Canada is an aging society, and the proportion of Canadians older than 65 is estimated to double within the next 10 years. It is well known that aging is associated with declining health, but there is also tremendous variability in aging outcomes. While physical activity can reduce the risk of many age-related diseases, such as cardiovascular disease and diabetes, Canadian seniors have low rates of physical activity.
Dr. Christiane Hoppmann’s research takes an innovative approach to examining key psychological factors, such as goals and planning, that may explain why some seniors are successful at implementing physical activity into their daily lives while others remain physically inactive. There is also recognition that the translation of physical activity goals into action demands cognitive and emotional resources that become increasingly limited with aging. For example, seniors with memory failures and fear of falling may encounter more difficulties engaging in physical activity. Hoppmann’s team will conduct an in-depth investigation of the psychological determinants of daily physical activity using a design called time-sampling. This method, which involves seniors completing a diary of their physical activities, memory, and emotions several times a day, will allow an examination of daily fluctuations across domains of functioning. Physical activity will also be assessed using portable electronic devices worn on the hip called accelerometers. Hoppmann’s team will also conduct one- and two-year follow-up assessments to link daily physical activity with long-term physical and mental health.
This research constitutes an important step to better understanding the psychological determinants of physical activity in seniors and their impact on physical and mental health. Findings will inform novel interventions (e.g. targeting goals and emotion-regulation) to promote healthy aging in community-dwelling and particularly vulnerable seniors in Canada.
Millions of newborns and infants die each year from infectious diseases. Many of these deaths are preventable, and analysis of the immune development of children can help define paths for medical intervention that may save lives.
Dr. Tobias Kollmann’s research team is conducting the first global comparison of immune development in cohorts of children from different countries. This project will compare the immune development of children born in Vancouver to those born in South Africa, Mozambique, Ecuador and Belgium. Preliminary research has found striking qualitative and quantitative differences in children’s immune development that appear to be directly related to their genetic make-up as well as the particular environment to which they are exposed. Kollmann’s team is dissecting the cause-effect relationship for the role of host genetics and studying the environmental factors that direct the developmental path of the innate and adaptive immune responses. Analysis of these genetic and environmental factors will potentially reveal pathways that direct future efforts to treat and prevent infectious diseases.
Kollmann’s team is already developing a platform that will help deliver targeted vaccinations to protect newborns. Using genetically altered strains of Listeria monocytogenes, the vaccine will induce a desired immune response only in specific cells and then disappear without harming the child. Preliminary data suggest this goal is within reach, and Kollmann’s team is working in partnership with industry to design and test a Listeria-based vaccination for newborns. Through this work, safe yet effective methods will be identified to prevent millions of newborn and infant deaths due to infectious diseases.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a syndrome marked by inattention and/or hyperactivity/impulsivity that affects 5-8 percent of Canadian youth. It makes up the most frequent referral for children’s mental health services and is associated with considerable psychosocial morbidity. A significant aspect of the impairment in ADHD is the difficulty these children face in getting along with peers. More than half of children with this condition are severely disliked by their peers or do not have a single friend. Peer problems result in loneliness and sadness for children with ADHD, and heighten the risk for future school failure, drug abuse, and delinquency. Treatments for the core symptoms of ADHD are ineffective at changing peers’ liking of children with ADHD, and if existing treatments do not also improve peer relationship problems, children with ADHD remain likely to experience poor health outcomes. These findings underscore the importance of developing adjunctive treatments capable of addressing the peer problems faced by children with ADHD.
Dr. Amori Mikami’s research focuses on the development, efficacy testing, and knowledge translation of novel psychosocial interventions for peer problems in children with ADHD. She proposes to expand upon an innovative intervention: training parents to improve the peer relationships of their children with ADHD. This is known as parental friendship coaching (PFC). Supported by the National Institute of Mental Health, Mikami created the PFC intervention and demonstrated in a randomized trial of 62 children with ADHD that PFC appeared effective relative to a no-treatment control group.
Mikami is following up on these promising preliminary results with a more definitive test of PFC and a better study of the mechanisms behind treatment efficacy. She will compare PFC against an active attention control intervention (to ensure the incremental value of the PFC techniques beyond social support and therapist time), involve 150 children from two diverse areas in Canada, follow up with participants eight months post-intervention, and use a thorough battery to measure outcomes, mediators, and moderators. Future studies will focus on disseminating new knowledge about PFC and peer problems to practitioners.
Malignant lymphomas are the fifth most frequent cancer in humans, affecting patients of all ages. Despite generally effective treatments, a significant number of patients still die from the progressive disease. Interactions of the malignant cells with cells of the tumor microenvironment are increasingly recognized to play a pivotal role in the development of many lymphoma subtypes. However, the clinical potential of an improved understanding of microenvironment-related biology remains largely untapped.
