Issue 21

november 2011 | Issue 20 | www.meducator.orgMarch 2012 | Issue 21 | www.meducator.org

Childcare as Healthcare enriched childhood experiences

Peer Support Centressupporting mental health at university

APPLYING DRAMA TO HEALTHAn interview with Hartley Jafine

Vitamin D are current guidelines correct?

Ciliary Dysfunctionthe function of microtubules

issue 21 | March 2012

ForumSpace

articles

INTERVIEW

ABOUT Us: Established in April 2002 with the support of the Bachelor of Health Sciences (Honours) Program (BHSc), The Meducator is McMaster University’s undergraduate health sciences publication. Through biyearly publications, a web page, and social media, we aim to provide a platform for undergraduate students to publish their work and share information with their peers. Our protocol strives to maintain a high standard of academic integrity by having each article edited by a postgraduate in the relevant field. We invite you to offer us your feedback by writing to our email: [email protected]

Editor-in-ChiefHiten Naik

Deputy Editor-in-ChiefDaniel Lee

Strategic AdvisorAhmad Alkhatib

Editorial BoardMatthew Chong

Mustafa AhmadzaiKhizer Amin

Shelly ChopraDaniel Elbirt

Keith LeeBhavik Mistry

Vaibhav MokashiHumna AmjadIlia OstrovskiKimia Sorouri

Andrew Webster

Graphics & DesignBrian Chin

Jennifer KwanXena Li

Ellen LiangAnnie Cheung

Yasmeen Mansoor

CommunicationsAashish Kalani

Mohsin AliTahir Ali

Paul CheonJohn Han

Health Forum LiaisonLebei Pi

ADDRESSThe Meducator

BHSc (Honours) ProgramMichael G. DeGroote Centrefor Learning and Discovery

Room 3308 Faculty of Health Sciences

1200 Main Street WestHamilton, Ontario L8N 3Z5

PRINTINGUnderground Media & Design

EMAIL the.meducator

@learnlink.mcmaster.ca

WEBSITEwww.meducator.org

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@TheMeducator

MEDUCATORSTAFF

LETTER FROM THE EDITOR 2

MEDBULLETIN 3

MEDABSTRACTS 6

Childcare as Healthcare:Parents’ Perceptions of Enriched Early Childhood Experiencesby Regina DeLottinville

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Ciliary (Dys)function in Human Disease:Mapping the Ciliogenesis Pathwayby Mustafa Ahmadzai

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University Campus Peer Support Centres:Benefits for Student Emotional and Mental Well-beingby Ikdip Kaur Brar, Jae Eun Ryu, Kamran Shaikh, Ashlie Altman & Jeremy Ng

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Hartley Jafine: The Role of Drama in the Health SciencesConducted by Ilia Ostrovski, Brian Chin & Shelly Chopra

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MACWIRE 25

19The Vitamin D Gambleby Andrew Webster

The New Canada Health Transfer:Increasing Disparity and Supporting Inertia?by Adrian Tsang & Justin Neves

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2The Meducator | March 2012

Celebrating 10 years of The Meducator

HITEN NAIKPresident & Editor-in-ChiefBachelor of Health Sciences (Honours), Class of 2012

LETTER FROM THE EDITOR:

This April, it will have been 10 years since the first edition of The Meducator was published in 2002. In his inaugural Letter from the Editor, Meducator founder Jonathan Ng states that the publication was established “with the vision of immersing individuals, interested in pursuing a health profession, into the world of medicine”. The issue went on to include a series of interesting pieces on topics that ranged from HIV vaccines to the health benefits of chocolate.

To permanently preserve the first issue and all 19 since then, we have worked with Nick Ruest at the McMaster library to integrate our publication into the university’s institutional re-pository (Digital Commons). By making articles discoverable through Google Scholar and assigning each a citation, this sys-tem will ensure that the work of our authors remains valuable at McMaster and beyond.

A brief perusal of all the past issues now published on our web-site (www.meducator.org) reveals that our content has broad-ened in scope over the years and has expanded to include ar-ticles—and now abstracts—based on research conducted by students from a diverse range of fields. Medicine is truly multi-disciplinary, and the idea that health is influenced by the most macro and micro of factors is certainly apparent in the articles of this, our tenth anniversary issue.

On a national scale, the federal government can directly in-fluence health care delivery by providing (or not providing) transfer funding to provinces. In light of recent news since their inaugural column, Adrian Tsang and Justin Neves from the McMaster Health Forum Student Subcommittee discuss this topic in the ForumSpace.

But while Stephen Harper seemingly has the power to influ-ence our health care, so do our parents. As recent nursing

graduate Regina DeLottinville aptly describes in her Research Insight piece, the experiences we have during our youth can play a strong role in dictating our health habits in the future.

However, there are several determinants of health that are less under our control. For example, ciliopathies are a series of dis-orders that have a genetic basis. In a thoughtful Critical Review, Mustafa Ahmadzai discusses the biology behind these diseases and highlights current research approaches that are used to learn more about them.

Mustafa’s article is followed by two additional Critical Reviews. A group from the recently founded Motivation for McMaster discuss the concept of peer-to-peer counseling and how it can be a valuable means to deal with mental health issues while at university. Andrew Webster then outlines the non-classical benefits of Vitamin D and describes how the current dosage recommendations might be off the mark.

The controversial policies and intriguing science featured in this issue may rightly occupy the minds of many students and health professionals, but the arts can also be used to improve our sense of perspective and regain our passions. Three mem-bers of The Meducator led by Ilia Ostrovski took the opportu-nity to interview Hartley Jafine to discuss the benefits of apply-ing drama to health care and health education. In the coming weeks, we hope to post a video of this interview on our new YouTube channel.

In closing this letter, I would like to extend a thank you to all members of The Meducator team that have made the last two issues possible, and would like to wish next year’s staff all the best going forward. I have now been involved in nine editions of The Meducator and am confident that the next nine will make Jonathan just as proud.

MEDUCATORSTAFF

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Over the last decade, the influence of religion on recovery from severe mental illness has emerged as an important

idea amongst clinical psychologists. Health professionals have found that spirituality quickens recovery by playing a role in stress reduction (e.g. through prayer), improves a patient’s sense of well-being, and lends guidance or structure to afflicted individuals.1

A study conducted by Webb et al.3 investigated how positive religious support could aid recovery in 81 adults with several mental illnesses such as schizophrenia, depression, or bipolar disorder. Recovery was assessed using a Recovery Assessment Scale which comprised of 41 questions related to the partici-pant’s personal confidence, willingness to ask for help, reliance on others and motivation to succeed. The study found that reli-gious support resulted in a statistically significant improvement in the subjects’ mental states.

The results of this study have important implications for health professionals as it encourages them to become more cognizant of spiritual issues and possibly make use of the patient’s existing religious community in treatments.4 For example, in the Unit-ed States, several religious professionals and ministries with training in mental health have been able to promote recovery.5 In conclusion, spirituality and religion can be positively uti-lized in future therapies to help individuals recover from severe mental illness.

SPIRITUAL HEALING & MENTAL ILLNESS

Vaibhav Mokashi

1Sullivan WP. Recoiling, regrouping, and recovering: first-person accounts of the role of spirituality in the course of serious mental illness. New Dir Ment Health Serv 1998 Winter;(80):25-33. 2 Huguelet P, Mohr S, Jung V, Gillieron C, Brandt PY, Borras L. Effect of religion on suicide attempts in outpatients with schizophrenia or schizo-affective disorders compared with inpatients with non-psychotic disorders. Eur Psychiatry 2007 Apr;22(3):188-194. 3Webb M, Charbonneau AM, McCann RA, Gayle KR. Struggling and enduring with God, religious support, and recovery from severe mental illness. J Clin Psychol 2011 Dec;67(12):1161-1176. 4Huguelet P, Mohr S, Borras L, Gillieron C, Brandt PY. Spirituality and religious practices among outpatients with schizophrenia and their clinicians. Psychiatr Serv 2006 Mar;57(3):366-372. 5Stetz KM, Webb M, Holder A, Zucker D. Mental Health Ministry: Creating Healing Communities for Sojourners. Journal of Religion, Disability & Health 2011 April-June 2011;15(2):153-174. Image adapted from: http://www.time.com

The rule of rescue is “the injunction to rescue identifiable individuals in immediate peril regardless of cost”.2 The hu-

man proclivity to abide by this principle is demonstrated in ac-counts of sailors risking their lives to find a shipmate lost at sea. Recently, the moral implications of abiding by this principle have come into question in deciding whether or not to perform a decompressive craniectomy (DC) on patients with a severe brain injury.

The procedure, which entails removing a large section of the cranium to relieve swelling-induced pressure, is extremely ex-pensive and often results in severe life-long disabilities for the patient. A newly derived model for indexing brain injury se-verity was tested to determine to what extent it could predict the outcome of patients receiving a DC. The study compared groups with above and below an 80% prediction of an unfa-vourable outcome. In the >80% group, only 12.5% of the pa-tients had a favourable outcome (p<0.05). Conversely, in the <80% group, 83% of the patients returned home, with only 6% requiring nursing home care (p<0.05).2

Difficulty arises when deciding to perform a DC since the risk involved with this procedure is high. Additionally, large oppor-tunity costs are associated with this decision-making process since consequences of the decision may not be appropriate for the patient. Physicians are put in a difficult situation since they must draw the line between morals and health benefits.

1 Honeybul S, Gillett G R, Ho K M, Lind C R P, J Med Ethics 2011;37:707-7102 Cookson R, McCabe C, Tsuchiya A. Public healthcare resource allocation and the Rule of Rescue. J Med Ethics 2008;34:540Image adapted from: http://www.stroke.ahajournals.org/content/38/9/2506/F3.expansion

Ilia Ostrovski

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RESCUE PRINCIPLE


The brain stores memories by forming connections between individual nerve cells. During learning, these connections,

known as “synapses”, change in number and strength as a result of alterations to their protein compositions. Long-term memo-ry formation involves maintaining these changes over long pe-riods of time. However, how this maintenance is achieved has remained a mystery to neuroscientists.

Recently, researchers at the Stowers Institute for Medical Re-search discovered a synaptic protein, Orb2, in the Drosophila fruit fly that appears to be essential for the formation of long-term memory. Orb2 is a self-complementary protein, able to stack with copies of itself to form oligomers located within neu-rons. After determining that stimulation of neuronal synapses increases Orb2 oligmerization, the researchers tested whether oligomeric Orb2 is essential for memory formation. Introduc-tion of a point mutation to reduce Orb2 oligmerization pre-vented the fruit flies from stabilizing long-term memory beyond 24 hours, a phenomenon not experienced by wild-type Drosoph-ila. This suggests that oligomeric Orb2 plays an important role in the persistence of memory.

The discovery that oligomers are involved in memory formation has numerous implications. In addition to providing insight into the complex workings of the brain, this finding also sheds light on many memory-related diseases, such as Alzheimer’s, caused by the accumulation of toxic oligomers. Further research in this area can give us a better understanding of when and how oligomers are detrimental to our health.

Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. The New England Journal of Medicine, 2011;365(17):1597–604.Image adapted from: http://www.emedicbuzz.com

A fter numerous debunked diet fads and weight-loss plans that promised everything but failed to deliver, the West-

ern world has come to realize the difficulties of not only losing weight, but also keeping it off.

A recent study by Dr. Joseph Proietto and colleagues at the University of Melbourne suggests that long-term biological changes in persons who are obese play a considerable role in hindering weight loss. Fifty men and post-menopausal women with body-mass indices between 27 and 40 were recruited to the study. For ten weeks, the participants were restricted to low-starch vegetable drinks, which provided 500-550 calories per day. Participants then entered the weight-maintenance phase, in which they returned to the consumption of ordinary foods, in amounts and ratios that were suggested to them by dietary experts. Follow-up occurred every two months for a span of one year.

It was found that weight-loss resulted in significant alterations in levels of appetite-mediating molecules, such as leptin, in-sulin, and gastric and pancreatic polypeptides. These changes were a homeostatic response in order to promote the regain of weight, and were consistent with the increase in appetite that was reported by participants. The researchers found that compensatory alterations to weight loss persisted even a year af-ter the ten-week diet, promoting the eventual regain of weight. This persistent biological transformation highlights the impor-tance of finding diets that can be maintained permanently.

