It’s been estimated that more than half of nursing home residents use wheelchairs as their primary means of mobility. But little research has examined wheelchair use within facility settings. A few studies have shown that nursing home residents experience a variety of wheelchair-related problems, such as wheelchair discomfort, immobility, poor posture, and dysfunctional wheelchairs. As well, rather than facilitating independence, wheelchairs may be used as restraints. William Mortenson is conducting a two-phase study on wheelchair use in nursing homes. In the first phase, Mortenson will explore the overall impact of wheelchairs and wheelchair seating on nursing home residents through interviews and observations. In the second phase, he will identify factors that predict wheelchair mobility and investigate the relationship between wheelchair use, activity participation and quality of life amongst nursing home residents. He has three goals for the study: to improve understanding of how the nursing home setting influences the availability of wheelchair equipment and impacts the use of wheelchairs; to improve opportunities for residents to access wheelchairs; to support lobbying for better funding for wheelchairs and wheelchair services. He also hopes his research will ultimately contribute to the health and quality of life of facility residents through the development of an intervention program, which could improve wheelchair-related institutional policies and practices for this increasing segment of the population.
Research Pillar: Population Health
The Genetics of Asthma, Atopy and Allergic Diseases
My research focuses on trying to identify why some children get asthma and others do not. By identifing specific environmental and genetic risk factors and determining how they work together to predispose children to developing asthma and other allergic diseases we can design better treatments. Studies have found a 1-in-5 risk of developing asthma if one parent has asthma. The odds rise to 2 out of 3 if both parents have asthma. However, in itself, a genetic predisposition does not ensure that asthma will develop. Asthma and allergic disease are the result of both genetics and the environment. The interaction between a genetic disposition and environmental factors is key in the development of – or in protecting against- asthma. I will use information from 250 French Canadian Asthma Families and two additional birth cohorts, and information from the town of Busselton Australia in my research. Home visits were conducted for all the families and children to collect information on environmental factors such as family history, number of children, parental occupations, daycare, pets, dust samples, infections, hospitalizations and medication usage. After reviewing the literature we have found 162 genes which may predispose children to developing asthma and we will be looking at these genes in conjuction with other environmental factors to try and better understand why some children develop asthma and others do not. Using statistical models we will look at what genetic and environment factors best explain why some children develop asthma and others do not. We will then do further laboratory experiments to try and identify these factors work together.
Step towards the prevention of gastric cancer and ulcers: understanding the role of water in Helicobacter pylori transmission
Peptic ulcers affect approximately 3 to 5 per cent of the Canadian population. Helicobacter pylori (H. pylori)—a bacterium that causes chronic inflammation of the inner lining of the stomach—plays a key role in the development of peptic ulcers, chronic gastritis and gastric cancer. As H. pylori has been detected in water, drinking water may play a direct role in transmission of the bacterium. To date, minimal research has been conducted regarding the potential association between H. pylori infection and detailed water system characteristics, such as water source, treatment, well depth and aquifer. Neil Bellack is now conducting the first population-based research project that will examine the association between H. pylori infection and exposures to different water system characteristics, as well as other factors that may affect transmission of H. pylori such as sewage disposal methods and land use. Results from this study will identify the role that water systems and water quality play in the transmission of H. pylori, and point to potential mechanisms for blocking transmission of the bacterium and preventing infection.
Lung disease epidemiology: evaluation of methods suitable for analyzing change in respiratory symptoms in longitudinal studies
In the past two decades, researchers have examined how lung health is affected by changes in smoking and environmental and occupational exposures, and in the process have learned a great deal about the way lung disease develops. However, most of these studies focused on lung function tests rather than information on chest symptoms, even though detailed information on these symptoms has been collected in a questionnaire used around the world since 1978. A change in symptoms, not in lung function, is the most common reason people seek medical attention and express concerns about potentially harmful workplace exposures. Victoria Arrandale is examining data on changes in coughing, phlegm, wheezing and breathlessness to determine if unused data on these symptoms can help explain the development of chronic pulmonary disease, and contribute to disease prevention through occupational surveillance programs. The results could flag early signs that have been overlooked until now. Ultimately, the goal is to lessen the impact of occupational lung disease by controlling exposures and developing early methods of diagnosing disease onset.
Life at the Margins: Understanding Social Determinants of HIV/AIDS on Women's Health Through Multidisciplinary Translational Research
Vancouver’s Downtown Eastside community has the highest rates of HIV infection and the poorest health outcomes in Canada. Female sex workers in the community are among those at highest risk of infection. The limited success of public health programs and harm reduction interventions in this population reflect the multiple barriers that compromise their access to care. This includes socioeconomic factors such as poverty and unstable housing, the stigma associated with sex work, multiple addictions, and limited autonomy and personal choice. Disease control and harm reduction measures typically focus on individual responsibility, and often do not accommodate for the influences that can increase HIV risk and diminish autonomy among women in the downtown eastside. Susan Berkhout is utilizing an alternative framework developed from contemporary feminist and bioethics literature on ”relational autonomy” in order to more accurately characterize HIV risk behavior, and to produce more effective prevention and treatment strategies aimed at reducing HIV risk among female sex workers. This model considers the socioeconomic and cultural influences, and relationships involved in sex work and injection drug use. The findings should contribute to new harm reduction strategies tailored for this population, provide ethical guidance for researchers working with members of vulnerable populations, and help health care providers enhance autonomy in female sex workers.
