Cancers of stomach and esophagus (the tube from the mouth to the stomach) are a major cause of illness and death. Worldwide, the incidence of tumours at the stomach-esophagus border is increasing more rapidly than any other type of cancer. Historically, gastric and esophageal cancers have been studied separately; however, recent evidence suggests these cancers have a lot in common. As a result, studying these cancers together may result in information about the origin or effective treatment of one cancer having similar implications for the other. Morteza Bashash is investigating whether certain genes are associated with the disease progression of these cancers. Specifically, he is testing whether these patients have alteration of two groups of genes that are associated with cancer progression, Matrix Metalloproteinase (MMP) and Tissue Inhibitors of Metalloproteinase (TIMP). He is monitoring newly-diagnosed patients to determine whether the progression of the disease depends on these genes or other possible determinants such as family history, and/or the patients’ ethnicity. He is also assessing whether the effects are different in geographic areas where the cancers are becoming more common (BC), and areas where the cancers are already common. The results from this research could help identify high risk patients and provide them with more effective treatment.
Research Pillar: Population Health
What Causes Parkinson's Disease? An Epidemiologic Analysis of Occupational Exposures
An estimated 100,000 Canadians have Parkinson’s disease, a neurodegenerative disorder that affects the body and brain, causing tremors, stiffness and impaired mobility. Dopamine is a chemical produced in the brain to carry signals between nerves. Parkinson’s develops when cells that produce dopamine die. Researchers have yet to determine what triggers the onset of Parkinson’s. Although a small proportion of cases seem to run in families, research indicates the explanation may lie in individual environmental and lifestyle exposures. For example, workplace exposure to chemicals such as pesticides, heavy metals and solvents may increase the risk of developing Parkinson’s. In one of the largest studies to examine Parkinson’s disease, Anne Harris is investigating whether exposure to the “whole-body vibration” workers can experience operating heavy machinery also elevates risk. Previous studies have shown that traumatic head injury from boxing and other activities can damage the part of the brain that produces signals crucial to mobility and brain function. Harris wants to determine whether the accumulation of smaller injuries over time from whole-body vibration also damages this part of the brain. Her findings could lead to new methods for preventing and treating Parkinson’s disease.
Safety of home birth: Consequences of hemorrhage in home birth
The safety of home birth for women at no identifiable risk is a controversial issue. Approximately 40 per cent of women accessing midwives in BC choose to give birth at home. If there is an emergency related to birth, access to definitive care can be delayed by geography, weather and timing of labour. Severe hemorrhage (bleeding) during childbirth is a clinical emergency that requires immediate invasive interventions by specialized health professionals. It is one of the top three leading causes of death among mothers. Survivors are at risk of developing kidney damage, surgical removal of the uterus and adverse events associated with blood transfusions. But little is known about the consequences of hemorrhage in home birth. Eman Hassan is researching the risk of developing serious consequences following hemorrhage in the home birth setting. She is comparing rates of unfavourable events that occurred due to hemorrhage among planned home births and planned hospital births in the period 2002-2004. The study will provide important information to practicing midwives and childbearing women about what may contribute to hemorrhage, who is at greater risk of developing these events, and the factors that may affect timely access to specialized care. This information will help prevent serious health problems among women considering home birth in BC, and will also be applicable to other provinces in Canada.
Person Perception in Individuals with Autism Spectrum Disorders
Autism has increased 700 per cent in the last decade. The developmental disorder is characterized by severe difficulties with social interaction and communication, an extremely limited range of activities and interests, and often by the presence of repetitive behaviors. A recent study showed autism spectrum disorders (ASD) are the most costly of all childhood disorders in terms of prevalence, outcome, response to treatment, economic cost and family stress. The ability to recognize and understand the constantly-fluctuating emotional expressions of the human face and their associated mental states usually develops in the first year of life. Research has shown that these abilities are seriously impaired in individuals with autism. The causes of this impairment are not yet understood, and although researchers have put forward a variety of explanations, there has been no definitive answer. Based on her past research, Lisa Jefferies is implementing a new approach to the study of person perception in individuals with low to severe autism spectrum disorder and a milder variant known as Asperger’s Syndrome. Jefferies’ approach is based on computer-generated, human-like “”talking heads”” that allow each component of an expression to be controlled and manipulated independently. She aims to use this tool to understand the root of face-perception deficits in children with autism. Jefferies also believes the talking heads will provide an ideal format for an intervention technique, as they could be programmed to focus on critical combinations of facial actions. Her ultimate goal is to develop new knowledge that will contribute to the design of more effective intervention and training to improve the social intelligence of individuals diagnosed with ASD.
