Faculty A-Z
Laurie Twells
Assistant Dean of Clinical Research, B.A. Memorial, MSc, LSHTM, London, UK , Ph.D. MemorialCommunity Health and Humanities (CHH)
Dr. Laurie Twells MSc, PhD is a Full Professor and Assistant Dean of Clinical Research in the Faculty of Medicine at Memorial University. Dr. Twells is a clinical epidemiologist with expertise in the areas of: epidemiology, health economics, health systems, health policy and patient-oriented research.
Dr. Twells is a founding member of the national Canadian Breastfeeding Research Network (CBRN), a collaborative initiative, with a goal to increase research capacity and advocacy in Canada related to the protection, promotion and support of breastfeeding.
Research interests include: the epidemiology of obesity in Canada; prevention of childhood obesity; management and treatment of adult obesity including bariatric surgery as treatment modality; the promotion, protection and support of breastfeeding including the implementation of the Baby Friendly Hospital (BFI) initiative and the expansion of midwifery in Newfoundland and Labrador; the relationship between preconception health and fertility; and women’s health and the prevention of chronic disease.
As a clinical epidemiologist, my research is interdisciplinary, collaborative and inclusive. I work with health care professionals, decision-makers, knowledge users, patient partners and students. I use an integrated Knowledge Translation approach to mobilize knowledge and inform evidence-based practice and heath policy with the goal to improve health outcomes and people’s lives.
Current Teaching:
Clinical Epidemiology Diploma and Graduate Program: MED6250 (Clinical Epidemiology), MED6255 (Clinical Research and Design)
Selected Publications:
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1 Donnan J, Huang R, Twells L. Patient Preferences for Attributes of Health Canada Approved Weight Loss Medications Among Adults Living with Obesity in Canada: A Qualitative Study. Patient Preference and Adherence. 2022 Apr 5; 16:911-923. doi: 10.2147/PPA.S350411. |
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2 Blackmore A, Howell B, Romme K, Gao Z, Nguyen H, Allwood Newhook LA, Twells L. The effectiveness of virtual lactation support: A systematic review and meta-analysis Journal of Human Lactation. 2022 Aug; 38(3):452-465. doi: 10.1177/08903344221099914. |
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3 Moga AM, Twells LK, Mayo NE. The prototype of a preference-based index of weight-related quality of life: demonstrating the possibilities. Quality of Life Research. 2022 Oct; 31(10):3061-3075. doi: 10.1007/s11136-022-03156-5. |
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4 Blackmore A, Etchegary H, Allwood-Newhook LA, Gao Z, Nguyen HV, Parsons-Mercer K, Twells L. The use of patient engagement to gather perceptions on the cost of infant feeding. Patient Related Outcome Measures. 2022 Nov 23; 13:239-247. doi: 10.2147/PROM.S366721. |
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5 Darmonkow G, Chafe R, Aslanova R, Hagerty D, Twells L, Barter OJ, Allwood Newhook LA. A Multi-Intervention Campaign Lowers Pediatric and Young Adult Diabetic Ketoacidosis Hospitalizations in a Canadian Province. Canadian Journal of Diabetes. 2021 Dec; 45(8):792-797. doi: 10.1016/j.jcjd.2021.03.013. |
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6 Street C, Twells LK, Leamon T, Taylor L, Etchegary H. Changing Health-Related Behaviors 1: Patient-Oriented Research and Patient Engagement in Health Research. In: Parfrey PS, Barrett BJ, (eds). Clinical Epidemiology. Methods in Molecular Biology, Vol 2249. New York, NY: Humana; 2021. doi: 10.1007/978-1-0716-1138-8_29 |
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7 Twells L. Evidence-Based Decision-Making 1: Critical Appraisal In: Parfrey PS, Barrett BJ, (eds). Clinical Epidemiology. Methods in Molecular Biology, Vol 2249. New York, NY: Humana; 2021. doi: 10.1007/978-1-0716-1138-8_21. |
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8 Twells LK, Harris Walsh K, Blackmore A, Adey T, Donnan J, Peddle J, Ryan D, Farrell A, Nguyen H, Gao Z, Pace D. Nonsurgical weight loss interventions: A systematic review of systematic reviews and meta-analyses. Obesity Review. 2021 Nov; 22(11):e13320. doi: 10.1111/obr.13320. |
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9 Warren S, Midodzi WK, Allwood Newhook LA, Murphy P, Twells L. Effects of Delayed Newborn Bathing on Breastfeeding, Hypothermia, and Hypoglycemia. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2020 Mar; 49(2):181-189. doi: 10.1016/j.jogn.2019.12.004 |
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10 Taylor A, Chowdhury S, Gao Z, Van Nguyen H, Midodzi W, Gill N, Halfyard B, Newhook LAA, Twells L. Infant feeding mode predicts the costs of healthcare services in one region of Canada: a data linkage pilot study. BMC Research Notes. 2020 Aug 15; 13(1):385. doi: 10.1186/s13104-020-05228-6. |
Description of Research:
The increasing prevalence of overweight and obesity is of major concern to Canadians.