Investigating Socio-Cultural and Structural Forces Affecting Sexually Transmitted Infection Testing and Treatment Among Youth in Northeastern BC
Despite public health efforts, sexually transmitted infection (STI) rates among young people are high and rising, with some groups of youth disproportionately affected. In particular, STI’s are a growing concern for youth living in northeastern BC’s oil, gas, and mining communities. These communities are experiencing rapid growth and social change, largely associated with an influx of young people attracted by the current economic ‘boom’ in the oil, gas and mining industries. Shira Goldenberg is investigating young people’s experiences accessing STI testing and treatment services in Fort St. John, British Columbia. She is examining how socio-cultural factors, such as social norms, gender, ethnicity, religion and structural forces, such as geography, economic restructuring, and public health service delivery mechanisms, affect young people’s experiences with STI testing and treatment. Shira will use this information to recommend ways public health planners can tailor STI interventions to improve the sexual health of youth in northeastern BC and other remote, resource-based communities.
Death anxiety and spousal caregiving of persons with dementia
Persons with a dementing illness such as Alzheimer disease are often cared for at home by family members. Caring for someone with Alzheimer disease can be a stressful and challenging experience. Death anxiety (the fear of death or the dying process) is one issue that has received little attention in research on family caregivers of persons with dementia. As a person with Alzheimer disease may die within years of receiving this diagnosis, a family member may experience death anxiety through fear of watching the person they care for die, or fear of dying while the person with dementia still needs their support. Anthony Kupferschmidt is seeking to understand the degree to which family caregivers of persons with dementia experience feelings of death anxiety and the effect of these fears on their health and ability to cope and continue in their caregiving role. Findings from this research could ultimately contribute to improvements in education and other community-level programs to better support caregivers of persons with a terminal diagnosis. Anthony is also the 2006 recipient of the Canadian Association on Gerentology Margery Boyce Bursary. This award supports post-baccalaureate students who have made a significant contribution to their community through volunteer activities with or on behalf of seniors and who are registered in a program of study focused on aging or the aged. This prestigious award is the only national award available to gerontology graduate students that is not granted on the basis of financial need.
Relations among maternal sensitivity in early infancy and infants' attachment security at 12 months
The quality of the mother-infant relationship early in infancy forms a foundation for infants’ subsequent social and emotional development. In particular, mothers’ sensitive responses to behavioural cues helps their infants develop a sense of self and other and helps them regulate their emotions. Attachment—or the bond between infants and their caregivers—is a developmental achievement in the first year of life that is essential for healthy physical and psychological growth. Studies have shown that insecurely-attached infants are at risk for a range of negative developmental outcomes. Nancy Mcquaid is working to identify ways in which mothers interact with their infants that facilitate, or inhibit healthy social and emotional development. Nancy’s research will contribute to our understanding of healthy infant development and will help develop means of intervention for infants who are at risk for developmental emotional and interactive disturbances, such as infants of mothers with postpartum depression and low birth weight infants.
Accelerated telomere shortening in women with breast cancer: The buffering effect of social support against physiological stress markers
Psychological stress has been frequently implicated in disease development and progression, but the determinants of this relationship remain unclear. A recent finding has demonstrated that chronic and perceived stress affects health by influencing the rate of cellular aging. The literature also shows that social support buffers against stress. Jillian Satin is exploring the relationship among stress, social support and cellular aging in women who have been diagnosed with breast cancer. While chronological age is usually used as a predictor of age-related disease, cellular aging may be a more accurate predictor of onset and a potential route of disease prevention. Jillian’s research is examining whether social support modulates the relationship between objective stressful life events and cellular aging. Since social support has been shown to decrease perceived stress, Jillian’s hypothesis is that social support decreases the accelerated rate of cellular aging. If this hypothesis is correct, it would suggest that social support interventions should be made available to those at risk and should be integrated into the health care that women with cancer receive. Although this study focuses on breast cancer, the findings could prompt further exploration into treatment of cancer and age-related diseases.
Who has Epilepsy in British Columbia?
According to national surveys, an estimated 30 per cent of Canadian children between six and 18 years of age suffer from chronic conditions and/or disabilities, including seizure disorders. However, these surveys do not allow for provincial analysis, due to small sample sizes, and there is limited comparability between surveys because of differences in target groups, methodologies and conceptual frameworks. Currently, there are no comprehensive prevalence data on children with special health care needs in BC, such as children with epileptic seizures, who account for half the visits to specialists because of neurological disease. Veronica Schiariti is researching the influences of neighbourhood income, population density, health care availability and community resources on the treatment prevalence of epilepsy in BC children under the age of 19. She is examining both diagnosis and treatment patterns of pediatric patients with epilepsy. Veronica hopes that her research will contribute to improved treatment for epileptic children by identifying disparities in health service delivery, informing health care policy decisions, and enabling long-term tracking and study of health and development outcomes at the individual level and in the broader population.