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.
Program: Scholar
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.
Evaluation of efficacy of borate-based fungistatic treatments on building materials and growth, pro-inflammatory and toxic products of secondary metabolism by selected micro-organisms
With the prevalence of “”leaky”” buildings in BC, there is increasing awareness of the potential health risks associated with damp building products fostering the growth of fungal organisms. These organisms grow from spores, which are naturally abundant in outdoor air. Although spores cannot grow on dry building materials, they can readily form colonies and grow on building materials that have sufficient moisture (e.g. resulting from water leaks, flooding or condensation). These fungi are thought to contribute to respiratory and inflammatory health problems in people. Dr. Karen Bartlett is studying the effects of a class of anti-fungal preservative containing borate. This preservative, used to inhibit fungal growth on wood products, is not yet approved for use in Canada. Dr. Bartlett is monitoring whether borate leaches out building materials when they are wet and becomes ineffective. She is also investigating whether the fungi produce any harmful byproducts in response to these preservatives that might create further health problems.
Investigating the link between symptom expression, medicalization and acculturation: The case of Portuguese immigrants
Dr. James has conducted groundbreaking research into the experiences of Portuguese immigrants with agonias, a commonly-expressed disorder that is literally translated as “the agonies.” While North American clinicians often diagnose agonias as anxiety and/or depression, and treat it with medication and psychotherapy, these approaches are often unsuccessful. Dr. James’ previous research indicates that the meaning, symptoms and treatment of agonias do not match the standard psychiatric disorders of anxiety or depression. Dr. James is investigating the differences in the way clinicians and members of Portuguese communities understand agonias; whether it is related to anxiety or depression; and whether assimilation into North American society changes community members’ understanding and experience of agonias. This research will further inform her work teaching therapists throughout Canada and the US how to conduct psychotherapy with ethnic minority patients.
Mechanisms and functions of activin/nodal signaling in early embryogenesis
We all start as a single cell, which divides and eventually forms the body. A great deal of cell communication goes into making decisions about this body plan. My research examines how cells communicate with one another during embryonic development. The body plan is set up by organizing centres, or groups of cells that dictate signals to other parts of the early embryo. Two centres have been identified in mammals: the anterior visceral endoderm (AVE) coordinates the development of the head, and the node arranges the trunk into front, back, left and right. The way these organizing centres control growth of the embryo, and the cell-to-cell signalling involved in the process, are poorly understood. The same signalling systems used in creating an embryo break down during cancer. Ultimately, if we can identify what happens under normal circumstances, we can better understand what goes wrong with signalling pathways during the development of cancer or congenital defects. The results of my research also have implications for stem cell research. Stem cells have the potential to differentiate into various types of cells. If we can determine the signals that cause particular cells to become liver, brain or kidney cells during embryonic development, researchers should be able to cue stem cells to differentiate into specific cell types.
Prevention of falls and hip fractures in the elderly through biomechanics
Falls are the number one cause of injury-related deaths and hospitalizations in Canada. Among the elderly, falls account for 84 per cent of all injuries and about 23,000 hip fractures annually. Reducing the frequency and severity of these injuries is a critical national health priority, and one that my research team is approaching from several angles. In one approach, we are using laboratory experiments and mathematical modeling to study age-related changes in posture and balance along with strategies for avoiding injury in the event of a fall. In another approach, we are determining how movement patterns and risk for falls are affected by physiological factors, such as muscle strength and vision, and by behavioural factors, such as risk-taking tendencies. On the applied side, the team is working to develop devices such as hip pads, compliant floors and exercise programs to help prevent fractures. This combination of basic and applied efforts should lead to the development of innovative and effective techniques to prevent falls and fall-related fractures in the elderly.
Brain and behaviour: mechanisms of human attention in patient and healthy populations
Attention problems are a major source of disability associated with a wide range of disorders, including autism, stroke and schizophrenia. In British Columbia alone, hundreds of millions of dollars are spent each year by the health system for the treatment and rehabilitation of people with disorders of attention. And this does not take into account the additional costs for the education system or the toll on patients and families. I am studying the brain mechanisms underlying our attention processes and comparing how these processes affect perception and action in healthy children and adults, and those who have attention disorders. My research team is using behavioural and neuropsychological assessments, combined with advanced imaging technologies, to reveal brain processes involved in different attention tasks and behaviours. New knowledge about how the brain works in these activities will help in understanding and possibly developing better treatment and rehabilitation options for people with attention disorders.
Family influence in pediatric chronic pain and disability
Up to 15 per cent of school-aged children and adolescents suffer from chronic pain conditions such as recurrent headaches and abdominal pain. Children with chronic pain frequently miss considerable amounts of school, do not participate in athletic and social activities, and suffer depression or anxiety. The family plays an important role in influencing how children learn to deal with pain, but little is known about how this learning occurs. My research will identify how families influence children’s responses to pain. I will compare studies of children between the ages of eight and 15 with chronic pain and disability with pain-free children and their parents. The research will examine how families interpret pain symptoms, how parents make decisions about their children’s complaints of pain, parents’ thoughts about their children’s pain, and parent-child behaviour during pain episodes. In addition, I am studying how health care providers and parents assess pain in children and the tools that we use with children to measure pain. My research will also explore the relationship between sleep disturbances and chronic pain in children, an area of research that has been overlooked until now. The results of these research studies will help family members and health care providers better manage children’s pain, and will help improve treatment and prevention of disabling pain in children.
Suicide and self-injury as a response to radical developmental and cultural change in First Nations youth
Young people kill themselves in heartbreaking numbers, and intended and unintended self-injuries are the leading causes of death among our youth. However tragic this is when viewed in the large, the rates of suicide in certain First Nations communities are even higher – in some cases hundreds of times higher – and arguably the highest in the world. I am working to identify both individual and cultural factors that might help reduce the horrendous toll. Previous research has shown a strong link between suicidal behaviours and disruptions in the usual process by which adolescents develop their self-identity. It has also revealed that among First Nations communities, the risk youth run for suicide turns very much on the extent to which different bands have succeeded in reconnecting to their own cultural pasts. My research is directed at understanding the ways cultural differences during the course of identity development help or hinder young people’s ability to insulate themselves from such risks. By understanding the implications of these differences and working out ways of sharing them with various First Nations Communities, it may be possible to assist these communities in reconstructing cultural practices that, once recovered, may serve to better insulate their youth from self-injury and suicide.