Research has shown that quality of health care services influences the health and well-being of women and their families during pregnancy, birth and the first two to three months after birth. Studies also show that access to effective health services is important in helping women follow healthy practices. Less is known about the ways in which relationships between women and their health care providers influence the effectiveness and fair distribution of health services. Helen Brown is investigating this question, with a focus on understanding how these relationships affect healthy practices among women from marginalized or less powerful groups. Helen hopes the research will help improve health care relationships, enhance quality of care, strengthen health promotion and education for childbearing women, and help policy-makers create more effective and equitable services.
Research Location: University of Victoria
Evaluation of common drug review dissemination and use of evidence by drug plans
The cost of publicly funded prescription drug programs in Canada is growing an estimated 15 per cent a year. Studies show drug plan staff have little time to reassess drugs already on the market and are overwhelmed with submissions from pharmaceutical companies seeking approval of new drugs. In September 2001, federal, provincial and territorial Health Ministers launched the Common Drug Review (CDR) to develop a national process for reviewing evidence on new drugs and reducing duplication among provinces. How CDR will integrate with current communication systems to share information between drug plan staff and researchers is not yet clear. Mowafa Househ is assessing how drug plans use and produce evidence within the CDR system, and how virtual networking can improve the exchange of this knowledge. Using web-based conferencing, Mowafa is developing a three-step protocol to improve links between drug plan manager and researchers. He is applying the protocol to three major drug plan issues: assessing new drugs, re-assessing existing drugs, and evaluating the impact of drug policies.
Income support and the health of women with disabilities: The dis/abling effects of discourses
Women with disabilities face many barriers to health, including poverty and inequality. Government-administered income support programs are necessary for the survival of many disabled women, yet these programs also create barriers to working, developing abilities and participating fully in activities available to non-disabled people. Sally Kimpson is examining the effects of disability income support policy and programs on women with disabilities. Through in-depth interviews with disabled women, she is studying how they participate in income support programs – including compliance with or resistance to different elements of these programs – and how they learn to participate in society while negotiating constraints related to the programs. Increasing understanding of how disabled women live with income support will help improve policy and programs, which will ultimately benefit women whose health and well-being are closely tied to securing income support.
Enhancing access to health care for marginalized groups through a study of relationships between street nurses and the people they serve
In previous research, people experiencing marginalization such as those living with mental illness, HIV/AIDS, illicit drug use and homelessness have reported very negative experiences with the health care system. These experiences can result in delays seeking treatment and greater future costs to the health care system. At the same time, these groups have reported positive experiences with street nurses (registered nurses who work on the street). Bernadette Pauly is assessing the nature and quality of health care relationships between street nurses and their clients, and how health and social policies and organizational structures affect these relationships. Increasing understanding of these relationships, along with factors in the environment where street nurses provide care, could ultimately reveal ways to improve health care delivery for marginalized groups and, ultimately, their health.
Regulation of thyroid hormone-dependent apoptosis and proliferation by the ING tumour suppressor
Thyroid hormones are critical for proper growth and development and are equally important in maintaining good health. Research has shown that these hormones play a key role in regulatory pathways that ensure cells act appropriately when signaled to grow, divide or undergo apoptosis (programmed cell death). Many molecules are involved in these pathways including proteins that are known to contribute to cancer progression. Dr. Caren Helbing is investigating the relationship between ING protein (a growth inhibitor) and thyroid hormones. ING’s tumour-suppressing action is reduced in many cancers, including a subset of breast cancers. Dr. Helbing is exploring how ING may be involved in regulating the way a cell responds to thyroid hormones. Clarifying the relationship between ING and thyroid hormones, may provide new insight into the ways cancer cells bypass normal cellular controls that normally would cause their destruction.