Majumdar A, Cesario W, White-Grindley E, Jiang H, Ren F, Khan M, et al. Critical Role of Amyloid-like Oligomers of Drosophila Orb2 in the Persistence of Memory. Cell. 2012 Jan 26.Image adapted from: http://www.newswise.com

Khizer Amin Keith Lee

HOMEOSTASIS: THE PRISON WARDEN OF OBESITY

THE BIOCHEMISTRY OF LONG-TERM MEMORIES

MedBulletin

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PUBLIC HEALTH & THE DRUG RESISTANT TB

THE DEBATE OF COGNITIVE NEUROENHANCEMENT

Recent reports of the emergence of an incurable form of tu-berculosis at the Hinduja Hospital in Mumbai, India have

raised concerns regarding increasing drug resistance to the dis-ease. Researchers in Mumbai have identified 12 patients with so-called totally-drug resistant tuberculosis (TDR-TB) that ap-pears to be resistant to all known treatments.1 Zarir Udwadia, a physician at the Hinduja Hospital who has been treating the patients, attributes the issue of drug resistance to poor manage-ment of the disease and a failure of public health in India.1 In particular, government-run health facilities in India are viewed negatively by the public due to chronic underfunding and un-derstaffing, effectively forcing desperate TB patients to seek care from private physicians who tend to be unregulated in both pre-scribing practice and qualifications.2 In fact, a study conduct-ed in Mumbai showed that the vast majority of prescriptions written by private physicians practicing in Dharavi for hypo-thetical TB patients were inappropriate and would have further amplified drug resistance.3 This problem is exacerbated by poor infection control in health settings and the lack of laboratory infrastructure to identify and confirm TB diagnoses, creating a breeding ground for infection and drug resistance.1 So far, only about 1% of those who have developed multi-drug resistant TB have had access to the Directly Observed Therapy, a Short Course program that treats normal TB. However, the Indian government has failed to provide treatment for the rest of the population living with TB, due to its high cost – US$4000 per patient for TB alone, compared to the $45 the government ac-tually spends per capita on health care in general.1,2

1Loewenberg S. India reports cases of totally drug-resistant tuberculosis. The Lancet. 2012 Jan;279(9812):205. 2Udwada ZF, Amale RA, Ajbani KK, Rodrigues C. Totally drug-resistant tuberculosis in India. Clinical Infectious Diseases [Internet]. 2011 Oct [cited 2012 Jan 28];0. Available from: http://cid.oxfordjournals. org.libaccess.lib.mcmaster.ca/content/early/2011/11/24/cid.cir889.full.pdf+html3Udwadia ZF, Pinto LM, Uplekar MW. Tuberculosis control by private practitioners in Mumbai, India: has anything changed in two decades? PloS One. 2010;5(8):1-5.Image adapted from: http://www.guardian.co.uk

Lebei Pi

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Cognitive neuroenhancement (NE), the process of improv-ing one’s intellectual abilities, has been debated by the sci-

entific community since the development of psychostimulatory drugs. At face value, the principle behind NE seems simple yet lucrative: the development of a pill to better one’s brainpower and thus one’s operative performance at school or work. How-ever, unpacking the physiological, moral, and social implica-tions of NE reveals how the notion is still in its infancy in the domain of non-therapeutic interventions.1

One of the largest challenges lies in the fact that many psycho-stimulants, acting through dopaminergic pathways, have both positive and negative effects. While dopamine is able to mediate learning and one’s intelligence quotient (IQ), overstimulation of the dopamine pathway causes addiction, a key side effect of most psychostimulants on the market today. This duality complicates research in NE and calls into question the potential benefit of psychostimulants. However, if one day the cognition-enhancing effects outweigh the counter-regulation of psychostimulants, is their marketing as neuroenhancers ethically justifiable? Social pressures to conform to the use of neuroenhancers for one’s in-tellectual performance parallel the manner in which athletes are often intimidated–by their opponents’ physical abilities–into using steroids. Although the average person faces many social pressures today, the key distinction between the purchase of a popular gadget and ingesting a NE drug is that the latter inter-venes directly at the neurobiological level.2 One’s sense of self and self-efficacy will be affected at the neuronal level in addition to the social burdens experienced when using a psychostimulant.

Although present for a number of years, the debate on the value of NE seems to have just begun. Further empirical research will determine what, if any, psychostimulants should be tested for cognition-enhancing effects in healthy individuals.

Shelly Chopra

1Heinz A, Kipke R, Heimann H, Wiesing U. Cognitive neuroenhancement: false assumptions in the ethical debate. J Med Ethics 2012 Jan 6.2Galert T, Bublitz C, Heuser I. Das optimierte Gehirn. Gehirn & Geist. 2009.Image adapted from: http://www.healthcarereformmagazine.com


M E D A B S T R A C T S

Sohaib Amjad1, David C. Rollo2

1 Honours Biology, Physiology Specialization, Class of 2012; 2 Department of Biology, McMaster University

Studies on longevity are becoming increasingly important due to the aging population. The house cricket, Acheta domesticus, is an effective model for longevity studies due to its short lifespan of 120 days. This study explored the effects of diet on reproduction and longevity in A. domesticus. There were four treatment groups: 1) control diet with reproduction, 2) control diet with reproductive isolation, 3) high protein diet with reproduction, and 4) high sugar diet with reproduction. We began monitoring the crickets following maturity to allow for reproductive analysis. Death counts were conducted daily, followed by replenishment of food and water supplies. Egg counts and weight measurements were conducted weekly. Results showed that crickets on the high sugar diet had significantly longer lifespan than other treatments. The lowest lifespan was seen in crickets on the high protein diet. Conversely, the highest repro-ductive output was seen in the high protein diet and the lowest was in the high sugar diet. The reproductively isolated control group had a significantly greater longevity than the reproductive control group. Taken together, the research shows an inverse relationship between reproduction and longevity as modulated by dietary consumption of proteins and carbohydrates.

Assessing the Effects of High Sugar and Protein Diets on Reproduction and Longevity in Crickets

Karen Chung1, Brittany Greene1, Jessica Lax-Vanek1, Sofija Rans1, Allyson Shorkey2, Michael Wilson3

Bachelor of Health Sciences (Honours), Global Health Specialization, 1Class of 2012; 2Class of 20133 Program in Policy Decision-Making/Centre for Health Economics and Policy Analysis, McMaster University

In Canada, the exposure and/or transmission of HIV is punishable by criminal law. Deficiencies in Canadian-focused research about the implications of criminalizing HIV exposure demonstrate a need for locally applicable research evidence. This study aims to inves-tigate the impact of HIV/AIDS criminalization on awareness, prevention, and stigma in the Greater Toronto Area through a scoping review and stakeholder interviews. Eleven databases were searched and the results were reviewed for relevance. Search yielded 1301 results, 148 relevant articles. Primary research is limited to 12 articles, while the remainder is comprised of case reports, editorials, commentaries and essays (n=136). Literature highlights confusion regarding behaviours constituting “significant risk”, resulting in dif-ficulties in the application of legal precedent and uncertainty regarding HIV knowledge in the general public. Some evidence suggests that criminalization contributes to disincentives for testing and disclosure, strained therapeutic relationships, HIV related stigma, and barriers to promoting shared responsibility for safer sex. Stakeholders (policy/content experts, executive directors and front-line workers from community-based HIV/AIDS organizations) were identified, and a purposive sample invited to participate in one-on-one, semi-structured interviews. Interviews depict the negative impact of criminalization on prevention efforts, heightened community awareness of prosecutions, and increased stigmatization of people living with HIV/AIDS. Participants recommend guideline development to optimize the use of criminal law pertaining to HIV/AIDS non-disclosure. These findings will significantly contribute to increasing primary research on the impact of HIV/AIDS criminalization in the Greater Toronto Area. Further research is necessary to characterize the impact from the perspective of people living with HIV/AIDS.

The Impact of HIV/AIDS Criminalization onAwareness, Preventiuon and Stigma in the GTA

Ravi Kumar1, A. Bhargava2, M. Manolson2

1 Bachelor of Health Sciences (Honours), Class of 2014; 2 Faculty of Dentistry, University of Toronto

Cutis Laxa is a genetic disorder in which a patient’s skin becomes loose and inelastic. The autosomal recessive variant of this disorder has been linked to a genetic mutation in vacuolar-type H+-ATPase (V-ATPase). This enzyme contains a cytosolic domain, responsible for hydrolyzing ATP, and a membrane-bound domain that actively transports protons across intracellular and plasma membranes. Proton pumping regulates housekeeping functions inside the cell, resorption of bone, and acidification of urine. A human missense mutation in one of the V-ATPase subunits (a2 P405L) that causes Cutis Laxa was recreated in the yeast V-ATPase to elucidate why a single amino acid change could affect enzyme activity. The mutation recreated in the yeast V-ATPase disrupted activity based on the inability of yeast to acidify their vacuoles. The membrane domain of the mutant V-ATPase was correctly assembled and targeted to the yeast vacuole but the cytosolic domain was not attached explaining why the vacuoles were not acidic. These results suggest that the loss-of-function mutation present in cutis laxa leads to decreased V-ATPase stability and/or assembly. Further experiments will be designed to assess if the mutation results in a conformational defect, and if so, therapeutics assisting in protein folding can be explored. Such therapeutics not only hold promise for cutis laxa, but also for other V-ATPase genetic diseases such as osteopetrosis, distal renal tubular acidosis and male sterility.

Human V-ATPase a2 P405L Mutation Results in Cutis Laxa byAffecting V-ATPase Assembly and/or Stability

7

Adrian Tsang1 and Justin Neves2

McMaster Health Forum Student SubcommitteeBachelor of Health Sciences (Honours), 1Class of 2012; 2Class of 2013

The Canada Health Act and its predecessor legislation explic-itly declare that “the primary objective of Canadian healthcare

policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable ac-cess to health services without financial or other barriers.”1 State-ments such as these have resonated with Canadians for decades, creating a strong sense of national pride in a health system that values fairness over privilege and need over the ability to pay. With that being said, as the global economy continues to struggle and the baby boomer generation begins to retire, there is a growing concern that our healthcare system may require significant reform.

In the First Ministers’ Accord of 2004, the prime minister and the premiers of each province and territory agreed upon a fund-ing strategy to increase federal support for healthcare through yearly cash and tax point transfers, known as the Canada Health Transfer. The ministers also agreed upon priority funding areas to improve healthcare, such as embracing information technologies and reducing wait times.2 With the Accord expiring in 2014, pol-icy entrepreneurs and health professional associations have been anxiously waiting for new negotiations to commence to push onto the agenda important health system policies on home care, prescription-drug insurance and a variety of other issues. They are going to have to continue waiting. This past December, the Harper government surprised the provin-cial and territorial governments as well as the general public when Finance Minister Jim Flaherty announced a take-it-or-leave-it deal, whereby the Canada Health Transfer would be delivered with no-strings-attached and a decline in the rate of increased spending starting in 2017. At the moment, the government’s proposal will also remove the equalization formula that balances Canada Health Transfer payments between “have” and “have-not” provinces. The proposal includes no statement about national priority funding

areas, which are usually identified during Health Accord negotia-tions.2 Canada Health Transfer payments—currently worth $27 billion in cash and $13.6 billion in tax points—will increase at the present rate of 6% per annum until 2017, at which point increases will be tied to economic growth with a guaranteed floor of a 3% increase per annum until approximately 2024.3 Health care spending has increased by 6.1% per annum over the last few years, meaning provinces will now have to find ways to limit this increase to ensure that their health systems are sustainable.3

At first glance, the rich provinces will become richer and the poor will become poorer. Under the terms of the proposal, the federal government will eventually distribute money from public coffers to the provinces and territories on a strict per-capita basis, which will exacerbate the wealth disparity across Canada in two ways. First, tax revenues from wealthier provinces are usually greater than those from poorer provinces on a per capita basis because they are tied to residents’ incomes. In fact, Alberta will signifi-cantly benefit from the proposed per-capita transfer because their tax points are so “strong” in comparison to the rest of the country (Figure 1).4

The current Canada Health Transfer which distributes $27 billion in cash and $13.6 billion in tax points to the provinces

to support health care, will expire in 2014. Near the end of 2011, the Harper government surprised Canadians with a

take-it-or-leave-it deal, whereby the Canada Health Transfer would be delivered with no-strings-attached and a decline

in the rate of increased spending starting in 2017. The proposed deal reflects a growing hands off approach to healthcare

in federal politics, furthers the divide between “have” and “have-not” provinces and represents a missed policy window for

implementing significant healthcare reforms.

FORUMSPACE

F O R U M S P A C E

The New Canada Health Transfer: Increasing Disparity and Supporting Inertia?

N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C.

