More than 25 percent of women who have a radical hysterectomy (surgery to remove the uterus, cervix, and upper vagina) as part of treatment for cervical cancer develop sexual difficulties related to genital arousal. There are no established treatments for these sexual problems leaving women with chronic distress. Dr. Lori Brotto has developed and is assessing whether a psycho-educational treatment can improve sexual arousal in these women. She is also assessing the effectiveness of combining the treatment with sildenafil citrate (Viagra). Dr. Brotto aims to incorporate qualitative feedback with psycho-physiological and self-report measures on the effectiveness of the psycho-educational treatment in hopes of improving clinical practice. The research could help improve sexual health, mood, and overall quality of life for cancer survivors and their partners. It could also broaden understanding of women’s sexuality and guide future research to better address women’s sexual health care needs.
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Stigma, risk and protective factors among vulnerable youth
Adolescence is a time of promise, when major physical, cognitive and relational transitions launch the development to adulthood. But stigmatization in communities and schools can derail this process for certain teens. Teens who are more likely to be stigmatized include youth on the streets; those in foster care or custody; sexually abused youth; gay, lesbian, bisexual and transgendered youth; and indigenous and ethnic minority adolescents. As a result of being stigmatized, these youth are at greater risk for health problems such as drug abuse, HIV infection and teen pregnancy. As part of an international study taking place in Canada, New Zealand and the US, Dr. Elizabeth Saewyc is examining behaviours and environments that stigmatize youth in schools. Dr. Saewyc is studying the links between stigma and risk behaviours, and exploring protective factors that can reduce these risks and build resilience among youth. The findings will be shared with groups of teens and youth workers in the three countries to gather their ideas for reducing stigma, creating safer schools, and preventing substance use and risky sexual behaviours in culturally meaningful ways. The research could lead to interventions to reduce or prevent stigma, to help youth cope with stigma, and to foster healthy development among vulnerable young people.
Costs, access and equity under income-based Pharmacare
Following the February 2003 First Ministers Health Accord, the Canadian Government created a five-year $16 billion Health Reform Fund targeted to primary health care, home care and catastrophic drug coverage. The drug coverage is intended to ensure that Canadians with serious health conditions have reasonable access to necessary drug therapy. Standards for catastrophic coverage will be determined in the coming years, yet there is little evidence to guide the choice of standards. Dr. Steven Morgan is evaluating two possible options for basing standards: mixed pharmacare and income-based pharmacare. Dr. Morgan is studying the change in BC from a mixed program, which covered drug costs for low income seniors and social assistance recipients and charged a $1,000 deductible to all other residents, to an income-based system that enables people to pay a sliding scale based on income levels. Dr. Morgan is comparing data from both systems to results in Manitoba, which also has an income-based program. He is assessing the impact of both systems on cost, access and equity for people across the spectrum of socio-economic status, age and health status. The results could help guide the development of provincial and national policies for drug coverage programs.
Community, culture and health
Dr. Cindy Patton has conducted a series of studies on knowledge transfer from medical experts to clinicians, media, policymakers and the public. In dramatic and exceptional cases, this exchange happens almost directly. The media’s extensive reporting on health emergencies involving SARS (Severe Acute Respiratory Syndrome) and BSE (Bovine Spongiform Encephalopathy or Mad Cow Disease) created demand from health consumers for more medical research, changes in public health policy, and reassurance about their risk for these conditions. But more often medical research filters down through clinicians and advocacy groups, who translate complex information for consumers and advocate for their medical needs. In addition, government policy makers must sort through information from researchers and citizens to adapt health policies and resources to changing medical needs. Dr. Patton is examining existing methods and systems for exchanging information in various settings—clinics, research centres and global information networks. The research could be used to create better channels for transferring specialized medical information. Dr. Patton is also developing training programs for researchers and the public to help improve their understanding of how to efficiently transfer knowledge from medical experts to people affected by health issues.
Behaviour of the newborn infant in response to pain, distress and caregiving influences
Recent evidence suggests newborn infants are more sensitive to pain and stress than older children and adults. The level of sensitivity may be especially acute for newborns who are at-risk for developmental problems due to prenatal exposure to pain, antidepressants or illicit drugs. Studies suggest that early exposure to pain and stress leads to changes in the newborn’s brain circuitry, and may increase vulnerability to abnormal behaviour and development. This has led to a search for better ways to understand and recognize infant pain and measure the effects of pain treatment. Dr. Fay Warnock is investigating the actions and interactions of healthy and at-risk infants. The research involves confirming a comprehensive list of behaviour associated with newborn distress, and comparing the actions of healthy and at-risk newborns during and after routine diaper change and heel lancing, a common procedure for obtaining a blood sample to screen infants for metabolic errors. She is also linking newborn behaviour with changes in facial action and heart rate. The research will further develop measures of newborn pain, improve understanding of how caregivers can help alleviate pain, and lead to protocols for preventing, assessing and treating newborn pain.
