Bachelor of health studies program students Alexandra Veres (left)听补苍诲 Seungree Nam both conducted research for (TAP) at Southlake Regional Health Centre under the mentorship of 91亚色 Professor Liane Ginsburg of the Faculty of Health鈥檚 School of Health Policy & Management. Veres explored the theme of hope in several of the patient education programs offered by TAP, while Nam鈥檚 project looked at whether or not the Hospital Anxiety聽& Depression Scale (HADS) was a valid outcome measurement tool in TAP鈥檚 outpatient fibromyalgia education program.

Both students were awarded research grants as part of the Canadian Institutes of Health Research鈥檚 (CIHR) mobility, musculoskeletal health and arthritis undergraduate summer studentship. The funding was designed to provide undergraduate and health professional students with opportunities to undertake research projects with established health researchers in an environment that provides strong mentorship.

Seungree Nam

The third student, Julia Salzmann, also of the bachelor of health studies program, conducted an extensive data collection and analysis on the effects of聽the use and integration of Internet communication/e-health technologies (ICTs) as a growing resource for addressing First Nations鈥� mental health. She received a research grant from the (NAMHR), which is funded by the through the CIHR. Salzmann requested to work under the direction of Professor Naomi Adelson, associate dean, research in the Faculty of Liberal Arts & Professional Studies, who is a collaborator on NAMHR and whose own research has focused on e-health technologies and the Internet as a health resource.

Julia Salzmann

What Nam found after helping to administer the HADS questionnaire to patients on the first and last day of the Fibromyalgia Education Program, entering all the data, conducting a statistical analysis, as well as a literature review, was that it was a relevant and appropriate tool to measure the program鈥檚 effectiveness in helping manage patient anxiety and depression.

HADS was developed to identify the possibility of anxiety and depression in patients involved in hospital clinics outside of the mental health department. Patients were also given a fibromyalgia impact questionnaire and a fibromyalgia history form.

鈥淲e did find a significant and meaningful outcome from the three surveys,鈥� Nam says.

Left: The graph Seungree Nam prepared for his research

According to the data, patients had a 10 to 13 per cent lower score for depression following the program. Their level of survey reported anxiety, however, remained the same, but when the patients were verbally asked during the program鈥檚 last session about their anxiety, they said they felt it had improved. Nam believes the discrepancy had to do with two or three questions on the post-survey which the patients found confusing.

Nam鈥檚 poster abstracts for the research were accepted at two different conferences: the Canadian Association of Ambulatory Care conference (held in September) and the in the United States in November. He is currently in the process of writing up his research.

As part of Veres鈥� research, she worked with four groups in TAP 鈥� inflammatory arthritis, osteoarthritis, osteoporosis and fibromyalgia. 鈥淲e were building on a 2009 pilot study done by TAP that explored the theme of hope in the inflammatory arthritis patient education program,鈥� she says. 鈥淭hat study found that the patients not only wanted the program, they wanted it to be delivered with an element of hope. They wanted to come out of it with hope.鈥�

What TAP wanted to know, says Veres, was whether this theme of hope carried through all four of the programs in TAP and what the patient learning needs were. After collecting and qualitatively analyzing the data, what the research found was that 鈥渢he theme of hope permeated through all four programs,鈥� she says. Up until now, hope was not a popular theme in patient education programs. Veres says she thinks the findings will make 鈥渁 big difference in how these patient education programs will be run in the future.鈥�

The information could lead to better patient adherence to treatment plans and improved quality of life, as well as reduced disability.

Veres abstract was accepted at the Canadian Association of Ambulatory Care conference recently and she hopes her forthcoming article will be published in a scholarly journal.

As there is little or no other research looking into the theme of hope in education programs from a patient鈥檚 perspective, Veres believes the research could be quite significant for the patient education community.

Salzmann wishes to pursue further research in Aboriginal health policy. So having the chance to look at e-health in a First Nations context was exciting to her.

