Syphilis, caused by the bacterium Treponema pallidum, is a chronic bacterial infection with a global distribution. Although this sexually transmitted disease is 100 per cent curable with penicillin, syphilis remains a health threat, with an annual incidence rate of 12 million active infections. In BC, new cases are being reported at almost double the national rate. Unchecked, the infection can damage every tissue and organ in the body, including the brain. Equally troubling, syphilis infection drastically increases vulnerability to HIV infection. Treponema pallidum is a highly invasive pathogen; following attachment to host cells, the organism invades the tissue barrier and enters the circulatory system, resulting in widespread bacterial dissemination. Little is currently known about the mechanisms this bacterium uses to initiate and establish infection.
Dr. Caroline Cameron has the only laboratory in Canada conducting basic research on this bacterium. She is using cutting-edge proteomic technologies to study two molecules that enable the bacterium to attach itself to host cells lining the bloodstream – a critical step in the development of infection. By understanding these mechanisms, Cameron hopes to identify potential ways that scientists could interfere with adhesion and disrupt the infection process. Ultimately, her work could lead to development of a vaccine to prevent syphilis.
The number of Canadians older than 65 is steadily increasing, a trend that will continue over the next few decades. The prevalence of age-related disorders such as dementia is also increasing, along with the related need for personal care and treatment. Cognitive impairment adversely affects quality of life in late adulthood, limiting independence and survival. To examine these important health issues, Dr. Stuart MacDonald is studying factors related to age-related declines in cognitive performance. Part of his research employs existing data from a Swedish study (the Kungsholmen Project; http://www.kungsholmenproject.se/) to examine patterns and identify early predictors of cognitive decline. As the average age of the Swedish population far exceeds that of Canada, research on the Kungsholmen data may provide important insights that can help inform Canadian healthcare policy and prevention strategies.
Dr. MacDonald is also researching how performance for select measures of memory and intelligence is influenced by cognitive training across a period of weeks, as well as regular aerobic exercise (walking three times per week for 30 minutes) over a period of months. Dr. MacDonald's goal is to clearly demarcate the stages and transitions of cognitive decline from mild age-related impairment to more severe dementia deficits. This will help identify early warning signs of cognitive impairment from a broad range of predictors. The findings could lead to more effective prevention based on knowledge of these risk factors, including campaigns to promote health-smart behavior.
The nature of the relationship between a healthcare provider and an individual receiving care has an impact on the success of psychotherapy and drug therapy. A strong professional working relationship can not only enhance the effect of psychological and psychiatric interventions, but can be therapeutic in and of itself. This has even been found in the treatment of very serious psychiatric conditions such as bipolar disorder and schizophrenia. Researchers have estimated that as least 30% of the effectiveness of psychotherapy and drug therapy can be accounted for by the quality of the professional relationship between an individual and his/her mental healthcare provider. There is a lack of understanding about the factors that are most important for developing a solid working relationship from the perspective of the individuals receiving the mental health services. Expanding upon research he conducted as a MSFHR trainee, Dr. Robinder (Rob) Paul Bedi is exploring this area. He is interviewing individuals currently receiving mental health services and analyzing the variables that they identify. The result: identifying the most common factors found to be essential in the development of positive therapeutic relationships. Bedi’s research aims to help mental healthcare providers develop strong working relationships with the individuals they treat, resulting in improved overall effectiveness of the mental health services that individuals receive.
A recent report from the World Health Organization revealed that about 1.5 million people died from TB in 2006. In addition, another 200,000 people with HIV died from HIV-associated TB. Current strategies aim to reduce the annual death toll from TB to less than 1 million worldwide by 2015, as set out in the United Nations Millennium Development Goals. Infection by the Mycobacterium tuberculosis microorganism causes TB. The current global strategy for TB control is based on reducing the spread of infection through massive vaccination campaigns with the BCG (bacille Calmette-Guérin) vaccine, and treatment of individuals with active disease using multi-drug combinations. However, there are challenges to this approach, including inefficiency of the BCG vaccine, the emergence of drug resistant strains of Mycobacterium tuberculosis (Mtb) and the difficulty in delivering a treatment that requires multiple drugs over periods of six months or more.
