There are more than 80,000 health care providers working in BC. They work in complex and demanding environments where they may be exposed to numerous potential health hazards, including those that are chemical (e.g. drugs or cleaning agents), biological (e.g. bacteria or viruses) and physical (e.g. noise or radiation) in nature. Dr. George Astrakianakis focuses on understanding the many factors that determine the potential for exposure to health hazards among health care workers, and how to best mitigate their associated risks. In the initial phase of his research, he is identifying the specific chemical exposures commonly encountered in the healthcare workplace, assessing the risk to health for healthcare providers, and defining appropriate exposure control measures. In subsequent phases, he will assess biological and physical hazards, and implement and evaluate control strategies. Much of Astrakianakis’ data will be drawn from surveillance information collected by the Occupational Health and Safety Agency for Healthcare, which supports BC’s health care industry in part by monitoring information on occupations, exposure incidents and injuries among the Province’s health care professionals This information will form the basis for creating a job exposure matrix (JEM), which will be used to map exposure levels to occupations and eventually to provide risk estimates. The ultimate goal of this project is to design and implement appropriate exposure control strategies — such as technology, policy and training — in health care settings and to evaluate their effectiveness in mitigating risk to health care providers.
Research Pillar: Population Health
The role of imprinting in placentation and obstetrical complications
Up to one per cent of pregnancies in British Columbia end in stillbirth. Two conditions thought to contribute to the rate of stillbirths are pre-eclampsia and intrauterine growth restriction (IUGR). Pre-eclampsia – a form of pregnancy-induced high blood pressure – affects approximately five per cent of pregnancies, and can be life-threatening to both mother and fetus. IUGR – where the fetus is significantly undersized for its gestational age – also affects approximately five per cent of pregnancies, and is linked to health problems at birth and beyond. Abnormal placental development is thought to be responsible for many complications of pregnancy, including pre-eclampsia and IUGR. The causes underlying abnormal placental development are largely unknown. It may involve errors in DNA methylation, a mechanism used to regulate the activity of certain genes – particularly imprinted genes. Unlike the more common type of genetic inheritance where the outcome in the offspring will depend on whether a gene is dominant or recessive, imprinted genes are parent-of-origin-specific, meaning they are only expressed from either the maternal or paternal chromosome. The placenta has an overabundance of genes expressed in this way. Errors in DNA methylation and imprinting can result in changes in gene expression. Danielle Bourque’s project aims to determine if disruption of normal DNA methylation and imprinted gene expression leads to the abnormal placental development associated with pre-eclampsia or IUGR. The eventual goal is to develop a strategy to improve early diagnosis of pre-eclampsia and IUGR, which will lead to improved treatments and outcomes for both mother and baby.
Perinatal outcomes in a provincial based cohort of HIV positive mother-infant pairs
Every year 2.4 million HIV positive women worldwide deliver infants. In Canada, increasingly complex highly active antiretroviral therapy (HAART) regimens are widely used by pregnant woman to improve maternal health and reduce transmission to fetuses. However, there are concerns about maternal and fetal complications with HAART. Oak Tree Clinic, British Columbia’s provincial referral centre for maternal-infant care of HIV positive women and their families, maintains a longstanding comprehensive perinatal database. Tessa Chaworth-Musters is investigating, updating and expanding this database to determine complication rates in HAART-exposed pregnancies. Chaworth-Musters is adding new data fields to reflect questions in the current literature, and where available, she is making comparisons to a provincial data set from the BC Reproductive Care Program and using statistical models to determine if specific variables impact outcomes. The findings will guide Oak Tree physicians in their treatment of pregnant HIV positive women and contribute to improvement of provincial and national antiretroviral therapy guidelines and pregnancy practices. Chaworth-Musters also aims to clarify inconsistencies in already published data. Her overall goal is for the research to facilitate understanding of optimal, safe, effective and non-toxic treatment during pregnancy of HIV positive women.
Effect of long term air pollution exposure on childhood respiratory diseases in the Georgia Basin: A cohort study
Asthma is the most common chronic disease in childhood. Long term studies indicate predisposition to asthma develops in the first three to five years of life. Recent evidence suggests exposure to air pollution from traffic is associated with new cases of asthma. However, the long-term impacts of air pollution exposure and whether this exposure causes asthma are unclear. Nina Clark is investigating the association between exposure to air pollutants and childhood respiratory diseases in southwestern BC. Using the BC Linked Health Database that connects various data sources to provide individual level health outcome data, Clark is tracking the exposure and health outcomes of approximately 120,000 children who were born in the region over the four-year period beginning in 1999. She will examine resources including maps detailing air pollution concentration, medical services plan billing records and hospital discharge records. Clark will also look at variables such as age, gender, birth weight and socioeconomic status. She hopes her research will lead to targeted reductions of air pollution exposure, such as zoning or land use restrictions to limit exposure of children, and help provide focus for future interventions and policies.
Remaining patient: Transforming the practices of health care to promote positive outcomes for teen mothers and their children
Teen pregnancy is a health issue affecting Canadian youth, particularly vulnerable teens. Unfortunately, teen mothers typically do not access health care regularly which hinders their ability to receive necessary information about both prenatal and maternal health. Without effective and early intervention, young mothers and their children have ongoing health, social and education issues that strain the health care system. While researchers have differing opinions about the impact of age on these health outcomes, most research defines teenage pregnancy as a health and social problem. Genevieve Creighton is studying whether the concept of teen mothers as “ill” stigmatizes teen mothers, making them reluctant to access the health care system for fear of being judged by health care workers and educators. Creighton is working with pregnant and parenting teens and their health care providers to determine whether certain attitudes and practices have a negative impact on their relationships and how these can be transformed. This information could help health and social service providers design more effective programs for teen mothers and other vulnerable populations.