250

200

150

100

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FIGURE 1: Per Capita Difference in Total CHT Entitlement between Current and Equal-per-Capita Cash Transfer, 2011-2012. Adapted from http://parl.gc.ca/Content/LOP/ResearchPublications/2011-02-e.htm#a6


1Canada Health Act. Department of Justice Canada. 1985.2First Minister’s Meeting on the Future of Healthcare 2004. Health

Canada. 2004.3Matier, C. Renewing the Canada Health Transfer: Implications for

Federal and Provincial-Territorial Fiscal Sustainability. Ottawa: Office of the Parliamentary Budget Officer. 2012.

4Gauthier, J. The Canada Health Transfer: Changes to Provincial Allocations. Ottawa: Office of the Parliamentary Budget Offi-cer. 2012.

5Coulombe S. Economic growth and provincial disparity: A new view of an old Canadian problem. 2009.

6Postl B.D. Final report of the federal advisor on wait times. Health Canada. 2006.

7Romanow, R.J. Building on Values: The Future of Healthcare in Canada. Ottawa: Commission on the Future of Healthcare in Canada. 2002.

8Gagnon, M.A & Hebert, G. The Economic Case for Universal Pharmacare: Costs and Benefits of Publicly Funded Drug Cov-erage for All Canadians. Canadian Centre for Policy Alterna-tives. 2010.

9 Drug Expenditure in Canada, 1985 to 2010. Canadian Institute for Health Information. 2010

Second, increases in economic development upon which the transfers will be based, will be led primarily by the west. In 2018 the Canada Health Transfer will begin to be tied to the growth in nominal gross domestic product (GDP), which is a measure of GDP without adjustment for inflation. While inflation increases the cost of delivering health services, the economic development of resource-rich provinces will significantly overshadow growth in resource-poor provinces.5 Without an equalization payment to re-distribute wealth across the country, this will negatively affect

“have-not” provinces like Ontario and Quebec and positively affect a “have” province like Alberta.

Under the new plan, Stephen Harper threatens to narrow the al-ready limited input that the federal government has in a domain where it makes substantial annual investments. Ottawa has in a sense become a hands-off benefactor, while leaving responsibil-ity to the provinces to continue to provide essential healthcare services that Canadians have come to expect on terms guaranteed by the Canada Health Act.

The re-negotiation of the Health Accord should have been the time to build on the initiatives from the previous agreement that are still in their infancy. Perhaps the most essential of these initia-tives was primary healthcare reform, which was mandated to en-sure equitable access to seven important areas: health promotion, illness prevention, health maintenance, home support, long-term care, community-based rehabilitation and pre-hospital emergen-cy medical services. There is also a need to continue successful initiatives, such as shifting non-acute resources from hospitals to community-based primary healthcare clinics with inter-profes-sional teams and disease-oriented collaborative practices. Finally, it is important to continue to improve access to care through the implementation of successful wait-time initiatives stemming from the activities of provinces from the previous agreement.6

The Health Accord could also have provided an opportunity to expand the Canada Health Act beyond hospital and physician services. The most significant of the potential expansions is argu-ably the creation of a national pharmacare program, which was first recommended in 1964 by the Royal Commission on Health Services and for which evidence and support has only continued to grow.7 Of all countries within the Organization for Economic

Cooperation and Development (OECD), Canada ranked second (behind only the United States) in the amount spent on prescrip-tion drugs. In fact, Canada’s total expenditure on pharmaceuticals is about thirty percent higher than the OECD average8 and now exceeds physician-based care, making it the second largest health expenditure in Canada’s health system (Figure 2).9 Despite high costs, Canada still has the lowest rates of public drug coverage amongst OECD countries and eight percent of Canadians are still unable to fill their doctors’ prescriptions due to cost.8 In order to reduce the inequality in access to medicines, it may be beneficial to unite the formularies of the thirteen provinces and territories into a single evidence-based national formulary. Doing so could reduce prescription drug costs by $10.7 billion dollars, or 43% of the $25.1 billion Canadians currently pay for drugs.8

The Canada Health Act and the Canada Health Transfer remain two of the most important policy levers to develop and imple-ment lasting healthcare reform. As pressure begins to mount on one of the most cherished pieces of the Canadian identity, there is a need for national leadership, not political trepidation. Universal and equitable healthcare is important to all Canadians. A Canada Health Transfer without federal guidelines or equalization pay-ments raises the possibility of creating a patchwork system with no strategic priorities and no efforts to address inequities across the country.

FIGURE 2: Total Health Expenditures by Use of Funds, 2010. Adapted from http://secure.cihi.ca/cihiweb/products/drug_expenditure_2010_en.pdf

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Regina DeLottinvilleBachelor of Science in Nursing, Class of 2011

Regina is a Registered Nurse and a recent graduate from the Bachelor of Science in Nursing Program. Her research

project largely concerned social determinants of health, and more specifically, early childhood development. She has

spent the past year exploring local parents’ perceptions and opinions about the importance of enriched early childhood

experiences. The focus of this research was to describe health benefits of enriched early childhood development that may

shape health behaviours later in life.

CHILDCARE AS HEALTHCARE: WHAT DO PARENTS THINK?

The concept of social determinants of health is widely consid-ered to be the cornerstone of practice in the emerging and

growing fields of public healthcare and health promotion. Health-care professionals along with the general public are becoming in-creasingly aware that good health is not simply a matter of good genes and the availability of healthcare resources. Rather, it is a summative outcome of many interrelated social, economical and societal factors, such as income, housing, employment conditions, education and nutrition.

So far, early childhood development has been clearly identified as one of the major social determinants of health. Although the health benefits and value of early childhood education may not be as obvious as other social determinants (such as income or hous-ing conditions), many of today’s public health researchers agree that experiences during pregnancy as well as early childhood have a profound effect on health behaviour and outcomes later in life.1 Not surprisingly, positive stimulation early in a child’s life can provide a solid foundation for healthy choices and practices that can continue into adulthood. From a primary health perspective, investing in early childhood development can be a powerful tool that has the potential to prevent adolescent pregnancies, tobacco use and substance abuse in adulthood, and a number of learning disabilities.2 Many beneficial health habits, such as eating sensibly and exercising, are strongly influenced by exposures in early child-hood, and in turn may have the potential to reduce the risk of diabetes and cardiovascular disease in adults.3 Particularly among children from low-income families, high quality childcare helps to address many social inadequacies by promoting intellectual and interpersonal stimulation. In turn, children exposed to the beneficial effects of enriched development may feel empowered and enabled to make healthy choices as adults.4 Currently there is

growing interest in analyzing the short-term and long-term ben-eficial effects of early childhood development programs. 5

Although there are emerging public health initiatives that recog-nize favorable outcomes from early childhood development pro-grams, some aspects remain unclear. Do parents view access to early childhood development programs as an important determi-nant of child health? How do parents perceive the significance of enriched childhood experiences (such as the ones obtained by attending Ontario Early Years Centers) in contrast to other health determinants? Although there are many factors that influence a child’s enrollment and attendance, the final decision to introduce the child to these programs is made by their primary caregivers. As such, it is important to understand how parents prioritize the opportunities for their child’s growth and development. So far, the results are not particularly optimistic. A survey conducted by Toronto Child Development Institute found that “less than half of the parents [interviewed] are knowledgeable about providing enriched, sensitive environments for their young children”.6

The introduction of the Ontario Early Years Centers (OEYCs) ini-tiative is an attempt to bridge the gap between the differing levels of positive developmental stimulation children receive at home. Currently, there are over a hundred OEYCs in Ontario that pro-vide a wide range of services to parents and their children from 0 to 6 years of age free of charge. The initiative is fully funded by the Ontario government and offers educational and informational resources for parents, as well as opportunities for their young chil-dren to learn through play.7 Public Health Nurses, as well as allied healthcare professionals, play a very important role in articulat-ing and delivering a strong message about health promotion to families that visit OEYCs. As such, sufficient knowledge regarding the role of early childhood development and social determinants of health is a cornerstone of public health practice. Today, health advocacy and policy development initiatives strongly benefit from

RESEARCH INSIGHT

R E S E A R C H I N S I G H T

Childcare as Healthcare:Parents’ Perceptions of Enriched Early Childhood Experiences


TABLE 1: Summary of early childhood education benefits, as perceived by parents participating in the research study.

Factor Described Benefit

Development - Social

Development - Intellectual

Health - Nutrition

Health - Hygiene

Health - Immunity

Health - Activity and Exercise

Hygiene education and reinforcement amongst children, particularly handwash-ing

Education about healthy food choices for children; nutritious snacks supplied by child development centers

Value through learn and play; “Domino effect” of staggered intellectual benefits

Opportunity to interact with other chil-dren; expansion of social support network for the parents

Short-term benefit of “immunity boost” through exposure to other children

Specialized activity, exercise programs and equipment; access to the swimming pool and the gym

Opportunities for parents to obtain health education and health teaching: referrals to various healthcare professionals

Health - Access to Health Services

deepened knowledge of the participants’ perspective of key de-terminants of health. In fact, research that examines participants’ perspectives can be meaningfully used to develop effective health policies.

STUDY METHODS: QUALITATIVE FRAMEWORK

It is evident that parents play a crucial role in introducing children to enriched early childhood experiences, and this, in turn, may have a powerful effect in shaping a child’s positive health behav-iours later in life. The focus of the current research project is to explore local parents’ opinions and perceptions about early child-hood education and its importance. The author used a qualitative study design because it serves as an effective source of evidence in public health practice.9 Within the qualitative framework, the method of interpretive description was utilized to describe and increase existing understanding of the phenomena. This simple yet unrestrictive method facilitates deeper understanding of the healthcare issue, as well as explores research participants’ values and beliefs.10

A total of 12 parents whose children attend OEYCs were in-terviewed for this study, and the participants were purposefully recruited from three centers that serve demographically, cultur-ally and socioeconomically diverse neighbourhoods in Hamilton, Ontario. Data were collected during the course of approximately 30-40 minute long interviews, which were audio-recorded, tran-scribed verbatim and later analyzed using NVivo 8.0 software.

RESEARCH FINDINGS: SOCIAL AND HEALTH BENEFITS OF ENRICHED EARLY CHILDHOOD

DEVELOPMENT

The parents who participated in the research study unanimously stressed that they perceive early childhood development as very important. Such findings could be due to the fact that the partici-pants were recruited and interviewed while their children were at-tending specialized child development centers. Nonetheless, one of the goals of the study was to describe the specific ways that early childhood experiences can benefit child health and development, as viewed by the parents. According to the participants, the devel-opmental benefits of early childhood experiences were limited to mainly social and intellectual aspects, while health benefits were much broader and included health education regarding nutrition and hygiene, opportunities for activity and exercise, improved im-munity through exposure to other children, and access to health services. The examples of such benefits are summarized in Table 1.

RESEARCH IMPLICATIONS: CHILDHOOD DEVELOPMENT IS BENEFICIAL, NOW WHAT?

During the interviews, the participating parents mainly stressed developmental benefits of early childhood education programs, and recognized their long-term social and intellectual value.

However, some participants demonstrated considerable difficul-ty articulating health benefits. Many described their perception of health as “eating right and exercise,” and struggled with fur-ther definitions. Additionally, the described health benefits were viewed as being short-term and immediate, such as nutritional knowledge and improved immunity. As a social determinant of health, early childhood development has both short-term and long-term benefits. The investment into early childhood de-velopment yields long-term health advantages by lowering the rates of learning disabilities, mental illness and substance abuse in adulthood, and preventing adolescent pregnancies.1,11 Parents recognized the value of early childhood education on young children, but did not perceive it as being an influential factor for their children’s health later in life. From the perspective of primary health framework, the long-term value of early child-hood development and its effect on health in particular need to be better communicated to parents. Healthcare professionals can play a vital role in transmitting these findings and can thus im-prove participation rates in enriched developmental programs.12

Although the study focused on the benefits of early childhood development on child health, the participants stated that such programs were beneficial for parents as well. Frequently cited ad-vantages included better bonding with the child and understand-ing the child’s needs, as well as an opportunity to socially interact with other parents, thus promoting knowledge exchange. Further studies are needed to determine improved parental outcomes

11

1Smith-Chant, B. Early childhood education and health. (2009). In Raphael, D. (Ed.), Social determinants of health. (2nd ed.), (pp. 143-156). Toronto: Canadian Scholars’ Press.

2Healthy child development. (2003). Retrieved from http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php#healthychild

3Canadian Nurses Association. (2005). Social determinants of health and nursing: A summary of the issues. Retrieved from http://www.cna- aiic.ca/CNA/documents/pdf/publications/BG8_Social_Determinants_e.pdf

4Canadian Institute of Child Health. (2004). The health of Can-ada’s children – A CICH profile: Income inequity. Retrieved from http://www.cich.ca/PDFFiles/ProfileFactSheets/English/Incomeinequity.pdf

5Thomas, H., Camiletti, Y., Cava, M., Feldman, L., Underwood, J., & Wade, K. Effectiveness of parental groups with professional involvement in improving parent and child outcomes (Public Health Practice Project Report). (1999). Retrieved from http://www.health-evidence.ca/articles/show/16149

6Child Development Institute Survey. (2008). Retrieved from http://www.childdevelop.ca/thirdpagefile/healthy_child_devel-opment/oeyc/index.html

7Ontario Ministry of Children and Youth Services: OEYC Loca-tions. (2009). Retrieved from http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/oeyc/ locations/index.asp.

