Pain communication during infancy and early childhood: When cry becomes a speech act

Elizabeth Stanford (Job) has focused her research on understanding and improving assessment of children’s pain, by learning more about how children express pain, and how pain expression changes from infancy to early childhood. In her Master’s research she pursued three major projects that provided insights into the nature of children’s pain experience and how to improve measurement strategies. Two of her studies examined the language children use when experiencing painful events. The first involved the analysis of recordings of children’s spontaneous use of speech during immunization injections. Results from the study improve understanding of the meaning of these experiences for children and the type of language parents and practitioners can expect from children when they are in pain. The second study examined a large database providing transcriptions of children’s use of pain language during a range of structured and unstructured activities. The results provide important information about children’s spontaneous use of pain language, and could help clinicians and researchers better understand and assess pain in young children. Elizabeth’s final study examined young children’s use of self-report pain scales and described the role of developmental factors in predicting use of these scales. Child age was found to be the best predictor of children’s abilities to use the self-report pain scale. The results also highlight the tendency for over-estimation of young children’s abilities to use self-report scales and the need for tools and training tasks to be developed for use with the scales.

Improving Therapeutic Decision-Making During Active Clinical Practice

The ultimate goal of Laura Esmail’s research is to improve the management of medication use and patient outcomes. Studies estimate that 4.3% of hospital admissions in industrialized countries are due to preventable adverse outcomes of drug therapy. To begin to address this problem, Laura developed and tested a decision-making network aimed to improve physicians’ drug therapy decision-making. The conceptual framework of this network was based on the theory of cognitive apprenticeships: the process of understanding concepts through engaging in authentic activities and actual practice. Through linking family physicians with clinical pharmacists using cellular-telephone instant group conferencing, Laura attempted to create a continuous, contextual, social learning environment in which therapeutic expertise and experience could be shared and acquired at the time of patient care decision-making. This network ultimately aimed to facilitate the collaborative decision-making process that often takes place between health care professionals during hospital medical rounds. Results of her study concluded that cellular-telephone instant group conferencing between family physicians and clinical pharmacists is a useful method for influencing and assisting with drug therapy decisions at the time of patient care decision-making. Further modifications to the network are necessary before feasibility can be fully assessed. This work is an important contribution towards the understanding of decision-making systems that can improve drug related morbidity and mortality and help advance patient care.

Family influence in pediatric chronic pain and disability

Up to 15 per cent of school-aged children and adolescents suffer from chronic pain conditions such as recurrent headaches and abdominal pain. Children with chronic pain frequently miss considerable amounts of school, do not participate in athletic and social activities, and suffer depression or anxiety. The family plays an important role in influencing how children learn to deal with pain, but little is known about how this learning occurs. My research will identify how families influence children’s responses to pain. I will compare studies of children between the ages of eight and 15 with chronic pain and disability with pain-free children and their parents. The research will examine how families interpret pain symptoms, how parents make decisions about their children’s complaints of pain, parents’ thoughts about their children’s pain, and parent-child behaviour during pain episodes. In addition, I am studying how health care providers and parents assess pain in children and the tools that we use with children to measure pain. My research will also explore the relationship between sleep disturbances and chronic pain in children, an area of research that has been overlooked until now. The results of these research studies will help family members and health care providers better manage children’s pain, and will help improve treatment and prevention of disabling pain in children.

Transgenic mouse models of congenital malignancies via expression of the ETV6-NTRK3 oncoprotein

During his Master’s research Christopher Lannon studied sensitivity to chemotherapy in adult and pediatric leukemias. Now Lannon is focusing on childhood cancers, which are biologically distinct from adult cancers and therefore present unique and interesting research challenges. He’s investigating a childhood tumour known as congenital fibrosarcoma (CFS). Several pediatric tumours, including CFS, are characterized by the fusion of two normal genes to form an abnormal fusion gene. Lannon aims to understand why this rearrangement of genetic material leads to malignant childhood tumours, with the goal of developing a mechanism to block the fusion.

Hepatitis A virus infections among children in British Columbia: Is routine vaccination needed?

Hepatitis A is a viral disease that causes inflammation of the liver. Once contracted, there is no treatment. Adults and older children with the disease usually suffer for four to ten weeks, and the symptoms include jaundice, fatigue, abdominal pain and fever. Young children usually have mild, symptom-free cases that go unrecognized, but can transmit the virus to people of all ages. The BC infection rates for hepatitis A virus have exceeded the national average for more than a decade. Yet a safe, effective vaccine has been available since 1994. The vaccine is currently only given to high-risk groups, and most cases reported by physicians come from these groups. I am investigating the risk of hepatitis A for children in two areas of BC that consistently report high infection rates. The study will determine whether universal childhood immunization is warranted. We can gauge risk for hepatitis A by testing saliva for antibodies to the virus, which would indicate a past infection. Our research team has tested about 800 randomly selected grade nine students. Students also filled out a questionnaire on potential risk factors. We are analyzing this data to identify why the hepatitis A rates may be higher in these areas and whether the scope of the disease is broader than reported cases indicate. If we find high rates of past infection, routine vaccination may be warranted. If low rates are found, the results will provide reassurance that existing sanitary measures are adequate to protect local children.