An examination of illicit drug use and sexual risk behaviours among a cohort of street-involved youth in Vancouver
Injection drug use has significant health consequences, including high rates of HIV and hepatitis C transmission. These problems have been exacerbated in recent years by the use of crystal methamphetamine (commonly called crystal meth), particularly in BC. Methamphetamine use is becoming increasingly common among marginalized youth, particularly those whose social and economic environment is the street. It is estimated there are between 45,000 to 150,000 street-involved youth in Canada, most of whom live in the large urban centres of Toronto, Montreal and Vancouver. Illicit drug use and unsafe sexual practices, including unprotected sex and sex trade work, increase susceptibility to HIV infection among street-involved youth. Brandon Marshall is one of the few researchers investigating the relationship between illicit drug use and sexual risk behaviours among street-involved youth. Using data collected from the B.C. Centre for Excellence in HIV/AIDS At-Risk Youth Study, he will examine how different social, structural, and environmental factors impact sexual practices. Specific factors include the age of first sexual experience, sexual orientation, illicit drug use, sexual relationships with older partners, access to health services, and involvement in the Downtown Eastside community of Vancouver, where drug use and poverty are prominent. This research will improve our understanding of illicit drug use and sexual activity in marginalized youth and will play an important role in developing sexual health education and prevention programs for youth at-risk.
Impact of community engaged arts on the health status of older adults
With the number of seniors in Canada’s population increasing, more older adults are potentially dealing with chronic or recurring health issues. Given this trend, there’s an essential need to identify health resources available to these individuals and to evaluate the effectiveness of these resources in impacting health status. Recent research has show that that creative involvement in the arts positively impacts the health of older adults. Elaine Moody is investigating how a community-based art project impacts health among its older adult participants. She is studying groups of seniors in the Vancouver area who are currently participating in community-engaged arts projects focused on developing creative and artistic abilities, and providing opportunities to meaningfully contribute to their communities. Through a questionnaire and a series of interviews, Elaine is collecting information about the health status of the participants, including physical, mental and social health, and overall well-being. Using statistical methods, she is examining the information obtained to determine if health status has improved over the course of the study. Her overall aim is to provide a clearer understanding of the health benefits of participating in community engaged arts for older adults.
Evaluating the inclinometer as a novel approach to estimate spinal compression for epidemiological and occupational field studies of back injuries
Almost 200,000 thousand workers are hurt on the job every year in BC. The majority of incidents involve musculoskeletal injuries, with back injuries accounting for approximately 25 per cent of all work claims. To reduce the occurrence of back injuries, we need a better understanding of the aspects of a job that are associated with the risk of injury. Most research is done with a small sample of workers in a controlled test environment. However, in order to have representative and generalizable results about the risk of injury, researchers require exposure data on large numbers of individuals at work so that relationships can be observed. To do this, they need accurate, inexpensive and easy-to-use tools to take out into the field. Spinal compression is a major risk factor for back injury. Robin Van Driel’s research is investigating the potential of estimating spinal compression by using an inclinometer (usually used for posture analysis), instead of the traditional electromyography method, to measure spinal compression among workers in five heavy industries in BC. By developing a better understanding of the work factors associated with the risk of injury, this research will help reduce the large personal and economic burden associated with low back disorders, and could be applied to many other occupational groups with similar risk factors.
Measurement error issues in studying the effect of gene-environment interactions on disease risks
Complex diseases, such as different types of cancers, are influenced by genetic and environmental factors and their interactions. There is overwhelming evidence that the effects of environmental factors on most cancers are modified by individual genetic characteristics. The accuracy of assessing the effects of gene-environment interactions on disease risks depends on how accurately the exposure to environmental factors can be measured or how accurately genetic makeup can be classified or both. Measurement error or misclassification can seriously distort the true effects of gene-environment interaction and produce biased estimates of the effects. Dr. Shahadut Hossain is developing a flexible modeling approach to adjust for biases when some of the quantitative environmental exposures are measured inaccurately. Hossain is also working to extend this methodology so that it can incorporate both exposure measurement errors and gene misclassification. His research involves studies of non-Hodgkin lymphoma, ovarian cancer and prostate cancer conducted with the Cancer Control Research Program at the BC Cancer Agency. Hossain hopes his work will enable the assessment of gene-environment interactions to be done more precisely, contributing to a better understanding of the effects of these interactions and more effective intervention strategies to prevent these diseases.
Development and evaluation of a novel group educational intervention to promote partner support for people with rheumatoid arthritis
In addition to the many physical challenges that arise from rheumatoid arthritis (RA), related problems with pain, fatigue, sleep and depression can affect quality of family relationships, work and hobbies. Although current drug treatments for RA can improve symptoms in some people, there is still a great need for other types of help to make peoples’ lives better. Research has shown that good social support from family can result in better wellbeing, pain reduction and improved quality of life. With other types of arthritis, education programs have resulted in better coping among arthritis sufferers and their partners. However, there is no similar program specifically for people with RA. Dr. Allen Lehman’s study is the first to create and test a program to improve social support for people with RA and their partners. He will develop the program by conducting consultations with people with RA, their partners and couples together. Groups will discuss challenges and successes in getting support, what kinds of support work and what is not helpful. The program will then be piloted with 30 couples. This study aims help couples better understand the disease and learn more about what one can and cannot do to be supportive. Because social support predicts good health, the program could also be applied to people with other types of arthritis and chronic disease.