Every year, approximately 2,200 British Columbians die of lung cancer and an additional 2,700 are diagnosed with the disease. While tobacco smoke is the primary cause of lung cancer in BC, approximately 25 per cent of lung cancer cases are not attributable to smoking. In fact, lung cancer in non-smokers accounts for the seventh leading cause of cancer death. Studies have found that environmental factors increase the risk of lung cancer in both smokers and non-smokers, including exposure to particulate air pollution, residential radon (a radioactive gas that leeches from soil and building materials), and arsenic in drinking water. These three exposures are widespread throughout BC and affect a large percentage of the population. However, no study has been conducted that determines how many, where and to what levels the BC population is exposed to these environmental carcinogens, or the risks posed to lung cancer development and the resulting burden on lung cancer in BC. Perry Hystad is creating current and historical provincial exposure models for particulate air pollution, radon and arsenic. These results are linked with provincial lung cancer data collected by the National Enhanced Cancer Surveillance System. His research will include exposure assessment, epidemiological analysis and burden of disease calculations. Hystad’s findings will shed light on the risks posed by these environmental carcinogens across BC. Ultimately, this work could help identify potentially susceptible populations and contribute to the development of prevention measures.
Year: 2008
Evaluating changes in the social, sexual, and drug-using networks of men who have sex with men (MSM) following testing and an enhanced prevention intervention for acute HIV infection: Applying social …
The primary purpose of this research is to provide insight into how to reduce the rising rate of HIV infection among men who have sex with men (MSM) in Canada. The number of HIV infections in Canada continues to rise annually, with MSM accounting for a disproportionate number of these new infections. Evidence now suggests that individuals are highly infectious during the early stage of HIV infection, and these individuals are responsible for generating 11 to 40% of new infections annually. Indentifying individuals as soon as possible after acquiring HIV infection and providing a risk reduction intervention is necessary to curtail this HIV epidemic among MSM. Traditional HIV antibody testing is unable to detect HIV during this early infective stage; a new technology (nucleic acid amplification test-NAAT) that can identify early HIV infection has recently become available and will be used in this study. Traditional epidemiologic methods have focused on individual-level risk factors (e.g. number of sexual partners, condom use) but these have failed to fully explain transmission dynamics or control epidemic growth. Social network analysis (SNA) is a methodology that considers relationships, and interactions among those with varying risk characteristics in the social context. SNA is increasingly being applied to infectious disease epidemiology and research suggests this is a useful approach to the study of HIV transmission dynamics. MSM who acquire HIV are likely to belong to social, sexual, and drug-using networks whose members have similar risk behaviours. We hypothesize that early HIV detection and risk reduction interventions targeting these individuals, and their networks, will reduce the transmission of HIV. This research will employ SNA to examine and describe the social, sexual, and drug-using networks of MSM diagnosed with early HIV infection using NAAT. Network information will be used to identify networks containing high levels of risk behaviour and networks with a high incidence of early HIV infection. An enhanced prevention intervention will be developed with MSM community participation and implemented among individuals within the network who are engaging in high risk behaviour, and who are prominent in the network. In addition, SNA will be used to evaluate how the networks change over time (post-intervention) considering network structure, sexual mixing patterns, rate of partner change, risk behaviour, and to determine forward HIV transmission events.
Breaking the cycle of peer victimization and maladaptive outcomes among adolescents: building strength through parent, peer, and teacher emotional support
Peer victimization — the experience of being a target of a peer’s hurtful teasing and aggressive behaviour — has major implications for adolescents’ mental health. It’s estimated that 15 to 27 per cent of adolescents are victimized by their peers and approximately 10 per cent of students face severe or chronic victimization by peers. Chronic and frequent victimization experiences can lead to increased levels of depression and anxiety among victimized adolescents and put them at risk for becoming more aggressive over time. Breaking the cycle of peer victimization is a priority; however less is known about the protective factors that will reduce levels of harmful outcomes associated with peer victimization. Rachel Yeung is investigating the associations between peer victimization and emotional and behavioural problems among adolescents across a four-year period. She is examining whether emotional support from parents, peers and teachers can moderate and protect against these harmful outcomes. Yeung will use data taken from a longitudinal Healthy Youth Survey, which followed 664 adolescents in an urban community via individual interviews. Yeung’s findings can support the importance of building existing support systems and fostering new relationships with parents, peers and teachers to prevent long term and negative mental health problems associated with peer victimization. This will also provide a basis for the development of effective prevention programs that aim to break the cycle of peer victimization and its harmful outcomes among older adolescents.
