Preeclampsia is the most common dangerous complication of pregnancy, affecting the health of both mother and fetus. While high blood pressure in the mother and the excretion of protein in her urine are the most visible symptoms of the disease, preeclampsia also causes systemic inflammation and organ damage. When this disorder occurs early in pregnancy, it is particularly dangerous and increases a womanâs later cardiovascular risk. Normally during pregnancy, the immune system changes and women become more susceptible to infectious agents. Two infectious agents in particular, Chlamydia pneumoniae (a bacteria) and cytomegalovirus (a virus), are thought to trigger early onset preeclampsia. These agents have already been linked to the development of cardiovascular disease later in life. However, it is still unclear what role they play in the onset and development of preeclampsia and its long term cardiovascular effects. Fang Xie is investigating the mechanisms between infection, innate immune response and the development of preeclampsia. Focusing on Chlamydia pneumoniae and cytomegalovirus, she will determine how pregnant women are affected by these two infectious agents and how immune system receptors respond to the infection, including possible gene mutations and inflammatory changes associated with these two types of agents. She will also determine whether infection results in changes to blood clotting mechanisms during pregnancy. A greater understanding of the role of infectious agents in preeclampsia will help in developing targeted treatments to prevent and cure this disease, leading to improved health care for both mother and fetus.
Year: 2008
Neuroimaging and quality of life of children with developmental coordination disorder
Developmental coordination disorder (DCD) affects six to 15 per cent of children aged five to 11. In BC, up to 48,000 of children may meet the diagnostic criteria for DCD. Children with DCD have significant motor coordination difficulties that interfere with their academic achievement and/or activities of daily living. While it was once believed that children with DCD would outgrow their motor difficulties, research suggests that these difficulties persist into adolescence and adulthood. Individuals with DCD tend to avoid social and physical activities, are at higher risk for obesity and coronary vascular disease, and experience social and emotional difficulties. There is some suggestion that DCD is related to differences in brain development, but this has yet to be confirmed. No studies have been conducted to determine how the brains of children with DCD differ from those of typically developing children, and few studies have explored the quality of life of children with this disorder. Jill Zwicker is exploring the neurobiological explanations for children with DCD, and studying how DCD impacts their quality of life. She is examining patterns of brain activation of children with and without DCD using neuroimaging techniques to determine differences in brain anatomy and activation during a fine-motor task. Zwicker will also be interviewing school-age children with DCD to determine how the disorder affects their quality of life. Zwickerâs findings will be used to educate physicians and therapists in BC and beyond regarding DCD. In the longer term, these efforts will lead to the development of scientifically grounded rehabilitation approaches specifically targeted towards enhancing brain activity, function and quality of life for children with DCD.
Exploring the social structural dynamics of health barriers and determinants of women in Vancouver's survival sex trade: an ethnographic study
A decade ago, HIV infection among downtown eastside residents exceeded those in any other part of the âdevelopedâ world. Current neighbourhood HIV prevalence estimates range between 19 and 22 per cent, and is reported higher amongst individuals who inject drugs. Risk of HIV infection is particularly profound for women who are young, coping with violence and multiple addictions, and whose survival necessitates work in the commercial sex industry. Women and girls are politically, socially and biologically more vulnerable to HIV infection. Many women in the community, including the majority of those who are part of the sex work economy, do access various health and social services, such as clinics, point-of-care and emergency services, as well as needle exchange programs. The use of condoms is also prevalent. Despite this, the rates of HIV infection remain high, particularly among sex workers who are also less likely to be treated for HIV/AIDS. Regardless of income generating strategies, HIV infected women in the community face multiple barriers to continuity of care. Suze Berkhout was previously funded by MSFHR for her early PhD work in HIV risk behaviours and health service needs among women in Vancouverâs inner city. Employing qualitative research methods and philosophical analysis, her research critically examines the impact of common stereotypes, life histories, and institutional norms and values on womenâs health care experiences, in order to unravel the paradox surrounding the health and well-being of vulnerable women. Rather than suggest that women who appear to systematically “”choose”” poor health are irrational or irresponsible, Berkhoutâs study seeks to understand what health trade-offs women may make in the context of their lives. For example, day-to-day concerns such as housing, food or caring for others may take precedence over health concerns. Likewise, womenâs previous experiences in the health system may themselves perpetuate mistrust toward health providers, leading to delays and discontinuation of medical care. Berkhoutâs findings will enable health care providers to better reflect on and respond to the experiences of patients within the health care system. Ultimately, her work could lead to more appropriate and responsive care for socially and economically disadvantaged women.
