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 âlive positivelyâ. Sarahâs 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.
Research Location: Children's & Women's Health Centre of British Columbia
Understanding low-income mothers' efforts to provide safe home environments for young children
Unintentional injuries represent the leading cause of death for children and youth under the age of 20. For children under five, approximately half of all deaths due to unintentional injuries occur in and around the home. Research shows that children living in low-income families are at greatest risk for home injuries. Studies also show that parental attitudes towards safety issues vary greatly, and that there are discrepancies between attitudes and taking action to prevent injuries. However, little is known about parentsâ underlying values about safety and injury risks to young children and how these values fit into the broader social context of children and safety issues. Lise Olsen is exploring low-income mothersâ experiences with safety issues in the home. Using ethnographic methods, including interviews and observations, the study will provide insight about the everyday challenges of keeping young children safe from injuries at home. Ultimately, Lise hopes the research contributes to the design of appropriate and relevant injury prevention programs and policies.
Truncation of huntingtin and its relationship to the pathogenesis of Huntington's Disease
Huntington disease (HD) is a fatal degenerative brain disorder caused by a defective gene, which causes cells in specific parts of the brain to die. This leads to symptoms including progressive deterioration in the ability to control movements and emotions, recall recent events or make decisions, and leads to death 15 to 20 years after onset. One in 10,000 Canadians has HD, and children with a parent with HD have a 50 per cent risk of inheriting the disease. There is neither a cure nor treatments to prevent Huntington disease. The HD gene produces a protein called huntingtin, which breaks into short fragments that dramatically promote cell death. Little is known about the exact function and toxic properties of this mutant protein. Now Rona Graham is expanding her earlier Masters research into the mechanisms that cause shortened huntingtin. She is investigating other forms of mutant huntingtin to determine their role in creating HD, and hopes the results will lead to new therapies to prevent or alleviate this disease and other neurodegenerative disorders.
Early progression and detection of ovarian cancer
In developed countries, ovarian cancer is the leading cause of death from gynecologic malignancies in women. The five-year survival rate is only 35 to 40 per cent, a rate that hasnât changed significantly in 25 years. The poor prognosis is due to the lack of a reliable test for early detection and the inability to identify early symptoms of the disease, which means the majority of ovarian tumours are diagnosed at an advanced stage. During progression to malignancy, normal ovarian surface epithelial cells, which give rise to the majority of epithelial ovarian cancers, acquire more complex and highly differentiated characteristics that most often resemble epithelial cells in the fallopian tube and uterus. This change may provide an advantage for growing cancer cells. Michelle Woo is screening ovarian tumour tissues for markers known to be present in the fallopian tube and uterus. She has recently discovered a protein in ovarian tumours that may be an early indicator of ovarian cancer. Another approach she is using to examine early changes in ovarian tumour progression involves the use of a unique three-dimensional culture system to mimic the development of ovarian tumours in women. Michelle hopes this research will identify new predictive markers that can be used for early screening and prevention of ovarian cancer.
Toxicogenetic analysis of valproic acid-associated hepatotoxicity in pediatric epileptic patients
Valproic acid is a drug that has been used successfully for the treatment of many types of seizures. Yet for some patients, the drug is associated with liver failure. Clinicians are not able to predict which patient will be at risk for this serious and sometime fatal side effect, but it is known that liver failure is more common in the very young patients and when the drug is used together with other anticonvulsants. Tony Kiang is studying the possibility that individuals could have a genetic predisposition for developing liver failure following valproic acid therapy. In his research project, Tony will be using advanced genomic technologies to test this hypothesis. Results from this research will help clinicians identify which patients are suitable to be prescribed valproic acid.
The relationship between developmental factors and the ability of children to accurately complete a self-report pain scale
Pain is a complex, subjective experience that cannot be measured directly. Self-report rating scales are commonly used to assess an individualâs pain experience, but with children, clinicians need to determine whether a child can accurately complete a scale. Little research has been done on methods to assess childrenâs accuracy in using these scales. As a MSFHR Masters Trainee, Elizabeth Stanford (Job) examined ways children use everyday language to describe pain. Now she is assessing young childrenâs ability to accurately convey their level of pain through methods that include pointing to a series of pain faces developed as a rating scale. The research will increase understanding of how developmental factors â such as language and numerical reasoning â influence childrenâs ability to accurately express pain with these scales, and ultimately lead to more effective pain assessment and treatment for children.
An Evaluation of an Asthma Education Program in a Pediatric Emergency Department
The increasing prevalence in asthma diagnoses in North America over the 1980s and early 1990s has led to increased asthma-related admissions and emergency visits at pediatric institutions. In many cases however early intervention at home may have been a superior method of treatment for milder cases. In an effort to increase parental and patient knowledge about early interventions many asthma education initiatives have been launched. Studies to date on the effectiveness of these initiatives have been mixed. Jay Joseph is assessing retention of knowledge about asthma by specifically studying asthma exacerbation cases presented at the emergency department of BCâs Childrenâs and Womenâs Health Centre. From these cases Jay is analyzing general parental knowledge of asthma and their knowledge of how to cope with specific exacerbation scenarios. Ultimately, Jay hopes results from his study will contribute to reducing GP/pediatrician consultation rates and repeat emergency visit and readmission rates.
Developmental changes in pain expression in infants
Assessing infant pain for clinical or research purposes is challenging because infants are unable to talk about their pain. However, infants can communicate distress and pain in a number of ways, including facial activity, body movement, crying and changes in physiological responses. Rami Nader is studying how pain expression changes during the first year of life, when infants undergo a particularly rapid rate of growth and development. He is also investigating the link between parentsâ assessments of pain and factors that influence those assessments. Improved understanding of how infant pain expression changes and what influences parentsâ reports of pain will contribute to refinement and development of more developmentally appropriate measures of pain.
Pathogenesis of confined placental mosaicism (CMP) during pregnancy
The frequency of chromosomal abnormalities in reproduction is significant â 15 to 20 per cent of all pregnancies end in spontaneous abortion, and half of these miscarriages are associated with chromosomal abnormalities. In 1983, two UBC professors discovered a condition now known as confined placental mosaicism (CPM), where a chromosomal abnormality is present in the placenta but not the fetus. CPM allows a pregnancy that would otherwise spontaneously abort to continue to term, and is present in at least two per cent of pregnancies. In his earlier research, Paul Yong confirmed that some types of CPM increase the risk for poor fetal outcomes such as low birth weight or complications such as pre-eclampsia. Now he is studying how chromosomal abnormalities cause alterations in placental structure and function. The hope is to identify potential therapeutic interventions in pregnancies affected by chromosome abnormalities in the placenta.
Characterization of a YAC mouse model of Huntington disease for use in therapeutic trials
Huntington disease (HD) is an inherited, neurodegenerative disease characterized by loss of motor control and cognitive decline, eventually leading to death. Elizabeth Slow is studying atrophy and cell loss in the striatum, the most affected region of the brain, and the motor dysfunction associated with HD. A group of proteins called caspases split other proteins, including huntingtin, the protein produced by the HD gene. In collaboration with researchers at Harvard, the University of California and the Buck Institute in California, Elizabeth is investigating whether this process triggers inappropriate cell suicide in the neurons affected by HD, thus causing the disease. If so, the results will determine whether caspase inhibitors are an effective treatment option for people with Huntington disease, which currently has no treatments to prevent or delay the condition.