Until recently, little was known about how Mtb alters the host immune system to cause infection. Through Dr. Zakaria Hmama’s work as an MSFHR Scholar over the past six years, important new knowledge has been developed regarding the sub-cellular and molecular mechanisms of host/pathogen interactions. His research over the next five years will focus on gene manipulation technologies to upgrade the current BCG vaccine with recent immunological concepts to maximize its protective properties. Hmama is also investigating an important virulence factor identified by his lab as a potential drug target for TB treatment.
Cancer is one of the leading causes of death in Canada. As a pathologist, Dr. Torsten Nielsen’s job is to accurately diagnose cancer and determine its type from more than 200 possibilities. For more than 50 years, these diagnoses have been made using a light microscope to examine tissue biopsies. However, this can be subjective, requiring the pathologist to make a judgment call in certain cases. Recent new technologies help determine the genetic profile of each type of cancer. This profile can be used to distinguish between cancers that otherwise appear almost identical under the microscope. The ability to detect subtle differences among cancers can be enormously important because the exact diagnosis determines what combination of surgery, radiation, hormone treatment or chemotherapy is the best treatment plan.
Using advanced genetic tools, Dr. Nielsen aims to develop clinical tests that more accurately identify difficult subtypes of cancer, and to then determine which treatments will work best for each subtype. Previously supported by an MSFHR Scholar award, he works with two cancer types in particular: breast cancer and sarcomas (tumours of muscle and bone). With breast cancer, he is working to develop inexpensive and easy-to-conduct clinical tests that accurately diagnose four types not easily distinguished under the microscope. With sarcomas, he is using new molecular tools to develop diagnostic tests and treatments that target specific molecular changes, to see if new drugs can cure these cancers with minimal side effects. His research could lead to simple, effective, and widely available diagnostic tools and personalized treatment strategies that will improve survival for cancer patients.
Every year, more than 20,000 people in Canada sustain a hip fracture. Of these, up to 20% die within 12 months and 50% do not return to their pre-fracture level of mobility. People who have a hip fracture have a higher risk of falling and an increased risk of a subsequent hip fracture compared with those of the same age who have never had a hip fracture. After a hip fracture, relative immobility initiates a vicious cycle where deteriorating balance and muscle weakness increases risk of falls and diminished bone health contributes to fracture risk. Although exercise is key to reversing this pattern, there have been relatively few clinical trials aimed at improving muscle strength, balance and enhancing bone health following hip fracture.
Dr. Maureen Ashe is conducting a randomized controlled trial to evaluate the impact of a targeted exercise program on the rate of falls, functional mobility and bone micro-architecture among older adults who have sustained a hip fracture. If successful, this intervention will result in fewer falls and improved bone health in a vulnerable senior population. Data from the research will inform recommendations for rehabilitation and contribute to the knowledge base for health-professionals, both in hospital and in the community, who manage care after hip fracture.
The primary methods for identifying and responding to differences between men and women in the health context are gender-based and gender-sex-based analyses (GBA/GSBA). While these approaches are intended to consider diversity within each group, they do not always capture how gender interacts with other factors such as race/ethnicity, socio-economic status, sexual orientation, geography, ability and age. Not taking these factors into account in health planning, implementation and research can result in real economic and human costs for health care consumers. These include lost opportunities, ill health, suffering and perhaps overall, an ineffective and inequitable health care system. A key challenge facing researchers and policy makers is how to move beyond singular variables (e.g. gender) to understand the complex dynamics at play between gender and health. Dr. Olena Hankivsky is examining how GBA and GSBA are applied in health planning, services and policy in Canada, Sweden, the UK, Australia and the Ukraine. She is exploring innovative improvements for analyzing gender and diversity in a health context. In particular, Hankivsky is conducting a gender and diversity analysis of the most recent health reform initiative in British Columbia — The Conversation on Health. The findings could contribute to developing policy tools and interventions that will improve the effectiveness and efficiency of health services and programs for vulnerable and marginalized populations in BC, Canada, and internationally.
