Chronic diseases represent an increasing burden for both the patient and healthcare system. Many people also now have more than one chronic disease. For those people with chronic diseases living in rural areas, the risk for hospitalization is more than 60% greater. These patients and their primary care providers face an enormous challenge in meeting their day-today health needs that patients with chronic diseases have.
Research Pillar: Health Services
Modeling Dynamical Neural Activity of Magnetoencephalography Measurements using a Real Time Hardware Phantom
The acts of perceiving, thinking, doing or feeling are marked by complex patterns of electrical activity in the brain. Dysfunction in neuronal activity is observed in many diseases and conditions, including epilepsy, dyslexia and Down syndrome. Magnetoencephalography (MEG) is a leading edge technology that images functional brain activity in the human cerebral cortex. The MEG installed in the Vancouver/Burnaby (V/B) MEG laboratory contains an array of 151 sensors configured to record minute magnetic fields that are generated when neurons depolarize in the brain. MEG is used to study neural patterns and pathways using human subjects. However, creating a phantom model to artificially activate sequences of simulated neurons in realistic patterns could help researchers explore dynamic neural networks in more detail. Using a phantom model would allow for more complex studies of brain activity and would also allow researchers to test what happens when pathways are “virtually” altered or severed. Using neuroscience, physics and engineering, Teresa Cheung is developing a phantom model of the cerebral cortex. She will use a series of magnetic dipoles to simulate the brain’s magnetic fields and write the software to control the activation of these fields. By creating a model that accurately simulates brain activity in healthy and dysfunctional states, Cheung’s research will help researchers better understand the complex workings of the brain.
The impact of therapeutic design on social engagement among residents with dementia during programmed activities in dementia care units
Dementia special care units (SCU) and freestanding special care facilities (SCF) for people with dementia are built using design principles that have been shown to enhance quality of life and reduce responsive behaviours that often occur when residents are disoriented or overstimulated by their surroundings. More supportive environments in these facilities are created through smaller unit sizes, homelike ambience, increased wayfinding, smaller activity spaces, and access to safe and secure wandering paths. Architectural planning and design features can improve the physical context where programmed activities such as music therapy, exercise sessions, creative arts, and therapy gardening occur. However, these specially designed spaces offer few therapeutic benefits without appropriate staff resources and family involvement to make the programs succeed, and consideration must be given to the combined effects of physical design, programs and policies, and staffing issues. Few studies have systematically assessed how modifications to the physical environment work in concert with social and organizational factors to enhance opportunities for residents to engage in positive social interactions through meaningful programmed activities. Krista Frazee is exploring the impact of the physical and social environments of care settings on residents’ social engagement during programmed activities in SCUs and SCFs, versus traditional integrated care facilities. She will also assess staff and family caregiver perceptions of activity spaces in helping them provide meaningful planned activities for residents. The findings from this study will be used to inform architects, interior designers, facility administrators and staff in various ways they can support the care and quality of life of residents with dementia through the integration of physical design and programmed activities.
CD-based ELISA for point-of-care diagnostics
Current methods of medical diagnostics, such as imaging and laboratory tests, tend to be time-consuming, labour intensive, and often limited to biomedical laboratories or hospital settings that have specialized equipment. In contrast, point-of-care diagnostic tools allow testing and diagnosis to be performed in a doctor’s office, at a significantly reduced cost and in a shorter time to obtain test results. This contributes to faster treatment decisions and better follow-up post treatment. The enzyme-linked immunosorbent assay (ELISA) is a popular tool for analyzing environmental or biomedical samples. The ELISA method uses a number of biochemical steps to detect the presence of a specific protein (such as an antigen or antibody) in a sample on a microscope slide, which is read by a robotic spotter or microplate reader. Preliminary research has suggested that these bioassays could be prepared on the surface of a compact disc (CD), and the results could be read by a standard computer drive equipped with special software. With commercialization, this method would undoubtedly reduce the cost of biomedical screening. Miao-Ling Ou is developing a diagnostic assay for detecting thrombin using this CD technology. Thrombin is a blood clotting factor that is the focus of many research studies on anticoagulation and cardiovascular disease therapy. Once fully developed, this CD-based ELISA method could be extended to other types of biomolecular interactions, such as those used in the screening of gene mutations or antibody-antigen interactions.
