Many children who have been born prematurely experience long-term cognitive, visual and motor deficits. A number of interrelated factors that commonly follow preterm birth are believed to contribute to neurodevelopmental impairment, including newborn illness and exposure to medications, abnormal brain development in the months following birth, and a characteristic type of brain injury known as white matter injury. Currently, there is little research regarding how white matter injury and abnormal brain development lead to impaired motor and cognitive function. Dr. Steven Miller is researching brain development and injury in premature babies to understand how such injuries occur and why specific brain regions are affected. Using magnetic resonance imaging (MRI) techniques, Dr. Miller is measuring brain development and white matter injury in premature newborns shortly after birth and then again when the newborns reach term-equivalent age. Subsequent tests measuring gross and fine motor skills, language and cognition will be conducted at 18 and 36 months of age to evaluate neurodevelopmental outcome. The results of this study will provide a better understanding of the factors impacting brain growth and injury in newborns, and lead to improvements in preventing or treating brain injury in this population. Dr. Miller’s research group also studies brain development and white matter injury in other groups of newborns at high risk of neurodevelopmental impairments, such as those with heart birth defects.
Program: Scholar
Functional dysconnectivity of hippocampo-prefrontal neural systems in Schizophrenia
Schizophrenia is a brain disease that affects one per cent of Canadians — more than 300,000 people — causing hallucinations and disordered thought . Early intervention and prevention of relapse are key to minimizing the impact of schizophrenia on individuals and society, and an understanding of the brain changes that lead to first episode and relapse are important for achieving preventive care. Major aspects of schizophrenia include memory dysfunction and reality distortion, such as hallucinations and delusions. The brain systems that underlie these symptoms appear to involve neural systems in the hippocampo-prefrontal regions of the brain. While these neural systems exhibit a high degree of connectivity in healthy subjects, it is thought that dysconnectivity may be an underlying cause for schizophrenic symptoms. To demonstrate the role of impaired neural connectivity in schizophrenia, Dr. Todd Woodward is conducting neuroimaging studies to identify and characterize two hippocampal-prefrontal neural systems associated with schizophrenia. This functional and physiological understanding of the disease may allow for better prediction of first episode and relapse, in order to maximize early intervention.
Hormonal effects on neuroplasticity and behaviour
Contrary to popular belief, neurogenesis—the creation of new neurons—occurs in the adult brain in all species, including the human. Research demonstrates that hormones play a role in neurogenesis; however, research in this area is limited. Dr. Liisa Galea researches the means by which hormones regulate adult neurogenesis, influence mood, and contribute to learning and memory processes. Focusing specifically on estrogen and corticosterone, she is examining how hormonal changes during pregnancy affect the birth and survival of neurons, how stress alters these processes, and the links to behavioural changes such as depression. Determining the functional link between hormones and neurogenesis on learning, memory and depression may result in the development of hormonal therapeutic measures for promoting cognition, and new treatments to trigger neurogenesis in diseases characterized by lost brain tissue, such as Alzheimer’s and Parkinson’s.
Why are women at increased risk of chronic obstructive pulmonary disease and lung cancer? Is inflammation the missing link?
Chronic obstructive pulmonary disease (COPD) is a term for a group of respiratory diseases—such as chronic bronchitis or emphysema—in which there is chronic obstruction of airflow through the airways and lung damage. In Canada, despite the fact that more men smoke than women, the rates of chronic COPD and lung cancer in women are expected to exceed those in men within the next five years. Dr. Donald Sin is investigating why women seem more susceptible than men to COPD and lung cancer. His research proposes that women mount a more vigorous inflammatory reaction to cigarette smoke and environmental irritants than men, resulting in chronic lung and systemic inflammation that can lead to COPD and in some cases, lung cancer. Dr. Sin is comparing sex-related differences in the relationship between lung and systemic inflammation and the development of lung cancer. His research will not only shed light on why women are more susceptible to COPD and lung cancer compared to men, but may also be an important foundation for developing medications to reduce the risk.
Immunity and childhood disease
Immune white cells, such as cytotoxic T lymphocytes (CTL) and natural killer (NK) cells, protect us from infectious diseases and cancer by killing infected or unwanted cells. Defects in the function or regulation of these cells can lead to immunodeficiency or autoimmunity. Two childhood diseases resulting from autoimmune malfunction include the common disease, type 1 diabetes (T1D), and X-linked lymphoproliferative (XLP) disease—a rare immunodeficiency. Dr. Rusung Tan studies the role of these cells in T1D and XLP. He is working to determine how defects in the molecular and cellular function of cytotoxic immune cells lead to disorders of childhood and will translate these findings into improved diagnostic tools, preventions and therapies for disease. His personal goal is to use the successes achieved in this work as models to drive the overall development of childhood immunity research in British Columbia.
