Culture, self-concept, and the presentation of distress: Implication for depression

A wide range of behaviours and physical symptoms can accompany depression. Cultural background may also influence how a person expresses depression symptoms. In China, where a low depression rate has long been reported, depressed patients are thought to be more likely to describe physical symptoms while de-emphasizing psychological problems; the reverse is true with non-Chinese in Canada. This raises the possibility that clinicians have misdiagnosed depressed Chinese patients. Andrew Ryder is investigating this possibility, focusing on the differences in the presentation of symptoms, as well as exploring larger theories about how self-concept and culture may affect the way patients experience and express depression. He hopes the research will increase the likelihood that Chinese-Canadian patients with depression receive appropriate diagnosis and care.

The effects of two training regimens on body balance, reaction time, muscle strength and bone strength in postmenopausal women with Osteoporosis: A six-month RCT

Because they have low bone mass, women with osteoporosis are at increased risk of fractures caused by falls. Reducing both bone loss and the risk of falling are essential in helping women prevent fractures. While previous research has shown that regular physical activity can optimize bone health and reduce the risk of falling by improving muscle strength, reaction time, and balance, little is known about what types of exercises are most effective. Teresa Liu-Ambrose is examining which exercise program works best for women who are at risk for falls: exercises that focus on either strength or agility, or programs that incorporate exercises for strength and agility equally. The findings from Teresa’s study will be incorporated into community-based exercise programs throughout BC to help women with osteoporosis reduce their risk of falls and fractures. In addition to improving quality of life for women with osteoporosis, a decrease in fractures would also lessen the enormous health care costs associated with fall-related injuries.

Literacy and health research

Low levels of literacy have been associated with poor health, poor understanding of treatment, greater use of health services, low adherence to treatment regimens, and poverty and unemployment. Considering that more than 40 per cent of Canadians fell into the two lowest categories of literacy in the 1994 International Literacy Survey, this is cause for concern. Recruited to BC from the University of Toronto, Dr. Irving Rootman is developing and implementing a research program on literacy and health in British Columbia. While the Canadian public health community has developed initiatives aimed at improving understanding of health information, there has been little research to measure the outcomes of these efforts. Dr. Rootman’s studies will assess the effectiveness of various approaches to improving health literacy in Canada and BC. His program will also provide training opportunities for graduate students, establish links between researchers across the country, and develop collaboration between researchers, health providers, policy makers and community members concerned about literacy and health.

Improving patient safety: Costs and effects count

Health economist Dr. Rebecca Warburton is analyzing the costs and effects of interventions to reduce the accidental harm caused by health care. Her research aims to provide a rational basis for establishing priorities among policies and programs for reducing errors. The US Institute of Medicine’s estimate that 44,000 to 98,000 Americans die every year as a result of preventable hospital mistakes has raised public awareness of errors in health care and focused attention on reducing risks and harm to patients. However, most Canadian hospitals are overwhelmed by the number of safety improvements suggested by experts or demanded by regulatory bodies. Limited resources, and lack of information about the likely costs and benefits of proposed changes, means that few safety strategies are actually implemented, and most changes are not well evaluated. Dr. Warburton’s research, conducted in partnership with the Vancouver Island Health Authority, compares the costs of patient safety improvements with the outcomes in terms of standard units such as life-years or quality-adjusted life years gained. Before joining the University of Victoria in 1999, Dr. Warburton spent 11 years in policy and research positions with the BC Ministry of Health. She is currently assessing the effectiveness of BC’s Premium Assistance Program, which subsidizes medical premiums for low-income residents, and assisting in the evaluation of BC’s Clinical Practice Guidelines and Protocols.

Molecular study of interaction between mycobacterium tuberculosis and the macrophage endosomal compartment: An approach to identify mycobacterial virulence factors

Much of the resurgence of tuberculosis during the past decade can be attributed to the fast spread of new bacterial strains that are resistant to the conventional anti-tuberculosis drugs. New therapeutic strategies are urgently needed, requiring a better understanding of the interaction of the causal agent, Mycobacterium tuberculosis, with the host cells. Monocyte/macrophages are the principal targets for mycobacterium. These cells possess a powerful intracellular killing mechanism and play an essential role in the clearance of bacteria. However, one of the major features of tuberculosis pathogenesis is the residency of bacteria in an intracellular vacuole that evades intracellular killing. Mycobacterium tuberculosis interacts with specific cell surface molecules, acting as “”an entrance gate”” and ultimately producing factors that inhibit the intracellular killing. Dr. Zakaria Hmama’s research focuses on the molecular mechanisms regulating the entry of the bacteria into macrophages and the resistance to intracellular killing. Such studies will provide a rational basis for the development of new drug strategies.

