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.
Research Pillar: Population Health
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.
Parent-child interactions in families of children with Attention Deficit Hyperactivity Disorder
Approximately four percent of children in elementary schools suffer from Attention Deficit Hyperactivity Disorder (ADHD). This disorder places children at an increased risk for developing problems such as antisocial behaviour, substance abuse and career difficulties. Carla Seipp is examining whether parents’ responsiveness to a child may be an important influence on the risks and impairments associated with ADHD. Carla will compare responsiveness during interactions between mothers and sons with ADHD, and mothers and sons with no behavioural difficulties. By focusing on the family environments of children with ADHD, Carla hopes to identify parenting behaviours that could reduce the risks and impairments associated with the disorder.
Sociality of pain behaviour: Potentiation by an audience
Effective pain management depends upon successful pain assessment, which is measured through careful attention to a patient’s verbal and nonverbal communications. This task is complex, because the way a patient expresses pain during assessment is influenced by the presence of health care practitioners, family members and other patients. In spite of tremendous recent advances in understanding the physiology and pharmacology of pain, the complex social relationships affecting pain communications are only now beginning to be studied. Melanie Badali’s earlier research focused upon the role of memory as it affects children’s and parents’ assessments of the child’s pain. Now, she is examining how people communicate pain if they believe the person observing can assist in relieving the pain. Melanie anticipates her investigations will help improve the accuracy of pain assessment and management, thereby ultimately reducing suffering from acute and chronic pain.
Gathering strengths: Contexts that reduce aboriginal children's risk for mental health problems
Research indicates peer victimization among children occurs every seven minutes on the playground, and every 25 minutes in the classroom. Wendy Hoglund is investigating the effects of rumour spreading, hitting, and other types of victimization on First Nations children’s healthy development in elementary school. She is examining how peer victimization affects areas such as mental health and academic competence. She is also assessing whether First Nations children in schools with more First Nations children and First Nations Programs, for example, experience less peer victimization and have better mental health, social, and academic outcomes than First Nations children in other school contexts. Wendy hopes this information will the development of preventative policies and programs to promote the health of First Nations children in Canada.
The effects of bone mineral density (BMD) testing on behaviour change over 3 years
Osteoporosis develops when bone density deteriorates, which causes bones to become fragile and fracture easily. Little data exists to demonstrate whether people modify their lifestyle after receiving bone density test results that indicate they are at risk of osteoporosis. Elaine Kingwell is assessing whether bone density testing influences people to seek information about osteoporosis and to adopt preventative behaviours believed to have a positive impact on bone density. The behaviours include increasing calcium and vitamin D intake, participating in physical exercise, and taking medications to prevent and treat osteoporosis. Elaine is also studying the way bone density test results are communicated to patients, to determine whether people are more likely to make lifestyle changes when they receive their results directly or when results are sent via their family physician.