There are disproportionately high rates of poor health among First Nations populations in comparison to the general Canadian population. A contributing factor is the limited access many geographically-isolated rural and remote First Nations communities have to health information. Dr. Sandra Jarvis-Selinger is focusing on a new and innovative approach supporting community access to health information. This approach involves the formation of Community Learning Centres (CLCs) in four communities located in the Ktunaxa Nation in southeastern BC. A CLC is both a physical and a virtual space for community members to access Internet-linked computers and web-based resources developed according to community-defined health priorities. Health information is created by and for community members and is both accessed at and disseminated via CLCs through information and communication technologies. Community engagement is the cornerstone of this project, with due emphasis placed on community input and governance, local health priorities and inclusion of traditional medicine, language and knowledge. Dr. Jarvis-Selinger is conducting a program evaluation to determine the effectiveness and sustainability of the CLC design and implementation. The evaluation is being co-developed with each community in order to match the communities’ needs, workflow, schedule and style of participation. This research will increase our understanding of how to successfully and sustainably: 1) support community-university partnerships; 2) improve community wellness; 3) expand access to and awareness of community health resources; and 4) increase employment opportunities through technical, research and interpersonal skills training. Overall, this research promises to make a meaningful contribution to the domain of First Nations community health through the use of technology.
Immune disorders – such as immunodeficiencies, leukemia and lymphoma, autoimmunity, and allergy – are significant health problems. For example, every year 5,600 Canadians people die of cancers of the immune system, such as leukemia and lymphoma, and these cancers account for 42% of all cancers in children. Current treatments for these cancers, such as chemotherapy and radiation therapy, have significant shortcomings. To improve recovery rates and reduce unwanted side effects, researchers need to develop new, specifically targeted treatment approaches. Treating diseases with few side effects requires knowing the signals involved in disease development. Dr. Ninan Abraham is focusing his research on understanding how a cytokine called interleukin-7 (IL-7) regulates immune cells by interacting with proteins to trigger biochemical pathways that control normal cell development and function. IL-7 is an essential growth factor that promotes the development of T cells and memory T cells, which are both essential for the body’s response to pathogens that lead to disease or infection. Being able to enhance development or survival of T cells by manipulating IL-7 could lead to the creation of more effective vaccines to boost the body’s immune response to disease. Conversely, since over-expression of IL-7 is associated with several forms of human T cell lymphoma, being able to limit this cytokine’s activity could also be important. By identifying how IL-7 promotes the development or survival of T cells and memory T cells, Abraham hopes for new strategies for treating these cancers and enhancing vaccines for long-term immunity.
Prescription medicines are a common and important form of treatment offered by family doctors. The information that doctors receive about the effectiveness and safety of medicines helps to determine their prescribing choices. Most doctors in Canada see pharmaceutical sales representatives regularly. Previous research has demonstrated that sales representatives influence prescribing choices and that doctors often underestimate the extent to which they are influenced. A recent example of this influence emerged in the US with the arthritis drug Vioxx. Despite a 2001 Food and Drug Administration advisory committee recommendation that doctors be warned of heart attack risks associated with the drug, sales staff were advised not to inform doctors of. By the time Vioxx was withdrawn from the market in 2004, it had been linked to between 88,000 and 140,000 heart attacks. Dr. Barbara Mintzes is investigating whether information critical to safe prescribing is provided to doctors by sales representatives. She is gathering data from three countries: Canada (British Columbia and Quebec), the US, and France. She aims to identify best practices in regulation of drug promotion, and to understand how the messages doctors receive from sales representatives can be incorporated into education to improve prescribing. Ultimately, her goal is to improve prescribing safety and appropriateness. A key component of the research will be discussions of the implications of the results with policy-makers, physicians, medical educators and industry.
