The objective of this study was to determine whether provincial health policies influence the supply of long-term care in a province, and the care received by residents that require it. This was achieved by first conducting a comprehensive review and comparative analysis of the long-term care policies of Alberta and Ontario, and then comparing health conditions of long-term care and assisted living/retirement home residents in both provinces. The latter comparisons used information collected from comparable versions of the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) and the RAI-MDS Home Care. The study hypothesis was that provinces with health policies favouring institutional over community care would have a higher proportion of residents with lower care requirements in institutional settings. The results show that this is not the case, and that institutional settings house those with high care needs in both provinces.

The objective of this study was to determine whether provincial health policies influence the supply of long-term care in a province, and the care received by residents that require it. This was achieved by first conducting a comprehensive review and comparative analysis of the long-term care policies of Alberta and Ontario, and then comparing health conditions of long-term care and assisted living/retirement home residents in both provinces. The latter comparisons used information collected from comparable versions of the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) and the RAI-MDS Home Care. The study hypothesis was that provinces with health policies favouring institutional over community care would have a higher proportion of residents with lower care requirements in institutional settings. The results show that this is not the case, and that institutional settings house those with high care needs in both provinces.

Evolution of viral myocarditis to dilated cardiomyopathy (DCM)represents a delicate balance between host innate immunity and T-cell acquired immunity. IRF-9 is a key member of a transcription factor family that regulates type I interferon (IFN) production, critical for innate antiviral protection. RESULTS: IRF9-/- mice showed dramatically increased mortality compared to the wildtype littermates (0% WT vs 72% IRF-9-/- on day 14, P<0.0001). On day 42, there was less cardiac hypertrophy and inflammation in IRF-9-/- mice compared to WT controls (p<0.05). Onn day 42 there was a dramatic increase in the number of cytotoxic and helper T-Cells in the wild-type mice that was not observed in the IRF-9-/- spleens (p<0.05). CONCLUSIONS: These data suggest a novel dual role of IRF-9 in not only regulating interferon in acute stage of viral infection in myocarditis, but also late acquired immunity activation, including CD4/8 populations, contributing to the development of chronic cardiomyopathy.

Master of Public Health / Kinesiology / David Dzewaltowski / Background: Childhood obesity represents a major public health problem. Increasing public and political attention has been directed towards the role of child-directed food advertising in the growth of childhood obesity. As a potential solution, scientists have begun to focus on children’s responses to advertising and on how parents can potentially modify or reduce advertising effects. This study explored the impact of food advertising on parent behavior and children's food choice and how these potential effects are moderated by household socioeconomic status (SES). Methods: Fifty-eight parent-child dyads (ages of 4-6) participated in a true experimental design where half the sample was randomized to be exposed to advertising and categorized as low income or higher income (qualified for free and reduced lunch, n = 11; paid, n = 18) and half was randomized into a control condition (qualified for free and reduced lunch, n = 12; paid, n = 17). Parents completed a questionnaire, viewed a cartoon with energy dense (ED) food commercials or control commercials with their children, and children subsequently choose either an energy dense food or a fruit or vegetable. Throughout the experiment parent and child behavior was videotaped. Binary logistic regression was conducted to examine the impact of advertising and household SES on parent behaviors and children’s food choice. Results: Advertisements had no effect on food choice. More low-income children chose a fruit or vegetable over an energy dense food (OR = 5.8), regardless of whether or not they were exposed to advertising (p<.05). Parents were more likely to be uninvolved in mediating children’s food choice when they were not exposed to advertising. Parents were also less likely to agree to energy dense foods after being exposed to energy dense food advertising compared to control advertising. However, SES moderated the advertising-parental practice effect for parental agreement to an ED food. After exposure to food advertising, more low-income parents agreed to an energy dense food compared to higher income parents. (p<.05). Conclusion: This study has demonstrated a link between advertising exposure and parenting behavior. Results suggest that this relationship may be moderated by socioeconomic status. This encouraging result may indicate that low-income parents are unaware of the various ways advertising could influence their children. Thus, future attempts should be made to investigate whether interventions that target parent-child communication strategies may empower parents to effectively curb unwanted advertising effects in children.

Despite the establishment of heart transplantation as a life-saving therapy for children and adolescents, little research has focused on the biopsychosocial impact of the transplant process. Few studies have captured the subjective experiences of young heart transplant recipients. This program of research examined how pediatric heart transplant recipients construct their worlds and the meanings they ascribe to their transplant experience. A grounded theory approach was implemented which guided data collection and analysis. A total of twenty-seven adolescents participated in semi-structured qualitative interviews. Findings illuminate pediatric heart transplantation to be a pervasive experience, with consequent impact on physical, psychological and social well-being. Participants described various biopsychosocial processes and experiences that occurred over the course of their transplant journey. Data analysis yielded themes of quality of life reflecting notions of temporality including: 1) the pre-transplant experience – a struggle to survive, 2) the transplant surgery and hospitalization – a difficult transition and 3) the post-transplant experience – an awakening and transformation. This research identifies that heart transplantation, which may contain elements of suffering and loss, may ultimately enhance young recipients’ overall quality of life. Results reveal the possibility that adolescent heart transplant recipients not only adapt to transplantation, but also potentially experience associated growth-enhancing experiences. An emergent theoretical model is presented, with implications for practice and research.