Spiritual Coping in Portuguese Immigrants to British Columbia
Numerous studies on the relationship between spirituality and mental and physical health have demonstrated that spiritual coping is an effective way of dealing with stress. Most research in this area has been conducted with members of ethnic and religious majorities. But little is known about how ethnic and religious minorities employ faith in coping with stress. Derrick Klaassen is examining the spiritual coping practices of Portuguese immigrants to British Columbia. Susan James and her colleagues at the University of British Columbia demonstrated that many of these immigrants suffer from a culture specific disorder termed agonias, translated as “”the agonies””. North American health care providers have generally misdiagnosed this problem as indigestion rather than anxiety or stress, and as a result the treatments have remained ineffective. Klassen has two goals for his research. The first is to add to the understanding of effective intervention for agonias by exploring the various healing systems that Portuguese immigrants employ (e.g. mental/health systems, spiritual, community, and cultural resources). The second goal is to examine the ways in which Portuguese immigrants use spiritual strategies to cope with agonias. Klaassen’s research involves conducting focus groups and revising an existing assessment tool for this community. The resulting questionnaire will serve both practitioners and scholars in their investigations of the role of spirituality in coping with stress in Portuguese immigrants. This project is part of a multi-stage program of research that will formulate a culturally sensitive treatment manual for health providers.
Goal adjustment processes and caregiver health: Can giving up be a good thing?
Mounting evidence indicates that caring for a family member with a chronic illness not only reduces the quality of life for the caregiver, it also increases the caregiver’s risk of becoming ill. Little is known about the specific mechanisms by which caregiving impacts health and well-being. One important factor may be the caregiver’s ability to adjust personal family and career goals to meet the demands of the difficult situation. If a caregiver is able to let go of goals set before the diagnosis, such as getting a promotion at work or building a vacation home, he or she may have an easier time adjusting to this new role, and in turn, experience reduced distress and better physical health. Teresa Marin is examining the impact of tendencies to adjust goals on both psychological and physical well-being. Once she has determined the relationship between goal adjustment and health in the context of caregiving stress, it will be possible to apply this knowledge to clinical interventions designed to foster better coping skills among caregivers. This research follows Marin’s MSFHR-funded Master’s work, in which she analyzed the mental and physical health of spouses caring for cancer patients to determine the daily impact of expressing or suppressing their emotions.
How the eating disorder therapist's personal experience of an eating disorder influences the therapeutic relationship with clients who have eating disorders: A grounded theory
The demand for eating disorders treatment in BC typically exceeds what is available in existing specialty programs. This service gap is often filled by community psychotherapists. Research indicates that eating disorders among eating disorder treatment professionals far exceeds prevalence rates in the general public. This suggests that there are likely to be therapists working in the field of eating disorders treatment who have recovered from, or who many currently struggle with, an eating disorder. Recovered/recovering eating disorder therapists are ethically obliged to evaluate how their personal experience may influence the therapeutic relationship with the eating disordered patient in helpful or harmful ways. Meris Williams’ research aims to enlarge our understanding of the recovered/recovering eating disorder therapist, especially how the personal history of an eating disorder influences the therapeutic relationship with eating disordered patients. She will conduct extensive interviews with 20 psychotherapists who provide services to patients with an eating disorder, and who themselves have received a diagnosis of an eating disorder. The study’s results can enhance the effectiveness of recovered/recovering eating disorder therapists by helping them assess their readiness to work with eating disordered patients. It can also help ensure that therapists’ personal experience is influencing the therapeutic relationship in a manner that benefits patients. The results could also be used to inform the education, training, and supervision of eating disorder therapists-in-training in BC. Ultimately, this research will help people seeking treatment for an eating disorder.
