Huntington’s disease (HD) and amyotrophic lateral sclerosis (ALS) are both progressive, fatal neurological diseases that together affect 6,000 Canadians. HD is associated with mental and physical deterioration, while ALS is associated primarily with physical deterioration. While there is a longstanding body of literature on the biomedical aspects of HD and ALS, there is little literature or knowledge regarding the experiences of people afflicted with these diseases. HD and ALS may progress in a manner that is unique compared to other non-neurological illnesses. Individuals can receive a diagnosis and then wait years or decades before the severe effects of the disease become apparent. During this time, these individuals are paradoxically ill in concept, but are still physically healthy and can lead comparably normal and productive lives. Michael Halpin is studying how these individuals experience knowing they are seriously ill prior to the development of the most severe symptoms, and how this affects they way in which they view health and their lives. Comparing and contrasting the experiences of people with HD and ALS, he will explore how this period of impending illness influences individuals’ perception of their health and how they view their lives as meaningful after diagnosis. Halpin’s research will improve our current understanding of individuals with these illnesses and give health professionals and researchers greater sensitivity to the concerns of these populations and their unique quality of life issues. Ultimately, this knowledge could help ensure that medical treatments and services are well suited to their experiences and needs.
Program: Trainee
Healthcare workers and antineoplastic drugs: Identifying the determinants of exposure and current challenges to reducing exposure
In health care settings, antineoplastic drugs are prepared and administered daily, mainly for the treatment of cancer. These drugs are inherently toxic and can therefore affect normal, healthy cells. On-the-job (occupational) exposure to antineoplastic drugs has been shown to cause a variety of health effects including cell mutations, adverse developmental and reproductive outcomes, and cancer. Absorption through the skin is suspected to be the main route of occupational exposure to antineoplastic drugs, and in spite of control measures used during their handling and preparation, studies have found antineoplastic drug contamination of surfaces in health care facilities. However, few studies have examined the potential for occupational dermal exposure. Chun-Yip Hon previously conducted a pilot study assessing the occupational dermal exposure risks of antineoplastic drugs to healthcare workers, and evaluated the cleaning protocols for drug-contaminated surfaces. He found that antineoplastic drug contamination of the drug preparation area is likely in British Columbian hospital pharmacies even after cleaning, and that the hands of pharmacy personnel may be contaminated even if the worker was not responsible for preparing the drug products. He’s now undertaking a full-scale study at hospitals situated within the Lower Mainland, investigating the procedures and process flows of antineoplastic drug handling, and determining who may come into contact with the drugs. He is quantifying antineoplastic drug contamination levels on surfaces throughout their process flow in each hospital, assessing workers’ knowledge of safe handling procedures as well as their risk of occupational dermal exposure. He will also determine the presence of antineoplastic drugs in health care workers through biological monitoring. Hon’s findings will determine the risk factors associated with occupational exposure to antineoplastic drugs in the health care sector, providing key information for those who work with antineoplastic drugs, occupational health and safety professionals, risk managers and policy makers.
Predicting relations between child language brokering and psychological health within immigrant Chinese families
People of Chinese ancestry make up the largest visible minority group in Canada and they comprise a major percentage of new immigrants to the country. Adaptation to life in a new Western country for Chinese immigrants often comes with stress and hardship, including language barriers and school or employment adjustments. In addition, family members may adapt to the new culture at different rates, creating additional stress that may result in new areas of conflict within the family and increased risk for poorer psychological health. Often, children are relied upon to provide interpretation and translation for their non English-speaking parents. Current research is divided on whether this role harms or supports the psychological health of children — reports cite outcomes that range from psychological distress and depression to pride and increased confidence. Tapping into data gathered through a larger Intercultural Family Study at the University of Victoria, Josephine Hua is studying 180 immigrant Chinese families living in Victoria or Vancouver. She’s examining the psychological implications of language brokering for both children and parents. She hypothesizes that children’s psychological health relating to this role depends on the underlying conditions and relationships within the family. For example, a child who feels pride in fulfilling family obligations is more likely to benefit from this role. Identifying the determinants of psychological health related to language brokering for both children and parents within immigrant families will suggest strategies for promoting healthy integration into Canadian society. Ultimately, this could help alleviate the economic and psychological costs associated with maladjustment among new immigrant families.
