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When clinicians are focusing on lifestyle changes for the management and prevention of multiple chronic conditions, they will often ask patients about their alcohol consumption, smoking habits, exercise regime and diet. But what about the quality and duration of their sleep?

Researchers at Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry have shown that how well you sleep and for how long is linked to increased odds of living with multiple chronic conditions, and argue that promotion of good sleep habits should be given greater focus in clinical practice and public health.

The study, “Sleep behaviours and multimorbidity occurrence in middle-aged and older adults,” was recently published in the journal Sleep Medicine. Funded through Lawson’s Internal Research Fund, it used data from more than 30,000 adults over the age of 45 who were part of the Canadian Longitudinal Study on Aging (CLSA).

“Sleep is still a neglected clinical and public health issue, and this study provides additional evidence of the potential role of sleep for the prevention and management of several chronic conditions,” said Dr. Saverio Stranges, principal investigator on the study, Professor and Chair of the Department of Epidemiology and Biostatistics at Schulich Medicine & Dentistry, and Lawson Associate Scientist. 

The team looked specifically at the occurrence of multimorbidity, which is defined as having multiple chronic conditions (two or more) that have been diagnosed in a single individual. The conditions can include relatively common chronic disease such as diabetes and hypertension, to depression and cancer, among others.

The study found that there was a consistent relationship between the odds of multimorbidity and self-reported poor sleep quality and altered sleep duration, which includes both too much and too little sleep.

Specifically, male participants who were dissatisfied or very dissatisfied with their sleep had a 20 per cent increase in the odds of multimorbidity. And participants aged 65 to 74 years of age who self-reported dissatisfaction with their sleep quality had a 43 per cent increase in the odds of multimorbidity. 

When looking at sleep duration, while the study found a link between multimorbidity and getting too little sleep, the researchers actually found that too much sleep had a much stronger link.

Female participants who self-reported short sleep duration (less than 6 hours a night) had a 16 per cent increase in the odds of multimorbidity and those who self-reported long sleep duration (more than 8 hours a night) had a 44 per cent increase in the odds of multimorbidity. Male participants who self-reported long sleep duration had a 45 per cent increase in the odds of multimorbidity. 

Previous international research has shown an association between sleep and a range of chronic conditions, but this is the first Canadian study to look specifically at the relationship between sleep and multimorbidity among middle-aged and older adults.

“This study highlighted an important relationship between self-reported sleep patterns, both duration and satisfaction, and the odds of multimorbidity among older female and male adults in Canada,” said Dr. Kathryn Nicholson, Adjunct Assistant Professor at Schulich Medicine & Dentistry, who was the lead author on the study. “Although it is important to acknowledge that this relationship was cross-sectional and causation cannot be determined from this study, we were fortunate to utilize a comprehensive data source like the CLSA, which allowed us to examine both the self-reported patterns of sleep and the occurrence of multimorbidity.”

The authors point out in the paper that there is already established evidence showing that lack of sleep has negative effects on the cardio-metabolic, endocrine, immune and inflammatory systems, and that over the past several decades the population has been experiencing poorer quality of sleep.

“This is concerning because if poor quality of sleep can increase the risk of a range of chronic conditions, then we should be concerned about sleep hygiene and put that at the centre of our focus both as clinicians and as public health scientists,” said Dr. Stranges.

The researchers will be continuing their research by using the first set of follow-up data from the CLSA to begin to explore longitudinal patterns between multimorbidity and other health indicators.

“High-quality sleep can be very beneficial, but achieving this high-quality sleep can sometimes be a challenge.  We hope that this study will continue to emphasize the importance of focusing on sleep as a key health indicator and ideally, this assessment of sleep will include a focus on sleep quality and sleep duration and be a point of conversation during a clinical encounter for all patients living with multimorbidity,” said Nicholson.

Additional study authors are Rebecca Rodrigues, Dr. Kelly K. Anderson, Dr. Piotr Wilk and Dr. Giuseppe Guaiana.

In a new study, researchers in London, Ontario found that women who used marijuana while pregnant were almost three times more likely to have an infant with low birth weight than women who did not use marijuana.

The study analyzed data from perinatal and neonatal databases at London Health Sciences Centre (LHSC) and is the first large-scale study in Canada to show this association between marijuana use among pregnant women and low birth-weight infants.

It was conducted by researchers at Lawson Health Research Institute, Western University and Brescia University College.

Maternal amphetamine use, chronic hypertension and smoking were identified as other top risk factors for low birth weight. The study also examined predictors of preterm birth, which included previously diagnosed diabetes, maternal narcotic use and insulin-controlled gestational diabetes.

