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NEXUS Portal Vol. 3, No. 1 (Winter 2009) 2009

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      lthough cardiovascular disease is the leading cause of death globally for both men and women, it is generally seen as a men’s health issue. Women’s and men’s understandings of their risk of heart disease have been widely studied, yet little is known about how women and men perceive the other gender’s risk and whether there are ethnic differences in the public’s understanding of heart disease. The Seeking Timely Access and Treatment (STAT 1) project, led by NEXUS Co-Director, Dr. Pam Ratner, seeks to unravel the gendered and ethnic dimensions of men’s and women’s conceptions of cardiovascular disease because knowledge is a crucial first step in promoting health behaviour change. A survey of 976 people aged 40 years and older in Metro Vancouver was conducted. Two recent analyses of this work led by NEXUS Postdoctoral Fellow Dr. Gilat Grunau and NEXUS colleagues have shed light on these aspects of public knowledge. First, the team found that men, compared with women, were more likely to respond ‘don’t know’ to a question about whether heart disease is the most common cause of death for women. Likewise, women responded in the same fashion about men. In addition, Chinese-Canadian and South Asian-Canadian participants were more likely than participants of other ethnic groups not to know the answer to whether heart disease is the most common cause of death for men and for women. Chinese-Canadian participants were more likely to disagree with the statement that heart disease is the most common cause of death for women [1]. These results show that not only is there is a significant lack of cross-gender knowledge about heart disease risk, but that gaps in knowledge or misconceptions about who is affected by heart disease vary significantly across ethnic groups. In a separate analysis, the team focused on heart health education as a factor underlying the differences described above [2]. They found gender and ethnic disparities in patient education provided by primary healthcare NEXUS Portal Volume 3, Issue 1 Winter 2009 U n i v e r s i t y  o f  B r i t i s h  C o l u m b i a  -  3 0 2 ,  6 1 9 0  A g r o n o m y  R o a d  -  V a n c o u v e r,  B C  V 6 T  1 Z 3 Putting Social Context Research into Practice My thesis presented an opportunity to answer an ongoing question raised by nurses in my clinical area: What is it like for patients who are admitted to a hospital on the morning of their coronary angioplasty, undergo the procedure, and are recovered and discharged home that very evening? The medical evidence guiding same-day discharge percutaneous coronary intervention (PCI) – a non-surgical approach to opening narrowings in the coronary arteries caused by the build-up of cholesterol using balloon angioplasty – is convincingly solid: It does not negatively affect people’s morbidity or mortality. Yet, nurses wondered about other outcomes, such as: How confident are patients about caring for themselves? Does the patient teaching program meet their needs? Who is at higher risk for not being able to manage their self-care? Under the supervision of Dr. Joy Johnson and with the collaboration of Dr. Pam Ratner and NEXUS trainee and colleague, Ms. Martha Mackay, I conducted a study to address these questions. Nurses in the Cardiac Short Stay Unit championed the project and greatly assisted in ensuring its success. It created opportunities to increase research capacity “at the bedside” as we held regular meetings to discuss methodology, challenges in the conduct of research in the clinical area, and the findings. We found, among other results, that the burden of having additional co-morbidities, a positive screening for depression and anxiety, and – importantly – living alone and lacking social support were significantly related to people’s sense of confidence and capacity to care for themselves in the days following successful PCI. NEXUS doctoral trainee Sandra Lauck reflects on mobilizing her MSN research to drive evidence-informed improvements to clinical practice. Sandra has been a NEXUS trainee since 2006 when she began her master’s with NEXUS Co-Director Dr. Joy Johnson. Presently, she is pursuing her doctorate under the supervision of NEXUS Co- Director Dr. Pam Ratner.    