Dr. Christian Steidl’s research focuses on B-cell lymphomas; in particular on the two related subtypes — Hodgkin lymphoma and primary mediastinal B-cell lymphoma — that often affect adolescents and young adults. This study will investigate tumor microenvironment interactions as therapeutic targets in B-cell lymphomas. Steidl’s team will seek to elucidate the underlying pathobiology of the tumor microenvironment, and macrophage interactions in particular, to identify novel drug targets and pave the way for the design of innovative clinical trials.
The study will also identify outcome predictors and resistance mechanisms of childhood and adult Hodgkin lymphoma. Molecular treatment outcome predictors will be developed using genomics approaches. Better outcome prediction using biological markers will identify patients at high risk and allow for personalized treatment approaches for children and adults suffering from relapsed Hodgkin lymphoma. Specifically, the recent emergence of novel targeted therapies holds the promise to overcome this high risk using these therapies to augment or replace existing therapies.
Finally, this research will define the mutational landscape of Hodgkin lymphoma and primary mediastinal B-cell lymphoma. This will involve the complete characterization of mutations by next-generation sequencing approaches. Preliminary data indicate that somatic mutations in both diseases are critically deregulating molecular pathways that might be targetable by novel therapeutic approaches. These studies will aim to transform novel findings into meaningful advances in clinical hematology.
Canadians take part in medical tourism when they travel to other countries with the intent of accessing private medical care. It has been speculated that medical tourism by patients from countries such as Canada is exacerbating health inequities in destination countries, and particularly in developing countries. However, there is a lack of evidence demonstrating that this is the case. There is also a lack of evidence to support claims that medical tourism is having a positive impact on destination countries by enhancing health-care infrastructure and bringing revenues into the public sector, among other potential benefits.
Dr. Valorie Crooks and her team are addressing this pressing knowledge gap by qualitatively examining the health equity impacts of medical tourism in six purposefully selected sites: Bridgetown, Barbados; Guatemala City, Guatemala; Monterrey, Mexico; Mexico City, Mexico; Chennai, India; and Bangalore, India. The results will be useful to Canadian health service providers and administrators, as medical tourism poses particular challenges to Canada. While the ethos of our health-care system rejects two-tiered care for essential services, the number of Canadian medical tourists paying out-of-pocket to go abroad is already considerable and steadily increasing. This research will allow for valuable insights to be gleaned early on in the “global conversation” about medical tourism, ultimately allowing Canadian patients to make informed choices and Canadian health-care providers and administrators to provide needed guidance to patients. The findings will also help Canadian health policy makers ensure that Canada’s normative and legal obligations to improve global health equity are being met, and that efforts to expand universal health-care and sustainable health system financing efforts in destination countries are not being undermined through the medical tourism industry and Canadians’ participation in it.
Access to antiretroviral therapy (ART) for HIV infection has dramatically increased in recent years. More than eight million people worldwide are now being treated, the majority of whom reside in sub-Saharan Africa. The success of ART roll-out has been possible through large increases in funding, but has been facilitated by the promotion of the “public health approach” to implementing ART in resource-limited settings. The public health approach is characterized by simplified drug formularies and standardized treatment monitoring, which does not insist on laboratory tests that are commonly used for ART management in industrialized countries.
In regions of the world where ART became widely available in the mid 1990s, such as British Columbia, ART expansion was associated with dramatic declines in HIV-related mortality and HIV transmission. However, the population-level impact of ART programs in Sub-Saharan Africa remains to be seen. Dr. David Moore’s program of research will examine how health policies regarding the design and implementation ART treatment programs in Uganda, a low-income country with a generalized HIV epidemic can potentially affect the future shape of the epidemic there.
Unplanned pregnancy is a problem in BC, especially among vulnerable populations who face stark economic, education-related, and work consequences. Women in BC spend almost 30 years trying to avoid pregnancy, compared with an average of less than three years spent pregnant or trying to conceive. Current surveys indicate that few women use highly effective contraception methods. Half of all pregnancies are unplanned and almost a third of BC women have an abortion. BC has Canada’s second highest abortion rate, and without the recent rate declines seen nationally. Moreover, vulnerable populations are overrepresented among those with unplanned pregnancies and especially among those seeking abortion.
Dr. Wendy Norman’s research program will develop evidence to support improvements to family planning access, quality of care, and health policy. This research will involve innovation end-users (health professionals, health system leaders, and an advisory board of citizens) in problem identification, prioritization, and research design leading to facilitated uptake of solutions. Norman’s research utilizes content expertise, collaborations, and trust established over decades as a respected and effective physician leader in this field. This program builds on more than $1.3 million dollars of project-based funding already in place and infrastructure support from research institutes, hospitals, and the University of British Columbia. Research partnerships have been established with all relevant health service organizations and health decision leaders in BC and are now forming with those across Canada.