In Canada, Newfoundland and Labrador (NL) has the highest provincial rates of excess body weight as measured by the Body Mass Index.
Being classified as overweight or obese is associated with morbidity due to the increased risk of developing hypertension, cardiovascular disease, type 2 diabetes and some cancers. One area of research that I am particularly interested in is the impact of excess body weight on the health system.
I just recently finished a research study examining the impact of excess body weight on the use of the health system, specifically visits to GP’s and specialists and hospital utilization.
My study found that obese individuals had an increased utilization of GP services and increased total physician costs when compared to normal weight individuals. I am interested in further study of overweight and obese populations in NL especially the growing childhood obesity epidemic.
I am also involved in another research study on childhood obesity.
With a research team, we set out to determine if exclusive breastfeeding was protective of preschool obesity in children 4 to 5 years of age.
The composition of breast milk is such that it includes all the nutrients that a growing infant needs, as well this composition changes throughout the day to provide a growing infant with his/her daily requirements.
The process of breastfeeding allows an infant to be in full control of energy intake.
There is a growing body of evidence including that published by the World Health Organization supporting the suggestion that exclusive breastfeeding can have a protective effect on childhood obesity. This study found a protective effect.
Another line of research that I am interested in is low levels of Vitamin D in the population and the purported association with disease.
Most Vitamin D comes from exposure to the sun and is metabolized in the skin.
Other than salmon, tuna, mackerel and fortified milk there are limited food sources. We need a certain amount of Vitamin D to ensure adequate calcium absorption and reduce the risk of rickets in children and osteomalicia in adults.
There is a general consensus among researchers that many populations in the northern hemisphere have insufficient levels of Vitamin D.
In a study we recently published (2008), approximately 70% of the children, pregnant mothers and newborns tested in NL were classified as having insufficient levels of Vitamin D.
There is a growing body of evidence based on primarily observational studies that low levels of Vitamin D may be associated with an increased number of health conditions such as certain cancers, multiple sclerosis and type 1 diabetes.
As NL has a very high prevalence of many of these diseases, it is an opportune place to study Vitamin D.
With my appointment to the School of Pharmacy I also intend to pursue research in the area of Pharmacoepidemiology and drug utilization and the launch of the Pharmacy Network in March 2009 will facilitate this type of research in NL.
Selected Publications
Newhook LA, Sloka S, Grant M, Randell E, Kovacs C, Twells L. Vitamin D insufficiency common in newborns, children, and pregnant women living in Newfoundland and Labrador, Canada. (Published on-line in the Journal of Maternal and Child Nutrition)
Twells L, Doyle M, Gregory D, Barrett B, Parfrey P. Acute care restructuring in Newfoundland: the history and impact on costs. Journal of Health Services Research and Policy 2005;10(Suppl 2):4-11
Way C, Gregory D, Doyle M, Twells L, Barrett B, Parfrey P. Acute Care Restructuring in Newfoundland and Labrador: Impact of Hospital Aggregation on Health Care Provider Outcomes. Journal of Health Services Research and Policy2005;10(Suppl 2):58-67
Twells L. Obesity in Newfoundland and Labrador, Report to the Department of Health & Community Services, Government of Newfoundland and Labrador, September 2005
Barrett B, Gregory D, Way C, Kent G, Doyle M, Twells L, O’Reilly D, Parfrey P. The Impact of Restructuring on Acute Care Hospitals in Newfoundland. A report to the Canadian Health Services Research Foundation (CHSRF), March 2003
Birnbaum D, Twells L, Jandiciu E. Antimicrobial Resistance: A deadly burden no country can afford to ignore: A report to the Canadian Committee on Antimicrobial Resistance (CCAR), March 2002. Report can be found at www.ccar-ccra.com
Twells L. An Assessment of the Burden of Illness of Antibiotic Resistance in Canada. A Report submitted to Health Canada May 2001
Selected Presentations
Twells L. Adult Obesity in Newfoundland and Labrador and its Impact on Primary Health Care Services, Primary Health Care Research Unit, Memorial University. March, 2008
Newhook LA, Twells L. Is there an association between breastfeeding rates (initiation and duration) and body mass index (BMI) in pre-school children living in and near St. John’s, NL?Pediatric Grand Rounds, Eastern Health. December 2007
Twells L, Turner L, Pullman D. The Genetic Lottery, Burden of Disease and the Just Allocation of Resources. 17TH Annual Conference and Meeting of the Bioethics Society, Halifax, NS. October 2005
Twells L. Acute-Care Restructuring in NL: the History and its Impact on Costs. Strategic Conference on International Health System Reform. St. Andrew’s, Scotland. September 2004
Twells L. A Two-Tiered Publicly Administered Health Care System. The 10th Joint Canadian Conference on Health Economics. Halifax, NS. May 2002
Twells L, Knight J, Alaghebandan R, MacDonald D, Bridger T, Chen Y.
Adult Obesity and its Impact on a Provincial Health System in Canada. The Obesity Society's 2007 Annual Scientific Meeting, New Orleans, LA. September 2007 [Poster]