In spite of prevention programs that target risky sexual behaviours in youth, many BC teens continue to experience serious health and social problems related to sexually transmitted diseases (STDs) and unplanned pregnancies. However, there are significant variations in the incidence of teen pregnancy and STDs among rural and remote BC communities. Terrace, for example, has relatively high rates, while 100 Mile House has lower rates than the provincial norm. Dr. Jean Shoveller is studying the factors that contribute to this variation in sexual health outcomes among youth. In addition to personal behaviours among teens, she is investigating how other factors – such as relationships with family and peers, community social norms and the influence of institutions including education, health and religion – may contribute to decisions they make around their sexual health. Through her five-year study of three rural/remote BC communities, Dr. Shoveller hopes to provide significant insight into how communities can help prevent adverse sexual health outcomes among their youth.
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Community partnership research in population health promotion: The development of tools and measures for planning and evaluation
Strong evidence suggests that the health system is not the primary factor determining the health of Canadians. Non-medical factors – such as income, social support, education, employment, housing, health practices, child development, gender and culture – are crucial determinants of health and quality of life. Regional health authorities across BC are increasingly taking a population health approach, which addresses these non-medical factors, in community-based initiatives. However, these efforts are often complex and involve diverse participants from within and outside the health system, making it difficult to evaluate their effectiveness. Dr. James Frankish is studying how health authorities are addressing non-medical determinants of health. He is developing and testing tools to provide evidence-based evaluation of community-level effects resulting from population health initiatives. A particular focus is inclusion of vulnerable populations in these initiatives and related policy and practice implications. Dr. Frankish is also the leader of the MSFHR/CIHR program for Transdisciplinary Training in Community Partnership Research: Bridging Research to Practice, which is co-funded by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.
Paracrine processes in prostate cancer progression
Prostate cancer is the second leading cause of cancer-related deaths in men. Advanced prostate cancer is often treated with androgen withdrawal therapy, which blocks the growth-promoting effects of androgens (such as testosterone). Unfortunately, the cancer eventually progresses to an androgen-independent state, allowing for tumour growth without androgens. Dr. Michael Cox is studying how prostate tumour cells with neuroendocrine characteristics contribute to the disease’s progression to androgen independence. His research aims to understand how these cells develop within prostate tumours, what effect such cells have on the growth rate of prostate tumours, and how hormones secreted by these cells influence therapeutic resistance and metastatic preferences during disease progression. Dr. Cox is also working to determine the molecular mechanisms by which prostate tumour cells develop genetic mutations and become less susceptible to cancer treatment. He is identifying how tumour cells respond to growth factors in the presence or absence of testosterone and the cellular changes that allow prostate tumour cells to utilize these growth factors to aid development of testosterone independence.
Molecular basis of toxoplasma pathogenesis
While there has been significant research conducted about how bacteria and viruses cause disease, in comparison, relatively little is known about eukaryotic pathogenic processes – specifically, the disease-causing mechanisms of parasitic protozoans, which are single-celled, nucleated organisms. Dr. Michael Grigg is investigating the protozoan parasite Toxoplasma gondii, a common eukaryotic pathogen capable of infecting essentially any nucleated cell in most warm-blooded species. This highly successful parasite currently infects close to one-third of the human population. There are only three main strains of the parasite in nature and each line causes profoundly different disease in animals. Toxoplasma is known to stimulate a variety of immunological responses in infected hosts. Hosts are unable to clear the parasite, resulting in a life-long infection. Dr. Grigg is studying the immunological and molecular interactions that modulate Toxoplasma pathogenesis in an animal model of the disease, and identifying the virulence factors that are essential to the success of particular strains of the pathogen. From his work, he hopes to uncover new mechanisms and principles of pathogenesis.
Molecular study of interaction between mycobacterium tuberculosis and the macrophage endosomal compartment: An approach to identify mycobacterial virulence factors
Much of the resurgence of tuberculosis during the past decade can be attributed to the fast spread of new bacterial strains that are resistant to the conventional anti-tuberculosis drugs. New therapeutic strategies are urgently needed, requiring a better understanding of the interaction of the causal agent, Mycobacterium tuberculosis, with the host cells. Monocyte/macrophages are the principal targets for mycobacterium. These cells possess a powerful intracellular killing mechanism and play an essential role in the clearance of bacteria. However, one of the major features of tuberculosis pathogenesis is the residency of bacteria in an intracellular vacuole that evades intracellular killing. Mycobacterium tuberculosis interacts with specific cell surface molecules, acting as “”an entrance gate”” and ultimately producing factors that inhibit the intracellular killing. Dr. Zakaria Hmama’s research focuses on the molecular mechanisms regulating the entry of the bacteria into macrophages and the resistance to intracellular killing. Such studies will provide a rational basis for the development of new drug strategies.