“Low birth weight and preterm birth are serious public health problems. Both are associated with a higher risk of infant mortality,” says principal investigator Dr. Jamie Seabrook, a Lawson associate scientist; and professor at Brescia University College, an affiliate of Western University, and Western University’s Schulich School of Medicine & Dentistry.

Low birth weight can lead to respiratory problems and asthma, and poor cognitive development during childhood. It also increases an infant’s risk of developing type 2 diabetes, hypertension and cardiovascular disease later in life. Preterm birth can cause childhood neurologic disability, as well as long-term medical consequences including respiratory, gastrointestinal and cardiovascular diseases and decreased immunity.

The research team investigated many potential factors that could be linked to birth outcomes, including demographics, prenatal factors and medical risks. The objective of the study was to determine the relationship between socioeconomic status and adverse birth outcomes, particularly low birth weight and preterm birth, in Southwestern Ontario.

However, they found that socioeconomic status had little influence on birth outcomes.

“There is a widely-held view that socioeconomic status is highly associated with low birth weight and preterm birth. However, there have been few population-based studies investigating this relationship in Canada. Most of this research has come from other developed countries, particularly the United States,” says Dr. Seabrook, who is also a Faculty Associate at Western’s Human Environments Analysis Laboratory. “It’s possible that Canada’s universal health care system provides a larger safety net for these mothers and their children.”

Live births between February 2009 and February 2014 at LHSC were included in the study. Infants with a birth weight of less than 2500 grams were classified as low birth weight. Preterm birth was defined as a live birth at a gestational age of less than 37 weeks.

The rates of low birth weight and preterm birth found in the study were 6.4 per cent and 9.7 per cent, respectively. The study notes that these rates are comparable to those reported by the Canadian Institute for Health Information in 2010-11, which found that 6.6 per cent of infants in Canada had low birth weight and 8.1 per cent were preterm births.

Median neighbourhood income was used as an indicator of socioeconomic status. Postal codes of the mothers were entered into a Geographic Information System and mapped to determine the location of home neighbourhoods, defined by boundaries of census dissemination areas. Dr. Seabrook adds that while the database used in the study included a large population-based sample, it is possible there may be incomplete or inaccurate data since it was obtained from chart records. For example, information on individual household income and length of time at an address was not available.

Along with Dr. Seabrook, the research team included Dr. Jason Gilliland, a scientist at Children’s Health Research Institute (a program of Lawson), Director of the Human Environments Analysis Laboratory at Western and professor at Schulich Medicine & Dentistry; Dr. Barbra de Vrijer, associate scientist at Children’s Health Research Institute, consultant in LHSC’s Obstetrics & Gynaecology department and associate professor at Schulich Medicine & Dentistry; Dr. Debbie Penava, Lawson scientist, LHSC physician and associate professor at Schulich Medicine & Dentistry; Dr. Paula Dworatzek, Chair and Associate Professor, School of Food and Nutritional Sciences at Brescia University College; and Emily Campbell, MScFN, RD, who was a graduate student at Brescia University College at the time of the study.

“Socioeconomic status and adverse birth outcomes: A population-based Canadian sample” was published in the Journal of Biosocial Science.

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Above: Dr. Jamie Seabrook

When patients with testicular cancer undergo lymph node removal surgery there is a risk that their fertility will be affected if proper nerve sparing techniques are not used. Up to 75 per cent of men will not be able to father children if they receive the surgery without these techniques.

Lawson’s Internal Research Fund (IRF) has awarded a grant to Dr. Nicholas Power, a researcher at Lawson and urologic oncologist at London Health Sciences Centre (LHSC), who is leading a study to identify the nerves involved in fertility that are affected in lymph node removal surgery for testicular cancer.

“Sometimes patients go through a lot to be cured of testicular cancer only to be left dealing with long-term survivorship issues such as fertility. We hope to gain new insights into how fertility can be preserved after these men receive lymph node removal surgery,” says Dr. Power, who is also an assistant professor at Western University’s Schulich School of Medicine & Dentistry.

In collaboration with Schulich assistant professors Dr. Marjorie Johnson and Dr. Brian Allman, and PhD candidate Tyler Beveridge, Dr. Power published initial results in The Journal of Urology announcing their discovery of a brand new anatomic structure, the pre-hypogastric ganglion, which needs to be spared in surgery to maintain fertility. They were also able to describe the first roadmap of retroperitoneal neuroanatomy – the anatomy of nerves in the space where surgeons locate lymph nodes most commonly affected by testicular cancer that has spread.