When does culture make a difference? Exploring the influence of culture in palliative and end of life care
Canada has a large and growing multicultural population with different perspectives on health and illness. This brings unique challenges to the provision of appropriate palliative and end-of-life care, where culture is known to influence communication patterns, decision-making styles, responses to symptoms, treatment choices, and emotional expression at end-of-life. Previous studies have shown that unresolved cultural differences can result in poor interactions and outcomes in end-of-life care. Although culture is known to be an important influence in health care, little is known about when and how people apply their cultural beliefs, values and practices to their health care experiences. Theories suggest that people often move back and forth between their traditional culture and mainstream culture to meet different needs. Harvey Bosma is exploring the ways in which culture influences interactions between culturally diverse patients and health care professionals in palliative care. He will use qualitative interviews and participant observations to develop rich and in-depth descriptions of these experiences from the perspective of a range of culturally diverse participants. Bosmaâs findings will provide valuable insight into when and how culture facilitates or challenges health care interactions. The information can be used by physicians, nurses and other health care professionals to better understand the needs and actions of culturally diverse patients. Ultimately, the findings of this study may be used to enhance culturally-competent and sensitive care at end-of-life so that palliative and end-of-life care is relevant and accessible to individuals and families of different cultures.
Economic studies of seniors at high risk of falls
Falls are a major public health problem in BC and around the world. Every year, approximately one third of adults in the community aged 65 years and older will fall. In BC, falls are responsible for 85 per cent of the $211 million annual direct cost of unintentional injuries. In New Zealand, a physiotherapist-initiated, progressive, home-based strength and balance training program reduced falls by 35 per cent; it proved cost-effective in persons aged 80 years and older. This program is currently undergoing a randomized clinical trial in BC for high-risk seniors. However, no economic outcomes have been published for any intervention to prevent falls in Canada. Jennifer Davis was previously funded by MSFHR for her early PhD work with the Falls Prevention Clinic at Vancouver General Hospital. Her current studies use economic data from the BC fall prevention trial to determine the cost implications of this program. Comparing this new program with the current standard of care, she will calculate the dollar cost per fall avoided, and the dollar cost per Quality Adjusted Life Year (a measure of disease burden, including both the quality and the quantity of life lived). She aims to perform cost-effectiveness and cost-utility analyses of the possible benefit of various types of exercise interventions compared with usual care. Davisâ long term research goal is to pioneer the improved economic evaluation of the burden of falls among seniors in Canada. This work will provide essential data for policy makers allocate health care resources in the most effective way.
Statin therapy in the prevention and management of rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic inflammatory disease in which the immune system attacks its own joints and organs. Aside from painful symptoms, people with RA are more likely to get heart disease and die at a younger age. Statins are drugs that lower cholesterol and are used in the treatment and prevention of heart disease. Recent studies have shown that statins also have anti-inflammatory properties that may help prevent the development of RA. They may also provide a benefit to people with RA by reducing heart disease and death. However, there have been no studies that have examined the association between statin use and the onset of RA, or whether statin use can lower heart disease and death in people with RA. Mary De Vera is investigating the potential role of statins in RA through a population-based analysis of British Columbians and their encounters with the health system. She is analyzing health care and prescription drug use of the general BC adult population to compare rates of new RA cases between statin users and non-users. She will use similar analysis in adults with RA to compare the rates of heart disease and deaths between statin users and non-users. By learning about the relationships between statin use and RA, this study has important implications for informing and improving care for people with RA. In addition, this study could provide information that will lead to a better understanding of how this devastating disease may be prevented.
Barriers to methadone maintenance therapy access in British Columbia
Methadone maintenance therapy (MMT) is the most widely used and well-researched treatment for opioid dependency in Canada. MMT is regarded as an essential means to overcoming the health, social, and economic harms associated with opiate addiction, including preventing new HIV infections, reducing mortality, criminal activity, syringe sharing and unprotected sex. British Columbia was the first worldwide to launch a methadone program, and has long represented a model of excellence in MMT provision. However, barriers to MMT access continue to occur, particularly among Aboriginal people and the most marginalized members of society. The number of patients receiving MMT has declined since 2002, in spite of a reported unmet need for MMT provision. Canadian health care providers and the patients they serve continue to regard MMT as a controversial treatment. At the root of the concern may be feelings by patients that their needs are not being met, barriers with patients’ ability to carry on with their lives and access other treatments, and differences in treatment goals between patients and health care providers. Azar Mehrabadi is investigating policies, attitudes and access related to MMT provision in BC. She is conducting interviews with family physicians and the patients they care for from private and public clinics across BC, drug user advocacy groups, decision-makers, and MMT regulatory body representatives, and gauging their attitudes and beliefs around optimal MMT outcomes. Mehrabadiâs work has important implications for health policy related to addiction, infectious disease prevention, and primary health care provision for marginalized populations in Canada. In particular, best practices for MMT delivery in BC have an important influence on addictions health policies in the rest of Canada and the United States.