Lung inflammation induced cardiovascular disease
There is substantial epidemiological evidence that inhalation of air pollution particles results in increased morbidity and mortality from heart conditions, such as heart attacks, cardiac arrhythmia, and heart failure. Recent research has shown that air pollution causes the development and progression of atherosclerosis, the underlying disease in vessels responsible for stroke and heart attacks. However, the biological mechanisms of air pollution-induced heart disease remain unclear. Dr. Stephan van Eeden is exploring at the cellular level the connection between the inhalation of air pollution particles and the development and progression of blood vessel disease (atherosclerosis). His hypothesis is that chronic lung inflammation caused by exposure to particulate matter air pollution and cigarette smoke cause a persistent, low-grade systemic inflammatory response that contributes to the development of atherosclerosis. He is conducting a series of studies to determine whether inhalation of air pollution particles destabilizes atherosclerotic plaques and trigger clot formation. This information will provide researchers and policy makers with a greater understanding of the adverse effects of air pollution on individuals’ health.
An investigation of injection drug use and HIV infection among drug using youth
Illicit drug use remains a major public health concern throughout Canada, and available evidence indicates that injection drug use and crystal methamphetamine use is steadily increasing among youth. Youth whose social or economic base is on urban streets are particularly vulnerable to illicit drug use, HIV infection and other adverse health outcomes. Adolescence and young adulthood are critical times with respect to illicit drug use and HIV infection, as it is a period during which many behavioural patterns that pose or offset future health risks become established. However, there remains a major gap in our understanding of factors that may facilitate or protect youth from initiating injection drug use, and there is a consequent lack of information around how to shape related interventions. Thomas Kerr is investigating the impact of psychosocial characteristics (e.g. self-efficacy and depression) and crystal methamphetamine use on patterns of illicit drug use, HIV risk behaviours and HIV incidence among drug users aged 14 to 24. Drawing data from two large population-based cohort studies that will follow 500 non-injecting drug using youth and more than 1000 HIV-negative injection drug users, he is addressing a growing threat to the health of many Canadians.
Priority setting and resource allocation in the Vancouver Island Health Authority
With limited resources in our health care system, difficult choices must be made in how health authorities prioritize services and allocate resources. Recent research has shown that decision-makers in health authorities face two sets of impediments in this task: a lack of skills in these processes, and an organizational culture in health administration that implicitly supports allocation based on historical patterns. Program budgeting and marginal analysis (PBMA) is a framework designed to assist decision-makers in weighing evidence from numerous sources to determine how resources might be allocated to improve health gain or to better meet other relevant criteria. To facilitate organizational adoption of PBMA as an alternative decision-making process, further research is required to develop strategies for implementation, as well as to drive key methodological aspects of the process. Craig Mitton is addressing these issues by applying PBMA across service areas in the Vancouver Island Health Authority (VIHA). While advancing key aspects of priority setting through the introduction of PBMA within VIHA, he is also facilitating skill-building among stakeholders in the application of the new decision-making process. He is also evaluating its implementation, which will not only refine the process for VIHA, but also contribute to the literature on priority setting in health organizations.
Priority setting methods for cancer control and care
Priority setting is the focus of health economics—a branch of economics concerned with issues related to the scarcity of health care resources. With cancer expected to be Canada’s primary cause of death by 2010, priority setting in cancer control and care is imperative. An aging population, rising health care costs and increasing demand have resulted in the need for identifying effective and cost-effective ways to improve cancer patient outcomes. Basing his work on an internationally-recognized economic framework for priority setting (called Program Budgeting and Marginal Analysis), Dr. Stuart Peacock is developing new evidence-based methods to help health care decision-makers determine the most effective cancer interventions to fund. His research will develop three significant innovations within this framework: methods to address improvements in life expectancy and quality of life from health programs; methods to address community preferences and equity concerns; and measures to evaluate priority setting and evidence-based decision-making. Dr. Peacock’s goal is to develop an evidence-based framework for decision-making in cancer services that is transparent, explicit and accountable.
Improving access to necessary care of older adults in British Columbia and Canada
By 2031, one-quarter of the Canadian population is expected to consist of adults aged 65 years and older. While many seniors lead healthy and active lives, a significant number live with multiple chronic health issues that require a broad spectrum of social and health services. In order to understand the health needs of seniors and the ability of the health system to meet them, high quality evidence about health and health care delivery is required to answer the many questions that still remain regarding seniors’ access to health services. Dr. Adrian Levy’s research encompasses four inter-related projects focused on generating knowledge about health services required for older adults in BC, including the impacts of changing health services and future health services requirements. These projects include: describing process flows for seniors from independent living to long-term care in the Vancouver Coastal Health Authority; examining the impact of closing residential care beds in BC; comparing wait times to long-term care in BC with those in Ontario; and determining the number of seniors who are institutionalized within in the community in which they live. Dr. Levy’s research findings regarding the health care needs and challenges facing older adults in BC will inform policy and program decision-making related to long-term care in the Vancouver Coastal Health Authority.