Fundamental questions related to the locations of Cerebrospinal Spinal Fluid (CSF) absorption deficit and causes of the pressure gradients that expand the ventricles with hydrocephalus remain largely unanswered. Work in the Johnston lab over a 15 year period has demonstrated that CSF moves through the cribriform plate foramina in association with the olfactory nerves and is absorbed by a network of lymphatic vessels located within the olfactory turbinates. A kaolin-based rat model of communicating hydrocephalus was developed as a collaborative effort with Drs. McAllister, Wagshul and Li. After developing a method to quantify lymphatic CSF uptake in rats, we examined and observed that the movement of a radioactive tracer into the nasal turbinates was significantly reduced in the kaolin-injected animals compared to saline injected controls. However, it was possible that while lymphatic CSF uptake was compromised, other CSF absorption pathways may have compensated. To answer this, we measured the CSF outflow resistance (Rout) and observed it to be significantly greater in the kaolin group compared with animals receiving saline and there was a significant positive correlation between CSF Rout and ventricular volume. Nonetheless, it is not clear how impaired CSF clearance could lead to a dilation of the ventricles since the ventricular and subarachnoid compartments are in communication with one another and pressure would likely increase equally in both. At this point, we came across a theoretical paper that postulated that a drop in periventricular interstitial fluid pressure might provide an intraparenchymal pressure gradient favouring ventricular expansion. In addition, studies in non-CNS tissues indicated that a disruption of beta-1 (β1) integrin-matrix interactions could lower tissue pressure. Based on these suppositions and data, we examined if these concepts had relevance to the brain. For this, we measured pressure in the brain and observed a decline in periventricular pressures to values significantly below those monitored in the ventricular system following the injection of the anti integrin antibodies. Many of the animals developed hydrocephalus over 2 weeks post antibody injection. These data provide a novel mechanism for the generation of intraparenchymal pressure gradients that is likely contributing to ventricular expansion.

Rationale: Ng et al. (2008) demonstrated that sub-acute hippocampal atrophy occurred between 4.5 and 24 months following moderate-to-severe traumatic brain injury (TBI); it remains to be determined if atrophy occurred before 24 months. Objectives: (1) to determine if sub-acute hippocampal atrophy occurs by the first year of injury; (2) to determine associated clinical and demographic variables. Methods: Ten moderate-to-severe TBI patients underwent MRI at 5 and 12 months post-injury. Glasgow Coma Scale (GCS) and demographic variables were correlated with change. Results: Significant hippocampal volume decreases were observed for right (P< 0.002, Cohen’s d= 0.34) and left (P< 0.036, Cohen’s d= 0.22) sides. GCS was significantly correlated with right (r= -0.663, P< 0.037), but not left percent hippocampal volume change (r= -0.327, P< 0.356). No significant correlations were observed for demographic variables. Conclusion: Sub-acute hippocampal atrophy occurs between 5 and 12 months post-injury and is associated with injury severity.

Animal models have yet to characterize alterations in body composition, wheel running activity, food intake, and neuroendocrine parameters, in chronic food restriction. This study investigated changes in these measures in food restricted rats, with and without access to running wheels, over four weeks. The data demonstrated that upon initiation of food restriction IGF-1 reductions paralleled loss of lean tissue while leptin levels were rapidly reduced which paralleled losses in body fat. Further, a lower limit threshold of body fat was identified, below which the correlation between leptin and fat mass was disrupted. Lastly, a decrease and plateau in body mass was mirrored by an increase and plateau in voluntary wheel activity in the food restricted population. The data suggest that there is a tight biological link between hyperactivity and body mass and that adequate nutritional support might attenuate the drive for obligate exercise even before weight is fully restored.

Non-alcoholic fatty liver disease (NAFLD) includes simple hepatic steatosis (SS) and non-alcoholic steatohepatitis (NASH). NAFLD is tightly linked to obesity and is thought to be secondary to various noxious signals, some of which may originate from the intestinal microbiota (IM). Despite a growing body of evidence supporting a link between obesity and altered IM, there are no studies assessing the IM of patients with NAFLD. In this cross-sectional study we aimed at comparing fecal levels of total bacteria, Bacteroidetes, C. coccoides, C. leptum, Bifidobacteria, E. coli, and Archaea between healthy controls (HC) and patients with SS or NASH. We found higher C. coccoides levels in NASH compared to SS and lower percentage Bacteroidetes in NASH compared to SS and HC. Controlling for body mass index and fat intake we found an association between presence of NASH and percentage Bacteroidetes. The latter inversely correlated with insulin resistance.

Recent discoveries enabled us to divide medulloblastoma into molecular sub-groups and uncover novel mutations in these tumors. However, except for superior survival of the WNT sub-group, the prognostic and therapeutic implications of these observations remain unclear. TP53 mutations which confer radioresistance revealed conflicting clinical relevance in different studies. We hypothesized that the effect of TP53 mutations on survival is modulated through molecular sub-grouping. This is especially important since therapeutic targeting of WNT can be achieved with administration of lithium. Here we first confirmed that TP53 mutant tumors confers unfavorable outcome only in SHH subgroup, but not in WNT. We demonstrated that while TP53 mutations cause radioresistance, activation of WNT/β-catenin signaling radiosensitizes medulloblastoma cells. We demonstrated that lithium activates the WNT pathway and effectively sensitize medulloblastoma cells to radiation. Furthermore, lithium did not sensitize normal neural stem cells to radiation, suggesting its potential as an effective radiosensitizer for medulloblastoma.