Osteoarthritis (OA), which results in the breakdown of joint cartilage, is the most common form of arthritis. Despite much research on the condition, there is no primary prevention strategy for the disease. Macro-level studies evaluating different prevention and treatment strategies are also needed. In collaboration with colleagues in Canada, the US and Europe, Dr. Jacek Kopec is conducting three osteoarthritis studies. The first involves the development of a computer simulation model of OA. The model will synthesize data from different sources, creating the world’s largest database simulating the nature history of OA. Results from this study will be used to assess prevention strategies and develop optimal treatments for the disease. The second study investigates whether or not moderate physical activity can cause OA. The third study focuses on patients’ preferences about different treatment options for OA of the hip and knee. As part of the study Dr. Kopec is developing a questionnaire that can be adapted to individual respondents, making the assessment more precise and efficient than previous questionnaires. The studies as a whole could advance knowledge of osteoarthritis and improve treatment of the condition.
Research Pillar: Population Health
Psychological pathways for the relationship between socioeconomic status and asthma in children
Research has shown a strong association between low socioeconomic status and poorer heath. Asthma, the most common chronic childhood condition, is more prevalent and more severe among children low in socioeconomic status. Although many factors have been proposed to explain the SES-asthma relationship (e.g. exposure to environmental allergens and irritants, gene by environment interactions, quality of medical care, etc.), these variables do not fully account for this relationship. Dr. Edith Chen is studying the role of psychological factors, such as stress, in explaining the SES and asthma relationship. She is testing whether children with asthma who have low socioeconomic status experience more stressful events and/or whether they have a tendency to interpret life events in a more threatening fashion than children from higher socioeconomic status, and ultimately whether stress helps to explain the connection between low socioeconomic status and poorer asthma outcomes. Some children with low socioeconomic status maintain good health despite adverse life circumstances. Dr. Chen is also examining whether children’s beliefs and supportive family and social networks can buffer children with asthma from the typical effects of low socioeconomic status on health. Results from this research may help improve the health of children with asthma.
A prospective transdisciplinary study of the impact of housing improvements on health: promoting global health equity through innovation and collaboration
Under the leadership of Dr. Jerry Spiegel, BC health researchers are playing an active role in addressing global health research priorities – issues that increasingly affect British Columbians as global citizens as well as individuals subject to increasingly global pressures. With a interdisciplinary team of researchers at the University of British Columbia, linked to colleagues at the universities of Victoria, Simon Fraser, Saskatchewan and Manitoba, with counterparts from Mexico, Cuba and other Latin American countries, Dr. Spiegel has developed a program of research which aims to improve world understanding of “upstream factors”, i.e. pathways whereby global forces affect health. For example, rapid urbanization is a growing global phenomenon that underscores the ongoing need for attention to the basic need for appropriate shelter. While there is a clear relationship between poor housing and poor health, little research has been done not only on the reasons behind rapid urbanization and deteriorating housing, but on the health gains that result from housing improvements. In a unique collaboration with world-class specialists in housing and health research, Dr. Jerry Spiegel is investigating the impact of housing on health. Dr. Spiegel and a multi-national, multi-disciplinary team are studying two groups in Cuba: one living in poor housing conditions that will receive state funded improvements to address hygiene, ventilation, illumination and overcrowding; and another group living in comparably poor housing that is not receiving improvements. The team is using a variety of methods — including ethnographic studies, surveys, environmental monitoring of homes and measurement of biological factors associated with health — to measure the effects of housing on health. Results from the study could be used to develop policies that will improve the health of vulnerable populations in Canada and throughout the Americas. Other international studies being conducted by Dr. Spiegel and his team address other social and ecosystem determinants of health, needed to provide valuable information to promote health in British Columbia and worldwide.
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.
Addressing needs through action: what can be done to help HIV positive kids (8 and up) to ""live positively"" in BC within their broader healthcare community?
There is little published information about Canadian children with HIV especially about the health-related needs of adolescents. Yet it is during this period when they begin dealing with issues such as disclosure, psychosocial therapy, HIV prevention and sexual health, that support is most needed. Sarah Fielden is examining the health needs of children with HIV and developing strategies to meet them. Her research involves conducting focus groups with children and adolescents, families and service providers to capture a range of perspectives on this issue, and to specifically explore factors in the health system and community that allow children and adolescents to “live positively”. Sarah’s aim is to help improve the health and health care of children with HIV, and assist health care providers, academics, organizations and families in developing effective, age-appropriate interventions.
Role of culture, rumination, and anger suppression on stress recovery
Researchers have identified several factors, including chronic hostility and a tendency to suppress emotion, that may predispose people to stress-related illnesses such as gastrointestinal problems and cardiovascular disease. A compounding factor is that cultures differ in the degree to which they expect members to show or suppress emotion, such as anger; yet little is known about the impact of culturally-mandated suppression of emotion on stress-related illnesses. Jeremy Anderson is examining how cultural and psychological factors may contribute to stress-related illnesses. His study involves provoking anger from two culturally distinct groups of participants, allowing just one of the groups to express the anger, and then comparing the stress responses from the groups by measuring blood pressure, heart rate and the stress hormone cortisol. The research will improve understanding of how culture affects stress-related illnesses and may also help in the design and targeting of healthy interventions for specific groups.
Improved assessment of exposure to regional and traffic-related pollutants and relationship to cardiac arrhythmia
Numerous studies over the last decade have associated air pollution with deaths. While many of those studies showed air pollution leads to respiratory disease, some research indicates air pollution-related deaths may involve cardiovascular conditions. The research suggests that people with chronic cardiovascular diseases are particularly susceptible to air pollution’s adverse health effects. Kira Rich is investigating the impact of air pollution on patients with cardiac arrhythmia (abnormal heart rate) who have implanted cardiac defibrillators. The defibrillators record the timing and duration of heart rhythm disturbances, and the data is regularly downloaded. Kira is comparing the information to air pollution data for Greater Vancouver to determine whether increases in air pollution correlate with increased risk of cardiac rhythm disturbances. She is also analyzing exposure to air pollutant concentrations at different sites to measure the effect on cardiac health.
Chemical high-level disinfection in acute care
Most hospital equipment is sterilized by heat or steam after use. But some types of equipment cannot be heat sterilized and must be disinfected using chemical products, which potentially could place employee health at risk. Karen Rideout is surveying BC hospitals and health care centres to assess current practices for using these chemicals. She is focusing on Glutaraldeyde, the most widely used solution in Canadian hospitals to disinfect endoscopy, bronchoscopy, ultrasound, and other equipment. Karen is also examining several new products to assess potential health effects and evaluate whether or not protective measures could reduce these effects. She plans to use this information to develop guidelines for use of disinfectant products, with the goal of making health care environments healthier.
Therapeutic existential experiences during wilderness exposure: Implications for wilderness therapy programs
Mark Ring already holds a PhD in Biochemistry, but his focus shifted recently to work on a degree in the social sciences. He is now researching the therapeutic benefits of exposure to wilderness. Wilderness therapy has been used to help at-risk groups, such as people with mental illness, adolescent alcohol and drug users, adult female survivors of sexual abuse, and war veterans suffering from post-traumatic stress disorder. Programs vary greatly, but include some outdoor adventure activity, from wilderness day trips to three-week hiking and kayaking expeditions. Most research has measured the positive impact of wilderness therapy on self-esteem and ability to interact socially. But participants’ first-hand reports suggest a deeper healing process occurs. Mark is interviewing participants to determine how this experience helps people adapt, live more fully, and find greater meaning in life. He hopes this information can help make wilderness programs more effective at improving participants’ emotional and mental health.