The prevalence of HIV infection among injection drug users and other highly marginalized groups is a significant health issue in Canada. Vancouver’s Downtown Eastside (DTES) is particularly hard hit, with HIV prevalence rates estimated at 25 per cent. These high rates of HIV infection persist in spite of efforts to reduce HIV transmission through various prevention programs, harm reduction strategies, treatment facilities and community law enforcement. HIV prevention strategies and treatment therapies that are effective among other populations have not had the same success in the most vulnerable and marginalized members of society. As an HIV clinician and researcher in the DTES, Dr. Mark Tyndall’s research takes three streams: Observational Cohort Studies: Identifying trends in risk behaviors, drug use patterns, HlV/Hepatitis C rates, social changes, law enforcement initiatives, and the impact of harm reduction interventions on key health indicators; Antiretroviral Therapy: Developing and evaluating strategies and programs that enhance the uptake, delivery and sustainability of antiretroviral therapy to marginalized groups; and Clinical trials research: Advancing Vancouver as a centre for clinical trials research for the evaluation of candidate HIV vaccines and other novel therapies among marginalized groups. Together, Dr. Tyndall’s studies will allow for evidence-based decision-making and improved health outcomes for marginalized groups living with HIV in the DTES and other urban areas in BC.
Program: Scholar
The exploration of genetic conditions affecting the health of aboriginal people
Canadian aboriginal people have shorter life spans and an increased burden of disease compared to their non-native Canadian counterparts. As in all populations, complex disease—both genetically and environmentally determined—plays a significant role. For example, among the Inuit of Baffin Island, the prevalence of one type of congenital heart defect is four times as high as in other populations.
Dr. Laura Arbour is exploring the genetic and environmental determinants of heart defects among the Inuit of Baffin Island. She will determine the contributing factors of genetics, intake of nutrients that are important in heart development (such as folate and vitamin A) and environmental exposures during pregnancy. She will also assess whether current public health efforts to reduce birth defects by fortifying flour with folic acid are sufficient for people in a northern environment. The goal of her research is to inform public health efforts aimed at prevention, early recognition of symptoms and timely treatment.
Psychosocial determinants of adolescent health behaviour
There are numerous segments of the Canadian population who experience a disproportionate burden of ill health. A key issue in addressing this disparity is the early identification of those groups of people who are vulnerable to poor health outcomes over the course of their lifespan. Identification of these groups, and the factors leading to this vulnerability, is a priority for researchers. One area of interest is in identifying the early childhood determinants of health behaviours, such as a child’s health, stress in the family, economic conditions or neighbourhood safety. Dr. Stefania Maggi studies the extent to which early influences can predict which children will follow trajectories of health vulnerability throughout the lifespan. Her research uses a combination of administrative databases, national surveys, and longitudinal data collection to follow up on the same individuals over a number of years, spanning developmental phases from early childhood to adolescence and young adulthood. By identifying what factors in childhood increase the likelihood of unhealthy behaviours and/or poor educational outcomes during adolescence her research will inform early prevention efforts aimed at the social determinants of health.
The role of Prostate cancer support groups (PCSGs) in health promotion
There is a significant body of research that describes the psychosocial, rehabilitation and health needs of men diagnosed with prostate cancer. These needs cannot always be met by professional health care services, particularly in the case of health promotion programs intended to help men with prostate cancer maintain and optimize their health and well being. While more and more men are accessing community-based support services such as Prostate Cancer Support Groups, little is known about whom these groups serve, what services they offer, and how they are funded.
Dr. John Oliffe is exploring the role of Prostate Cancer Support Groups in health promotion, and determining how men’s health and illness behaviours are informed and influenced through attending these support groups. Through a better understanding of how these groups operate, he hopes to develop recommendations about how best to support this type of resource, and identify potential ways to integrate the groups with professional health care services. This work will help inform future content, design and implementation of prostate cancer health promotion programs.
Impact of nutrition and physical education school policies on childhood obesity: Understanding the implementation process and its impact on behavioural and weight outcomes
The prevalence of childhood obesity is rapidly increasing in Canada, increasing fivefold for both boys and girls from 1981-99. As the genetic characteristics of the human population have not changed in the past 30 years, childhood obesity is thought to be caused by behavioural and environmental factors that predispose children to consume more calories than they expend. Obesity is also linked to a number of diseases, including cardiovascular disease, type 2 diabetes, and some cancers. Schools provide an ideal setting to intervene on children’s behaviours. Recently, policy strategies have been proposed to change the school environment to limit access to unhealthy food and to increase opportunities for children to be more physically active. However, these changes are taking place without the scientific evidence necessary to support these strategies. Louise Mâsse is examining the impact of school-based policies on changing nutrition and physical activity behaviours among children. In addition, she is identifying the factors that prevent from implementing healthy school policies and creating healthier environments. The results of her study will provide insightful information for policy-makers to improve the health of BC children
Social class and health: Innovative theoretical exploration and empirical confirmation
Two broadly-defined approaches to conceptualizing social class can be applied to the empirical study of health inequalities. In the first, social class is equated with the socioeconomic status of individuals, i.e., with individual-level measures of wealth, educational credentials and/or occupational prestige. Explanations for empirical relationships between health and this particular conception of social class generally address material, behavioural or psychosocial phenomena, such as housing conditions, lifestyle choices or perceptions of relative standing. In the second, social classes are social groups, defined by the nature of their relationships to the economic mode of production and forms of control wielded in the workplace (the perspective of the neo-Marxist theorist Erik Olin Wright), or defined relationally in social space by their possession and utilization of various economic, educational, social and cultural capitals (the perspective of the French social theorist Pierre Bourdieu). In this tradition, explanations for class-health associations attempt to simultaneously address individual-level and group-level factors in a complex mix of agency and structure. Dr. Gerry Veenstra is investigating relationships between social class and health and well-being in Canada, integrating individual-level models founded upon material, lifestyle and psychosocial explanatory factors with social-structural theoretical frameworks inspired by theorists like Bourdieu and Wright. Building upon his previous work in BC, Dr. Veenstra will engage in an ethnographic exploration of different class positions and then administer a questionnaire survey to randomly-selected Canadian adults, assessing possession of various manifestations of control and capital. He will apply linear-causal statistical techniques such as regression analysis and relational techniques such as multiple correspondence analysis to this survey data in an attempt to identify and explain factors underlying social class and health inequalities in Canada.
