Pain is a complex, subjective experience that cannot be measured directly. Self-report rating scales are commonly used to assess an individual’s 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 children’s 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 children’s 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 — such as language and numerical reasoning — influence children’s ability to accurately express pain with these scales, and ultimately lead to more effective pain assessment and treatment for children.
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 BC’s Children’s and Women’s 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.
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 parents’ assessments of pain and factors that influence those assessments. Improved understanding of how infant pain expression changes and what influences parents’ reports of pain will contribute to refinement and development of more developmentally appropriate measures of pain.
The goal of this research unit is to understand the molecular mechanisms leading to neuronal (brain cell) death in Huntington Disease, an incurable genetic disorder that usually strikes in mid-life, causing progressive, irreversible and ultimately fatal neurological damage. With a focus on the fundamental molecular structure and function of neurons, such research also has relevance in understanding the development and effects of other degenerative neurological disorders, such as Alzheimer’s and Parkinson’s Disease, and for understanding recovery from brain injury. As the study of disease reveals information about normal structure and function, this research will also contribute new knowledge about healthy brain development.
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 parents’ 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 mothers’ 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.
Building on his earlier research, which was supported by a MSFHR Trainee Award, Damon Poburko is now investigating the mechanisms involved in mitochondrial regulation of calcium. An average cell has several hundred mitochondria, which provide the energy for cells to function properly. Research has shown mitochondria are involved in programmed cell death, or apoptosis, when they take up large, toxic loads of calcium. In addition, mitochondria sense calcium changes, allowing them to tailor energy production to cell needs. Mitochondria also help regulate intracellular calcium levels, which determine blood vessel constriction in vascular muscle. The findings should help explain how vascular tone is regulated, and how blood is shunted to different parts of the body as needed. Ultimately, this research may lead to the development of new therapies to treat vascular diseases.
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.
The frequency of chromosomal abnormalities in reproduction is significant — 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.
Almost 10 per cent of women who become pregnant develop hypertension (high blood pressure). Experts agree that pregnant women with severe hypertension should receive blood pressure medication to protect them from stroke. However, it is not clear if or how much the medication would benefit pregnant women with mild to moderate hypertension. A complicating factor is that the medication may also contribute to poorer growth and lower birth weight in babies, placing them at increased risk for health problems as newborns, children and adults. According to a national survey, Canadian obstetricians are unsure about prescribing blood pressure medication to women with mild to moderate hypertension. To help clarify the issue, Dr. Laura Magee and her research team have designed a Control of Hypertension in Pregnancy Study (CHIPS), aimed at determining if it is better for the baby (i.e. better growth before birth and better health thereafter) to allow a mother’s blood pressure to be higher than normal during pregnancy or to prescribe blood pressure medication to lower it. To begin, Dr. Magee is conducting a pilot trial to assess whether or not physicians would adhere to the treatment protocols in a full trial and to confirm if sufficient patients could be enrolled. If the pilot study indicates that CHIPS is feasible, the full trial will be conducted at major maternity centres across Canada.
Pharmacogenetics-the study of how genetic makeup affects an individual’s response to drugs-fascinates Evan Kwong. The field addresses the underlying causes of why drugs may affect people differently, bringing the study of genetics into a practical, clinical setting. In the future, having access to a patient’s genetic profile could help clinicians more quickly and accurately select the right therapy. Evan’s research focuses on the common painkiller codeine, which produces pain relief as it is metabolized into morphine by a liver enzyme. A genetic variation in 25 to 40 per cent of people of Chinese descent appears to be associated with decreased function of this liver enzyme. Evan hopes to determine whether people who carry this genetic variation metabolize codeine less effectively. With that knowledge, clinicians could offer other drugs that will be effective.