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.
Program: Scholar
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.
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.