9Jack, S. (2006). Utility of qualitative research findings in evidence-based public health practice. Public Health Nursing, 23(3), 277-283.

10Thorne, S., Kirkham, S. R., & MacDonals-Emes, J. (1997). Inter-pretive description: A non-categorical qualitative alternative for developing nursing knowledge. Research in Nursing & Health, 20(1), 169-177.

11What determines health? (2008). Retrieved from http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php

12Williams, J., & Holmes, C.(2004). Children of the 21st century: Slipping through the net. Contemporary Nurse, 18(1-2), 57-66. Retrieved from http://www.atypon-link.com.libaccess.lib.mcmaster.ca/EMP/doi/abs/10.5555/conu.2004.18.1-2.57

13Ontario Children’s Secretariat. (1999). Early Years Study. Toron-to: Publication Ontario.

14Windsor-Essex County (2007). Ontario Early Years Center Ser-vice Plan, 2007-2008. Retrieved from http://www.citywindsor.ca/DisplayAttach.asp?AttachID=8764

15Gehlert, S., Sohmer, D., Sacks, T., Mininger, C., McClintock, M., & Olopade, O. (2008). Targeting health disparities: A model linking upstream determinants to downstream interventions. Health Affairs, 27(2), 339-349. Retrived from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2494954/

Reviewed by Dr. Linda O’Mara, RN, PhDDr. Linda O’Mara is an Associate Professor at McMaster University School of Nursing. Her primary research interests are currently in public health and primary care collaboration, adolescent health promotion, and nursing education. Currently, she is the site lead of a multi-year study that focuses on public health and primary care collaboration.

from children’s participation in early childhood programs. How-ever, these findings need to be shared with the parents and health policy stakeholders in order to improve attendance at childhood development centers, and in dealings with the issue of underuti-lization of childhood development programs.

Although healthcare professionals describe early childhood de-velopment as a foundation that impacts individual health behav-iours later in life, parents and caregivers may not be fully aware of the full spectrum of developmental and health benefits that it brings.13 OEYCs offer fully government-subsidized childhood development services, yet certain centres remain underutilized in some areas, despite noticeable efforts on the part of operational staff to expand attendance, particularly amongst multicultural, francophone, and aboriginal communities.14 It appears that there is a lack of awareness among the public, in that they perceive par-ticipation in early childhood development programs as simply a form of childcare, and not as a potentially advantageous health promotion activity. The value of enriched early childhood devel-opment may not seem very apparent at first glance, yet its im-portance should not be underestimated. From the public health perspective, the investment in early childhood education may be a

perfect example of “upstream” thinking: it makes sense to dedicate sought-after healthcare resources towards shaping positive health behaviours and disease prevention, rather than being confronted by the complex necessity of disease treatment.15 As such, under-standing parents’ perceptions of early childhood development ser-vices has important implications for public health practice. This foundational research can shape the delivery and promotion of early health education—a practice that extends beyond individual health benefits and emphasizes the preventive role of the health-care system in addressing health and disease-related outcomes.

ACKNOWLEDGEMENTS

I thank Linda O’Mara, RN, PhD for invaluable guidance and research mentorship provided throughout the project. I would like to acknowledge all the parents that participated in the study, and thank Lauren Brydges, R.E.C.E. and Gayle Reese, E.C.E.C. for facilitating access to Ontario Yearly Years Centers through which participants were recruited. This work was supported by the Canadian Institutes of Health Research (CIHR) Health Professional Student Research Award.


Microfilaments comprise linear polymers of actin proteins that maintain cellular shape. The expansive actin network,

which is directly involved in cellular movement, responds to chemical signals released during development, immune events, and other processes pertinent to cell growth and survival.1 It is well known, for instance, that immune factors stimulate rear-rangement of the actin architecture in neutrophils during inflam-mation, facilitating their amoeboid movement and the elimina-tion of invading pathogens.2 Microtubules comprise the second distinct class of cytoskeletal filaments that complements the actin network.

Microtubules are composed of alpha- and beta-tubulin heterodi-mers that polymerize into tubular structures.3 In mammals and most eukaryotic organisms, microtubule assembly begins at the centrosome, which serves as the cell’s microtubule organizing centre (MTOC). As a cytoplasmic organelle, the centrosome is integral to cell division; mitotic microtubules anchor and separate chromosomal DNA, radiating outward from the MTOC across the divisional axis (Figure 1).3,4 The role of the centrosome is far more robust, however, and extends well beyond the separation of genetic material in mitotic cells. In fact, the centrosome facilitates formation of the cilium, a long slender structure that projects out-

Mustafa AhmadzaiHonours Biology & Pharmacology Program (Co-op), Class of 2012Laboratory of Dr. William Tsang, Institut de Recherches Cliniques de Montréal

The centrosome coordinates formation of the microtubule network, a key component of the mammalian cytoskeleton. Aside from its supporting role in separating genetic material during cell division, the centrosome facilitates the formation of cilia (ciliogenesis) in non-dividing and differentiated cells. Cilia may be motile or non-motile, participating in a range of physiological activities including mucociliary transport, hearing, vision and kidney filtration processes. Ciliopathies occur when cells fail to undergo ciliogenesis or when cilia are improperly formed, affecting all of these functions to varying degrees. While there is increasing emphasis on the genetic factors contributing to these ciliopathies, many proteins involved in the cilia formation program remain elusive. The use of gene knockdown and functional assays are indispensable tools in determining how various proteins contribute to the onset of ciliopathies, ultimately laying the foundation for the development of future gene- and drug-therapy options.

FIGURE 1: Microtubule anchoring during mitosis. Several microtubule sub-types facilitate separation of daughter chromatids during mitosis. Aster microtubules radiate outwards from the MTOC during mitosis and polar microtubules span across opposite poles of the cell. Kinetochore microtubules associate with daughter chromatids, facilitating their separation.6

CRITICAL REVIEW

C R I T I C A L R E V I E W

Ciliary (Dys)function in Human Disease:Mapping the Ciliogenesis Pathway

13

ward from the surface of the cell into the surrounding environ-ment.5

CILIA AND HUMAN DISEASE

The physiological roles of cilia have been well studied in humans, and most human cells are now thought to possess cilia. These can range from cells of the fallopian tube, which sweep the egg through the reproductive tract, to tracheal epithelial cells, which sweep de-bris out of the airways.7 In large part, cilia are classified according to their function. Those involved in mucociliary transport in the trachea, for instance, are said to be motile since they actively bend and impart force on objects within their vicinity. In contrast, non-motile (primary) cilia function as chemo- and mechano-sensors by transducing external stimuli into a cellular response. Audi-tion, for example, occurs when mechanical sound waves bend hair cells possessing cilia in the inner ear. This electrically excites the hair cells, and stimulates neurons and downstream neuronal networks, culminating in what is perceived as sound.7 Dysfunc-tion of motile and non-motile cilia has been consistently linked to various developmental and long-term defects, motivating greater research into the genetic basis of cilia formation (ciliogenesis).8

Ciliogenesis occurs primarily in non-proliferating (quiescent) and differentiated cells, and is facilitated by the mother centri-ole of the centrosome. During interphase, the mother centri-ole migrates to the cell membrane and, through an unknown

mechanism, is anchored to the inner cell surface.6 Here, it po-lymerizes nine sets of microtubule doublets in a circular ar-rangement, which forms the cilium’s skeleton (Figure 2). In addition, most motile cilia and some primary cilia possess a central set of microtubules doublets, which is needed in or-der for the cilium to bend as a result of interactions with vari-ous microtubule-associated motor proteins, such as dynein.6,7

Loss-of-function gene mutations that compromise cilium forma-tion can misdirect growth and transcription factors pertinent to organ development. The left-right asymmetry of the human body plan, for instance, is dependent on the whip-like beating of cilia in the extra-embryonic tissue during early stages of embryogen-esis.12 Without the left-ward sweeping of these growth factors by motile cilia, the heart fails to develop on the mid-left side of the body and the larger lobe of the liver fails to develop on the right.12

Until recently, the roles of motile and non-motile cilia in human diseases were poorly characterized and few ciliogenic proteins had been studied. Now, advances in experimental techniques permit scrutiny of the genetic mechanisms that contribute to ciliopathies. Mutations in several genes involved in ciliogenesis have conse-quently been linked to ciliopathies through genome-wide and population-based studies concerning Senior-Loken, Meckel-Gru-ber, and Bardedt-Biedl syndromes,8 which involve auditory, visual and renal system complications, as well as severe developmental defects, such as anencephaly and mental retardation.9,10 Despite these findings, little is known regarding the mechanism of cilium formation. Before gene therapy or pharmacological interventions can be developed, researchers must therefore elucidate the key players involved in ciliogenesis.

DECODING THE CILIOGENESIS PROGRAM: RECENT ADVANCES AND BREAKTHROUGHS

Much like proteins involved in regulating cell division checkpoints, key players that promote or inhibit ciliogenesis have been identified.10,11 In a recent study, Tsang et al. identified the mechanism by which centrosomal proteins interact to modulate ciliogenesis in retinal pigmented epithelial cells.12 Using this cell line, the group demonstrated that interactions between centrosomal protein of 110 kDa (CP110) and centrosomal protein of 290 kDa (Cep290) are necessary in order to suppress cilium formation. Although it was previously known that CP110 participates in centrosome replication, centrosome separation, cytokinesis and ciliogenesis, the exact molecular mechanism(s) by which CP110 modulates these different biological processes were not fully understood. From a clinical standpoint, Cep290 gene mutations have also been extensively linked to various ciliopathies, like nephronophthisis, which is the leading cause of pediatric kidney failure.13

Extensive post-translational modifications of centrosomal microtubules allow them to be detected by indirect immunofluorescence techniques, using antibodies directed against the modified tubulin sub-units coupled with fluorophores. Once

FIGURE 2: Microtubule arrangements in cilia. After migrating to the cell membrane, the mother centriole (indicated as the basal body) facilitates forma-tion of the cilium. The cross-sectional view of the basal body indicates a circular pattern of microtubule triplets arranged along the structure circumference. In contrast, the cilium possesses nine doublets of microtubules. Typically, microtu-bules of the cilium interact with a host of microtubule-associated proteins like dynein, which is a motor protein. The central doublet of microtubules participates in bending of motile and some primary cilia.9


Reviewed by Dr. William Tsang, PhDDr. Tsang is Assistant Research Professor at the Institut de recherches cliniques de Montreal, Director of the Cell Division and Centrosome Biology research unit, Assistant Research-Professor in the Department of Pathology and Cell Biology at the Universite de Montreal, and adjunct professor in the Department of Medicine at McGill University. His group studies cilia biology and ciliopathies and employs a variety of techniques, such as immunofluorescence microscopy, flow cytometry and mass spectrometry. The valuable mechanistic insights gained from his research will be integral to the development of novel diagnostic and therapeutic interventions for ciliopathies.

1Ballestrem C, Wehrle-Haller B, Imhof BA. Actin dynamics in living mammalian cells. J Cell Sci 1998;12, 1649-1658.

2Weiner OD, Servant G, Welch MD, Mitchison TJ, Sedat JW, Bourne HR. Spatial control of actin polymerization during neutrophil chemotaxis. Nat Cell Biol 1999;1(2), 75-81.

3Nogales E. A structural view of microtubule dynamics. Cell Mol Life Sci 1999;56(1-2), 133-42.

4Tanaka TU, Desai A. Kinetochore-microtubule interactions: the means to the end. Curr Opin Cell Biol 2008;20(1), 53-63.

5Lee K, Battini L, Gusella GL. Cilium, centrosome and cell cycle regulation in polycystic kidney disease. Biochim Biophys Acta 2011;1812(10), 1263-71.

6Lodish H, Berk A, Kaiser CA, Krieger M, Scott MP, Bretscher A, Ploegh H, Matsudaira P. Microtubule Structures. In Freeman WH, editors. Molecular Cell Biology. 6th ed. New York: Freeman and Company; 2007.

7Satir P, Christensen ST. Overview of structure and function of mammalian cilia. Annu Rev Physiol 2007;69, 377-400.