t was not long into my MSN program that the worlds of clinical practice and research began to merge. In much of my graduate studies, from theory to methods to study design, I drew from my experience as a critical care nurse and clinical educator. This in turn opened up possibilities to apply new learning to my practice, and create connections between practice and research. Heart Health Knowledge: Do Gender and Diversity Matter? - see “Social Context” on page 3 -  Trainee Spotlight...2  Knowledge  Exchange Corner...3  Social Context  (Continued)..........3  NEXUSnews..........4  Heart Health  (Continued)..........4  Upcoming Events..5 in this issue - see “Heart Health” on page 4 - “There is a significant lack of  cross-gender knowledge about heart disease risk” [Photo: iStock] Sandra Lauck putting research into practice [Photo: S. Lauck] I A might be surprised to find that I love dancing to the latest electronic music somewhere out in the bush. Some people might also be surprised by the scale of the harm reduction work I do at some music festivals. I even ended up with a small role in the documentary on the 10-year anniversary of the Shambhala Music Festival. Which talent would you most like to possess? I’d love to be able to play a variety of musical instruments or DJ well. If  you could live anywhere in the world, where would it be? Florence! I spent a very happy four months in “Firenze” about eight years ago and fell deeply in love with the city and with Tuscany. What human quality do you most admire? Compassion If  you had a motto, what would it be? “When in doubt, say YES”…and it’s gotten me into a lot of trouble and fun too. Warren Michelow is a doctoral student in the UBC School of Population and Public Health supervised by NEXUS Lead Investigator Dr. Jane Buxton. He joined NEXUS as a trainee in 2007 and is also a trainee in the Integrated Mentor Program in Addictions Research Training (IMPART). Warren’s research areas include healthcare and epidemiology with a focus on licit and illicit drug use. He was born in Durban, South Africa and has called Vancouver home for the past 19 years. How would you describe your involvement with NEXUS? I’ve been connected with NEXUS since shortly after I began my studies at UBC. I’ve attended NEXUS seminars and the 2008 Spring Institute. Currently I’m involved in helping plan the 2009 Spring Institute as a member of the Spring Institute Planning Committee.  What is your favourite thing about NEXUS? I like the diversity of the participants and that so much of the research undertaken at NEXUS links closely with interventions. Why is NEXUS important to you? NEXUS provides a space to meet and interact with other researchers and students exploring the social contexts of health behaviour. I really appreciate the exposure to a wide variety of research approaching similar questions from different angles and using different methodologies. NEXUS also offers a lot of support to trainees and helped cover some of my travel expenses so that I could present at an international conference in Spain last year. How did you initially become interested in social contexts of  health behaviour? I’ve been working in harm reduction for many years and have coordinated a harm reduction group that provides crisis support at multi- day music festivals to folks who are affected by drug use. So much early harm reduction work was premised on educating users and asking them to change their behaviour, often with little success. From my observations, I began to wonder if there might be ways to alter the physical and social environments so NEXUS Trainee Spotlight Each issue, different NEXUS trainees take the spotlight and share a bit about their academic lives and beyond. that some of these drug-related crises might turn out differently without expecting the users to know more or to behave differently. I began modifying some of our interventions toward this end and saw surprisingly dramatic positive results. This sparked a desire to explore this area more formally. My research now examines the social and environmental factors influencing drug using behaviour among high intensity recreational drug users, which fits within the NEXUS approach. What are some of  your recent accomplishments that you are most proud of? From September 2006 to September 2008, I was a member of the CARBC interdisciplinary research team that piloted an alcohol and other drugs monitoring system in BC. Among my roles was to develop and implement a set of related survey instruments for street- involved youth, adult injection drug users, and high-intensity recreational drug users. The pilot was successful and now four cycles of surveying have been completed in Vancouver and Victoria over the past two years and other provinces are interested in adapting the instruments for local use. Also, the harm reduction work I have been involved with at large music festivals has been really successful beyond what I imagined. Our most recent project involved 56 trained volunteers working round the clock over five days at a festival of more than 10,000 people. Over the years of doing this work we have trained