The role of the spouse in pain and disease course among persons with rheumatoid arthritis
Rheumatoid arthritis (RA) is an incurable autoimmune disease that affects approximately one in 100 Canadians. It is associated with a variety of distressing and debilitating symptoms including chronic pain, stiffness and inflammation of the joints, fatigue, and frequent mood changes. As a result of their disease and related distress, persons with RA (PWRA) typically experience a wide range of daily stressors, such as difficulties performing household chores, impaired ability to work or hold a job, difficulties engaging in leisure or social activities, and interpersonal tensions resulting from added burdens for friends and family members. Although biomedical factors prompt the initial pain symptoms, psychological and social factors appear to play a significant role in the severity and course of the disease over time. For example, social support from family and friends and effective coping strategies may help to decrease pain and increase functional ability of PWRA. A relatively unexplored component of this phenomenon is the role of the spouse, who is most often the primary caregiver for PWRA . Mark Lam is investigating the relationship between the well-being and mood of the spouse and the level of support they provide to the RA patient. He seeks to answer the impact of spousal support on the RA patient’s well-being and symptoms and course of their disease. Findings regarding the role of the spouse and the social support they provide will help inform families, friends, and health care providers as to the most beneficial ways in which to respond to patients suffering from RA, helping them cope more effectively with their pain and disability.
Population-based comparison of two regimens for emergency contraception: a pharmacoepidemiologic study
Hormonal emergency contraceptives (EC), commonly referred to as “”morning after pills,”” have the potential to prevent pregnancy before it starts. They can be used as a preventive measure after unprotected sex by women who do not have a routine contraceptive method in place, who experience contraceptive failure such as condom breakage, or who miss several oral contraceptive doses. With the goal of improving women’s access to ECs, pharmacists in British Columbia were granted authority by the provincial government in 2000 to prescribe ECs without a doctor’s prescription. After granting pharmacists EC prescriptive authority, the province saw a 102% increase in EC prescriptions. The most commonly used ECs are the Yuzpe regimen, containing estrogen and progestin, and the progestin-only levonorgestrel regimen. Previous research has suggested that the effectiveness of the Yuzpe and levonorgestrel regimens is 76% and 89%, respectively.. However, there is growing evidence that the effectiveness of ECs has been overestimated in clinical studies. Also, there have been no studies to date that measured the outcomes (pregnancy versus no pregnancy) among women who received ECs under conditions of routine use. Using anonymized health data from all women who sought ECs from pharmacists in British Columbia in 2001 and 2002, pharmacist and graduate student Dr. Vivian Leung is comparing pregnancy rates between the two regimens. The rates will be used to estimate the effectiveness of each regimen and evaluate whether their effectiveness differs significantly when used in the routine community care setting. Leung’s study will explore the health outcomes of ECs on a larger scale than ever before. Her work will contribute important knowledge to better inform women and clinicians of optimal EC use in the prevention of unwanted pregnancy.
Is there a “low-risk” drinking level for youth? Exploring the harms associated with adolescent drinking patterns
Substance use among youth continues to be a large public health concern, including alcohol consumption among underage youth. While much research has explored youth involvement in substance use and on the negative impacts of that use, there is a lack of consensus in the literature about how to approach the prevention and treatment of youth substance use. A focus on abstinence as the only acceptable outcome is a key controversy in prevention and treatment approaches. While Canada’s laws support abstinence as the desired stance for substance use, studies show that zero-tolerance approaches to drug and alcohol prevention are often ineffective. There is some evidence of the effectiveness of harm-reduction strategies, which focus on reducing youth’s levels of risk and experiences of harm from substance use. While there are low-risk drinking guidelines for adults in British Columbia, there are currently no accepted low-risk drinking guidelines for youth, nor a clear consensus on whether any alcohol consumption by youth below legal drinking age can be considered acceptable and low risk. Kara Murray is drawing on existing research literature and survey data to explore the issues of underage alcohol consumption and its health outcomes. She’s assessing the risk of harm at different levels of alcohol consumption, specifically at low frequency and low quantity of use as outlined in the Canadian low-risk drinking guidelines. She’s also identifying whether there are age or gender differences at different levels of alcohol consumption. Murray’s research will contribute to the advancement of knowledge by attempting to formulate a continuum of risk that identifies distinct levels of hazardous and non-hazardous alcohol use for youth. Ultimately, her work could inform changes to the current prevention and educational strategies that are used.
The effect of co-led mutual support groups in long-term care facilities on well-being
The social relationships that residents form within long-term care facilities (LTCF) are believed to buffer them from loneliness and depression to a greater degree than relationships with family and friends outside of facilities. Furthermore, support from friends and social groups has been associated with positive outcomes for older people living with chronic and serious health conditions. Traditional social activities in LTCF are not usually led by residents and are often passive entertainment programs that don’t provide the necessary supportive environment for residents to interact beyond surface social interactions. These activities are not usually grounded in research evidence, and some programs intended to foster resident well-being actually have adverse effects, including the perception among residents that activities offered are “childlike.” Currently, there is a lack of research evidence showing the benefits of specific social activity programs provided to residents in LTCF. One aspect of particular interest is the use of co-led self-support groups, which aim to enhance residents’ sense of belonging, self-development and self-determination. In this format, an activity staff member co-leads the groups with a resident group member, and acts in the role of a facilitator in order to assist with any special needs of the residents. Kristine Theurer is studying the benefits of co-led mutual support groups. Her assessments of resident well-being will be based on measures of sense of belongingness, loneliness, life satisfaction and happiness. From her findings, she will provide recommendations for co-led group formation, number of participants, suggested theme topics and supportive materials. Ultimately, her work will help LTCF provide appropriate evidence-based programming that supports residents to achieve a better quality of life.