New Perspectives on Gender, Diversity, and Health Policy, Planning, and Services
The primary methods for identifying and responding to differences between men and women in the health context are gender-based and gender-sex-based analyses (GBA/GSBA). While these approaches are intended to consider diversity within each group, they do not always capture how gender interacts with other factors such as race/ethnicity, socio-economic status, sexual orientation, geography, ability and age. Not taking these factors into account in health planning, implementation and research can result in real economic and human costs for health care consumers. These include lost opportunities, ill health, suffering and perhaps overall, an ineffective and inequitable health care system. A key challenge facing researchers and policy makers is how to move beyond singular variables (e.g. gender) to understand the complex dynamics at play between gender and health. Dr. Olena Hankivsky is examining how GBA and GSBA are applied in health planning, services and policy in Canada, Sweden, the UK, Australia and the Ukraine. She is exploring innovative improvements for analyzing gender and diversity in a health context. In particular, Hankivsky is conducting a gender and diversity analysis of the most recent health reform initiative in British Columbia — The Conversation on Health. The findings could contribute to developing policy tools and interventions that will improve the effectiveness and efficiency of health services and programs for vulnerable and marginalized populations in BC, Canada, and internationally.
Community Learning Centres: A Model of Community Engagement in Health, Education & Training
There are disproportionately high rates of poor health among First Nations populations in comparison to the general Canadian population. A contributing factor is the limited access many geographically-isolated rural and remote First Nations communities have to health information. Dr. Sandra Jarvis-Selinger is focusing on a new and innovative approach supporting community access to health information. This approach involves the formation of Community Learning Centres (CLCs) in four communities located in the Ktunaxa Nation in southeastern BC. A CLC is both a physical and a virtual space for community members to access Internet-linked computers and web-based resources developed according to community-defined health priorities. Health information is created by and for community members and is both accessed at and disseminated via CLCs through information and communication technologies. Community engagement is the cornerstone of this project, with due emphasis placed on community input and governance, local health priorities and inclusion of traditional medicine, language and knowledge. Dr. Jarvis-Selinger is conducting a program evaluation to determine the effectiveness and sustainability of the CLC design and implementation. The evaluation is being co-developed with each community in order to match the communities’ needs, workflow, schedule and style of participation. This research will increase our understanding of how to successfully and sustainably: 1) support community-university partnerships; 2) improve community wellness; 3) expand access to and awareness of community health resources; and 4) increase employment opportunities through technical, research and interpersonal skills training. Overall, this research promises to make a meaningful contribution to the domain of First Nations community health through the use of technology.
Regulation of T Cell Development, Function and Transformation by Interleukin-7.
Immune disorders – such as immunodeficiencies, leukemia and lymphoma, autoimmunity, and allergy – are significant health problems. For example, every year 5,600 Canadians people die of cancers of the immune system, such as leukemia and lymphoma, and these cancers account for 42% of all cancers in children. Current treatments for these cancers, such as chemotherapy and radiation therapy, have significant shortcomings. To improve recovery rates and reduce unwanted side effects, researchers need to develop new, specifically targeted treatment approaches. Treating diseases with few side effects requires knowing the signals involved in disease development. Dr. Ninan Abraham is focusing his research on understanding how a cytokine called interleukin-7 (IL-7) regulates immune cells by interacting with proteins to trigger biochemical pathways that control normal cell development and function. IL-7 is an essential growth factor that promotes the development of T cells and memory T cells, which are both essential for the body’s response to pathogens that lead to disease or infection. Being able to enhance development or survival of T cells by manipulating IL-7 could lead to the creation of more effective vaccines to boost the body’s immune response to disease. Conversely, since over-expression of IL-7 is associated with several forms of human T cell lymphoma, being able to limit this cytokine’s activity could also be important. By identifying how IL-7 promotes the development or survival of T cells and memory T cells, Abraham hopes for new strategies for treating these cancers and enhancing vaccines for long-term immunity.
