The use of illicit drugs in Canada is associated with substantial, widespread consequences, including high rates of death and health complications among users, and significant social and economic costs to society. Canada has traditionally addressed illicit drug use with law enforcement measures, with prevention and treatment measures playing a secondary role. Recent efforts to reform Canadian drug policy go hand-in-hand with a strong need for expanded research to support the development of effective and evidence-based intervention programs and public health policies. Dr. Benedikt Fischer is examining how to develop more effective public health-oriented prevention, treatment and policy options to reduce the harms of illicit drug use. His research focuses on five main areas: street drug use monitoring; opioid treatment programs; prevention and treatment for hepatitis C among illicit drug users; cannabis control reform; and criminal justice interventions for drug offenders. Dr. Fischer is integrating basic, clinical and social health research and working in collaboration with researchers from across Canada, with an emphasis on issues of national relevance as well as those specific to British Columbia.
Program: Scholar
Investigating the molecular basis of collagen's finely tuned stability with single-molecule manipulation techniques
Collagen is the fundamental structural protein in our bodies, which means changes in its chemical composition can have profound, widespread effects on health. For example, connective tissue diseases, the leading cause of disability and absence from work in Canada, can be caused by a change affecting only one position out of 1000 in the DNA sequence that codes for collagen. As we age, collagens in our body tissues become chemically modified, leading to structural changes that result in weakening of bone structure and the deterioration of joints, arteries and the retina, a situation that is exacerbated by diabetes. The controlled production and degradation of collagen is important for normal embryo development; a breakdown in this controlled pathway is also associated with the spread of cancerous tumors in the body. All of these health-related problems are related to chemical changes in collagen, which lead to changes in its structural and elastic properties at the tissue level. Dr. Nancy Forde is studying the elastic properties and stability of single collagen molecules, to identify the relationship between chemical changes and changes in the structure and function of collagen. Her team is employing the world’s smallest tweezers, optical and magnetic tweezers, to grab, stretch and twist single collagen proteins. This special equipment is currently applied to protein study at only a handful of labs worldwide. Dr. Forde and her team are directing their efforts to better understand how changes in collagen at the molecular level affect the elastic and structural properties of tissues. This research could help explain how tissues deteriorate with age, as well as the impact of these changes on the development and severity of diseases such as cancer and diabetes.
A molecular picture of the innate immune response to Salmonella: quantitative proteomic and cell biological analysis of Salmonella vacuole development
Salmonella bacteria reside in the intestines of animals and can be transmitted to humans via contaminated food or water. These bacteria cause diseases such as typhoid fever and acute gastroenteritis, posing major health problems throughout the world. The body normally produces an immune response to these invading microorganisms. In a process known as phagocytosis, the blood’s immune cells engulf the bacteria, enclose them in specialized internal compartments, and then release destructive enzymes that kill them. However, Salmonella and several other intracellular parasites have evolved methods to subvert this process. By blocking the delivery of the destructive enzymes, these parasites avoid extermination and are able to survive and multiply inside the immune cells. Ultimately, bacteria escape from the cell and spread throughout the body to cause disease. Dr. Leonard Foster is employing advanced proteomic methods and instrumentation to explore and describe what occurs at the molecular level during phagocytosis. This research will lead to a better understanding of the basic operation of this important aspect of immune function. It will also advance knowledge of the molecular mechanisms employed by Salmonella bacteria to prevent the immune cells from delivering the destructive enzymes, potentially leading to better methods of protecting against Salmonella infection.
The Canadian healthy resident – healthy patient study
Research has shown that physicians with healthy personal habits are more likely to encourage patients to adopt such habits. This suggests that improving the health of physicians may, in turn, contribute to improved health of patients. Dr. Erica Frank is leading the ‘Canadian Healthy Resident–Healthy Patient’ study which is examining the link between physician health and patient health. Using a survey questionnaire, Dr. Frank is collecting personal and clinical information from medical residents nationally. These data will form the basis for development of interventions to improve the personal and clinical health practices of health professionals in training and practice. Dr. Frank’s study will then pilot those interventions in BC, and disseminate the results nationally and globally. Results from this research hold promise for informing policies and programs involving healthcare providers and communities.
Parents of children with cancer: a study of factors related to their psychological wellbeing
A diagnosis of cancer not only affects the patient, it also greatly affects the family caregivers. The physical and emotional effects of caring for a loved one with cancer can be devastating, with fatigue and burn-out a frequent occurrence. Dr. Anne Klassen is studying factors affecting the wellbeing of parent caregivers of children with cancer, with a specific interest in the direct and indirect relationships and supports that may contribute to differences in psychological wellbeing among these parents. Her study is recruiting a population-based sample, from British Columbia, Manitoba and Ontario, of approximately 500 families with children in active treatment for cancer. She is collecting data on a comprehensive set of factors, including background and context variables; child characteristics; caregiver strain; caregiver self-perception; coping factors and psychological wellbeing. Results from Dr. Klassen’s research will further the understanding of why some parents are able to cope with caring for a child with cancer while others cannot. Ultimately this research will help with earlier recognition of families at risk and the development of preventive or other strategies to better meet their needs, for the benefit of children, parents and families.
