Up to half of all Canadians with HIV also have hepatitis C, with co-infection highest among injection drug users. Dr. Anita Palepu is researching the impact of drug and alcohol use among people co-infected with HIV and hepatitis C on their adherence to HIV treatment and on treatment outcomes. Dr. Palepu, who focuses on health and social problems faced by vulnerable urban populations such as drug users and homeless people, is also examining the role of addiction treatment in clinical outcomes. In a related project, she is conducting a quality of life study with vulnerable populations such as injection drug users, homeless people and street youth to assess the effectiveness of interventions intended to improve their lives. Dr. Palepu is also part of a national network of researchers evaluating the effects of programs designed to prevent homelessness, or help people exit homelessness, on the health of those considered âhard to house.â The research could inform health and social policies and ultimately help improve the health of vulnerable urban populations.
Program: Scholar
Identification of circulating cells with a myogenic potential
Degenerative diseases have an enormous economic and social impact on BCâs aging population. In the long term, identifying cells that could regenerate organs damaged by degenerative diseases could revolutionize how these conditions are managed. Care could shift from expensive, lifelong drug treatments to therapies that permanently restore organ function. Research suggests that bone marrow contains stem cells (precursor cells that have the ability to develop into cells specific to types of tissues) capable of repairing damaged tissues in adults. To efficiently use stem cells, however, the cells responsible for tissue repair must be identified from among the many cell types present in bone marrow. Dr. Fabio Rossi is identifying bone marrow cells that repair damaged muscle, exploring their characteristics and investigating how they repair damaged tissue. Findings could lead to therapies that efficiently restore organ function.
Intestinal innate immunity: recognition and response to enteric bacterial pathogens
Bacterial infections of the gastrointestinal tract are very common, particularly among children. These infections cause diarrheal outbreaks and millions of deaths worldwide. Bacteria are also a major problem in Canada, with BC having one of the highest rates of intestinal bacterial infection in the country. Bacteria are believed to trigger a variety of gastrointestinal diseases, including inflammatory bowel disease, a debilitating and chronic condition that affects one in every 1,000 Canadians. Despite the prevalence of bacterial pathogens (disease-causing organisms), little is known about how the immune system recognizes and combats intestinal bacterial infections. This information is important because the immune response to these bacteria determines who is susceptible to infection, as well as the severity of the resulting disease. Dr. Bruce Vallance is researching how bacteria cause intestinal disease and how the immune system identifies and fights these infections. Dr. Vallance is investigating whether genetic differences in hosts influence susceptibility to food and water-borne bacteria. He aims to identify immune responses and genetic factors that either protects against intestinal bacteria or causes susceptibility to infection. This research could help explain how bacteria cause intestinal disease and ultimately lead to new treatments to prevent both bacterial infections and bacterial-induced gastrointestinal diseases.
Bioinformatics for the study of gene regulation
Genetic diseases can result from subtle variations in the DNA sequences of genes. Approximately three million differences exist between the DNA of any two individuals. While most of these differences have no functional impact, researchers have linked numerous variations to diseases. These linkages have provided insight into disease development, enabled the creation of diagnostic tests and accelerated the creation of therapeutics. Most of the known functional DNA variations result in decreased activity of proteins produced by a gene. But Dr. Wyeth Wasserman suspects many functional variations actually alter gene activity, rather than the sequence of proteins encoded by genes. This is because information flows from genes through an intermediate RNA molecule, and is translated to construct proteins. Variations that disrupt this flow could have dramatic consequences. Using bioinformatics (analysis of genetic data using advanced computing algorithms), Dr. Wasserman aims to identify regulatory variations that likely impact gene function and contribute to genetic diseases.
The public health impact of obstructive sleep apnea hypopnea – a focus on work productivity, occupational injuries and motor vehicle crashes
Sleep is an integral part of our lives. Inadequate or poor quality nightly sleep has many adverse health and safety consequences. The most important medical disorder that disrupts sleep is obstructive sleep apnea hypopnea (OSAH), a common, under-diagnosed condition characterized by recurrent collapse of the upper airway during sleep (up to 100 times per hour). Symptoms of the disease include loud snoring, nocturnal choking, poor quality sleep, recurrent awakenings, daytime sleepiness, impaired alertness, reduced quality of life, hypertension and strokes. Therapy to prevent the upper airway from collapsing can reverse many of these symptoms. Dr. Najib Ayasâs work is focused on investigating the pathogenesis, diagnosis, therapy, economic impact, occupational impact, public health, and safety consequences of sleep disorders, with a particular focus on OSAH. For instance, by developing a comprehensive registry of patients with OSAH, he hopes to determine whether patients with OSAH suffer from reduced work productivity and higher rates of occupational injuries and motor vehicle crashes; and whether therapy reduces these risks. Findings could then be used to develop screening and treatment guidelines for OSAH, and occupational and transportation policy recommendations. In the future, this unique registry will help identify biochemical cardiovascular risk, genetic and biochemical factors associated with OSAH.
