Seniors at high risk of falls: Clinical and economic studies

Falls among older people are a major health problem. In Canada, hospital emergency departments report that 86 per cent of seniors’ injury-related admissions are due to falls, and individuals who present to an emergency department after one fall are at particularly high risk of falling again and incurring significant injuries. Current practice guidelines encourage a sophisticated and costly program to prevent subsequent (secondary) falls, including referrals to physiotherapy, ophthalmology, family practice and occupational therapy. However, despite the proven effectiveness of this approach, current “real life” practices throughout BC do not generally follow these guidelines, and the outcomes – both physical and economic – have not been studied in a Canadian context. Working within VGH’s Falls Prevention Clinic, Jennifer Davis is conducting the first Canadian randomized controlled trial to compare secondary falls and fall rate between seniors receiving “gold standard” care at the Clinic versus those receiving the standard of care with their GP. She will also detail health resource utilization for all study participants in order to analyze the cost-effectiveness of the Clinic intervention versus the standard of care.

The Determination of Accessibility to and Utilization of Fair PharmaCare by Various Ethnic Minority Groups

Since the mid-1990s, North American prescription drug expenditures have been escalating at double-digit rates. Canadians spent $18 billion on prescription medicines in 2004. The rising cost of prescription drugs has raised concerns about the affordability of health care for Canadians. Provincial drug coverage programs within Canada employ diverse strategies for reimbursement. In British Columbia, an income-based drug benefit plan is utilized. This program, dubbed Fair PharmaCare, requires residents to register with the government to be eligible for public subsidy. Vivian Leong is evaluating levels of participation in the Fair PharmaCare program in different socioeconomic and socio-cultural communities to determine the factors that influence access among ethnic minorities. Vivian will identify whether some groups have unequal access to pharmacare subsidies, and if so, why the inequity exists. She is also assessing whether provincial government efforts to promote awareness among minority groups have been effective. This research will help policy makers address inequities and target health promotion to reach and better serve various ethnic communities in British Columbia.

Role of Amyloid in Failure of Transplanted Human Islets

In Type 1 diabetes, beta cells are destroyed by the immune system, leaving the body unable to produce insulin. Type 1 diabetic patients inject insulin several times a day to normalize their blood glucose levels. Estimating the correct dose of insulin to administer is difficult: too much insulin leads to hypoglycemic shock, while chronic hyperglycemia (a shortage of insulin) can lead to organ damage and related complications such as blindness, kidney failure, neuropathies, vascular damage and pain in the limbs. The transplantation into diabetics of insulin-producing islet cells shows promise for relief from daily insulin injections and the development of diabetic complications. However, islet transplantation is in the early stages, and long-term rates of transplanted islet graft survival and maintained function are low: only 10 per cent of islet transplanted recipients remained free from insulin injections five years post-transplantation. Kathryn Potter is working to better understand the mechanisms underlying graft failure. In particular, she is interested in how stressors unrelated to immunity—such as pre-transplant and post-transplant hyperglycemia and the use of immunosuppressants—may cause dysfunction in transplanted beta cells and lead to graft failure. Her research may lead to modifications to current transplantation protocols that improve long-term islet transplantation success rates.

First Nations Women Leaders: Building a Bridge from Cultural Identity to Healthy Youth

In British Columbia, First Nations youth are five to 20 times more likely to die by suicide than their non-Aboriginal peers. These youth suicide rates, however, are not uniformly high across the almost 200 First Nations communities in BC. Research has found that suicide rates are lowest in those communities that have been especially successful in preserving and promoting their cultural heritage and in securing local control over key aspects of community life. More recently, it has been found that suicide rates are lower in communities where women actively participate in their local government. Robin Yates is exploring the relationship between First Nations women leaders, cultural identity, and lower suicide and injury rates of youth in BC First Nations communities. The results of her research will enhance the development and exchange of knowledge regarding factors that preserve and promote healthy youth in First Nations communities.

The Effect of Chronic Exercise on Lymphatic Function in Breast Cancer Survivors with Lymphedema

A serious, chronic condition facing 28 per cent of women who have received treatment for breast cancer is breast cancer-related lymphedema (BCRL)—a painful swelling of the hand or arm. Typically resulting from the removal of a patient’s lymph nodes and/or radiation treatment, BCRL is characterized by an impaired lymphatic system, which is no longer able to properly drain fluid from tissues. In addition to pain, women with BCRL live with side effects such as restricted movement in the affected arm, increased risk of infection and reduced quality of life. Although exercise was initially believed to aggravate BCRL, current research suggests that exercise may actually help in reducing the severity of lymphedema and alleviating symptoms. MSFHR previously funded Kirstin Lane for her PhD research to develop a test that uses nuclear medicine in combination with exercise to measure lymphatic function in women with BCRL. Now, as an MSFHR Post Doctoral Fellow, Kirstin is applying this test to evaluate and compare lymphatic function in women with BCRL before and after a three-month program of supervised upper extremity exercises. The results of this research may confirm exercise as a safe, positive treatment option for BCRL. This information could be used to create exercise programs for preventing and treating the condition, thereby improving the health and quality of life for women living with BCRL.