Molecular basis of toxoplasma pathogenesis

While there has been significant research conducted about how bacteria and viruses cause disease, in comparison, relatively little is known about eukaryotic pathogenic processes – specifically, the disease-causing mechanisms of parasitic protozoans, which are single-celled, nucleated organisms. Dr. Michael Grigg is investigating the protozoan parasite Toxoplasma gondii, a common eukaryotic pathogen capable of infecting essentially any nucleated cell in most warm-blooded species. This highly successful parasite currently infects close to one-third of the human population. There are only three main strains of the parasite in nature and each line causes profoundly different disease in animals. Toxoplasma is known to stimulate a variety of immunological responses in infected hosts. Hosts are unable to clear the parasite, resulting in a life-long infection. Dr. Grigg is studying the immunological and molecular interactions that modulate Toxoplasma pathogenesis in an animal model of the disease, and identifying the virulence factors that are essential to the success of particular strains of the pathogen. From his work, he hopes to uncover new mechanisms and principles of pathogenesis.

The relationship between socioeconomic status and short-acting beta-agonist use by asthmatics in BC

Asthma is a chronic disease that affects approximately one in 20 Canadians. Research has shown an association between lower socioeconomic status and poorer outcomes for asthma patients, including more hospital admissions and emergency room visits and a greater likelihood of a fatal attack. Excessive use of short-acting bronchodilators, which help manage acute episodes of asthma, indicates inadequate asthma control and has been associated with poorer outcomes. Larry Lynd is investigating whether there is a relationship between lower socioeconomic status-measured by education, income, occupation and characteristics of residence-poor asthma control, and the overuse of bronchodilators. Confirming that relationship could determine whether inappropriate management of asthma is at least partially responsible for poorer outcomes. Larry hopes this research can lead to policies and strategies aimed at improving the management of asthmatics of lower socioeconomic status.

Community partnership research in population health promotion: The development of tools and measures for planning and evaluation

Strong evidence suggests that the health system is not the primary factor determining the health of Canadians. Non-medical factors – such as income, social support, education, employment, housing, health practices, child development, gender and culture – are crucial determinants of health and quality of life. Regional health authorities across BC are increasingly taking a population health approach, which addresses these non-medical factors, in community-based initiatives. However, these efforts are often complex and involve diverse participants from within and outside the health system, making it difficult to evaluate their effectiveness. Dr. James Frankish is studying how health authorities are addressing non-medical determinants of health. He is developing and testing tools to provide evidence-based evaluation of community-level effects resulting from population health initiatives. A particular focus is inclusion of vulnerable populations in these initiatives and related policy and practice implications. Dr. Frankish is also the leader of the MSFHR/CIHR program for Transdisciplinary Training in Community Partnership Research: Bridging Research to Practice, which is co-funded by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.

Ecological approaches to understanding health behavior and outcomes among youth

In spite of prevention programs that target risky sexual behaviours in youth, many BC teens continue to experience serious health and social problems related to sexually transmitted diseases (STDs) and unplanned pregnancies. However, there are significant variations in the incidence of teen pregnancy and STDs among rural and remote BC communities. Terrace, for example, has relatively high rates, while 100 Mile House has lower rates than the provincial norm. Dr. Jean Shoveller is studying the factors that contribute to this variation in sexual health outcomes among youth. In addition to personal behaviours among teens, she is investigating how other factors – such as relationships with family and peers, community social norms and the influence of institutions including education, health and religion – may contribute to decisions they make around their sexual health. Through her five-year study of three rural/remote BC communities, Dr. Shoveller hopes to provide significant insight into how communities can help prevent adverse sexual health outcomes among their youth.

The impact of changing work and community conditions on the health of workers and their children in BC resource dependent communities

Health research has established a strong link between socio-economic status and health outcomes. However, in BC’s resource-dependent communities, the income and social status situations for many workers vary throughout their working lives as a result of changing technologies and labour market conditions. Downsizing and restructuring in the labour market often results in greater frequency and duration of unemployment. Workers who retain their jobs often experience increased work stress in adapting to new on-the-job requirements, and entire resource-based communities are affected when industries downsize and restructure. Dr. Aleck Ostry is focusing on the health of workers in resource-based industries, and the health of their children. Dr. Ostry is studying the health outcomes of more than 28,000 sawmill workers between 1950 and 1998 in 14 BC sawmills, as well as approximately 23,000 of these workers’ children. He will explore to what extent labour market experiences at work and in the community affect the health outcomes of workers, and how these experiences also affect the health of their children. As changing market conditions in the global economy affect workforces throughout the world, this research is gaining national and international recognition.