8Christensen ST, Pedersen LB, Schneider L, Satir P. Sensory cilia and integration of signal transduction in human health and disease. Traffic 2007;8(2),97-109.

9Morales CR. Histology of the Respiratory System [homepage on the Internet]. Montreal, Canada: McGill Molson Medical Informatics; [updated 2008; cited 2012 February]. Available from: http://alexandria.healthlibrary.ca.

10Davenport JR, Yoder BK. An incredible decade for the primary cilium: a look at a once-forgotten organelle. Am J Physiol Renal Physiol 2005;289(6), F1159-69.

11Badano JL, Mitsuma N, Beales PL, Katsanis N. The ciliopathies: an emerging class of human genetic disorders. Annu Rev Genomics Hum Genet 2006;7, 125-48.

12McGrath J, Brueckner M. Cilia are at the heart of vertebrate left-right asymmetry. Curr Opin Genet Dev 2003;13(4), 385-92.

13Tsang WY, Bossard C, Khanna H, Peränen J, Swaroop A, Malhotra V, Dynlacht BD. CP110 suppresses primary cilia formation through its interaction with CEP290, a protein deficient in human ciliary disease. Dev Cell 2008;15(2), 187-97.

14Coppieters F, Lefever S, Leroy BP, De Baere E. CEP290, a gene with many faces: mutation overview and presentation of CEP290base. Hum MutaT 2010;31(10), 1097-108.

15Spektor A, Tsang WY, Khoo D, Dynlacht BD. Cep97 and CP110 suppress a cilia assembly program. Cell 2007;130(4), 678-90.

exposed to light, protein-bound antibodies reveal the protein’s relative position in the cell by re-emitting light at a visible wavelength. In parallel, loss of function mutations associated with ciliopathies can be emulated using silencing RNA (siRNA), a class of double-stranded RNA molecules that interferes with mRNA and protein expression. Importantly, siRNA provides a considerable degree of control over gene-expression and is a valuable tool for studying gene function.

Combining these techniques, Spektor et al. and Tsang et al. found that siRNA-mediated depletion and overexpression of CP110 augmented and suppressed cilia formation, respectively, suggesting that CP110 is a negative regulator of ciliogenesis.12,15

In striking contrast, Cep290 promotes cilia formation, since siRNA-mediated knockdown of Cep290 leads to inhibition of cilia formation. They also examined protein interaction using co-immunoprecipitation and found that CP110 readily

associates with Cep290. Furthermore, unlike wild-type CP110, overexpression of a CP110 mutant incapable of binding Cep290 can no longer inhibit cilia formation in the affected population. Collectively, these findings suggested that Cep290 is inherently ciliogenic and that CP110 is required in order to suppress ciliogenesis.15

This experimental approach provided an elegant means of elucidating one component of the cilia formation program. Presently, there are few therapeutic options available for individuals suffering from centrosomal disorders. Undoubtedly, a deeper understanding of the basic science underlying ciliogenesis is critical to the development of drug- and gene-therapy options later on. To these ends, further research is merited in order to elucidate missing stages of the cilia formation pathway, including the identity and properties of the numerous proteins involved in the process.

15

UNDERGRADUATE STUDENTS’ MENTAL HEALTH PROBLEMS AND POTENTIAL

SOLUTIONS

S tudents in university and college, especially those in first year, face many hardships throughout their studies. They may have

difficulty dealing with numerous issues, including relationships with friends, family, and significant others, as well as academic stress that develops as their term progresses (Figure 1). These is-sues make them vulnerable to mental health issues and range from mild, with students feeling anxious or lonely, to severe, in the form of clinical depression.1,2 These feelings often have a nega-tive impact on academic performance, retention, and graduation rates.3 Additionally, depression and anxiety have been linked to higher rates of suicide, substance abuse, troubled relationships, and difficulties with sexual identity.1 The Centers for Disease Control and Prevention reported the suicide rate for young adults to be on the rise, specifically for the 15–19 year age group and the 20–24 year age group.4 This implies that risk for suicide is a significant problem during high school and persists among young adults in university and college.5 Among adults, those aged 18-24 have the highest reported suicidal tendencies.6 Researchers with the World Health Organization’s world mental health survey ini-tiative have shown that identifying and treating depression early may reduce the serious consequences of depression and prevent the consideration of suicide.7 Most alarming of all, an epidemi-ological study by Mackenzie et al. through the College Health Intervention Projects involving 1,622 Canadian post-secondary students found that the 15-21 age category had the highest past-

year prevalence rate of mental illness at 39% in 2011.1 With up to 25% of students in university or college reporting symptoms of depression, and approximately 10% of students having suicidal thoughts, interventions should be considered to improve emo-tional wellbeing on campuses.1

A survey asking questions relating to perceived stress, internal re-sources, and social support provided to 2000 university students found a strong positive correlation between perceived feelings of stress and low mental health.8 A lack of proper services to help alleviate such stress and emphasis on developing protective fac-tors such as mastery and self-esteem among the student popula-tion can have a negative impact on the overall mental health of students on campus.8 Services that can help to reduce the stress that students experience, and to increase mental and emotional wellbeing, include professional counsellors, psychiatrists, and peer support centres. Professional counsellors and psychologists are powerful resources students can use to improve and maintain their mental health. Researchers used a questionnaire to survey undergraduate students at the University of Birmingham.9 They allowed students considered as high-risk for dropping out to un-dergo professional counselling and found that 15 out of 16 high risk students who underwent counselling successfully completed their first year.9 Their results suggest that students who reported feeling overwhelmed and stressed were less likely to drop out of university or college after having received professional support.9

Thus, professional counselling can be an effective tool in increas-ing student retention rates (Figure 1).

Ikdip Kaur Brar1*, Jae Eun Ryu2*, Kamran Shaikh3*, Ashlie Altman4, Jeremy Ng5

Motivation for McMaster

1Life Sciences, Class of 2012; 2Arts and Science, Class of 2014; 3Life Sciences, Class of 2013; 4Biology and Pharmacology Co-Op, Class of 2012; 5Biology, Class of 2013*Authors with equal contributions

Within undergraduate student populations, there has been a rise in the incidence of mental health issues such as depression

and anxiety. These problems have been shown to negatively impact emotional wellbeing and academic success.1 Many

elements of the undergraduate experience, including stressful transitions from high school to first year, contribute to mental

health problems amongst this student body. Peer support is a relatively recent resource for universities to address growing

mental health concerns on campus. Peer support, which involves trained students who voluntarily provide emotional

support to peers, offers a unique function to student mental health. It can be useful throughout a student’s undergraduate

career and is also beneficial to those who provide the support. While it may not replace professional mental health services,

it may be a significant addition to the existing student wellness support systems on university campuses today.

CRITICAL REVIEW


University Campus Peer Support Centres:Benefits for Student Emotional and Mental Well-Being


However, professional counselling services are also accompanied by high service costs and wait times. Institutional budget cuts and administrative adjustments have put professional counselling ser-vices under financial scrutiny.10 Additionally, it has been shown that students will refrain from seeking professional assistance when wait times and appointments are involved.11 While provid-ing professionally trained counsellors for all students who require such services would be ideal, the reality is that this cannot always be met from a logistical point of view. As a result, peer support centres have recently been explored as a potentially flexible and inexpensive adjunct to professional counselling. A report that in-vestigates this sought to explore a particular model of peer support, recent academic research on its effectiveness, and how these ini-tiatives can be expanded or improved upon to better address the needs of mental health in university settings.12 The report suggests that both peer support and professional services are beneficial to

emotional wellbeing, but peer support may be more feasible when professional services cannot be utilized (Figure 1).12

DEFINING AND UNDERSTANDING THE PROCESS OF PEER SUPPORT

Peer support can be divided into several categories based on three criteria: the medium in which it is conducted; the individuals running the service; and the administration in control of the ser-vice.13 One of the major benefits of peer support is that it offers a comfortable environment for the student seeking support. This is due to the fact that the students providing support may have encountered similar life experiences and can relate to them.14 Stu-dents providing peer support on university and college campuses have endured many of the stressors that accompany being an undergraduate student. As a result, peer supporters can offer au-thentic empathy and validation to fellow peers, which can make students feel more comfortable and receptive to the advice and suggestions presented.15 Furthermore, peer support establishes a foundation for an open conversation or discussion aimed at fa-cilitating a desirable change.13 The council of Higher Education Quality concluded that the effectiveness of peer support lies in the fact that students are ultimately in the best position to recognize the problems of their peers.16 This kind of support received by the students can bring a positive change to the emotions that are currently experienced, since it can reduce the sense of loneliness, frustration and other negative feelings. If necessary, the desirable change may involve seeking professional help.13 This is shown in a report that suggests peer support is most successful when diverse perspectives and competencies of supporting students, as well as those of academic and guidance staff, are brought together to take on the complex, multi-dimensional issues encountered by stu-dents (Figure 1).17

THE DIFFICULTY OF TRANSITIONING FROM HIGH SCHOOL TO UNIVERSITY

A longitudinal study examining university expectations in fresh-men followed 226 Canadian undergraduates before and half-way through their first-year.18 The researchers found that the most ef-fective peer programs aim to prepare students for the challenges that they may face throughout university or college.18 At the same time, they provide students with effective strategies that can be employed to overcome these challenges.18 Considering these facts, it is vital to establish a peer support system that could provide guidance to help students overcome problems.19,20

Major life transitions, such as changing schools, can be stressful since they physically sever existing sources of social support, in-cluding family and friends.2 These changes may lead to homesick-ness, which is one of the most frequently reported concerns of first year college and university students (Figure 1). Homesickness can be problematic if experienced for prolonged periods of time.21 Students who are homesick find it difficult to adapt and perform in new situations because they are far from familiar environments

Overview of the Student Support Process

Common Adversities Faced by Incoming Post-Secondary Students:

Independent Benefits

Cost-Effective to Student

Lessened Wait-Time to Gain Sup-port

Positive Interven-tion Provided Be-fore the Need for Professional Coun-selling

Positive Interven-tion that Encour-ages Professional Counselling

Peer Support Session(s)

Independent

Benefits

Professional Exper-tise in Mental Health Illness

A Referral Point when Peer Supporters are Faced with Address-ing an Issue Beyond their Scope of Training

Combined Benefits

Comfortable and Safe Environment

Self-Realization and Identification of Disconcerting Thoughts and/or Behaviours

Provision of Sup-port from Diverse Perspectives

Improvement in Ability to Address Adversity

Professional Counselling Methods of

Support

Amplification of Prior Mental Health Issue

Loneliness

Lost of Social Support

Homesickness

Increased Stress

Novel Environment

Lack of Knowledge and/or Preparation for the University Experience

Unforeseen Academic Hardship

FIGURE 1: An Overview of the Student Support Process. The transition into post-secondary education is often filled with various adversities, and yet, any one or combination of factors may require students to seek external support.1,2 In the post-secondary setting, students generally have two institution-established options: peer support session(s) and professional counseling. Student-to-student peer support is unique in that it has the ability to both provide intervention to the supported student so that they may never require professional counselling, as well as encourage those that require professional counseling to identify the need and take that initiative.17, 23 Should these resources be made successfully avail-able to students in need, both options are able to provide the support-seeking student with various benefits to assist them with their successful transition to the university experience.12

17

such as their family setting or community.22 Depression and re-current thoughts about death or suicide have most often been as-sociated with students suffering from homesickness.21 Researchers have found that most first year university students who display signs of insecurity and poor social skills before starting their un-dergraduate education have a greater tendency to exhibit signs of homesickness during the first few weeks of their first term.22 Counselling or peer support may be an effective way to help stu-dents adjust to the university environment since it is capable of relieving some of the anxiety, depression and stress experienced by first year students. Peer support can provide students with the skills necessary to manage stress independently. This is done so by discussing strategies that are specific to the problem the student is encountering (Figure 1).23

THE EFFECT OF PEER SUPPORT SERVICES ON CAMPUS THROUGHOUT STUDENTS’

UNDERGRADUATE CAREERS

Not only is peer support an effective way to combat the stress and depression that can accompany the transition from high school to university, it can also be useful throughout a student’s undergraduate career.2 Researchers conducted a web-based survey at a large university in 2005 and 2007 and screened the results for symptoms of mental disorders.23 Their results indicated that 60% of students suffering from at least one mental health issue remain afflicted by the same issue two years later.23 This suggests that mental health problems can be long-lasting and may persist throughout one’s academic career. Additionally, the study revealed that less than half of those with a mental health problem received effective treatment within the two-year time span.23 Only 32.9% of those surveyed in 2005 and 42.9% in 2007 had a perceived need to receive professional treatment.23 However, those who visit peer support may benefit because peer supporters can help identi-fy disconcerting thoughts and behaviours and urge those without a perceived need to receive professional help.20,24 In this case, peer support can be a beneficial addition to student campuses along-side professional services.