Roles of the cilium, a sensory organelle, in health and disease
Cilia are slender appendages that protrude from most cells and tissues in humans. The motile forms produce whip-like motions, while the non-motile (known as “primary”) forms act as antennae, detecting chemical and physical changes in their environment. Both forms of cilia are critical to human health. For example, motile cilia propel sperm in males, and move debris in respiratory airways. Primary cilia are implicated in sensory processes such as vision, sense of smell and hearing. Defects in the forms or functions of cilia can cause a wide range of human ailments, including kidney and heart disease, obesity and diabetes, and sensory impairments such as blindness. Using bioinformatics, genetics, cell biology, biochemistry and genomics approaches, Dr. Michel Leroux is studying previously unknown components of cilia and characterizing them in the nematode C. Elegans and in human tissue culture cells. He is also working to identifying genes associated with the many ciliary disorders in humans, including some associated with obesity and cystic kidney disorders. By providing fundamental insights into the form and functions of cilia, Dr. Leroux’s studies may uncover new potential targets for therapy in a wide range of human diseases.
Sensory function and dysfunction in neurotrauma: models, molecules and mechanisms
Spinal cord injury (SCI) interrupts the flow of information between the brain and spinal cord. As a result, people with SCI experience muscle paralysis. They also experience changes in sensation, ranging from a complete loss of sensation to chronic pain. Dr. Matt Ramer’s research focuses on the sensory nervous system and how its changes due to trauma related to sensory dysfunction. In particular, he is interested in the balance between factors that promote or inhibit the growth of nerve fibres (axons). Dr. Ramer is investigating the effects of growth-promoting and growth-inhibiting molecules on the anatomy of spinal sensory axons, on their connectivity within and outside the spinal cord, and on behavioural outcomes resulting from spinal cord injury. This work will increase our understanding of sensory dysfunction and may identify new therapies for SCI.
The effect of resistance training on cognitive performance, cortical plasticity, and fall risk in women aged 65 to 75 years old: A 12-month randomized controlled trial
Falling and fall-related injuries among the elderly is a significant health issue for seniors in Canada. Older adults with cognitive impairment are at particular risk; 60 per cent fall annually, a rate that is twice that of their peers with normal cognition. Previous research has demonstrated that current falls prevention programs, such as multifactorial interventions, are ineffective in people with cognitive impairment. This suggests the need for an innovative approach to falls prevention in this group, such as targeting cognitive function itself to reduce falls. As a two-time MSFHR Trainee, Dr. Teresa Liu-Ambrose researched the effectiveness of exercise and rehabilitation programs for preventing falls in women at risk, and the specific dimensions of cognition associated with falls risk in older women. Building on this research, Dr. Liu-Ambrose is now investigating whether resistance training — a mode of exercise proven to reduce the physiological risk of falls in older adults — also benefits cognition. In her study of cognitively-intact women aged 65 to 75, Dr. Liu-Ambrose is determining whether a 12-month resistance training program improves high-level cognitive function. Using standard neuropsychological tests and brain imaging techniques, she will measure changes in cognitive performance and cortical function. She will also evaluate changes in physiological falls risk. Results from this novel study will provide valuable insight into the development of falls prevention programs that specifically focus on cognitive function in older adults.
Pre-eclampsia: Immunology, innovation and improvement
Pre-eclampsia is the most common dangerous complication of pregnancy, affecting the health of both mother and fetus. While high blood pressure in the mother and the loss of protein in her urine are the most visible symptoms of the disease, pre-eclampsia also causes inflammation and organ damage. The disease is a form of systemic inflammation, and is particularly dangerous when it occurs early in pregnancy. Dr. Peter von Dadelszen’s program of research covers a broad range of laboratory, clinical and health services research related to pre-eclampsia. He is studying the role of the immune system in the development and progression of the disease, as well as potential targets for the prevention of pre-eclampsia, and new screening techniques and predictive models. He is also researching new methods to modify pregnancy outcomes, including a novel disease-modifying therapy and development of a province-wide, structured approach to monitoring and managing pre-eclampsia. Through a greater understanding of the various facets of pre-eclampsia, Dr. von Dadelszen hopes to spur improvements in clinical care and health outcomes.