Intrinsic capacity of spinal circuits for restoration of motor coordination after neurotrauma
While the brain is the body’s command centre, connections within the spinal cord control rhythmic activities like walking. The brain contributes to such movements, but spinal cord circuits can coordinate muscle activity on their own, relying on feedback from moving limbs to regulate the pattern. When these connections are lost or altered due to injury to the brain or spinal cord, movement in the arms and legs may be greatly reduced depending on the location and severity of the injury. Dr. Paul Zehr’s research focuses on improving understanding of how coordinated muscle activity in arms and legs can be improved after neurotrauma. He is working with individuals who have had strokes or spinal cord injuries to determine the extent to which enhanced sensory feedback techniques can retrain spinal cord circuits and improve limb coordination. New knowledge gained from this research may lead to more effective methods of improving motor coordination following brain or spinal cord injury.
Development of a leisure time walking program based on the theory of planned behaviour stage 1: belief elicitation and evaluation
Substantial evidence associates physical inactivity with the development of several chronic diseases and premature mortality. Conversely, extensive research indicates physical activity helps prevent cardiovascular disease, obesity, stroke, diabetes, cancer, osteoporosis and other conditions. Despite this information, about 57% of adult Canadians do not meet the minimal requirements for physical activity, and half of those who begin a regular physical regimen drop the activity within six months. The overwhelming majority of Canadians — more than 70% — choose walking as their preferred physical activity during leisure time. Dr. Ryan Rhodes is studying beliefs about leisure time walking. The research includes an initial study assessing physical activity beliefs and a second survey assessing actual time spent walking. Results from the research will be used to develop a provincial leisure time walking campaign for adults. Dr. Rhodes’ ultimate goal: developing effective campaigns for promoting physical activity in specific populations, such as middle-aged adults and older adults.
Who “crashes” onto dialysis? Impact of social determinants of health on renal patients’ access to dialysis treatment
Despite the fact that chronic kidney disease almost always presents warning signs, 30-50 percent of new renal patients in BC “crash” onto dialysis or are referred late for assessment of kidney disease. Both scenarios are associated with increased morbidity (severity of symptoms), increased hospital stays, reduced opportunities for more ambulatory modes of care, such as peritoneal dialysis or early kidney transplant, and increased mortality (incidence of death). There is much to be learned about the range of possible determinants that may influence renal patients’ ability to access treatment. Nancy Blythe will investigate the social determinants of health of 1300 renal patients who initiated dialysis in BC in 2001-2002. Her aim is to determine whether certain social structural barriers in society (availability of social support, adequate income, etc.) constrains patients from seeking treatment before their chronic illness advances to an acute stage, resulting in late referral to the health system or the onset of dialysis under emergency conditions. Subsequently she will study whether those same social barriers and suboptimal initial access negatively influence ongoing access to dialysis as well as morbidity and mortality. It is anticipated that the research results will contribute to better ways of assisting renal patients to obtain optimal access to this life support treatment.
The role of the tumor suppressor ING in cell growth and death in a frog model system
Mary Wagner is interested in the fundamental mechanisms that govern a cell’s decision to divide, mature or die. Armed with this information, she says, we can gain greater insight into many different diseases where these basic functions are altered. For example, cancer is characterized by uncontrolled cell division, and inappropriate cell death is the hallmark of degenerative diseases such as Alzheimer’s and muscular dystrophy. Mary is studying the role of ING (INhibitor of Growth), a protein that helps regulate these basic cell functions. While ING is also found in the cells of humans, mice, rats and yeast, Mary is studying the protein’s role in the metamorphosis of tadpoles into frogs—a drastic and rapid transformation involving tail death, leg growth and brain remodeling. She is also investigating how environmental pollutants can act as hormones to disrupt normal cell development and function.
Psychosocial predicators of success following memory intervention in older adults
Memory difficulties accompany the aging process. Two common examples include reduced ability to recall recent information or events and problems remembering to do something in the future. Programs have been developed to help older adults, including people with Alzheimer’s and their caregivers, deal with age-related memory changes. Although most benefit from these programs, not everyone responds equally and some do not seem to benefit at all. Little research has been done to investigate how psychosocial factors, such as personality characteristics, coping abilities and emotional status, affect the success of memory intervention programs. In her doctoral research, Patricia Lynn Ebert is assessing the impact of psychosocial factors on adults 70 and older who are in memory programs. Patricia hopes the results will lead to greater understanding of memory function in older adults, improved memory intervention programs, and better outcomes for program participants.