Interestingly, peer support has shown to be beneficial for both those providing and those receiving support.24 One study trained lay people to be peer supporters and used statistical analysis based on questionnaires to determine benefits of peer support on the supporters.25 Their research showed that after one- and two-year periods of providing support, the volunteer peer supporters re-ported increased psychosocial performance and well-being.25

Furthermore, individuals who became peer supporters reported feeling more self-aware.25 Another study used a questionnaire survey to peer supporters in UK schools.19 The students noted that peer supporters had acquired useful skills and were pleased to show that they cared presumably about their peers.19 Researchers also noted that peer supporters experienced a “gratifying sense of responsibility” associated with their roles.24 They also identified qualitative research conducted by another researcher indicating peer supporters show increased self-esteem and confidence.13

THE POTENTIAL OF PEER SUPPORT

In recent years, there has been a rise in the number of univer-sity students reporting mental illnesses, indicating a greater need for institutions to expand their mental health support services.11 Peer support centres can be beneficial in improving the emotional well-being of the student population. However, the issue is that many students with mental health issues do not seek professional counselling or peer support services even if they are available on campus.11 The lack of interest in using such professional services may be explained by a lack of student knowledge about their ex-istence or about the services provided.11 A peer support service offering both drop-in, immediate support, and the ability to book appointments would ensure that students can access peer sup-port services when they need them, without conflicting with their schedules. Through careful steps taken to design, develop, and establish a student-based peer support program, peer support has the potential to be a valuable addition to mental health support services on university campuses.12

Reviewed by Dr. Debbie Nifakis, Ed.D., C.PsychDr. Debbie Nifakis is a Psychologist and the Clinical Director of the Student Wellness Centre. She has practiced psychotherapy at uni-versity counselling centres for over thirty years. At McMaster, she co-developed and ran the first Peer Helper Program for over twenty years and has presented at conferences as an invited speaker on the benefits of Peer Helping in post-secondary institutions.

About Motivation for McMasterMotivation for McMaster (MFM) was founded in January 2011 to provide motivational lectures free of charge to all McMaster un-dergraduate students. Believing that more could be offered to students, MFM designed and developed a student-to-student peer sup-port program that was implemented in September 2011. After recruiting and training student peer supporters, MFM officially began providing peer support in October 2011. MFM’s volunteer team provides monthly motivational lectures and up to 25 hours of student peer support every school-week, and has logged more than 2000 hours since January 2011. Authors Ikdip Brar, Jae Eun Ryn, Kamran Shaikh, and Ashlie Altman are peer supporters at MFM. Jeremy Ng is MFM’s co-founder and director of the MFM peer support pro-gram. MFM may be contacted at [email protected].

Other ResourcesOther peer-based student support groups on campus include the following: The Student Success Centre, the Chaplaincy Centre, the Student Health Education Centre (SHEC), and the Queer Students Community Centre (QSCC). Professional counselling on campus is provided at the Student Wellness Centre (SWC).


1Mackenzie, S, Wiegel, JR, Mundt, M, Brown D, Saewyc, E, Hei-ligenstein, E, et al. Depression and suicide ideation among stu-dents accessing campus health care. American Journal of Ortho-psychiatry. 2011; 81(1):101-7.

2Compas, BE, Wagner, BM, Slavin, LA, Vannatta, K. A prospective study of life events, social support, and psychological symptom-atology during transition from high school to college. American Journal of Community Psychology. 1986; 14(3):241-57.

3Kitzrow, M. The mental health needs of today’s college students: Challenges and recommendations. NASPA Journal. 2003; 41(1):165-79.

4Centers for Disease Control and Prevention. CDC surveillance summaries. Morbidity and Mortality Weekly Report. 2001; 50:1-34.

5Kisch, J, Leino, EV, Silverman, MM. Aspects of suicidal behaviour, depression, and treatment in college students: Results from the spring 2000 National College Health Assessment survey. Suicide and Life Threatening Behavior. 2005; 35(1):3-13.

6Crosby, AE, Cheltenham, MP, Sacks, JJ. Incidence of suicidal ide-ation and behavior in the United States, 1994. Suicide and Life-Threatening Behavior. 1999; 29:131-39.

7Wang, PS, Angermeyer, M, Borges, G, Bruffaerts, R, Chiu, WT, De Girolamo, G, et al. Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organi-zation’s world mental health survey initiative. World Psychiatry. 2007; 6(3):177-85.

8Bovier, PA, Chamot, E, Perneger, TV. Perceived stress, internal resources, and social support as determinants of mental health among young adults. Quality of Life Research. 2004; 3(1):161-70.

9Rickinson, B, Rutherford, D. Increasing undergraduate student retention rates. British Journal of Guidance and Counselling. 1995; 23(2):161-72.

10Destefano, TJ, Mellott, RN, Petersen, JD. A preliminary assess-ment of the impact of counselling on student adjustment to col-lege. Journal of College Counseling. 2001; 4:113-21.

11Furr, SR, Westefeld, JS, McConnell, GN, Jenkins, JM. Suicide and depression among college students: A decade later. Profes-sional Psychology: Research and Practice. 2001; 32(1):97-100.

12Chatterton, S, Harris, J, Hill, S, Kingsland, L. Helping ourselves: Organizing a peer support centre. Ottawa: Health and Welfare Canada; 1988.

13Solomon, P. Peer support/peer provided services underlying pro-cesses, benefits, and critical ingredients. Psychiatric rehabilita-tion journal. 2004; 27(4):392-401.

14Mead, S, MacNeil, C. Peer support: What makes it unique? Inter-national Journal of Psychosocial Rehabilitation. 2006; 10(2):29-37.

15Hoffman, M, Richmond, J, Morrow, K, Salomon, K. Investigat-ing ‘sense of belonging’ in first-year college students. Journal of College Students Retention: Research, Theory and Practice. 2002; 4(3):227-56.

16Higher Education Quality Council. Guidance and counselling in higher education. London: Higher Education Quality Council; 1994.

17Carter, K. & Mcneill, J. Coping with the darkness of transi-tion: Students as the leading lights of guidance at induction to higher education. British Journal of Guidance and Counselling. (1998); 26(3):399-415.

18Pancer, S. M., Hunsberger, B., Pratt, M. W. & Alisat, S. Cognitive complexity of expectations and adjustment to university in the first year. Journal of Adolescent Research. (2000); 15(1):38-57.

19Naylor, P, Cowie, H. The effectiveness of peer support systems in challenging school bullying: the perspectives and experiences of teachers and pupils. Journal of Adolescence. 1999; 22(4):467-79.

20Varenhorst, BB. Why peer helping? The Peer Facilitator Quarterly. 1992; 10(2):13-7.

21Shahmohammadi, N. Effectiveness of cognitive-behavioral man-agement of stress on students’ homesickness. Mediterranean Journal of Social Sciences. 2011; 2(6):107-11.

22Fisher, S, Hood, B. Vulnerability factors in the transition to uni-versity: Self-reported mobility history and sex differences as fac-tors in psychological disturbance. British Journal of Psychology. 1988; 79:309-20.

23Zivin, K, Eisenberg, D, Gollust, SE, Golberstein, E. Persistence of mental health problems and needs in a college student popula-tion. Journal of Affective Disorders. 2009; 117(3):180-5.

24Cowie, H, Hutson, N. Peer support: A strategy to help bystand-ers challenge school bullying. Pastoral Care in Education. 2005; 23(2):40-4.

25Schwartz, CE, Sendor, M. Helping others helps oneself: Response shift effects in peer support. Social Science & Medicine. 1999; 48:1563-75.

19 CRITICAL REVIEW

Vitamin D is the colloquial term for Vitamin D3, a secosteroid prohormone that is naturally produced in certain layers of the

skin.1 It is endogenously synthesized from a naturally occurring precursor called 7-dehydrocholesterol (7-DHC), which under-goes further conversion upon continued exposure of the skin to moderately intense light in the UV-B range.2

In addition to its well-known role in maintaining the mineral-ization of bone, research over the past few decades has unveiled multiple potential non-classic actions of Vitamin D3.

3 Apart from causing severe bone disorders, deficiencies in Vitamin D3 are also thought to contribute to the development of many life-threaten-ing cancers, the emergence of a wide variety of autoimmune dis-orders, increased bacterial susceptibility, and the appearance of a number of diseases resulting from hormone dysregulation (such as diabetes and osteomalacia).3

Unfortunately, most Canadians live with insufficient levels of Vi-tamin D3 in their bodies.4 Even in the southernmost extremities of Canada, the latitude and quality of sun exposure during early fall to mid-spring does not provide sufficiently intense exposure of the human skin to UV-B radiation.1 This results in minimal endogenous Vitamin D3 production during these months. The use of sunscreens, while important in reducing the risk of mela-noma, inhibits the production of Vitamin D3 during the summer months and further compounds this deficiency.2

In March 2010, Statistics Canada estimated that 1.1 million Ca-nadians (approx. 4% of the Canadian population) had a Vitamin D3 deficiency so extreme that they were at risk of acquiring osteo-porosis or osteomalacia if they were adults, and rickets if they were children.5 The study also found that 10% of Canadians had levels that are inadequate for maintaining bone health, and that 77% of the population did not have appropriate serum levels by Health Canada’s standards.6

Over the past few decades, hundreds of clinical studies have pro-

vided evidence that dietary supplementation is an effective way to compensate for inadequate endogenous Vitamin D3 production. As such, there is a unanimous agreement in the Canadian health science community that the nationwide deficiency can only be effectively overcome by ensuring Canadians include adequate Vi-tamin D3 supplements in their diet.7

At this point, however, the unanimity ends. Largely outside public view, a fierce debate has emerged over the definition of an “ad-equate” supplemental dose. On November 30, 2010, Health Can-ada and the US Institute of Medicine (IOM) co-released the con-troversial publication, Dietary Reference Intakes (DRIs) for Vitamin D and Calcium.7 In this report, Health Canada and IOM took a conservative stance, recommending 600 IU of Vitamin D3 per day for all persons of 9-70 years of age, 400 IU for young children and infants, and 800 IU for adults over 70 years. It also set the Toler-able Upper Intake Level at 4,000 IU for those older than 9 years.7 These dosage recommendations differ only slightly from those of the Canadian Cancer Institute, which states that 1,000 IU per day is adequate for the majority of the adolescent and adult popula-tion.8 By contrast, a significant number of researchers in the field recommend substantially higher daily dosages of between 2,000-4,000 IU for those above 9 years. Many of them also believe that the upper cap could be safely set to 10,000 IU before any toxic overdose effects are seen.9-11 Health practitioners—those who are tasked with providing advice to their patients—are caught in the middle, working with contradictory directives and information.

NON-CLASSIC ACTIONS OF VITAMIN D3

Why have so many researchers taken a seemingly radical stance on Vitamin D3 dosage recommendations? Predominantly, many are worried that a number of the non-classic actions of the vita-min—including its purported role in suppressing carcinogenesis, maintaining the immune system, and regulating critical hormone levels—are not sufficiently facilitated when taken at low-dosages.

Andrew WebsterBachelor of Health Sciences (Honours), Class of 2015

Studies have shown that most Canadians are deficient in Vitamin D3. In addition to its role in systemic calcium

regulation, Vitamin D3 is also proposed to be integral to the suppression of cancer, as well as to the regulation of certain

immune and endocrine components. Many experts are seriously concerned that Health Canada’s current Vitamin D3

dosage recommendations are inadequate to facilitate these mechanisms. A bitter debate on dosage has ensued—largely

between researchers and regulatory bodies such as Health Canada and the US Institute of Medicine—leaving health

practitioners caught in the middle with contradictory directives and information.


The Vitamin D Gamble


Vitamin D3 is thought to be involved in the suppression of vari-ous cancers, including those of endothelial tissue and bone, and possibly breast, colorectal, and pancreatic cancers.3 The influ-ence of Vitamin D3 on the latter three cancers is still debated and merits further research, however, there are conflicting data from published epidemiological, geographical, laboratory, and clinical studies.12 Regardless, it is generally agreed upon that adequate levels of Vitamin D3 can assist in the successful differentiation of endothelial and bone cells and can suppress uncontrolled, rapid cell proliferation.13

Once produced or ingested, Vitamin D3 is initially inactive. It is rapidly hydroxylated in the liver to form the hormone 25(OH)D3, and subsequently enters the circulation. In the kidneys, it is hydroxylated on-demand once more, forming the active hormone 1,25(OH)2D3.