Improving public health through active transportation: Understanding the influence of urban infrastructure on decisions to travel by bicycle
Cycling offers great benefits as an urban transportation option in terms of public health. It’s free of air and noise pollution, and it incorporates physical activity into people’s daily routines, therefore contributing to increases in fitness, decreases in obesity, and potential declines in heart disease, cancer and diabetes. Cycling rates in Canadian cities are very low compared to those in European centres. Despite the room for growth, Canadian municipalities are struggling to accomplish even modest changes in cycling rates. Some cities have sponsored research to understand how to encourage their residents to cycle more, but none have investigated how neighbourhood characteristics and transportation networks are related to cycling rates. Meghan Winters is researching which characteristics influence cycling rates in MetroVancouver. Information about factors such as population density, hills, distances to shops and workplaces, street types and bike routes will be linked to information from more than 2,000 Vancouver area residents about whether they drive, cycle, walk or use transit for their most common weekly trips. She will measure the effect of neighbourhood characteristics and transportation networks on the likelihood of a trip being made by bicycle. By providing evidence on how to build neighbourhoods that are favourable for active transportation, this study will help make the healthy transportation choice an easier choice, thus improving the fitness and health status of the community.
The MTHFR C677T polymorphism and postpartum mental illness in at-risk women
Psychotic disorders (which include schizophrenia, schizoaffective and bipolar disorders) are common mental illnesses, affecting about 3 per cent of the population. Women face a number of challenges when dealing with these disorders, especially when it comes to pregnancy, childbirth and parenting. Women with a history of a psychotic disorder have substantial risks for a postpartum episode of mental illness like depression or psychosis. Postpartum mental illness carries risks for suicide and infanticide, as well as other less dramatic but still significant problems like difficulties with parenting skills and problems with mother-child bonding and attachment. Research has shown that, in general, psychotic disorders stem from interactions between genetic and environmental influences. The specific genetic variations that increase risk for postpartum episodes of mental illness are largely unknown. Dr. Jehannine Austin will use a new approach to investigate whether a variation to one particular gene contributes to risk for postpartum episodes of mental illness in women with a history of mental illness. This gene is known to encode a protein whose function is dependant on the B vitamin, folate. Dr. Austin will not only look at genetic variations, but will also measure folate levels in pregnant women at high risk of postpartum mental illness. If her work shows that the genetic variation plays a role in risk for postpartum mental illness, it may be possible to decrease risk for postpartum episodes of mental illness by providing folate supplements for these women.
Neighborhood Social Capital and Population Health: Exploring Community Resources and Access
Recently, the concept of community social capital – the extent and quality of community social ties – is receiving a great deal of interest from population health researchers and policymakers. This interest stems from efforts to understand relationships between the social and economic conditions of communities and the health and well-being of the people who live in these communities. Research on social capital to date has been focused primarily on the extent of social ties and interpersonal trust in communities. This limited focus has overlooked crucial elements that make community social ties useful for maintaining or improving population health: the various socioeconomic, political, and psychosocial resources that are possessed by members of social networks and how residents access (or are restricted from accessing) these network-based resources.
Dr. Richard Carpiano is determining how specific resources based in neighbourhood social ties, and access to these resources, matter for adult health and well-being. He will analyze one of the best available community health datasets for investigating social capital and neighborhood socioeconomic conditions: the Los Angeles Family and Neighborhood Survey (L.A.FANS). This project has two major benefits. It will extend population health planners’ understanding of community social capital by showing what aspects of neighbourhood social ties matter for health and well-being and how social conditions of local areas have health promoting and health damaging consequences. More broadly, it will help extend population health research on neighbourhoods and local communities by exploring the different ways that social context matters for adult health and well-being.