An examination of internet use for health information among Canadian baby boomers using the 2000 general social survey
The internet is a powerful health promotion tool, and it’s predicted that this technology has the potential to influence the way health information and services are distributed and accessed. Baby boomers (those born 1946-1965) are a prime target for this type of health promotion technology, since they have been exposed to the growth and widespread use of the Internet. Additionally, baby boomers are more concerned about healthy lifestyles and healthy aging than previous generations, are more interested in self-help resources, and are more demanding of good service. While previous research has found a high percentage of internet access and use among older Americans, no surveys have been carried out in the Canadian context. With the proper education and tools, baby boomers can not only delay functional loss, but improve their current health status and prevent the onset of several chronic illnesses and disabilities that begin to appear in mid-life. Providing them with appropriate, targeted resources requires knowledge about current utilization trends, needs, barriers and other concerns that could be hindering them from seeking online information regarding their health. Danielle Sinden is using national data gathered as part of the 2000 General Social Survey to examine trends, types, and levels of access to the Internet. She is also exploring predictors of health information-seeking behaviour, including sex, socioeconomic status, living arrangement/marital status, foreign-born status, region of residence, and perceived barriers and usefulness. Sinden’s research will lay a foundation of knowledge for developing online health promotion strategies targeting modifiable risk factors for baby boomers. Ultimately, this could lead to more favourable long term health outcomes that contribute to healthy aging.
Defining perceptions and utilization of pharmacotherapy for menopausal symptoms among Chinese immigrant women in British Columbia
By 2017, one in five people living in Canada will belong to a visible minority group, and nearly half (between 3.2 and 4.4 million) will be Chinese or South Asian. A variety of factors – including language, education, socioeconomic status and employment – affect health and access to health care. Gender, ethnicity, and immigration are also increasingly recognized to have a significant impact. Medication use for menopausal symptoms has not been explored in the context of gender, ethnicity and immigration in Canada. Women, particularly Chinese women, have historically been underrepresented in clinical trials, resulting in a limited understanding in this group. As a result, few studies have examined Chinese immigrant women’s experiences with medications for menopausal symptoms. Dr. Elaine Chong will focus on a knowledge gap relating to medications used for menopausal symptoms, among Chinese immigrant women who access health services through a specialized outpatient clinic in Vancouver. Chinese immigrant women constitute a group that has health disparities and may have less access to evidence-based care than other women in Canada. Chong’s research will help shed light on differences in medication use and health disparities among a vulnerable group. She hopes these results can be applied to culturally-appropriate interventions that support Chinese immigrant women in attaining optimal health status.
Validating a computer adaptive test for the measurement of health outcomes in adults with musculoskeletal disorders
Although effective medical treatments and supportive services for people with joint problems (such as arthritis) are available, the choice of specific treatments and services offered must be guided by knowledge about the various challenges they encounter in their daily lives. Important health outcomes reported by people with joint problems can include their competence with daily activities, their ability to walk and handle objects, their pain or discomfort, and their emotional wellbeing. Computerized adaptive assessment systems can be used to efficiently obtain information about self-reported health outcomes by selectively administering questions that are most meaningful and relevant to an individual’s condition. The resultant information can be used to track changes in a person’s health outcomes over time and facilitate decision-making and communication between patients and health care professionals about the impact of arthritis. This can provide the patient with more information and control with respect to their choice of treatment. Dr. Richard Sawatzky is investigating whether a recently-developed computerized health outcomes assessment system for people with arthritis provides accurate and trustworthy information. He is specifically examining the extent to which the information provided by system is valid irrespective of differences among individuals that may lead to variations in how they interpret and answer the questions. His assessment uses data from almost 6,500 participants across the country. Sawatzky’s research will ensure that the individual’s experiences with respect to several health outcomes relevant to arthritis are obtained and reported in the most accurate, informative, and efficient manner.