well over 100 volunteers across BC and Alberta and they have taken the initiative to run crisis and support centres at festivals in their areas. It has become a new “norm” that a multi-day music festival should offer this kind of support on par with first aid and security. If  you could pursue any research topic outside your field, what would it be? Something to do with health informatics. My previous career was in computing and I’d love to find a way to bring my information system skills and my epidemiological research skills together. What might someone be surprised to learn about you? I think people who know me mainly as an older, grey-haired PhD student Warren Michelow: epidemiologist by day, harm reduction activist by night Page 2NEXUS: Researching the social contexts of health behaviour NEXUS Portal Volume 3, Issue 1 NEXUS Trainee Warren Michelow presented his work at the International Harm Reduction Conference in Barcelona, Spain, July 2008, with the help of a NEXUS travel grant. [Photo: W. Michelow] NEXUS Knowledge Exchange Corner Youth Sexual Health Team Launches Camp fYrefly BC The Youth Sexual Health Team, led by NEXUS Lead Investigator Dr. Jean Shoveller at the UBC School of Population and Public Health, launches the first-ever Camp fYrefly in British Columbia, July 2-5, 2009. Camp fYrefly is an innovative intervention for youth sexual minority health that originated as a university- community educational project in Alberta in 2004. The camp takes a ‘by-youth-for-youth’ approach to developing leadership skills, social understanding, and support for lesbian, gay, bisexual, trans-identified, two-spirited, intersex, queer, and allied youth. By helping young people to positively address the issues they share as sexual minorities in BC, the camp aims to cultivate the leadership skills and networks that will enable to them to better understand and navigate the social contexts that affect their health and wellbeing. Camp fYrefly BC will offer over 25 workshops to 60 participants, ages 14-24, with the support of corporate sponsors and individual community donors. For more information on Camp fYrefly or to make a donation please visit www.youthsexualhealth.ubc.ca/home/campfyrefly. NEXUS Spring Institute 2009 Focus on KE Knowledge exchange (KE) is a core component of the NEXUS mission. Because its role in health research is becoming increasingly important, this year’s Institute will take a critical look at KE, from its political and ethical dimensions to specific methods and creative practices in accomplishing KE. Conference sessions will contend with questions such as: What does knowledge exchange in health research actually mean? What are some of the ethical and personal challenges or rewards faced in undertaking KE? What are some of the barriers to KE and how might they be overcome? Who are the parties involved in KE and in which direction(s) does the knowledge flow? What happens when well-intentioned KE efforts backfire? Keynote addresses will be delivered by Dr. Sylvie Stachenko, former Deputy Chief Public Health Officer of the Public Health Agency of Canada, currently Dean of the School of Public Health at the University of Alberta, and Ms. Victoria Schuckel, Director of Research at the BC Ministry of Health Services. Mr. Dan Reist, Director of the Communication and Resource Unit of the Centre for Addictions Research of BC, will interactively lead participants in a principal keynote workshop. The 2-day Institute takes place on April 16 & 17, 2009. Please visit http://www.nexus.ubc.ca/ opportunities/learning/SpringInstitute2009.htm. Prostate Cancer Support Group Summary The executive summary of the CIHR-funded NEXUS study ‘Role of Prostate Cancer Support Groups in Health Promotion’ has now been released and is available for download on the NEXUS website at http://www.nexus.ubc.ca/ news/news.aspx.  NEXUS Lead Investigator Dr. John Oliffe led the team on this project which included NEXUS Co-Director Dr. Joan Bottorff, NEXUS Co-Investi- gator Dr. T. Gregory Hislop, and Dr. Michael McKenzie from the BC Cancer Agency. BC Climate Change and Health Report NEXUS Lead Investigator Dr. Aleck Ostry is the lead author on a new white paper commissioned by the Pacific Institute for Climate Solutions for BC’s Climate Action Secretariat on climate change and health in BC. This document will likely form the basis of a climate change and health research agenda for the province over the coming years. The full report is available online: http://nexus.ubc.ca/documents/ Health(2).pdf Page 3NEXUS: Researching the social contexts of health behaviour NEXUS Portal Volume 3, Issue 1 Understanding how these social conditions affected the quality of self-care allowed us to advocate clinical changes to better support