This research looked at the importance of incorporating the First Nations鈥� holistic, traditional and cultural approach to healing, wellness and mental health services using ICTs. 鈥淕enerally speaking, Aboriginal peoples have a much more holistic approach to health,鈥� she says. 鈥淭hey incorporate the individual, the community and the environment, and look at all realms of health, including the mental, physical, emotional and spiritual parts of a person.鈥�

This research explored the use and integration of ICTs in addressing Aboriginal mental health as a growing resource. 鈥淩esearch has shown that tele-health is a great tool, but we must consider who will finance this initiative, will it be sustainable and will it contribute to the overall health of the community? It鈥檚 a very politicized issue,鈥� says Salzmann.

In researching the issues involved, Salzmann completed an extensive national literature review on ICTs. 鈥淭ele-health is a huge hot button topic now,鈥� she says. 鈥淭o be equitable in health in the long term, Aboriginal health has to be on the agenda.鈥� What it comes down to is that the Aboriginal people鈥檚 own ways of seeing health, as well as their culture, has to be included in any ICT initiatives.

Salzmann鈥檚 will be presenting her work at the at Queen鈥檚 University later this month. She also hopes to have her forthcoming article on the research published in a scholarly journal and she is hoping to pursue a master鈥檚 degree in public policy or public administration in the future.

Republished courtesy of YFile鈥� 91亚色鈥檚 daily e-bulletin to research stories on the research website.

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The study is the first to look at the effects of yoga on cortisol levels in women with fibromyalgia. The condition, which predominantly affects women, is characterized by chronic pain and fatigue; common symptoms include muscle stiffness, sleep disturbances, gastrointestinal discomfort, anxiety and depression.

Previous research has found that women with fibromyalgia have lower-than-average cortisol levels, which contribute to pain, fatigue and stress sensitivity. According to the study, participants鈥� saliva revealed elevated levels of total cortisol following a program of 75 minutes of hatha yoga twice weekly over the course of eight weeks.

"Ideally, our cortisol levels peak about 30 to 40 minutes after we get up in the morning and decline throughout the day until we鈥檙e ready to go to sleep," says the study鈥檚 lead author, Kathryn Curtis, a PhD student in 91亚色鈥檚 Department of Psychology, Faculty of Health. "The secretion of the hormone, cortisol, is dysregulated in women with fibromyalgia," she says.

Right: Yoga affects the release of cortisol

Cortisol is a steroid hormone that is produced and released by the adrenal gland and functions as a component of the hypothalamic-pituitary-adrenal (HPA) axis in response to stress.

"Hatha yoga promotes physical relaxation by decreasing activity of the sympathetic nervous system, which lowers heart rate and increases breath volume. We believe this in turn has a positive effect on the HPA axis," says Curtis.

Participants completed questionnaires to determine pain intensity pre- and post-study; they reported significant reductions in pain and associated symptoms, as well as psychological benefits. They felt less helpless, were more accepting of their condition and were less likely to "catastrophize" over current or future symptoms.

"We saw their levels of mindfulness increase 鈥� they were better able to detach from their psychological experience of pain," Curtis says. Mindfulness is a form of active mental awareness rooted in Buddhist traditions; it is achieved by paying total attention to the present moment with a non-judgmental awareness of inner and outer experiences.

"Yoga promotes this concept 鈥� that we are not our bodies, our experiences, or our pain. This is extremely useful in the management of pain," she says. "Moreover, our findings strongly suggest that psychological changes in turn affect our experience of physical pain."

The study 鈥� Curtis鈥檚 thesis 鈥� was published yesterday in the Journal of Pain Research. It is co-authored by her supervisor, 91亚色 psychology Professor Joel Katz, Canada Research Chair in Health Psychology, and Anna Osadchuk, a 91亚色 undergraduate student.

Curtis was supported by a Canadian Institutes of Health Research (CIHR) Canada Graduate Scholarship and a CIHR Strategic Training Grant Fellowship in Pain: Molecules to Community.

Republished courtesy of YFile 鈥� 91亚色鈥檚 daily e-bulletin.

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