What happens after conventional treatment? Investigating the feasibility of a complementary and alternative medicine (CAM) modality for breast cancer survivors
It is estimated that there are well over 10.5 million cancer survivors in North America and over 40 percent of the females are breast cancer survivors. Nearly three quarters of the cancer survivors experience some kind of debilitating effect(s) from cancer diagnosis and conventional treatments, including considerable fatigue, psychological distress, impaired quality of life, cognitive dysfunction, cardiac toxicity, loss of appetite, poor mental health and reduced physical and sexual functioning. These effects are particularly prevalent in breast cancer survivors who received multiple treatments over an extended period of time. Increasingly, health care providers and patients are looking to innovative solutions to address adverse effects that are often poorly managed by conventional medicine. Approximately 80 per cent of breast cancer survivors use some form of complementary and alternative medicine (CAM) to help them manage the difficult physiological, emotional and psychological symptoms that often persist. A growing body of randomized controlled research implies that yoga therapy has physiological and psychosocial benefits for the chronically ill – however, controlled trials are lacking for its use within cancer. Dr. Suzanne Slocum_Gori has previously conducted NIH studies within the US investigating yoga therapy for HIV/AIDS. Now, she’s focusing on the feasibility of using yoga therapy as part of the BC Cancer Agency’s (BCCA) health services for breast cancer survivors. Slocum-Gori’s study will consist of two phases. She will examine both the acceptability and sustainability of such a program within BCCA’s mainstream health system for Phase I, including the identification of factors that promote and impede acceptability, sustainability, recruitment and attrition. Phase II of the study will consist of a controlled pilot study to measure the effectiveness of yoga therapy for breast cancer survivors over time.
Exploring the social structural dynamics of health barriers and determinants of women in Vancouver's survival sex trade: an ethnographic study
A decade ago, HIV infection among downtown eastside residents exceeded those in any other part of the “developed” world. Current neighbourhood HIV prevalence estimates range between 19 and 22 per cent, and is reported higher amongst individuals who inject drugs. Risk of HIV infection is particularly profound for women who are young, coping with violence and multiple addictions, and whose survival necessitates work in the commercial sex industry. Women and girls are politically, socially and biologically more vulnerable to HIV infection. Many women in the community, including the majority of those who are part of the sex work economy, do access various health and social services, such as clinics, point-of-care and emergency services, as well as needle exchange programs. The use of condoms is also prevalent. Despite this, the rates of HIV infection remain high, particularly among sex workers who are also less likely to be treated for HIV/AIDS. Regardless of income generating strategies, HIV infected women in the community face multiple barriers to continuity of care. Suze Berkhout was previously funded by MSFHR for her early PhD work in HIV risk behaviours and health service needs among women in Vancouver’s inner city. Employing qualitative research methods and philosophical analysis, her research critically examines the impact of common stereotypes, life histories, and institutional norms and values on women’s health care experiences, in order to unravel the paradox surrounding the health and well-being of vulnerable women. Rather than suggest that women who appear to systematically “”choose”” poor health are irrational or irresponsible, Berkhout’s study seeks to understand what health trade-offs women may make in the context of their lives. For example, day-to-day concerns such as housing, food or caring for others may take precedence over health concerns. Likewise, women’s previous experiences in the health system may themselves perpetuate mistrust toward health providers, leading to delays and discontinuation of medical care. Berkhout’s findings will enable health care providers to better reflect on and respond to the experiences of patients within the health care system. Ultimately, her work could lead to more appropriate and responsive care for socially and economically disadvantaged women.
When does culture make a difference? Exploring the influence of culture in palliative and end of life care
Canada has a large and growing multicultural population with different perspectives on health and illness. This brings unique challenges to the provision of appropriate palliative and end-of-life care, where culture is known to influence communication patterns, decision-making styles, responses to symptoms, treatment choices, and emotional expression at end-of-life. Previous studies have shown that unresolved cultural differences can result in poor interactions and outcomes in end-of-life care. Although culture is known to be an important influence in health care, little is known about when and how people apply their cultural beliefs, values and practices to their health care experiences. Theories suggest that people often move back and forth between their traditional culture and mainstream culture to meet different needs. Harvey Bosma is exploring the ways in which culture influences interactions between culturally diverse patients and health care professionals in palliative care. He will use qualitative interviews and participant observations to develop rich and in-depth descriptions of these experiences from the perspective of a range of culturally diverse participants. Bosma’s findings will provide valuable insight into when and how culture facilitates or challenges health care interactions. The information can be used by physicians, nurses and other health care professionals to better understand the needs and actions of culturally diverse patients. Ultimately, the findings of this study may be used to enhance culturally-competent and sensitive care at end-of-life so that palliative and end-of-life care is relevant and accessible to individuals and families of different cultures.