1 The latter hormone binds with Vitamin D3 recep-tors (VDRs) that are located in a range of tissues.3

Many of the early cancer studies in the 1990s focused on the pro-tein-modulating nuclear activity of activated VDRs and the Reti-noid X Receptor (RXR) heterodimer, as well as Vitamin D3-DNA intercalation.13 Given recent advancements in gene regulation research and analytical technologies, however, studies have also discovered VDR-independent activity of Vitamin D3.

14 They have pinpointed a variety of pro-oncogenic and anti-oncogenic tran-scription factors that are actively regulated by non-hydroxylated Vitamin D3.

14 Many of these transcription factors are expressed only in specific cell types, and hence the mechanisms of cancer-suppression are thought to vary widely between different tissues.3

A major study recently conducted by the University of Maryland postulated that the DNA-binding affinity of the RUNX2 tran-scription factor is increased by non-hydroxylated Vitamin D3 in endothelial, bone, and breast cells.16 In osteoblast cells in the bone, increased RUNX2 DNA-binding affinity amplifies the expression of cancer–suppressing proteins that stimulate immature osteoblas-tic differentiation and inhibit rapid osteoblastic proliferation.13,16

Within cancerous breast cells, it also ensures that such cells do not stimulate the metastatic cancerous development of osteoblasts—thus helping to prevent the spread of cancer from breast to bone.16

Meta-analyses of clinical and community studies in the breast can-cer field have found that Vitamin D3 supplement doses must be in the range of 2,000 IU and 3,000 IU per day to begin to see any reduced risks of cancer.17 In other areas, doses exceeding 1,000 IU are found to be necessary.9

Vitamin D3 also plays a crucial role in regulating both the innate and adaptive components of the internal immune system. With-out appropriate levels of the compound, animals are found to have an increased susceptibility to bacterial infection, as well as to autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, Type I diabetes mellitus, inflammatory bowel disease, certain forms of lupus, and pre-natal islet cell autoimmunity.18

The innate immune system is comprised of non-selective defense mechanisms that destroy pathogens. Some of these mechanisms involve the use of proteins that damage the structural integrity of bacterial cells.18 Vitamin D3 acts as an intermediate signaling molecule in the production of certain bactericidal peptides, such as cathelocidin.3 These peptides coalesce within phagosomes and severely damage the cell membranes of ingested bacterial cells.18 When toll-like receptors (TLRs) on macrophages are activated, 1-α-hydroxylase (the enzyme catalyzing the hydroxylation of Vitamin D3) and VDRs are immediately produced by the mac-rophage.3,18 Circulating 25(OH)D3 in the blood is converted to 1,25(OH)2D3.

3,18 This subsequently binds with VDR, causing the formation of a VDR-RXR heterodimer complex—allowing for transcription of cathelocidin.18 Deficiency in Vitamin D3 is thus believed to handicap our ability to fight off bacterial infections, as it prevents the sufficient production of bactericidal proteins.18

The adaptive immune system, on the other hand, employs antigen-specific targeting that allows for “learned” elimination of patho-gens by specialized cells.3 Vitamin D3 is thought to be involved in specific mechanisms that suppress the autoimmune functions of this system.18 Under certain circumstances, such as an abnormally low level of immature dendritic cells (DCs) and high levels of in-flammatory cytokine production by monocytes, the body begins to produce antibodies against its self-antigens.18 One of the roles of immature DCs is to present self-antigens to T-cells in a way that facilitates the buildup and maintenance of immune system tolerance to host cells. Too low a level of immature DCs can result in a low tolerance to the body’s own cells, leading to excessive autoimmune responses.18 By various complex mechanisms involv-ing the differentiation of T- and B-cells, Vitamin D3 inhibits DC differentiation and maturation, and thus preserves adequate levels

FIGURE 1: Diagram of VDR, RUNX2, RXR interactions on the transcriptional level.15

21

of the immature DC phenotype needed in order to suppress the development of autoimmune disorders.18 Vitamin D3 also inhib-its the production of inflammatory cytokines by monocytes and increases the production of anti-inflammatory cytokines, so that when autoimmune responses do occur, widespread inflammatory damage does not ensue.3,13,18

Similar to the results of many clinical trials, Vitamin D3 supple-mentation dosages used in studies testing MS- or other autoim-mune-afflicted patients, only seem to produce positive results when exceeding levels of 4,000 IU per day.19 This is far above Health Canada’s recommended dosage.

Finally, Vitamin D3 also plays a critical role in hormonal regula-tion. Three major classes of hormones are regulated by Vitamin D3 including Parathyroid hormone (PTH), Fibroblast Growth Factor 23 (FGF23), and insulin.3 The regulatory action of Vitamin D3 on the first two hormones forms a negative feedback loop that modu-lates blood serum levels of 1,25(OH)2D3.

3 This is accomplished by hormonal control over the transcription of 1-α-hydroxylase in the kidney. PTH upregulates this transcription and stimulates the hydroxylation of 25(OH)D3 in the kidney to 1,25(OH)2D3. In contrast, FGF23 downregulates transcription of 1-alpha-hydrox-ylase, and inhibits further 1,25(OH)D3 production. By interact-ing with VDRs, 1,25(OH)2D3 inhibits the further secretion of PTH and stimulates the production of FGF23.3 Together, the concentrations of 1,25(OH)2D3, PTH and FGF23 maintain se-rum 1,25(OH)2D3 levels at a constant and adequate level.3 When imbalances in these hormones occur, as caused by inadequate in-take levels of Vitamin D3, other conditions can develop, such as osteomalacia (in the case of FGF23).3,12

Insulin, unlike PTH and FGF23, has a less-obvious connection with Vitamin D3. Although the mechanism is not fully under-stood, it is thought that 1,25(OH)D3 stimulates insulin secretion, largely through the interaction of VDRs with calbindin-D28K.3 The latter, when fully activated, can also help to prevent the cy-tokine-mediated destruction of β-cells. Hence, Vitamin D3 defi-ciency can lead to insulin dysregulation as well as an increased risk for Type I diabetes mellitus.3

THE DOSAGE DEBATE

The putative non-classic actions of Vitamin D3 are considerable and diverse. Dosage plays a significant role in determining the effectiveness of Vitamin D3 supplementation in driving these mechanisms.

Health Canada’s previously mentioned report was published fol-lowing a joint Canadian and US evaluation of existing research surrounding the disputed non-classic actions and their requi-site dosages of Vitamin D3.

7 Surprisingly, the report concluded that the potential anti-cancer and auto-immune benefits of in-creased Vitamin D3 intake have not yet been proven, nor the po-tential overdose risks, including kidney and other internal organ calcification,not yet accounted for.7 It even went so far as to de-clare that “there is no additional health benefit associated with Vitamin D intakes above the level of the new Recommended Di-etary Allowance”.7

Since the release of the report, many in the field have criticized its method of meta-analysis, describing it as overly-cautious and hyper-stringent.20,21 Many health practitioners had hoped for bet-ter guidance and expected a recommendation of at least 1,000 IU per day for any age category, the level thought to constitute the absolute minimum dose needed for any significant overall benefit.4,11,21 Perhaps Health Canada’s stance is a consequence of the overblown Vitamin E-cardiovascular research throughout the 1990s, after which few claims were found to be entirely valid.22

A recently-released American meta-analysis study seems to agree with Health Canada’s position. The United States Preventive Ser-vices Task Force report states that a number of the clinical cancer-prevention studies lacked properly-controlled external variables such as family health history, while the statistical methods of oth-ers were not appropriate.23,24 They concluded that many of the proposed cancer-suppressing effects of Vitamin D3 were not yet sufficiently evidenced. However, the report also judged that fur-ther research and re-evaluation are required to establish proper Vitamin D3 dosage recommendations.23,24

As the hype surrounding Vitamin D eventually diminishes and studies are performed that examine the validity of previous experi-ments and conclusions, we may see that the accepted scope of the vitamin’s non-classic actions will recede. However, even if only a handful of these non-classic actions are proven, the potential ther-apeutic effects of vitamin D will still bolster general public health.

FIGURE 2: Diagrams depicting the action of 25(OH)D3

and 1,25(OH)2D

3 on

the innate and adaptive immune system.3

FIGURE 3: Diagrams depicting the interactions of Vitamin D 3, FGF23, and PTH.3

Dendritic Cell

Macrophage Macrophage or Keratinocyte


Reviewed by Dr. Jonathan (Rick) Adachi, MD, FRCPCDr. Rick Adachi is a Professor in the Department of Medicine at McMaster University, and is the Alliance for Better Bone Health Chair in Rheumatology. Currently, he is involved in the Canadian Multicentre Osteoporosis Study, and has been looking into the structural analysis of bone and cartilage as measured by pQCT and pMRI.

1Nees F. Kirk/Othmer Encyclopedia of Chemical Technology. Vol. 1: A to Alkaloids. Vol. 2: Alkanolamines to Antibiotics (Glycopeptides). 4. Auflage. (Reihenherausgeber: J. I. Kroschwitz). Herausgegeben von M. Howe-Grant. Wiley, Chichester. Vol. 1: 1991. XXII, 1087 S., geb. 135.00 £ – ISBN 0-471-52669-X; Vol. 2: 1992. XXVIII, 1018 S., geb. 135.00 £ – ISBN 0-471-52670-3. Angewandte Chemie 1993;105(2):318-319.

2Tian XQ, Chen TC, Matsuoka LY, Wortsman J, Holick MF. Kinetic and thermodynamic studies of the conversion of previtamin D3 to vitamin D3 in human skin. Journal of Biological Chemistry 1993 July 15;268(20):14888-14892.

3Bikle D. Nonclassic Actions of Vitamin D. Journal of Clinical Endocrinology & Metabolism 2009 January 01;94(1):26-34.

4Schwalfenberg G. Not enough vitamin D. Canadian Family Physician 2007 May 01;53(5):841-854.

5Statistics Canada. Vitamin D Status of Canadians 2007 to 2009. 2010 April 14.

6Langois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S. Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Statistics Canada Catalogue-Health Reports March 2010;82-003-X.

7National Research Council. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: The National Academies Press; 2010.

8Canadian Cancer Society. Sensitivity to Vitamin D. 2010; Accessed December, 2011.

9Garland CF, French CB, Baggerly LL, Heaney RP. Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention. Anticancer Research February 2011 February 2011;31(2):607-611.

10Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporosis International 2005;16(7):713-716.

11Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. The American Journal of Clinical Nutrition 1999 May 01;69(5):842-856.

12National Institutes of Health-Office of Dietary Supplements. Dietary Supplement Fact Sheet: Vitamin D. 2011 June 24.

13Mechanisms of the Anti-Cancer and Anti-Inflammatory Actions of Vitamin D. Annu Rev Pharmacol Toxicol (1):311.

14Fleet JC, Desmet M, Johnson R, Li Y. Vitamin D and cancer: a review of molecular mechanisms. - Biochemical Journal 2012 Jan 1;441(1):61-76.

15Gutierrez S, Liu J, Javed A, Montecino M, Stein GS, Lian JB, et al. The Vitamin D Response Element in the Distal Osteocalcin Promoter Contributes to Chromatin Organization of the Proximal Regulatory Domain. Journal of Biological Chemistry 2004 October 15;279(42):43581-43588.

16Underwood KF, D’Souza DR, Mochin MT, Pierce AD, Kommineni S, Choe M, et al. Regulation of RUNX2 transcription factor-DNA interactions and cell proliferation by vitamin D3 (cholecalciferol) prohormone activity. Journal of Bone and Mineral Research 2011:n/a-n/a.

17Vitamin D and prevention of breast cancer: Pooled analysis. The Journal of Steroid Biochemistry and Molecular Biology (3–5):708.

18Aranow CM. Vitamin D and the Immune System. Journal of Investigative Medicine 2011 August;59(6):881-886.

19Kimball S, Vieth R, Dosch H, Bar-Or A, Cheung R, Gagne D, et al. Cholecalciferol Plus Calcium Suppresses Abnormal PBMC Reactivity in Patients with Multiple Sclerosis. Journal of Clinical Endocrinology & Metabolism 2011 September 01;96(9):2826-2834.

20Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. Journal of Bone and Mineral Research 2011;26(3):455-457.

21Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006 08/01;116(8):2062-2072.

22Blumberg JB, Frei B. Why clinical trials of vitamin E and cardiovascular diseases may be fatally flawed. Commentary on “The Relationship Between Dose of Vitamin E and Suppression of Oxidative Stress in Humans”. Free Radical Biology and Medicine 2011;43(1):1374-1376

23Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D With or Without Calcium Supplementation for Prevention of Cancer and Fractures: An Updated Meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2011 December 20;155(12):827-838.

24Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know. Journal of Clinical Endocrinology & Metabolism 2011 January 01;96(1):53-58.

