The cornerstone of treatment for rheumatoid arthritis is early intervention with drug therapies. There are, however, limitations to the long-term effectiveness and safety of the conventionally-used drugs. While the use of new drug therapies, called biologicals, have yielded positive results in clinical trials, these drugs are many times more expensive than the traditional therapies for rheumatoid arthritis. Already a Doctor of Pharmacy, Carlo Marra is focusing his PhD studies in Health Care and Epidemiology on the long term costs and consequences (such as health-related quality of life) of using biological agents instead of traditional drug therapies. The potential of these drugs to reduce other direct and indirect health care costs and improve quality of life for patients with severe rheumatoid arthritis may, in fact, make them more-cost-effective over the long term. The results of this study could help inform drug therapy funding decisions by provincial drug plans.
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An exploration of the consequences of health care organization and delivery for children with chronic health conditions
Health care reform is bringing about significant changes in the way health services are structured and delivered to children with chronic health conditions. Research suggests that the availability of health care services and the quality of interactions within the health care system have an immense impact on the lives of these children. But services are often fragmented, shaped by priorities that compete with children’s needs, or are not accessible to all families. Gladys McPherson’s research focuses on how the structure and organization of health care, as well as the nature and quality of interactions within the health care system, shape the lives of children with chronic health conditions. She is exploring how the principles and priorities in the health care system influence the lives of children with chronic health conditions, and the impact of their experiences with the system on their well-being, growth and development.
Reducing the injury of community homecare workers
Given that a growing number of elderly people choose to continue living at home, but need some support to live independently, community homecare services are an increasingly important part of our health care system. Recent reports indicate that the community healthcare workers who provide these services have the highest injury rate among all health care professionals in BC. With his postdoctoral research, Dr. Il Hyeok Park aims to reduce the injury rate and the cost of injuries to the health system. Dr. Park is investigating three interventions to reduce injuries: educating community healthcare workers about proper lifting techniques, using a new assessment tool to gauge possible risks at work sites, and providing mechanical lifting equipment. This project should help improve community healthcare workers’ health and the quality of homecare services.
Effects of context on coping responses of parents in universal newborn hearing screening programs
Early identification of hearing loss in newborns is associated with improved cognitive, speech, language, and social-emotional outcomes. Yet a high proportion of parents withdraw from universal newborn hearing screening programs following the first screening, even if the screening indicates a need for further testing. This is thought to be due, in part, to parents’ anxiety and stress over the initial results. Brenda Poon is investigating how the screening program environment affects the way parents cope with the stress of discovering their newborn child may have hearing loss. Based on her findings, she hopes to recommend developing services in universal screening programs that are sensitive to parents’ emotional and coping responses at each stage of the screening. With improved services in place, parents may be less likely to withdraw their child from screening programs before the infant’s hearing status can be confirmed, allowing for earlier intervention.
Sociality of pain behaviour: Potentiation by an audience
Effective pain management depends upon successful pain assessment, which is measured through careful attention to a patient’s verbal and nonverbal communications. This task is complex, because the way a patient expresses pain during assessment is influenced by the presence of health care practitioners, family members and other patients. In spite of tremendous recent advances in understanding the physiology and pharmacology of pain, the complex social relationships affecting pain communications are only now beginning to be studied. Melanie Badali’s earlier research focused upon the role of memory as it affects children’s and parents’ assessments of the child’s pain. Now, she is examining how people communicate pain if they believe the person observing can assist in relieving the pain. Melanie anticipates her investigations will help improve the accuracy of pain assessment and management, thereby ultimately reducing suffering from acute and chronic pain.
