Base de données de recherche des TNO

Régions: Inuvialuit Settlement Region, Gwich'in Settlement Area

étiquettes: health, aboriginal community, public health

Objectif(s): To obtain local information on the burden of disease from H. pylori infection, risk factors for H. Pylori-associated diseases, and factors that influence successful treatment to eliminate this infection.

Description du projet: This licence has been issued for the scientific research application No.4668. This research aims to answer questions posed by community members in the Northwest Territories (NT) and their health care providers about health risks from H. pylori infection. The Canadian North Helicobacter pylori (CANHelp) Working Group formed to develop a comprehensive approach to investigating community health problems related to H. pylori infection in NT communities and to identify public health solutions aimed at reducing related health risks. The objectives of this research program are: 1. To conduct community-based participatory research projects to obtain local information on the burden of disease from H. pylori infection, risk factors for H. pylori-associated diseases, factors that influence successful treatment to eliminate this infection, and describe the genomic features of bacterial strains and investigate whether such features contribute to the disproportionate health burden this infection imposes on such communities; 2. To conduct policy analysis to identify cost-effective H. pylori management strategies that are ethically, economically, and culturally appropriate for northern communities; and, 3. To develop and implement knowledge exchange strategies that help community members, health care practitioners and health care decision makers understand H. pylori-associated health risks as well as solutions and unsolved challenges for reducing these risks. The Aklavik H. pylori Project was launched as a starting point for the CANHelp Working Group’s research program. It is of interest to conduct similar projects in additional Northern communities to identify differences and similarities across diverse northern settings, and increase the number of participants to facilitate statistical analysis of subgroups. This will enhance the generalizability of the results across northern populations and yield useful inputs for cost-effectiveness analysis aimed at formulating recommended H. pylori management policies to health authorities. The research protocols developed in Aklavik were piloted there and have been adapted for use in new communities. Aklavik was selected for the initial project because Aklavik residents had made known their concerns about the risks posed by H. pylori infection. Due to the success of the Aklavik H. pylori Project, the CANHelp Working Group was asked by the Inuvialuit Regional Corporation to create the Inuvialuit Settlement Region (ISR) H. pylori Project to include the remaining ISR communities, and by community leaders in Fort McPherson to initiate a research project in their community. The research team will screen participants for H. pylori infection using the non-invasive 13C-urea breath test. This test is regarded as the most accurate non-invasive test and can be used safely in pregnant women and human of all ages. It detects the presence of urease secreted by H. pylori in the stomach, using either mass spectrometry or nondispersive isotope-selective infrared spectroscopy to measure the 13C/12C ratio in breath samples collected before and after administration of 13C-labeled urea. Participants will also be offered the option of multiple tests for detecting H. pylori infection using breath, blood, or stool specimens, regardless of symptoms. The research team will interview participants using structured questionnaires to identify environmental and behavioural risk factors and to ascertain upper gastrointestinal symptoms and previous diagnoses of H. pylori infection and related diseases. Interviews are conducted in the language and location of the participant’s preference (home or project office). A household questionnaire is administered to one individual in each household collects household attributes and exposures, while an individual questionnaire collects individual attributes and exposures from each participant. Gastroenterologists will perform upper gastrointestinal endoscopy to examine the stomach for visible lesions and collect biopsies of stomach tissue. Temporary endoscopy units equipped with rented endoscopy towers and gastroscopes will be set up at field sites (e.g. local health centres), with the support by technical service from Olympus Canada. The gastroenterologists will be assisted by trained Alberta Health Services endoscopy nurses and service aids. Temporary territorial medical licenses will be arranged for the Alberta MDs and RNs. In keeping with field settings, procedures will be performed unsedated using ultrathin transoral gastroscopes. During endoscopy all relevant mucosal lesions will be noted and at least seven gastric biopsies will be collected from predetermined locations for histopathologic assessment and microbiologic cultures. The gastroenterologists will prescribe treatment for H. pylori-positive participants. As the research identifies factors that influence treatment effectiveness in the participating communities, the prescribed treatments will be tailored to participants based on relevant factors. Treatment regimens will be distributed to participants in bubble packs organized for easy identification of days and times pills are to be taken. Participants will be instructed to leave untaken doses intact and return bubble packs at the end of treatment to permit assessment of adherence. Follow-up breath tests will be offered to assess H. pylori status 8-12 weeks after treatment. Participants will be offered repeat breath tests and endoscopic examinations to assess their infection status and gastric abnormalities a few years after their participation in the research project. Participants who have reinfection or are newly infected with H. pylori will receive treatment from our gastroenterologists. The prevalence of H. pylori infection and associated diseases will be estimated by community and demographic subgroups of interest. To identify risk factors for H. pylori infection and gastric abnormalities, multivariable logistic regression models will be used to estimate prevalence odds ratios and 95% confidence intervals as measures of association. Community Planning Committees have been developing strategies for communicating study information to community members, with particular consideration to targeting groups such as youth and elders. Throughout the project, information has been disseminated to the community by means of radio broadcasts, flyers, and progress reports. A video documentary about the Aklavik H. pylori Project was created to convey to the community how the research has been carried out within the community and at the University of Alberta. In addition, community presentations are held periodically to present early findings from the research to the community using a slide or video presentation. A novel knowledge exchange program (KEP) was developed to recruit youth from Aklavik to travel to Edmonton and learn about the research process. They developed dissemination materials with scientists together and delivered the knowledge to their community in a meaningful way. Based on the community feedback, the team will expand the KEP to other communities in the NWT The fieldwork for this study will be conducted from January 24, 2020 to December 31, 2020.