An application of situational awareness to child resuscitation
An estimated 23,000 preventable deaths occur annually in Canadian hospitals. One area of practice that is particularly time-sensitive and prone to errors is child resuscitation. The range of medical conditions underlying the need for child resuscitation, and the broad range in age and size of children, make this event one of the most stressful for healthcare providers. As a first responder, nurse performance is crucial to resuscitation outcomes. Situational awareness (SA) describes an individualâs awareness of what is happening, why it is happening and what will happen next. SA has been proposed as the primary basis for decision-making and performance in complex, dynamic systems and has been used extensively in high risk industries such as aviation and the military to understand how people assess threats and ensure safety within the work environment. Kimberley Shearer was previously funded by MSFHR for her early PhD work in situational awareness. She is continuing her research into the SA requirements for nurses during child resuscitation, determining what nurses need to pay attention to and anticipate in order to prevent error. She is developing a tool for objectively measuring nurse SA based on information gathered from a series of in-depth interviews with resuscitation team nurses. The tool will be validated by comparing the performance and stress levels demonstrated by novice and expert nurses during a simulated child resuscitation. Shearerâs research has implications for simulation teaching to reduce clinician error in pediatric settings. The development of an objective measure of SA can assist in the evaluation of clinician performance, facilitate understanding of differences between novices and experts, and permit testing of the effects of changes in technology on clinician performance.
Spatial epidemiology of trauma: understanding and preventing injury through geographic analysis
Over the course of the last two decades, the notion that health and well-being is tied to societal and environmental circumstances that may overlap and intersect with important elements of individual experiences has been widely utilized as a means of characterizing the inequitable distribution of a wide range of health outcomes, including injuries. Importantly, the population health perspective model is transforming how we understand the complex interaction between the environment and injuries, and tailoring prevention and policy responses to address the inequitable distribution of their occurrence. Yet, there are currently no frameworks in place for how we quantify the interconnectivity between social, environmental, and geographical determinants of injury and building evidence that highlights the underlying relationship between all three factors with injuries. Addressing the ecological and geographical questions regarding this complex interaction entails integrating the current injury prevention models with the tools and analysis functions of geographic information systems (GIS). GIS are widely recognized as essential tools in public health promotion and surveillance as they allow for the integration of multiple data sources and the visual and spatial analysis of health data in relation to locations, distances, or proximities. GIS can increase our understanding of current population access to emergency medical services, the extent that injuries âclusterâ in certain areas and among certain population groups, as well as help researchers better understand and locate the links between people and their environments that may either reduce or increase injury risk. Nathaniel is currently applying GIS in a number of research areas in order to determine where important systems elements might be augmented to improve population access to critical care, for identifying incidence patterns that might have gone under noticed had they not been examined using GIS, as well as how this technology might be used to help researchers more accurately target prevention efforts to reach communities in-need. This research will help structure ongoing injury prevention efforts in British Columbia as well as provide future researchers with a number of frameworks for using GIS to improve our understanding of the societal, environmental, and geographic factors associated with injury.
Optimizing the impact of antiretroviral treatment as an HIV prevention intervention in marginalized populations
The introduction in the mid-1990s of highly active antiretroviral therapy (HAART) helped HIV become a manageable disease in industrialized settings such as Canada. Mortality and morbidity associated with HIV have been dramatically reduced with the increased use of these drug regimens and are associated with reduced transmission probability of HIV within sexual relationships. It has been proposed that HAART be integrated into HIV-prevention activities as a means of helping curb epidemic growth. Evaluating the impact of HAART is complex. For example, while the effect of reduced symptoms and increased lifespan is beneficial to the individual, modelling studies have shown that unless infectiousness of individuals is sufficiently reduced by antiretrovirals, the negative impact of an increased incubation period (leading to increased number of opportunities for transmitting infection and a larger population of transmitters) can actually increase how fast the infection spreads. Using mathemathical modelling methods, Kathleen Deering is comparing the impacts of HAART in Vancouver (where HIV-infected individuals have free access to treatment), and in southwest India (where only about 10 per cent of HIV-infected people have access). Her studies, which consider infection biology, behavioural and demographic characteristics of the population, and the spread of infection over time, will be used to compare different treatment strategies for HAART, and to project disease outcomes. Deeringâs research will provide evidence for developing HIV treatment and care recommendations that will help maximize the effectiveness of HAART among marginalized groups in Canada and India.