Gathering strengths: Contexts that reduce aboriginal children's risk for mental health problems
Research indicates peer victimization among children occurs every seven minutes on the playground, and every 25 minutes in the classroom. Wendy Hoglund is investigating the effects of rumour spreading, hitting, and other types of victimization on First Nations children’s healthy development in elementary school. She is examining how peer victimization affects areas such as mental health and academic competence. She is also assessing whether First Nations children in schools with more First Nations children and First Nations Programs, for example, experience less peer victimization and have better mental health, social, and academic outcomes than First Nations children in other school contexts. Wendy hopes this information will the development of preventative policies and programs to promote the health of First Nations children in Canada.
The effects of bone mineral density (BMD) testing on behaviour change over 3 years
Osteoporosis develops when bone density deteriorates, which causes bones to become fragile and fracture easily. Little data exists to demonstrate whether people modify their lifestyle after receiving bone density test results that indicate they are at risk of osteoporosis. Elaine Kingwell is assessing whether bone density testing influences people to seek information about osteoporosis and to adopt preventative behaviours believed to have a positive impact on bone density. The behaviours include increasing calcium and vitamin D intake, participating in physical exercise, and taking medications to prevent and treat osteoporosis. Elaine is also studying the way bone density test results are communicated to patients, to determine whether people are more likely to make lifestyle changes when they receive their results directly or when results are sent via their family physician.
The relationship between socioeconomic status and short-acting beta-agonist use by asthmatics in BC
Asthma is a chronic disease that affects approximately one in 20 Canadians. Research has shown an association between lower socioeconomic status and poorer outcomes for asthma patients, including more hospital admissions and emergency room visits and a greater likelihood of a fatal attack. Excessive use of short-acting bronchodilators, which help manage acute episodes of asthma, indicates inadequate asthma control and has been associated with poorer outcomes. Larry Lynd is investigating whether there is a relationship between lower socioeconomic status-measured by education, income, occupation and characteristics of residence-poor asthma control, and the overuse of bronchodilators. Confirming that relationship could determine whether inappropriate management of asthma is at least partially responsible for poorer outcomes. Larry hopes this research can lead to policies and strategies aimed at improving the management of asthmatics of lower socioeconomic status.
An evaluation of the full circle project: The effects of a theatre-based HIV prevention intervention on audience and actor/educator learning
What are the best ways to ensure young people listen to and act upon information about avoiding high risk sexual behaviours? This is the research focus for Josephine MacIntosh, who is delving into the individual, social and cultural factors that may perpetuate the epidemics of HIV and sexually transmitted diseases, especially among young women. Josephine is studying the effectiveness of using a theatre-based intervention program among youth aged 13 to 15. The theatre productions will consist of a series of original dramatic productions researched, scripted, produced and presented by youth volunteers. She hopes to develop an educational approach that can engage the audience and actors as they learn about issues such as abstinence, treatment of HIV and sexually transmitted disease, pregnancy prevention, decision-making, peer-pressure, negotiation for safer sex and alternative safer sexual behaviours.
Transcriptional regulation of HIV LTR and mechanism of HIV latency and reactivation
Anti-retroviral therapy for HIV typically suppresses the virus in patients’ blood to undetectable levels, enabling people with the infection to live symptom-free. However, some T cells are latently infected by HIV and remain unaffected even by prolonged treatment. These latently infected cells and other lymphocytes pose the major barrier to eliminating HIV infection, and provide a latent reservoir for the virus to reactivate. Long-term anti-retroviral treatment can also cause HIV resistance to therapy in some patients. An alternate strategy is therefore needed to target the latently infected virus and ultimately cure AIDS. Dr. Jiguo Chen is researching how HIV-1 establishes latency and how it reactivates. He and other colleagues in the Sadowski lab have isolated and identified a complex of several transcription factors termed RBF-2 (Ras-responsive element binding factor), which binds to HIV long terminal repeat (HIV-1 LTR) and represses HIV-1 transcription during latency. He believes that this complex plays a role in establishing and maintaining latency. He is using several different experimental strategies to determine the role of RBF-2 and to learn how it works during latency and reactivation, so new drug therapies can be designed to clear HIV from patients’ immune systems.