The identification of susceptibility genes and phenotypic subgroups for autism spectrum disorders
Autism Spectrum Disorders (ASDs) are characterized by impairments in social interaction and communication, as well as restrictive behaviours and interests. These life-long disabilities affect more than 1 in 250 individuals. It has been shown that early diagnosis is essential for children with ASD: the earlier intervention is initiated, the better the outcome. However, affected children are commonly not definitively diagnosed until they are three years of age or older. Sibling, twin and family studies have shown that ASDs are largely genetic in origin and certain chromosomal regions harbouring possible ASD susceptibility genes have been identified. Recent studies suggest that between 5 and 48% of individuals with autism exhibit chromosomal anomalies. This suggests that small chromosomal anomalies, such as microdeletions and microduplications, may be relatively common and clinically important markers for identifying underlying causes of, and susceptible gene regions for, ASDs. Dr. Suzanne Lewis is researching the genetic susceptibilities of ASD, using a novel method for the analysis of regional changes in DNA called microarray-based comparative genomic hybridization (array-CGH). Using this method she is identifying and characterizing chromosomal abnormalities in 100 subjects with ASD. In parallel, Dr. Lewis is also researching ASD phenotypes – genetic influences in combination with respective behavioural, physical, medical, environmental and family findings. Dr. Lewis aims to build a research pathway that identifies genetically distinct subgroups of ASD that also share unique clinical phenotypes. Through researching this genotype/phenotype correlation Dr. Lewis ultimately hopes her research will contribute to a better understanding of the genetic causes and consequences of autism and help in developing methods for the very early identification of infants and families at risk for autism.
Evaluating socioeconomic status differences in patient preferences for asthma therapy using discrete choice experimentation
Asthma is one of the most common chronic conditions affecting Canadians. Despite the availability of effective therapies and guidelines on how to manage asthma appropriately, poorly controlled asthma remains a significant health issue, with morbidity (complications) and death rates continuing to increase both in Canada, and worldwide. Dr. Larry Lynd’s previous research identified that asthmatics of lower socioeconomic status are more likely to have poorly controlled asthma. Building on his previous work, Dr. Lynd is now studying the factors that may be contributing to these differences, using a novel methodology called Discrete Choice Experimentation, originally developed for market research. Study participants complete a questionnaire which is designed to determine their individual preferences for different aspects of asthma management. The questionnaire asks questions related to areas such as avoiding side effects, realizing a benefit from drug therapy, and how much individuals are willing to pay to achieve these outcomes. By comparing this data with their socioeconomic information, Dr. Lynd hopes to determine if there are differences between individual’s preferences are based on their levels of education and household income. The results of this study will provide further insight into some of the factors that may be contributing to poorly controlled asthma, which in turn will contribute to the development of specific programs and interventions aimed at improving asthma control and outcomes. This study is one component of Dr. Lynd’s broader research program involving the development and application of new methods for therapeutic risk-benefit analysis.
Understanding community capacity in mental health reform through an examination of the gendered dimensions of the Riverview redevelopment process in British Columbia
Recent mental health reforms in British Columbia have resulted in a shift in the way services are delivered to people with serious and chronic mental health problems. Specifically, the main source of care for people has shifted from the provincial psychiatric hospital (Riverview Hospital) to smaller care facilities located in various regions throughout the province. Dr. Marina Morrow is studying the impact of these service changes on various groups affected by deinstitutionalization by examining the experiences and needs of recipients of mental health services, family members of people with mental illness, mental health care providers, administrators, advocates, and community members. Dr. Morrow is particularly focussing on issues relating to gender, and how the needs of women and men leaving Riverview Hospital might differ. Dr. Morrow is also examining the capacity of the current mental health system to respond to individuals, that have been newly discharged from Riverview, to ensure their successful integration into communities, and how the system can provide community-based support to individuals who become ill in the future. Dr. Morrow hopes the results from her research will contribute to improving the mental health care system’s response to people with serious and chronic mental health problems so that they can live full and productive lives in their communities.
Understanding the role of cryptochromes in human circadian phototransduction
The human eye is much more than the organ of vision. In addition to the machinery of the eye that allows us to see, the retina also houses photoresponsive molecules (photoreceptors) that mediate non-visual, light-driven signaling pathways. Our biological clock is regulated by the input of these light signals, including the circadian (24-hour) oscillation of our biochemistry, physiology, and behaviour. Many human functions rely on circadian rhythm and its accurate synchronization with the outside world by light (circadian phototransduction), including sleep, hormone regulation and brain function. Despite its central role in human health, however, virtually nothing is known about circadian phototransduction, including the light-driven events in a key photoreceptor called cryptochrome. Dr. Melanie O’Neill aims to uncover these events and to describe the mechanism of action of cryptochromes as circadian photoreceptors at the molecular and cellular level. Her research will provide a critical link between light input and biological response, and offer the basis for a description of circadian phototransduction that rivals our detailed description of vision. This research will enable an understanding and potential manipulation of biological timing that may transform our view of human health and our treatment of a host of human diseases including sleeping disorders, depression, and cancer.
Gender and ethnic differences in treatment seeking for acute coronary syndromes
Important advances in the diagnosis and treatment of heart attacks have resulted in a growing majority of people recovering and resuming healthy, active lives following a heart attack. In spite of these medical advances, however, little progress has been made in reducing the time it takes for individuals to seek medical assistance after they first experience symptoms of a heart attack. Many people still arrive at a hospital too late to receive the full benefit of clot-busting therapy and other drugs. Patient-related delays result in a significant number of poor health outcomes and deaths. To achieve better clinical outcomes following a heart attack, people must be able to recognize heart attack symptoms and be willing to seek treatment immediately. Dr. Pamela Ratner is examining the many factors that shape people’s understanding of their risk of heart attack, the symptoms that occur, and the course of action that should be taken. She is focusing specifically on gender and ethnicity, together with other socio-demographic, clinical, psychological, and social factors. Dr. Ratner’s research aims to clarify the roles that gender and ethnicity play in modifying these factors, and to develop a theory of treatment seeking for cardiac symptoms. Results from her research will contribute to designing effective interventions that improve responses and decrease patient-related delays.