this vulnerable group. Based on the study’s recommendations, our clinical team is presently developing a proposal to validate an instrument to identify this small group of people who are at higher risk of not being able to confidently care for themselves following their cardiac procedures. We are also intent on including a limited screening for psycho-emotional distress in our practice, given the growing body of evidence linking depression and cardiac disease. Our objective is to change our practice and our program by considering these less traditional risk factors that greatly affect recovery following PCI. This work has inspired me to continue to build connections between my practice as a clinical nurse specialist and my research interests. For my doctoral dissertation, I am working with Dr. Pam Ratner to study patient-reported outcomes of cardiac patients living with an implantable cardioverter-defibrillator (ICD). We are collaborating with educators at the St. Paul’s Hospital ICD clinic to investigate questions, such as: What is the relationship between ICD therapy and quality of life, including family life and intimacy, return to work and driving, exercise and leisure activities? What services are known to be effective and how can we best support patients and their families? Social Context (continued from page 1) “Understanding...social conditions...allowed us to advocate clinical changes to better support this vulnerable group” New Book on Men’s Health NEXUS investigators Dr. John Oliffe and Dr. Paul Galdas have authored chapters appearing in a new book on men’s health slated to be released by John Wiley & Sons on March 30, 2009. Men’s Health: Body, Identity, and Social Context, edited by Alex Broom and Philip Tovey, brings together expert contributors examining the socio- cultural dimensions of men’s health and offers a critical appraisal of the theoretical underpinnings of men’s health. Oliffe and Galdas both contend with connections between masculinities and health behaviour, examining prostate cancer and help-seeking respectively. NEXUS Poster Session NEXUS held its annual poster session on November 26, 2008, which was attended by over 30 NEXUS members, including lead investigators, co-investigators, and trainees. Of the 10 posters presented, 5 were presented by NEXUS trainees. Posters covered a range of topics including complementary medicine education, safer crack use initiatives, smoking susceptibility and new fathers’ smoking, and public knowledge of heart attack signs. Heart Health (continued from page 1) NEXUS Portal Volume 3, Issue 1 Page 4 providers about heart disease risk and prevention. Women were less likely to report discussing heart disease risk and management with their healthcare providers. Chinese-Canadian participants less frequently received heart disease education compared with participants of other ethnic origins. These differences persisted after taking into account income, highest level of education attained, age, and other factors. The findings from both studies point to several changes in primary care practice that could help to level these knowledge deficits and promote heart health. Providers could make targeted efforts to improve education about heart disease and its risk factors for women in general, and for postmenopausal women especially, who are at increased risk. It is also critical that healthcare providers are aware that some ethnic populations may not be receiving patient education similar to that received by people of other communities and work to actively address this gap. Finally, men and women must be educated about the other gender’s risk of heart disease because all adults play integral roles in making decisions that affect the prevention and early detection of heart disease. NEXUS: Researching the social contexts of health behaviour NEXUS Welcomes 3 New Co-Investigators NEXUS was pleased to welcome three new co-investigators to the team in early 2009. Dr. Carolyn Gotay is Professor and Canadian Cancer Society Chair in Cancer Primary Prevention in the UBC School of Population and Public Health. Dr. Gotay’s research areas include health behaviours that reduce risk factors for cancer, disparities in risk behaviours and cancer-related outcomes in specific population groups, the cancer control continuum, and approaches to cancer prevention and control that incorporate individual, community, healthcare, and policy interventions. Dr. Erin Michalak is Assistant Professor, MSFHR Scholar, and CIHR New Investigator in the Mood Disorders Centre of the UBC Department of Psychiatry. She is also Postdoctoral Coordinator in the Faculty of Medicine. Dr. Michalak’s work focuses on bipolar disorder, seasonal and non-seasonal depression, quality of life, psychosocial