This innovative program of research and capacity-building will transform health service delivery of family planning in BC and throughout Canada. Women, especially among vulnerable populations, will experience improved access to high quality family planning via. equity-enhancing strategies within BC’s evolving health-care system.
HIV treatment has advanced remarkably since 1996, with the advent of highly active antiretroviral therapy (HAART). HAART stops HIV replication and, as a result, the virus is reduced to undetectable levels. This allows immune reconstitution to take place, leading to long-term disease remission and prolonged survival.
The BC Centre for Excellence in HIV/AIDS (BC-CfE) has demonstrated that HAART renders HIV undetectable in sexual fluids and can dramatically reduce HIV transmission. As a result, the BC-CfE is engaged in a number of HIV “treatment as prevention” initiatives aimed at expanding HIV testing and treatment within BC and internationally to decrease HIV-related morbidity and mortality, as well as HIV transmission.
Dr. Bohdan Nosyk’s research is focused on cost-effectiveness analysis of treatment as prevention strategies to inform the most effective allocation of scarce health resources. The initial objective of this proposal is to construct a mathematical cohort simulation model to determine the cost-effectiveness of HAART scale-up in terms of the total costs accumulated, quality adjusted life years, and HIV incidence in BC from 1996 to 2010. A series of statistical and econometric analyses are required to estimate the relevant clinical and economic parameters needed to populate the simulation model. These analyses will be facilitated by the availability of linked administrative datasets and prospectively collected longitudinal data of HAART utilization, duration, and health outcomes at the population level in BC. The analyses will be stratified by HIV acquisition risk factor. This model will be used to predict the potential impact and cost-effectiveness of future policy changes in BC and internationally.
The men and women who work in Canada’s off-street sex industry are an underserved and poorly understood population that represents the majority of the Canadian sex worker populace. Men and women off-street sex workers experience an array of interrelated factors known to be associated with significant morbidity and mortality including violence and victimization, economic vulnerability, limited access to health services, substance abuse, arrest, exploitation, inconsistent condom use, STI, and HIV.
Dr. Victoria Bungay’s research program seeks to contribute to the growing body of knowledge addressing the intersecting causes and contributing factors that exacerbate vulnerability for health inequities among the men and women who work in the off-street sex industry. This knowledge is critical to informing effective multi-level interventions aimed at protecting sex worker health and safety. Informed by critical perspectives on the connection between health and social issues, the research program will:
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Identify and examine how specific health issues (e.g. STI, HIV, violence, exploitation) and social processes (e.g. racism, poverty, heterosexism, sexism) intersect in ways that may compound their effects and exacerbate health inequities.
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Generate policy and programming recommendations needed to promote effective service delivery to protect individuals’ sexual health.
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Use an integrated approach to knowledge translation to facilitate the translation of this knowledge into social, health and legal policies and programs to protect the health of sex workers.
The research includes a series of ongoing and planned studies that include ethnographic methods, discourse analysis, and mixed-method designs. Bungay employs an integrated approach to knowledge translation that includes collaboration with stakeholders throughout the entire research processes. Her program of research is among the first studies in North America to examine intersections between gender, race, sexuality, and class as influential for male and female sex worker health and safety in the off-street context.
Although traditional HIV prevention strategies — behaviour modification, condoms, needle exchange – have been very successful, their effect has reached a plateau since they are not always available, practical, or fully adhered to. In the past five years, research has shown that using antiretroviral therapy (ART) to treat those infected with HIV not only decreases mortality and morbidity but also decreases HIV transmission. Unfortunately, many individuals are still unaware that they are HIV-positive or that they should be on ART, since they have not been linked to our health-care system. These individuals will unnecessarily suffer from their disease and they will incur avoidable hospitalizations, physician visits, and costs.
Dr. Viviane Lima aims to identify different strategies to decrease the public health and economic burdens of HIV in British Columbia (BC). Since individuals living with HIV should follow the same continuum of care from infection until the time of first ART, diminishing the individual and economic burdens of HIV will require a combined effort of different players in our health-care system and the development of a comprehensive strategy to tackle each component in the continuum of care pathway. Lima’s research will employ innovative statistical and mathematical models to analyze these data and compare the potential effects of different complex strategies. This project will create great opportunities for trainees to be supported across a variety of disciplines, further enhancing BC’s competitive advantage in population-health and HIV research. The proposed methodology can also be applied to other diseases, conditions, and settings dealing with similar issues.