23

Interview with Hartley JafineBA, MA

Conducted by Ilia Ostrovski1, Brian Chin2 and Shelly Chopra1

Bachelor of Health Sciences (Honours), 1Class of 2014; 2Class of 2012

Hartley Jafine is an instructor of theatre and arts-based courses in the Bachelor of Health Scienc-

es program. He has studied and used applied drama—a form of theatre that is now being used as

a tool for social and interpersonal skill development—as an educational medium for many years.

The Meducator recently had the opportunity to interview Jafine on the effectiveness of applied

drama in helping students regain their passion and health professionals understand their patients.

QYour work focuses primarily on the use of drama as an educational technique. Could you please elabo-

rate on what applied drama entails and how you got in-volved in this area?

Typically when I tell people that I facilitate drama and arts-based courses in a health science program, I get the same response

“Hmmm…how does that work?” Well, the link is very simple and it all started when I was completing my Masters of Arts in ap-plied drama. Applied drama is a field that uses theatre as a tool for personal or social development and growth. As an MA student I started to investigate how theatre could be applied in a hospital setting. The intent was to take a space that is typically very fright-ening and a place that no one wants to be in and turn it into a space that is a bit more positive. From this idea, I started to think about how theatre could be used in professional healthcare train-ing settings and how theatre could be applied to health science education, and that led me to where I am currently. As a PhD student, I am investigating the role theatre could play in health science education and training to develop transferable skills like communication, empathy, and collaboration skills.

QWhat are the common expectations of students in medical school?

Students typically enter medical school when they have the most idealistic attitude and the most compassion because they have chosen a career as a healer. They are going into a profession where they are going to ‘do good’ so to speak. The problem arises once they enter third year or clerkship. The idealism and the compas-sion and the empathy starts to decline a little bit, and that is partly

because of the structure that they find themselves in. The pres-sures and the demands of clerkship do not necessarily allow them to develop skills like compassion and empathy.

Once third-year medical students enter their clerkship year, they begin to discover that their idealistic views are not necessarily compatible with the realities. What typically happens is that med-ical students become complacent instead of trying to find alterna-tive ways of being. This is where applied theatre directors such as Bertolt Brecht and Constantin Stanislavski come in. Stanislavski created theatre in the form of psychological realism: an audience member would go to his play and leave the play thinking “yes, that is the way it is, I felt that too and that must be the way it always is”. This creates a type of environment that continually perpetuates a problem. Brecht, however, created theatre where audience mem-bers leave thinking “wait a minute, life should not be like that, there should be a way out for that person and something needs to change.” Third-year medical students tend to follow Stanislavski’s route where they continue to feed into the systemic problem in-stead of trying to find new ways to rally against it. The problem is that as medical students begin to lose their compassion and lose their empathy this impacts other spaces such as their collaboration with other healthcare professionals and their communication with future patients.

QWhat purpose does theatre serve in medical educa-tion?

Theatre skills are life skills and the skills that an actor learns in becoming a pro-theatre artist are equally applicable to healthcare professionals. Engaging in these theatre-based mediums allows

INTERVIEW

I N T E R V I E W S P O T L I G H T

The Role of Drama in the Health Sciences


participants to develop transferable skills, like communication, collaboration, the idea of presence and active listening, being in the moment, and empathizing with another human being. Through theatre, participants are able to embody other characters, perhaps characters that are suffering from illness or disease. By liv-ing a patient’s experiences, healthcare professionals might be able to learn something new and then use that newfound knowledge when engaging with a future patient in a clinical setting.

Not only can theatre develop important transferable skills that can then be applied to clinical settings, but engaging with theatre and the arts can have another really important effect; allowing one to regain play. Play can substantially improve the mental and psycho-logical health of professionals. As we get older, we tend to play less and less and that’s because play is seen as frivolous, unproductive, and something only children do. But what we do not realize is that through engagement with the act and art of play, we can gain huge benefits. Play encourages individuals to seek out optimism. Play gives the immune system a bounce. Play allows for the de-velopment of a sense of community. These roles can all contribute to the mental health of the healthcare professional and studies repeatedly show that through engagement with play, healthcare professionals mark a higher level of psychological resilience.

QHow can applied drama maintain the mental well-being of healthcare professionals working in high-

stress environments?

So, in our society, and particularly in the world of health sciences, there is this notion of performing perfection. There are extreme pressures in the healthcare field to be perfect, to not admit mis-takes, or to never share any weaknesses or anxieties. Now, this is understandable because healthcare professionals are dealing with important stakes, other peoples lives, but the problem arises when not admitting anxieties or mistakes has a detrimental effect on the health and the psychological wellbeing of healthcare professionals. And so, theatre can allow the space for healthcare professionals to discuss these anxieties, to discuss these fears, to explore alternative ways of being. In a theatre space, it’s ok if people make mistakes, it’s ok if people fail, it’s about celebrating these, and saying “ok, that happened, now what can we do to fix it, what other world exists where this doesn’t happen.” It is through engaging with the-atre, hopefully, that they can reduce their anxiety and leave with the mental health necessary to their practice.

QHow is theatre currently being integrated into aca-demic settings?

Today, theatre is being used in health science education in medi-cal schools across Canada, the USA, England, and other parts of the world. A former student of mine, who took my Theatre for Development (HTH SCI 3CC3) course, was accepted into University of Alberta’s medical school. Using the knowledge he gained through this course, he developed his own theatre course within the medical school. A recently conducted study identified that through the engagement in theatre-based games and exercises, these medical students developed empathy skills, communication

skills and presence, as well as identified psychological resilience as an outcome of taking the theatre course.

In addition to curriculum-based applied drama, theatre has been used in extracurricular settings as well and for quite some time. The University of Toronto’s medical school has been doing their annual production “Daffodil” for 101 years as of 2012 and the University of Western Ontario, has been doing their medical school show “Tachycardia” since the 1950s. What this says to me is that theatre has a presence and continues to have this presence in medical schools, which are not two things which you typically think would go together. The reason for this success is that these shows typically address fears and anxieties that the medical stu-dents are facing at the time. This links directly to the central goals of applied drama; to explore the anxieties and fears that we are currently facing and to explore alternative ways of existence. Cre-ating plays around the fears and anxieties of clerkship, or apply-ing and matching residency programs really resonate with medi-cal school audiences. It is this engagement with theatre that gives them the opportunity to laugh and make fun of the system they find themselves battling and working within.

QFrom your personal experience, how is this form of education typically received by students?

I have facilitated theatre and arts-based programs in the Bachelor of Health Sciences program for the past five years. From my lived experience and from my research, I have noticed the importance that students have identified of engaging with theatre. From their personal reflections, from conversations, from research, I have dis-covered that students who engage with theatre, especially students who are in health science programs—which are very outcome-oriented in their curriculums—identified that through the process of participating in theatre courses and through arts-based medi-ums, they have developed important transferable skills, skills like communication, empathy and collaboration, as well as being able to develop a strong sense of identity and having the ability to play and have fun, which, as I have said, has huge psychological ben-efits. Additionally, I have facilitated workshops at the Canadian Conference on Medical Education. The physicians who attended, discussed with me how embodying a character who was suffering from depression, from anxiety, from other illnesses, gave them a better understanding of what those patients and individuals go through. They can then take this in to their practice when engag-ing with their patients in the future.

The use of theatre in health science education and training has been increasing year by year—which is fantastic—but the prob-lem, the obstacle, is that it tends to only exist on the fringes, as elective courses, as extracurricular intervention. What needs to happen now is that healthcare professionals need to find ways to fully integrate theatre into their curriculum because engaging in theatre offers important benefits that all participants in health sci-ence education can grow from.

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Image adapted from: sxc.hu

Recently, Dr. Mark Larché, the Canada Research Chair in Allergy & Immune Tolerance and a professor in the McMaster Department of Medicine, developed a vaccine that can be used to assist people with cat allergies. The researchers targeted a particular amino acid sequence from the protein released on the cat’s fur that stimulates an allergic response. Larché produced a vaccine by coding the key components of the amino acid sequence that would provide relief for a large portion of the population. In this immunotherapy, the vaccine targets the allergen-specific T cells with the synthetic peptides. This study has prompted the possibility for other possible vaccines related to common allergies.

Larché, H. Lee, J. Kleine-Tebbe, R.P. et al. Development and Preliminary Clinical Evaluation of a Peptide Immunotherapy Vaccine for Cat Allergy. Journal of Allergy and Clinical Immunology, 2011; 127 (2).

Image adapteed from: success.org

An investigation conducted by Dr. Matthew Kwan, a post doctoral fellow of the Department of Family Medicine has found that an adolescent’s physical activity drops 24% by early adulthood. The longitudinal cohort study, published in the American Journal of Preventive Medicine, followed 683 Canadians chosen from Statistics Canada’s National Population Health Survey. Participants were followed up twice a year for a span of 12 years starting at the age of 12 -15. The results show that there was a greater decrease in physical activity amongst men than women. However, the gender differences in physical activity may be due to the impact of major life transitions such as getting married or having a child. Understanding the gender differences highlights the need for gender-specific interventions to prevent the decline of physical activity in men and to increase the physical activity in women.

Ejim L, Farha MA, Falconer SB, Wildenhain J, Coombes BK, Tyers M, et al. Combinations of antibiotics and nonantibiotic drugs enhance antimicrobial efficacy. Nat Chem Biol. 2011 Jun;7(6):348-350.


Doctors have repeatedly warned of the dangers of a high sodium diet, and it is generally accepted that too much salt is not good for you. However, researchers at McMaster, including Dr. Martin O’Donnell and Dr. Salim Yusuf, have found that both low and high levels can have negative effects on the heart. The analysis included almost 30,000 people who were at an increased risk of heart disease. It was found that urinary sodium excretions greater or less than 4 to 5.99 grams per day were associated with an increased risk of cardiovascular death and hospitalization due to coronary heart failure.

Donnell MJO, Yusuf S, Gao P, Mann JF, Mcqueen M, Sleight P, et al. Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events. Journal of the American Medical Association, 2011;306(20):2229–38.

Image adapted from: http://jnnp.bmj.com

Huntington’s disease (HD) is an age-related neurodegenerative disorder resulting in gradual motor loss and cognitive decline. Currently, there exists no cure for HD and no known method to halt disease progress. In collaboration with researchers at the University of Alberta, Dr. Ray Traunt’s cell biology lab has discovered a successful intervention in rodent studies. Infusion of GM1, a lipid, into the brains of rodents with HD inhibited a toxic protein known as huntingtin. Moreover, GM1 addition was able to restore normal brain function through unknown repair mechanisms. Hence, the logical next step is to look for drugs that can potentially mimic the effects of GM1.

Di Pardo A., Maglione V., Alpaugh M., Horkey M., Atwal R.S., Sassone J., et al. Ganglioside GM1 induces phosphorylation of mutant huntingtin and restores normal motor behavior in Huntington disease mice. Proceedings of the National Academy of Sciences, 2012.


A recent study suggests that routine population-based screening programs for autism may not be necessary. Autism is a neurodevelopmental disorder that can have several implications, including difficulty in areas such as communication, fine and gross motor skills, and intellectual skills. Dr. Jan Willem Gorter, a researcher in McMaster’s CanChild Centre for Childhood Disability Research and associate professor of paediatrics, and his team conducted a literature review assessing the effectiveness of autism screening programs. They discovered that none of the tests contained all facets of a useful screening program, including accuracy, sensitivity, specificity and predictive value. Gorter argues for the need of a randomized control trial analyzing the usefulness and implications of the autism screening program.

Al-Qabandi, M., Gorter, J.W., Rosenbaum, P. Early Autism Detection: Are We Ready for Routine Screening? Pediatrics, 2011; 128 (1).


Researchers at McMaster’s Department of Biology led by Dr. David Rollo have found that a key to promoting longevity may involve consuming just the right mix of dietary supplements. Mice were supplemented with a complex mix of ingredients – such as vitamins, garlic, ginseng, and green tea extract – that previous research had shown to be useful in counteracting various aging mechanisms. Supplemented mice showed no loss of total daily locomotion and cognitive decline was offset. Consumption of the supplement resulted in modest increases in life span but the delay in the onset of functional decline suggests the possibility that “growing up” may not always equal “growing old”.

Aksenov V., Long J., Liu J., Szechtman H., Khanna P., Matravadia S., et al. A complex dietary supplement augments spatial learning, brain mass, and mitochondrial electron transport chain activity in aging mice. Age, 2011; DOI 10.1007/s11357-011-9325-2.

MACW

IRE

Research Highlights AT MCMASTER Compiled by Khizer Amin and Bhavik Mistry


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