“There has never been a definitive anatomic study of the nerves of the retroperitoneum so it was our goal to provide the first comprehensive study of the nerves as they relate directly to patients who have testicular cancer,” explains Dr. Power. “After we published the initial results we were approached by textbook authors to use our data in upcoming editions of anatomy and surgical atlases. This will help to provide insight into nerve sparing techniques for surgeons who have not been trained at high-volume centers and ultimately improve the quality of care in testicular cancer patients overall.”

Already Dr. Power has found that using this knowledge when he performs lymph node removal surgery for testicular cancer has led to a 95 per cent success rate of preserving fertility.

The IRF will go towards their research to further investigate the actual function and physiology of the retroperitoneal neuroanatomy using a pig model.

“Lawson’s IRF provides incredible support for a field of study such as ours that is not yet at the stage of applying for a large grant. Receiving the funding gives us the independence to test out novel yet important hypotheses that will then lead us to further grants,” says Dr. Power.

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Above: Dr. Nicholas Power

The IRF is designed to provide Lawson scientists and students the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph's Health Care Foundation).

Health researchers in London and across Canada welcomed news that the federal government will provide urgently-needed financial support for research teams whose work has been largely shut down by the COVID-19 pandemic. 

Prime Minister Justin Trudeau has announced $450 million in new funding to help Canada’s academic research community during the COVID-19 pandemic. 

“Research staff in Canada are the source of new innovations and ideas that help keep us healthy, protect our environment, and drive our economy. We are fortunate to have some of the world’s brightest minds. We are making sure Canadian universities and health research institutes have the support they need to sustain their research capacity through this difficult situation, and continue to attract and retain talent, for the benefit of all Canadians,” says The Rt. Hon. Justin Trudeau, Prime Minister of Canada. 

The investment will: 

• Provide wage supports to universities and health research institutes, so they can retain their research staff who are funded from industry or philanthropic sources and are unable to access some of the government’s existing COVID-19 support measures. This would apply even if their work has been temporarily suspended. The government will provide up to 75 per cent per individual, with a maximum of $847 per week. 
• Support universities and health research institutes to maintain essential research-related activities during the crisis, and to ramp back up to full research operations once physical distancing measures are lifted. This will cover up to 75 per cent of total eligible costs, and will support activities such as the safe storage of dangerous substances and restarting data sets that were interrupted during the pandemic. 

“Research personnel in our universities and health research institutes are significant drivers of science, discovery, and innovation in Canada. By providing these institutions with immediate support, we continue to nurture Canada’s talent pipeline and sustain our innovation capacity, while helping to mitigate the negative impacts of COVID-19 on the research community,” says The Hon. Navdeep Bains, Minister of Innovation, Science and Industry. 

This announcement follows a tremendous effort by organizations and individuals across Canada over the course of this pandemic to secure support for hospital-based research. From outreach and meetings to letters and media interviews, many advocacy-based initiatives were undertaken to bring this important issue to the attention of key decision-makers. HealthCareCAN spearheaded these efforts, working tirelessly on behalf of the national health research community. 

Lawson is extremely thankful to the federal government for recognizing the critical importance of protecting Canada’s research enterprise and providing urgently-needed financial support. “While we know financial pressure remains, this will help to keep research teams intact while research has been interrupted and provide assistance for when research activities gradually resume,” says Dr. David Hill, Lawson Scientific Director. 

A special thank you to local MP Peter Fragiskatos for London North Centre who took up this issue in Ottawa. His strong leadership and representation made the key difference in successfully securing this new funding. 

“Tackling the COVID-19 crisis in Canada has required an all-hands on deck approach and Canada’s health researchers have answered the call by suspending all other crucial hospital-based research to meet the challenge,” adds Dr. David Hill. “With this federal support we can now work to ensure that we can maintain other critically needed research on other diseases even as we pursue what promises to be a lengthy battle against COVID-19.” 

Background: 

• Canadian healthcare-based research is a $3 billion annual sector of the economy and employs 50,000 highly skilled researchers and other staff across the country. 
• Health research is one of Canada’s great national achievements and biomedical research conducted in Canada is at the forefront of current essential research and clinical trials around COVID-19. 
• This work is fundamental to life in a society and a key driver for progress, innovation and the economy. Canada’s health researchers are global leaders in driving improvements in disease prevention, diagnosis, treatment and care. 
• Ontario’s research hospitals have long been the engines of health invention and discovery in provincial and national innovation. From Ottawa, London, Toronto, Kingston, Sudbury and Thunder bay, the more than 20,000 researchers and staff at these hospitals are driven by their passion to improve health. 