Improving patient safety: Costs and effects count
Health economist Dr. Rebecca Warburton is analyzing the costs and effects of interventions to reduce the accidental harm caused by health care. Her research aims to provide a rational basis for establishing priorities among policies and programs for reducing errors. The US Institute of Medicine’s estimate that 44,000 to 98,000 Americans die every year as a result of preventable hospital mistakes has raised public awareness of errors in health care and focused attention on reducing risks and harm to patients. However, most Canadian hospitals are overwhelmed by the number of safety improvements suggested by experts or demanded by regulatory bodies. Limited resources, and lack of information about the likely costs and benefits of proposed changes, means that few safety strategies are actually implemented, and most changes are not well evaluated. Dr. Warburton’s research, conducted in partnership with the Vancouver Island Health Authority, compares the costs of patient safety improvements with the outcomes in terms of standard units such as life-years or quality-adjusted life years gained. Before joining the University of Victoria in 1999, Dr. Warburton spent 11 years in policy and research positions with the BC Ministry of Health. She is currently assessing the effectiveness of BC’s Premium Assistance Program, which subsidizes medical premiums for low-income residents, and assisting in the evaluation of BC’s Clinical Practice Guidelines and Protocols.
Literacy and health research
Low levels of literacy have been associated with poor health, poor understanding of treatment, greater use of health services, low adherence to treatment regimens, and poverty and unemployment. Considering that more than 40 per cent of Canadians fell into the two lowest categories of literacy in the 1994 International Literacy Survey, this is cause for concern. Recruited to BC from the University of Toronto, Dr. Irving Rootman is developing and implementing a research program on literacy and health in British Columbia. While the Canadian public health community has developed initiatives aimed at improving understanding of health information, there has been little research to measure the outcomes of these efforts. Dr. Rootman’s studies will assess the effectiveness of various approaches to improving health literacy in Canada and BC. His program will also provide training opportunities for graduate students, establish links between researchers across the country, and develop collaboration between researchers, health providers, policy makers and community members concerned about literacy and health.
The effects of two training regimens on body balance, reaction time, muscle strength and bone strength in postmenopausal women with Osteoporosis: A six-month RCT
Because they have low bone mass, women with osteoporosis are at increased risk of fractures caused by falls. Reducing both bone loss and the risk of falling are essential in helping women prevent fractures. While previous research has shown that regular physical activity can optimize bone health and reduce the risk of falling by improving muscle strength, reaction time, and balance, little is known about what types of exercises are most effective. Teresa Liu-Ambrose is examining which exercise program works best for women who are at risk for falls: exercises that focus on either strength or agility, or programs that incorporate exercises for strength and agility equally. The findings from Teresa’s study will be incorporated into community-based exercise programs throughout BC to help women with osteoporosis reduce their risk of falls and fractures. In addition to improving quality of life for women with osteoporosis, a decrease in fractures would also lessen the enormous health care costs associated with fall-related injuries.
Culture, self-concept, and the presentation of distress: Implication for depression
A wide range of behaviours and physical symptoms can accompany depression. Cultural background may also influence how a person expresses depression symptoms. In China, where a low depression rate has long been reported, depressed patients are thought to be more likely to describe physical symptoms while de-emphasizing psychological problems; the reverse is true with non-Chinese in Canada. This raises the possibility that clinicians have misdiagnosed depressed Chinese patients. Andrew Ryder is investigating this possibility, focusing on the differences in the presentation of symptoms, as well as exploring larger theories about how self-concept and culture may affect the way patients experience and express depression. He hopes the research will increase the likelihood that Chinese-Canadian patients with depression receive appropriate diagnosis and care.
Epidemiology, genetics and molecular biology of a virulence-associated bacteriophage of Chalamydia pneumoniae
Dr. Karuna P. Karunakaran is exploring a mystery around how Chlamydia pneumoniae (an infectious bacteria) is implicated in atherosclerosis (hardening of the inside of the arteries). While a strong link has been established between C. pneumoniae and atherosclerosis, 60 to 80 per cent of the adult population is infected with the bacteria with no apparent ill effects. One explanation may be that some strains of the bacteria are more capable of causing vascular disease than others, due to genetic variation. In fact, one strain of C. pneumoniae has been shown to contain a bacteriophage, a virus that infects bacteria and integrates itself into the genetic code. Preliminary studies have indicated a strong association between vascular disease and the presence of this strain. Karuna is studying the biology of the implicated bacteriophage, and hopes to identify the strains of C. pneumoniae that may cause vascular disease. This may lead to effective design of a vaccine to combat vascular disease caused by infectious bacteria.