functioning, and the development of psychosocial assessment scales. Dr. Renée-Louise Franche is Director of the Disability Prevention Program, Occupational Health and Safety Agency for Healthcare (OHSAH) in BC. Dr. Franche’s research focuses on work disability prevention (return-to-work/stay-at-work), musculoskeletal conditions, mental health, and other chronic health conditions. She also studies working conditions in the healthcare sector, as well as organizational readiness for change. NEXUSnews NEXUS Postdoctoral Trainee Chizimuzo Okoli (right) shares his work with Co-Investigator Helen Ward (centre) and Trainee Affiliate Karen Cook (left). [Photo: S. Coen] NEXUS Co- Investigator Sabrina Wong, Co-Director Pam Ratner, and Lead Investigator John Oliffe (from left to right) admire a poster presented by NEXUS Trainee Martha Mackay (not shown). [Photo: S. Coen] 1. Grunau GL, Ratner  PA, Hossain, S. (2008). Ethnic and gender differences in perceptions of mortality risk in a Canadian urban centre. International Journal of General Medicine 1: 41-50. 2. Grunau, GL, Ratner, PA, Galdas, P, Hossain, S. (in press). Ethnic and gender disparities in patient education for secondary prevention of heart disease. Journal of Patient Education and Counseling. NEXUS is funded byNEXUS is a community of academic and clinical researchers and graduate students pursuing health behaviour research from a variety of perspectives including Nursing, Public Health, Epidemiology, Health Promotion, Sociology, Pharmaceutical Sciences, and Geography. Its mission is to develop knowledge, interventions, and policy recommendations based on a critical analysis of the social contexts that 1) create barriers to health, 2) affect health seeking, and 3) influence system responses. NEXUS is building expanded research  programs related to these three themes in health behaviour using the analytical lenses of gender, diversity, and place. Dr. Lynda Balneaves Dr. Joan Bottorff Dr. Jane Buxton Dr. Lorraine Greaves Dr. Joy Johnson Dr. John Oliffe Dr. Aleck Ostry Dr. Ric M. Procyshyn Dr. Pamela Ratner Dr. Jean Shoveller Dr. Judith Soon Dr. Annette Browne Dr. Joyce Davison Dr. Renée-Louise Franche Dr. Paul Galdas Dr. Carolyn Gotay Ms. Sukhdev Grewal Dr. Su-Er Guo Dr. T. Gregory Hislop Dr. Mieke Koehoorn Ms. Martha Mackay Ms. Mary McCullum Dr. Erin Michalak Dr. John Ogrodniczuk Dr. Birgit Reime Dr. Chris Richardson Dr. Carole A. Robinson Dr. Rick Sawatzky Ms. Tracy Truant Dr. Helen Ward Dr. Sabrina Wong Dr. Mary Lynn Young NEXUS Lead Investigators NEXUS Co-Investigators UBC Celebrate Research Week 2009 Celebrate Research Week, March 9-13 in Vancouver and Kelowna, is an annual showcase of UBC research open to the public. March 10, 2:30-4:30pm, Robson Square, 800 Robson Street, Vancouver ~ Sexual Health in a Social World: How Do Social Contexts Shape the Wellbeing of Sexual Minority Youth?  This interactive session explores the connections between sexual minority youth and their social context to help participants better  understand how social context affects youths’ health. The latest research about sexual minority youth health inequities will be  presented and participants will be introduced to an innovative health, social, and educational intervention to promote their health. March 12, 12-1:30pm, UBC-Okanagan, Library 306 & March 13, 5:30-7pm, Robson Square, 800 Robson Street, Vancouver ~Men’s Health: Minds, Bodies, and Masculine Ideals  Joan Bottorff, John Oliffe, Paul Galdas, Elizabeth Saewyc, and Jennifer Matthews explore how the everyday behaviours of men,  including those that impact on health, are influenced by societal views of masculine practices. This panel examines research on  men’s depression, fathers’ smoking, South Asian Canadian men’s heart health, and young men’s sexual health to understand the  relationships between masculinity and men’s health experiences. NEXUS Seminar Series 2008-09 Seminars are presented at the UBC Vancouver and Okanagan campuses and are broadcast online via WebEx. February 25, 2009 ~ Diversity in the Nursing Workforce: The Key to Success or a Source of Tension?    Angela Wolff, NEXUS PhD Trainee March 25, 2009 ~ Complementary Medicine Education and Outcomes    Lynda Balneaves, NEXUS Lead Investigator; Tracy Truant, NEXUS Co-Investigator;    Alison Brazier, NEXUS Alumna NEXUS Spring Institute 2009 Knowledge Exchange: From Research to Social Action and Back April 16 & 17, 2009 St. John’s College, 2111 Lower Mall, UBC Vancouver, BC V6T 1Z4 Upcoming Events For more information on NEXUS events please visit www.nexus.ubc.ca/opportunities/learning/learning.htm Page 5NEXUS: Researching the social contexts of health behaviour NEXUS Portal Volume 3, Issue 1


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