Temperature Dependence of the Cardiac Sodium Calcium Exchanger

Mortality associated with open-heart surgery is two to three times higher in newborns than in adults. Christian Marshall believes this is due to a lack of knowledge about heart function in newborns, including how the neonatal heart responds to surgery. He’s focusing, in particular, on the inability of newborn heart cells to control calcium levels. When unregulated, calcium can initiate destructive events leading to cell death. Marshall is examining the effects of changes in temperature on the sodium-calcium exchanger (NCX), a protein in the heart cell membrane that is key to calcium regulation. Since surgeons need to reduce the temperature of the heart to perform open-heart surgery, and much of the cell damage occurs when warming the heart after surgery, Marshall is seeking a better understanding about temperature effects on NCX. He hopes this will reveal ways to reduce cell death during heart surgery and contribute to a better survival rate for these tiny patients.

Gonadotropin-releasing hormone (GnRH) in reproductive biology and medicine

The long-term goal of my research is to understand the multi-faceted role of gonadotropin-releasing hormone (GnRH), the primary regulator of the reproductive process. Our brains release GnRH to the pituitary gland, where it stimulates the synthesis and release of the gonadotropin hormones that regulate gonads (ovaries and testes). My research has shown that GnRH also affects cell function in the ovaries and placenta and the hormone may play a role in controlling estrogen and progesterone production. GnRH has a role in both normal ovarian physiology and in the development of ovarian cancer. Ovarian cancer is a major cause of death, but little is known about the way it develops. We are seeking new knowledge that will help us understand the role of GnRH in the development of ovarian cancer, which should lead to more effective treatments in future. We also know GnRH affects the successful implanting of an embryo to establish a pregnancy and the formation of placenta, but that process is not well understood. My research will help explain the causes and process of fertility. Synthetic GnRH compounds are often used in different areas of reproductive medicine, such as fertility and sterility, ovulation control and assisted reproduction. This research will provide a better understanding of the cellular and molecular effects of these compounds and should improve clinical applications as a result.

Prediction and prevention of autoimmune diabetes mellitus

Jacqueline Trudeau’s research focuses on autoimmune disease – disorders that cause the immune system to destroy normal body tissues. She’s specifically interested in how a specific type of immune cell, T-cells, are mistakenly activated in autoimmune disorders. Type 1 diabetes is an autoimmune disease in which T-cells destroy insulin-producing B-cells in the pancreas. This leads to hyperglycemia (high blood glucose), insulin dependence and other complications associated with diabetes. Given that autoimmune diseases may develop and be present for years before being diagnosed, they are difficult to treat. It is also challenging to understand how the disease process is initiated and the course of development thereafter. Jacqueline is developing techniques to identify T-cells that specifically destroy B-Cells before hyperglycemia sets in. She aims to design an approach for identifying children at the early stage of developing diabetes, a critical window of opportunity when treatment could save remaining B-cells

Pathogenesis and Treatment of Huntington's Disease

There is currently no effective treatment for Huntington’s disease, a progressive and ultimately fatal neurological disorder caused by a defect in the Huntington Disease gene. Symptoms of the inherited disease, which usually appear at mid-life, include abnormalities in movement, difficulties with awareness and judgement, and emotional instability. Using genetically altered mice, Jeremy Van Raamsdonk is investigating the underlying genetic and cellular changes that give rise to Huntington’s disease and potential treatment strategies. The research involves testing both drug and gene-based treatments targeted at the root cause of the disease, as well as assessing treatments to minimize the damage to the nervous system. By developing specific treatment strategies, Van Raamsdonk aims to limit damage to nervous system cells and increase the lifespan and quality of life for people with Huntington’s disease.

Lymphocyte defects in X-linked lymphoproliferative disease

Dr. Ala Aoukaty has spent nine years investigating anti-viral and anti-tumour cells. Aoukaty’s doctoral research focused on understanding the signalling process that occurs after receptors on the surface of cells are engaged. That experience provided him with a strong background to conduct postdoctoral research on X-linked lymphoproliferative disease (XLP), a fatal disorder caused by a genetic mutation and characterized by severe infectious mononucleosis, immune deficiency and malignant lymphomas (tumours). A large Aboriginal family that carries the genetic mutation has been identified. Aoukaty will isolate and study cells from XLP patients and carriers of the disease in the family to study the abnormal immune responses at work. The research will shed light on how the immune system specifically responds to Epstein-Barr virus, which causes infectious mononucleosis, provide insights in general about lymphoproliferative disorders (diseases of immune system tissue), and enable the testing of gene replacement therapies.