Truncation of huntingtin and its relationship to the pathogenesis of Huntington's Disease
Huntington disease (HD) is a fatal degenerative brain disorder caused by a defective gene, which causes cells in specific parts of the brain to die. This leads to symptoms including progressive deterioration in the ability to control movements and emotions, recall recent events or make decisions, and leads to death 15 to 20 years after onset. One in 10,000 Canadians has HD, and children with a parent with HD have a 50 per cent risk of inheriting the disease. There is neither a cure nor treatments to prevent Huntington disease. The HD gene produces a protein called huntingtin, which breaks into short fragments that dramatically promote cell death. Little is known about the exact function and toxic properties of this mutant protein. Now Rona Graham is expanding her earlier Masters research into the mechanisms that cause shortened huntingtin. She is investigating other forms of mutant huntingtin to determine their role in creating HD, and hopes the results will lead to new therapies to prevent or alleviate this disease and other neurodegenerative disorders.
Role of alveolar macrophage proteinase genetic polymorphisms in the development of emphysema
Emphysema is a destructive lung disease that obstructs the airways and compromises oxygen transfer from the lungs to the bloodstream, causing a decrease in respiratory function. More than 1,100 people die of the disease in Canada each year. Currently, there are no treatments to cure emphysema. Cigarette smoking is the major risk factor for developing the disease. Yet only 15 to 20 per cent of smokers develop symptoms. An increase in protein-degrading enzymes called proteinases is believed to play a role in the origin of emphysema. Previous studies also suggest a genetic predisposition to airflow obstruction. Variations in the genes regulating these proteinase enzymes may be responsible for individual differences in response to cigarette smoke. Alison Wallace is researching whether genetic variants in proteinases increase smokers’ susceptibility to emphysema. If so, this information would help identify people at risk for the disease, contributing to early promotion of anti-smoking strategies and possibly leading to new methods for early detection and treatment. In addition, drugs that inhibit proteinases could be targeted to patients predisposed to emphysema, but unable to quit smoking.
Early progression and detection of ovarian cancer
In developed countries, ovarian cancer is the leading cause of death from gynecologic malignancies in women. The five-year survival rate is only 35 to 40 per cent, a rate that hasn’t changed significantly in 25 years. The poor prognosis is due to the lack of a reliable test for early detection and the inability to identify early symptoms of the disease, which means the majority of ovarian tumours are diagnosed at an advanced stage. During progression to malignancy, normal ovarian surface epithelial cells, which give rise to the majority of epithelial ovarian cancers, acquire more complex and highly differentiated characteristics that most often resemble epithelial cells in the fallopian tube and uterus. This change may provide an advantage for growing cancer cells. Michelle Woo is screening ovarian tumour tissues for markers known to be present in the fallopian tube and uterus. She has recently discovered a protein in ovarian tumours that may be an early indicator of ovarian cancer. Another approach she is using to examine early changes in ovarian tumour progression involves the use of a unique three-dimensional culture system to mimic the development of ovarian tumours in women. Michelle hopes this research will identify new predictive markers that can be used for early screening and prevention of ovarian cancer.
Game on: diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports
In early adolescence, both girls and boys report increases in levels of depression. However, by late adolescence the rates of depression among girls are double those found among boys. Research shows that boys and girls’ perceptions about athletic competence (how good they are at sports), social acceptance (how popular they are among peers), and body dissatisfaction (negative feelings about their bodies) are strong predictors of depression. Since girls tend to report lower levels of athletic competence, participate in sports at lower rates, and report higher levels of body dissatisfaction than boys, they may be at greater risk for depression. Erin Boone is examining whether positive involvement in team sports increases perceptions of athletic competence and social acceptance, and helps to diminish body dissatisfaction among both girls and boys. The study will be among the first to assess the mechanisms that link positive team sports involvement to diminished risks for depression in adolescence. Findings will outline the mental health benefits associated with team sports involvement and highlight the need to sustain adolescents’ interest and participation in sports.
Molecular analysis of transplant recipients
One of the major problems for patients who have undergone heart or other transplants is the potential for the body’s own immune system to attack the newly introduced organ. As a result, patients must take large doses of immunosuppressive drugs daily to prevent rejection of the new organ, which the body perceives as foreign. Unfortunately, these medications interfere with normal immune response, which leads to a wide range of dangerous side effects, including higher susceptibility to infections and cancer. Dosage must be carefully monitored: not enough, and the body will begin to reject the organ; too much, and patients must deal with the serious side effects. The goal of Edward Chang’s work is to develop new genetic tests to predict exactly how much medication each individual patient requires to ensure the organ is accepted with minimal side effects.