Pharmaceutical sales representatives, patient safety and cost-effectiveness of care: comparative cross-sectional survey
Prescription medicines are a common and important form of treatment offered by family doctors. The information that doctors receive about the effectiveness and safety of medicines helps to determine their prescribing choices. Most doctors in Canada see pharmaceutical sales representatives regularly. Previous research has demonstrated that sales representatives influence prescribing choices and that doctors often underestimate the extent to which they are influenced. A recent example of this influence emerged in the US with the arthritis drug Vioxx. Despite a 2001 Food and Drug Administration advisory committee recommendation that doctors be warned of heart attack risks associated with the drug, sales staff were advised not to inform doctors of. By the time Vioxx was withdrawn from the market in 2004, it had been linked to between 88,000 and 140,000 heart attacks. Dr. Barbara Mintzes is investigating whether information critical to safe prescribing is provided to doctors by sales representatives. She is gathering data from three countries: Canada (British Columbia and Quebec), the US, and France. She aims to identify best practices in regulation of drug promotion, and to understand how the messages doctors receive from sales representatives can be incorporated into education to improve prescribing. Ultimately, her goal is to improve prescribing safety and appropriateness. A key component of the research will be discussions of the implications of the results with policy-makers, physicians, medical educators and industry.
From Efficacy to Community Effectiveness. The proposed program of research, mentoring and knowledge translation will addresses the more effective, scalable, population-based, chronic disease and that …
The unprecedented investment in biomedical research during the past 50 years has resulted in many important advances in health care knowledge. However, the successful and timely integration of these advances into clinical practice remains a major challenge, especially in primary care and community settings. There is growing recognition that one of the obstacles to translating knowledge into clinical practice may be the knowledge itself, and how, where and by whom it was generated. Often, research knowledge is created in academic settings with little opportunity for involvement or input from primary care providers, community partners or patients. Dr. Janusz Kaczorowski aims to generate more high quality research evidence by end-users themselves, and under clinical conditions that closely resemble real life primary care and community settings. He believes that such an approach will help develop evidence that is more relevant to healthcare professionals working in these setting, which will speed up the knowledge transfer process. Building on his previous work across North America, Kaczorowski’s research focuses on the development of innovative primary care and community-based strategies for chronic disease prevention and management that will have a positive impact on the lives of British Columbians and Canadians. Strategies include collaborative ways to involve, in addition to family physicians, community caregivers (such as pharmacists), volunteer peer health educators, community-based organizations and patients in the research process.
Development of an Integrated Risk Assessment and Risk Management Tool for Health Care in BC, Phase 1 – assessment of chemical exposure hazards encountered by health care workers in BC
There are more than 80,000 health care providers working in BC. They work in complex and demanding environments where they may be exposed to numerous potential health hazards, including those that are chemical (e.g. drugs or cleaning agents), biological (e.g. bacteria or viruses) and physical (e.g. noise or radiation) in nature. Dr. George Astrakianakis focuses on understanding the many factors that determine the potential for exposure to health hazards among health care workers, and how to best mitigate their associated risks. In the initial phase of his research, he is identifying the specific chemical exposures commonly encountered in the healthcare workplace, assessing the risk to health for healthcare providers, and defining appropriate exposure control measures. In subsequent phases, he will assess biological and physical hazards, and implement and evaluate control strategies. Much of Astrakianakis’ data will be drawn from surveillance information collected by the Occupational Health and Safety Agency for Healthcare, which supports BC’s health care industry in part by monitoring information on occupations, exposure incidents and injuries among the Province’s health care professionals This information will form the basis for creating a job exposure matrix (JEM), which will be used to map exposure levels to occupations and eventually to provide risk estimates. The ultimate goal of this project is to design and implement appropriate exposure control strategies — such as technology, policy and training — in health care settings and to evaluate their effectiveness in mitigating risk to health care providers.