Genetic discrimination in mutation carriers identified through predictive testing for HD

In her earlier research supported by a MSFHR-BCMSF Junior Graduate Studentship Trainee Award, Yvonne Bombard completed a qualitative study of how individuals live with, and manage the potential for, genetic discrimination. Based on these findings, she adapted an Australian survey to reflect the concerns and experiences relevant to Canadians at risk for Huntington’s disease (HD). Yvonne’s work now focuses on recruiting 300 Canadian participants to complete the adapted survey. Survey results will then be analyzed to identify the nature and frequency of discrimination against Canadians who test positive for the HD gene mutation (but who have not yet developed outward symptoms) when applying for insurance, in their work environment, and in social and family settings. The findings of the study will help counsellors, patient support groups, and the health policy communities identify areas where more education or policy may be needed. Ultimately, this research may lead to better supports and improved health of individuals identified as being at risk for developing Huntington’s disease.

Decision Making Related to Cancer Risk-Reduction Among BRCA1/2 Carriers

Women who learn through genetic testing that they are at high risk for developing hereditary breast and ovarian cancer may choose to undertake several risk-reducing strategies, including surgery, chemoprevention, and increased screening. An emerging body of research is beginning to describe high-risk women’s experiences and satisfaction upon adopting these risk-reducing strategies; however, little is known about how women come to make these decisions. Because of the highly personal nature of this decision, most health care providers attempt to support decision-making about risk-reducing strategies, rather than recommend particular courses of action. In order to support women and to develop and evaluate appropriate interventions, it is essential to understand how women arrive at these decisions. Fuchsia Howard is identifying the personal, psychological and social contextual factors that influence women’s decision-making about breast and ovarian cancer risk-reducing strategies. This research will contribute to an understanding of the impact of genetic testing for hereditary breast and ovarian cancer risk on the psychological health and quality of life of women found to be at high-risk. This understanding will inform future development of appropriate interventions within programs offering genetic services.

Perfectionism and Social Rejection in the Development of Eating Disorder Symptoms

The causes of eating disorders are complex, yet a number of factors have emerged that may put individuals at increased risk for developing these disorders. These include social factors, such as social exclusion and personality traits, such as perfectionism. With support from a 2003 MSFHR Trainee Award, Brandy McGee studied how perfectionism combines with cultural influences, such as physical ideals suggested in advertisements, to cause eating disorders. Brandy is now exploring how multidimensional perfectionism interacts with experiences of social exclusion to produce eating disturbances. She is testing the hypothesis that social rejection will lead to an upswing in eating disturbances (such as binge eating, thoughts about food, negative mood, etc.) in individuals with high levels of social dimensions of perfectionism, but not in women with low levels of perfectionism. The outcomes of this study will help us better understand how social factors shape health status and enable us to better predict who is at risk for eating problems, and to intervene earlier to promote health.

Improved Biostatistical Methods to Detect Gene-by-Environment Interaction in Case Control Association Studies

Complex genetic diseases are thought to result from genetic susceptibility factors acting in conjunction with environmental, lifestyle or non-genetic factors such as infectious, chemical, physical, nutritional and behavioural exposures. In the past, researchers have used the case-control study design to investigate disease associations with non-genetic factors. Recently, new genetic information in the form of Single Nucleotide Polymorphisms (SNPs) has been integrated into these population health studies in an attempt to better understand the joint effects of non-genetic and genetic risk factors. However, conventional statistical methods for this study design are not powerful enough to detect such joint effects, even for studies with very large sample sizes. Jihyung Shin is developing new biostatistical methods to more efficiently extract information from case-control data about statistical interactions between genetic and non-genetic risk factors for disease. By developing extensions of the methodology to allow for missing information on genetic risk factors in a statistically valid way, her work can accommodate the analysis of disease associations with SNP haplotypes, which are combinations of genetic variants at several nearby SNPs on the same chromosome. This type of analysis can offer improved power over analysis of single SNPs for detecting the effects of genetic factors and their interactions with non-genetic risk factors. The ability to identify interactions between genes and non-genetic factors that affect the risks of complex genetic disorders will improve our understanding of disease pathogenesis and help with the development of more effective and appropriate treatments, prevention and screening tools.

Neuromechanical determinants of the metabolic cost of healthy and pathological gait

Walking is a vital means of mobility for most people. While walking is easy for healthy people, for individuals who have suffered a stroke and have partial paralysis of one side of their body (hemiparesis), walking can be difficult. Often, these people will avoid walking, because their gait requires nearly twice the metabolic energy of healthy gait. These increased energy demands may partially explain why stroke patients tend to walk slowly and avoid carrying heavy loads, impairing their daily activities. Dr. Max Donelan’s research aims to advance our understanding of the fundamental principles that underlie locomotion physiology and to apply these principles to directly improve human health. Across the range of his research, he uses a combination of mathematical modeling and empirical experimentation, which involves techniques from biomechanics, energetics and neurophysiology. To study the metabolic cost of gait after stroke, Dr. Donelan is determining the important mechanisms that make normal walking easy and energy-efficient, and how these mechanisms are compromised in individuals with stroke-related paralysis. The results of his research will guide the design of rehabilitation strategies and devices aimed at lowering metabolic cost and increasing patient mobility.