Making Outreach Matter: Exploring Interventions and Decision-Making for Two Intravenous Drug User Populations in Vancouver’s Downtown Eastside
Within the intravenous drug user (IDU) population of Vancouver’s Downtown Eastside (DTES), female commercial sex workers and Aboriginal women are overrepresented. These two groups are especially vulnerable to unique sets of health and social challenges that may be related to their substance dependency, including increased susceptibility to sexually transmitted infections, physical violence, psychological trauma and malnutrition. Their social challenges can include increased contact with law enforcement, lower education, unemployment and inability to access community support. The needs of these two groups both intersect and diverge based on a series of factors. There are currently numerous services and interventions that target intravenous drug using women, including emergency mental health counselling, addictions treatment and recovery, harm reduction (both for IDU and commercial sex work) and general support groups. However, the rates of use of these services by commercial sex workers and Aboriginal women are relatively low. This suggests that many women either choose not to or cannot make use of the available health services and interventions. In order for these interventions to effectively help these two groups of women in coping with deeply interconnected health and social challenges, these factors must be investigated, addressed and understood within a complex matrix. Ashley White is conducting an in-depth study to explore the characteristics, perceptions of health services, and needs of commercial sex workers and Aboriginal women practising intravenous drug use. Her findings will provide essential insight into potential ways that health planners can offer accessible services that better meet the requirements of these women.
Development of a pipeline for the analysis of flow cytometry data
Flow cytometry (FCM) is a method of sorting and measuring types of cells by fluorescent labelling of markers on the surface of the cells. It plays a critical role in basic research and clinical therapy in the areas of cancer, HIV and stem cell manipulation. For example, it can be used to diagnose some types of cancer, based on which labelled antibodies bind to a particular cell’s surface. It is widely recognized that one of the main stumbling blocks for FCM analysis is in data processing and interpretation, which heavily relies on manual processes to identify particular cell populations and to find correlations between these cell populations and their clinical diagnosis and outcome (e.g. survival). Manual analysis of FCM data is a process that is highly tedious, time-consuming (to the level of impracticality for some datasets), subjective and based on intuition rather than standardized statistical inference. Dr. Ali Bashashati has developed a “pipeline” for automatic analysis of FCM data – a computational platform that can identify cell populations, find biomarkers that correlate with clinical outcomes, and label the samples as normal or diseased. Preliminary evaluations of this pipeline have shown accuracy levels of more than 90 per cent in identifying some sub-types of lymphoma. Moreover, a biomarker that contributes to a more aggressive behaviour of a specific sub-type of lymphoma has been discovered. Bashashati is now testing and refining the platform to improve its analytical power and applicability to a range of FCM data, testing its performance across a number of ongoing FCM studies in BC. Ultimately, he hopes to provide an accurate, powerful computational platform to increase the efficiency of using FCM for research and clinical purposes.
CD34 in development of lung inflammatory diseases
Ever since its discovery more than 20 years ago, the CD34 antigen has been widely used as a marker to identify stem cells, precursor cells that give rise to all types of specialized cells. However, the exact function of CD34 expression on hematopoietic precursors and mature cells is still not well understood. Dr. Marie-Renée Blanchet and colleagues have uncovered some fascinating details about the role of CD34 in allergy and asthma. The team recently demonstrated that CD34 is expressed on mature mast cells and eosinophils – two types of cell that respond to injury during inflammation of the body’s tissues – and that the CD34 antigen is involved in their recruitment to the lung and peritoneum. They showed that mice without the CD34 antigen are protected against development of airway hyper-responsiveness and airway inflammation, which are two major hallmarks of allergic asthma. Finally, in preliminary experiments, these mice also showed protection in hypersensitivity pneumonitis, another model of lung inflammation. Now, Blanchet is working to better understand the mechanisms behind these recent findings. Many cell types involved in asthma and hypersensitivity pneumonitis express CD34, some in which the role of this protein remains unknown (eg. fibrocytes and dendritic cells). She plans to use models to elucidate the role of CD34 expression in these cells. Ultimately, she hopes her studies will reveal potential targets for treatment of allergy and inflammation.