See also: 

• Prime Minister announces support for research staff in Canada – Government news release 
• Canada’s health research enterprise welcomes federal support – HealthCareCAN media release 
• OHA Media Statement re: Federal Government Supporting Ontario’s Hospital-Based Research Enterprise 

In a new study from Lawson Health Research Institute (Lawson) and Western University, researchers have shown that probiotics can potentially protect honey bees from the toxic effects of pesticides.

Honey bees are critical to agriculture as they pollinate approximately 35 per cent of the global food crop, contributing an estimated $4.39 billion per year to the Canadian economy. Pesticides are currently used to maximize crop yields, but the most common pesticides, neonicotinoid insecticides, are a major factor in colony collapse disorder which is killing honey bee populations.

“The demise of honey bees would be disastrous for humankind. A current dilemma in agriculture is how to prevent bee decline while mitigating crop losses,” says Dr. Gregor Reid, Director for the Canadian Centre for Human Microbiome and Probiotic Research at Lawson, and Professor at Western’s Schulich School of Medicine & Dentistry. “We wanted to see whether probiotics could counter the toxic effects of pesticides and improve honey bee survival.”

The study was performed by trainees Brendan Daisley and Mark Trinder in Dr. Reid’s lab at St. Joseph’s Hospital in London, Ontario. The researchers utilized fruit flies as a well-known model for studying pesticide toxicity in honey bees. Both insects are affected similarly by neonicotinoids, have very similar immune systems, and share many common microbes present in their microbiota – the collection of microorganisms found in each insect.

The researchers found that fruit flies exposed to one of the world’s most commonly used pesticides, imidacloprid (IMI), experienced changes to their microbiota and were more susceptible to infections. The flies were exposed to a comparable amount of pesticide as honey bees in the field.

By administering a specific strain of probiotic lactobacilli, survival among fruit flies exposed to the pesticide improved significantly. The mechanism involved stimulating the immune system through a pathway that insects use to adapt to infection, heat and other stresses.  

“Our study showed that probiotic lactobacilli can improve immunity and potentially help honey bees to live longer after exposure to pesticides,” says Daisley, an MSc candidate. He notes that probiotic lactobacilli could be easily administered through pollen patties, which are used by beekeepers to provide nutritional support and anti-pesticide effects to honey bees.

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Above: Brendan Daisley, an MSc candidate at Western's Schulich School of Medicine & Dentistry, working in Dr. Gregor Reid's lab at St. Joseph's Hospital

Over the winter months, honey bee mortality has been steadily increasing with ranges of 38 to 58 per cent in recent years, two to three times higher than the sustainable level. In Ontario alone, 340 bee keepers reported an abnormally high number of bee deaths, with over 70 per cent of dead bees testing positive for neonicotinoid residues (Government of Ontario).

“While cessation of pesticide use would be ideal, farmers currently have little alternative to obtain the yields that keep their businesses viable,” says Dr. Reid. “Until we can cease using pesticides, we need to find ways to protect humans and wildlife against their side effects. Probiotics may prove as an effective protective intervention against colony collapse disorder.”

The researchers hope to further study the mechanisms involved in this process and perform field tests on honey bee populations in Ontario.

The study, “Neonicotinoid-induced pathogen susceptibility is mitigated by Lactobacillus plantarum immune stimulation in a Drosophila melanogaster model”, is published in Nature’s Scientific Reports. The research was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC).

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Above: Dr. Gregor Reid, Director for the Canadian Centre for Human Microbiome and Probiotic Research at Lawson, and Professor at Western’s Schulich School of Medicine & Dentistry

A recent study suggests the use of probiotics to prevent respiratory tract infections in Canada could result in nearly $100 million per year in savings.

There is growing evidence that probiotics can reduce the risk of respiratory tract infections and lower their frequency, as well as reduce the duration of an infection, antibiotic use and absences from work. Replicating a research model used in France, researchers examined the potential clinical and economic impacts in Canada.

Sponsored by The Alliance for Education on Probiotics, the study included researchers from Lawson Health Research Institute (Lawson), Western University, Laval University and Utrecht University. It incorporated two separate scenarios from two meta-analyses. A meta-analysis combines data from multiple studies using a statistical approach.

Results from the study showed that regular probiotic use could eliminate between 573,000 to 2.3 million days per year of respiratory tract infections, resulting in 330,000 to 500,000 fewer sick days for Canadians and 52,000 to 84,000 fewer antibiotic prescriptions. This would translate to $1.3 to $8.9 million in health system savings. When accounting for productivity losses due to illness, it could save $61.2 to $99.7 million.

Respiratory tract infections are highly contagious infections of the sinus, throat or airways, including influenza or ‘the flu.’ Currently, 5 to 20 per cent of the Canadian population experience at least one respiratory tract infection per year. It’s estimated that respiratory tract infections represent 2.9 per cent of all health care costs in Canada.

