs. Controls
Mothers Fractured
Fathers Fractured
Both Parents Fractured
Either Parent Fractured
Neither Parent Fractured
Cases
Controls
38 %
54%
22%
71%
29%
23%
39%
9%
54%
46%
Baseline Characteristics and Risk Factor Comparisons
Age (years)
Activity (hrs/day)
Sleep (hrs /day)
Sunlight (hrs/week)
Calcium (mg/day)
Cola (drink/day)
Force estimate (0 -3)
Male
Cases
Controls
9.1
10.1
9.1
24.2
1550
0.4
2
63%
8.5
10.3
8.5
23.7
1559
0.3
2
52%
SUMMARY
! This study provides important evidence supporting the need to further
investigate the genetic basis of common childhood fractures.
Inclusion Criteria
!C
h
ild
r
e
n
a
g
e
d
0
1
6
y
r
s
!
!C
lin
ic
a
lly
d
o
c
u
m
e
n
te
d
fr
a
c
tu
r
e
fo
rc
a
s
e
s
!
!
If Mother
Fractured
! Childhood fractures appear to be heritable, a feature which is
independent of the environmental risk factors for fracture.
Complete Report Forms
150
!
!P
o
te
n
tia
ls
tu
d
y
s
u
b
je
c
ts
w
e
r
e
id
e
n
tifi
e
d
b
y
th
e
e
m
e
r
g
e
n
c
y
n
u
r
s
e
s
!
!R
e
s
e
a
r
c
h
e
rn
o
tifi
e
d
!
!C
o
n
s
e
n
ts
ig
n
e
d
,in
fo
r
m
a
tio
n
p
a
c
k
a
g
e
a
n
d
r
e
p
o
r
tfo
r
m
g
iv
e
n
to
c
o
m
p
le
te
/p
o
s
t
b
a
c
k
!
!
Odds Ratios
95 % CI
P Value
!D
a
ta
e
x
tr
a
c
te
d
fr
o
m
r
e
p
o
r
tfo
r
m
s
-e
n
te
r
e
d
in
to
M
S
A
c
c
e
s
s
d
a
ta
b
a
s
e
b
y
r
e
s
e
a
r
c
h
e
r
!
S
t.J
o
h
ns
,N
L
!
!
!
!
!
!
M.Sc. FRCPC
of Pediatrics, Stollery Children s Hospital • 2Dept. of Pediatrics, Janeway Children's Hospital, Memorial University of Newfoundland, St. John's, NL, Canada
Mother
Fractured
16/71(23%)
Father
Fractured
28/71 (39%)
FUTURE CONSIDERATIONS
! Further expansion of this study with increased sample size, the addition
of bone mineral density tests and serum markers of bone metabolism is
warranted.
! This may also provide important evidence supporting the undertaking of
genetic linkage studies to further understand fracture susceptibility.
ACKNOWLEDGEMENTS
Janeway Research Foundation for financial support
Samra Mian & Sarah Matheson for data entry
RP Evans for technical support