NWT RESEARCH DATABASE

Regions: Inuvialuit Settlement Region, Gwich'in Settlement Area

Tags: health, public health

Objective(s): To develop a comprehensive approach to investigating community health problems related to H. pylori infection in NWT communities and to identify public health solutions that respond to community health care needs as perceived by community members and health authorities.

Project Description: This licence is being issued for the scientific research application No. 940. The research aims of this project are to develop a comprehensive approach to investigating community health problems related to H. pylori infection in NWT communities and to identify public health solutions that respond to community health care needs as perceived by community members and health authorities. As a starting point, a project will be carried out in the Hamlet of Aklavik, with the following aims, which could be expanded later to culturally diverse NWT communities. This project is divided into four phases which include: phase I: Conduct a community-based investigation of H. pylori infection to test residents for H. pylori infection and collect data on related clinical, social, and environmental factors; phase II: Using endoscopy to examine the stomach, estimate the prevalence of visible abnormalities, and obtain biopsies to: 1) characterize inflammation and abnormal changes; 2) estimate the prevalence of bacterial strains that are resistant to antibiotics or associated with more severe disease; phase III: Conduct a trial to identify effective treatment and follow those treated long-term to identify factors associated with treatment failure and reinfection; phase IV: Conduct policy analysis to develop cost-effective strategies for management of H. pylori infection; inform community members of the research results in a manner that helps them understand how they can use this information to safeguard health. This project targets all residents of Aklavik as inclusion of the entire community will enhance participation and achieve broad representation. This project incorporates the principles of the Association of Canadian Universities for Northern Studies (ACUNS) and the Alberta Aboriginal Capacity and Developmental Research Environments (ACADRE) Network, an agency supported by the Canadian Institute for Health Research/Institute of Aboriginal Health, the Department of Indian and Northern Affairs, the Government of Alberta, and the University of Alberta. Karen Goodman sought community approval for this project at a meeting she attended in Aklavik on November 21, 2006 of the Aklavik Health Committee, with representation from the Hamlet of Aklavik, the Aklavik Community Corporation, the Gwich’in Band leadership, elders, the Old Folk’s Home, and the Aklavik Health Centre. Standard data collection procedures will be developed for informed consent, participant recruitment, questionnaire administration, obtaining data from medical records, biologic specimen collection, transport of samples to Edmonton laboratories, training of personnel on data collection procedures, laboratory analyses, data management and data quality control. A manual of procedures, to be prepared under Dr. Goodman’s supervision before the initiation of participant recruitment, will outline each procedure. A community coordinator in Aklavik will oversee the local project activities, as well as transport of specimens and transfer of data to Edmonton. A research coordinator based in Edmonton will be trained on data collection procedures by study investigators, and will in turn train the Aklavik community coordinator and any participating Aklavik health centre personnel. The research coordinator will periodically travel to Aklavik to monitor the quality of data collection. A project manager based in Edmonton will work closely with Dr. Goodman to oversee study operations and the management of study data. The project manager will maintain a central database with all study data. The data will be accessible to the research team members and the Study Planning Committee. Participants will be interviewed using a structured clinical questionnaire regarding previous diagnoses of H. pylori infection or other diseases of the stomach or esophagus, previous treatments for H. pylori infection, frequency of symptoms of upper abdominal discomfort, and other indications for H. pylori testing (family history of stomach cancer, long-term use of NSAIDs or aspirin) or endoscopy (reflux, anemia, dark stools, loss of appetite, recent weight loss). In addition, relevant information will be taken from participants’ medical records. Another questionnaire will be used to interview participants about social and environmental factors. Questionnaires will be based on those developed previously by members of the research team, adapted for the local population. Interviews will be conducted privately. Study Planning Committee workshops develop strategies for communicating study information to community members during recruitment and after data collection to report study findings; particular consideration is given to targeting groups such as Youth and Elders. Facilitated by Dr. Fletcher’s Anthropology Visualization Laboratory, this dimension of the project will involve youth and other interested community members in the collaborative production of media for effective communication of study information. The fieldwork for this study will be conducted in Aklavik from March 17 to December 31, 2009.