“If we could reduce the burden of respiratory tract infections, it would benefit both patients and Canadian taxpayers,” says Dr. Gregor Reid, Director for the Canadian Centre for Human Microbiome and Probiotic Research at Lawson, and Professor at Western’s Schulich School of Medicine & Dentistry.

The research showed that children under the age of 10, individuals living in a community setting (including office work in open spaces) and those not vaccinated against influenza would benefit the most.

Respiratory tract infections are typically viral in nature. Existing treatments rely on symptom control while an estimated 26 per cent of patients are also prescribed antibiotics. These antibiotics are largely unnecessary since antibiotics are not effective against viruses. “Antibiotics are often prescribed even when an infection is likely to be viral. Antibiotics can have serious side effects like destroying many beneficial bacteria in the human body,” says Dr. Reid. 

Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”

“People are increasingly making probiotics a part of their daily diet or dietary supplements for their proven health benefits,” explains Dr. Reid “The fact that probiotics can also be used to prevent respiratory tract infections makes them even more important.”

Dr. Reid notes that several probiotic products can be effective in preventing respiratory tract infections, as outlined in the Clinical Guide to Probiotic Supplements. These include probiotic yogurts and oral capsules.

The study, “The Clinical and Economic Impact of Probiotics Consumption on Respiratory Tract Infections: Projections for Canada,” is published on PLoS One.

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Above: Dr. Gregor Reid (Photo credit: Schulich School of Medicine & Dentistry)

As the world’s most important single species of pollinators, honey bees perform many ecosystem functions. They are critical to the global food supply. 

Honey bee populations are declining at alarmingly high rates here in Ontario and around the world. 

“If the bees disappear, humanity is in big trouble” states Dr. Gregor Reid, Lawson researcher and professor at Western. He is also the leading scientist for the study. “Imagine walking into the grocery store and a third of the food wasn’t there. That is what would happen.”

Pesticide exposure, infection and habitat loss are the main factors suspected to be causing the decline in honey bee populations. Pesticides in particular make infections more severe and exacerbate the consequences of nutritional deficiencies in habitat loss – making those problems even worse.  

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Since current industrialized agricultural practice rely on pesticides to maintain high crop volume, their complete removal from the equation is not currently feasible. 

“We need an alternative solution that interferes with this process where high level of pesticides cause issues like infections and habitat loss to have more severe consequences for the honey bees,” says Dr. Reid. “Supplementing honey bees with probiotic bacteria is that solution, we believe.” 

“It may sound overly dramatic to state the research will ‘save the world’s honey bees’, but that is the goal, and other groups around the world are trying to follow this lead.”

The group of researchers from Lawson Health Research Institute and Western University are supplementing honey bees with a nutritional food item containing three carefully chosen strains of beneficial or probiotic bacteria to improve the overall health of the hive and specifically address infection and nutritional needs. 

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“We are creating what we call a BioPatty. In addition to normal nutrient substances, we infuse it with a select recipe of probiotics,” explains Dr. Graham Thompson, the regional bee expert and professor at Western University who helped set up the field-testing site and manages of the honey bee hives. “Our goal is to make the bees healthier and their immune system more vigorous. This helps them stay efficient and do their important jobs, and not be so vulnerable to the stressors of living in an urban and industrial world.”

The team’s previous scientific findings in a fly model, showed that these bacterial strains could reduce the toxic effects of pesticides and increase resistance towards infection. In May 2018, they moved their research from the lab and into the field thanks to OMAFRA funding, and started to test their BioPatties in a local apiary. 

American Foulbrood caused by the pathogen Paenibacillus larvae, attacked the hives. This is one of the most serious honey bee diseases. Infection outbreaks nearly always lead to complete colony collapse and loss of the hive.  “But the hives that were given the probiotics were the only ones not to be destroyed, so that was an encouraging early result,” says Brendan Daisley, a PhD student with Dr. Reid who was involved with the development of the research and coordinates sample processing and data collection. 

“These results have far-reaching implications as American Foulbrood, despite its geographically-suggestive name, infects honey bees worldwide. It causes a tremendous financial burden to apiary owners and famers alike, who rely on honey bees directly or indirectly as a means of livelihood,” explains Daisley. 

The probiotic approach might reduce the need for antibiotics that are so commonly used in many apiaries. 

This work is taking place in London, Ontario and the study will continue over the next three years. Going forward, the researchers are planning to work with collaborators in a number of other countries around the world to determine the feasibility of large-scale implementation of probiotics for honey bees. 

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