Cervical cancer and sexuality: effects of a psychoeducational intervention and sildenafil on sexual arousal, relationship satisfaction and quality of life after hysterectomy
More than 25 percent of women who have a radical hysterectomy (surgery to remove the uterus, cervix, and upper vagina) as part of treatment for cervical cancer develop sexual difficulties related to genital arousal. There are no established treatments for these sexual problems leaving women with chronic distress. Dr. Lori Brotto has developed and is assessing whether a psycho-educational treatment can improve sexual arousal in these women. She is also assessing the effectiveness of combining the treatment with sildenafil citrate (Viagra). Dr. Brotto aims to incorporate qualitative feedback with psycho-physiological and self-report measures on the effectiveness of the psycho-educational treatment in hopes of improving clinical practice. The research could help improve sexual health, mood, and overall quality of life for cancer survivors and their partners. It could also broaden understanding of womenâs sexuality and guide future research to better address womenâs sexual health care needs.
Stigma, risk and protective factors among vulnerable youth
Adolescence is a time of promise, when major physical, cognitive and relational transitions launch the development to adulthood. But stigmatization in communities and schools can derail this process for certain teens. Teens who are more likely to be stigmatized include youth on the streets; those in foster care or custody; sexually abused youth; gay, lesbian, bisexual and transgendered youth; and indigenous and ethnic minority adolescents. As a result of being stigmatized, these youth are at greater risk for health problems such as drug abuse, HIV infection and teen pregnancy. As part of an international study taking place in Canada, New Zealand and the US, Dr. Elizabeth Saewyc is examining behaviours and environments that stigmatize youth in schools. Dr. Saewyc is studying the links between stigma and risk behaviours, and exploring protective factors that can reduce these risks and build resilience among youth. The findings will be shared with groups of teens and youth workers in the three countries to gather their ideas for reducing stigma, creating safer schools, and preventing substance use and risky sexual behaviours in culturally meaningful ways. The research could lead to interventions to reduce or prevent stigma, to help youth cope with stigma, and to foster healthy development among vulnerable young people.
Costs, access and equity under income-based Pharmacare
Following the February 2003 First Ministers Health Accord, the Canadian Government created a five-year $16 billion Health Reform Fund targeted to primary health care, home care and catastrophic drug coverage. The drug coverage is intended to ensure that Canadians with serious health conditions have reasonable access to necessary drug therapy. Standards for catastrophic coverage will be determined in the coming years, yet there is little evidence to guide the choice of standards. Dr. Steven Morgan is evaluating two possible options for basing standards: mixed pharmacare and income-based pharmacare. Dr. Morgan is studying the change in BC from a mixed program, which covered drug costs for low income seniors and social assistance recipients and charged a $1,000 deductible to all other residents, to an income-based system that enables people to pay a sliding scale based on income levels. Dr. Morgan is comparing data from both systems to results in Manitoba, which also has an income-based program. He is assessing the impact of both systems on cost, access and equity for people across the spectrum of socio-economic status, age and health status. The results could help guide the development of provincial and national policies for drug coverage programs.
Community, culture and health
Dr. Cindy Patton has conducted a series of studies on knowledge transfer from medical experts to clinicians, media, policymakers and the public. In dramatic and exceptional cases, this exchange happens almost directly. The mediaâs extensive reporting on health emergencies involving SARS (Severe Acute Respiratory Syndrome) and BSE (Bovine Spongiform Encephalopathy or Mad Cow Disease) created demand from health consumers for more medical research, changes in public health policy, and reassurance about their risk for these conditions. But more often medical research filters down through clinicians and advocacy groups, who translate complex information for consumers and advocate for their medical needs. In addition, government policy makers must sort through information from researchers and citizens to adapt health policies and resources to changing medical needs. Dr. Patton is examining existing methods and systems for exchanging information in various settingsâclinics, research centres and global information networks. The research could be used to create better channels for transferring specialized medical information. Dr. Patton is also developing training programs for researchers and the public to help improve their understanding of how to efficiently transfer knowledge from medical experts to people affected by health issues.
Behaviour of the newborn infant in response to pain, distress and caregiving influences
Recent evidence suggests newborn infants are more sensitive to pain and stress than older children and adults. The level of sensitivity may be especially acute for newborns who are at-risk for developmental problems due to prenatal exposure to pain, antidepressants or illicit drugs. Studies suggest that early exposure to pain and stress leads to changes in the newbornâs brain circuitry, and may increase vulnerability to abnormal behaviour and development. This has led to a search for better ways to understand and recognize infant pain and measure the effects of pain treatment. Dr. Fay Warnock is investigating the actions and interactions of healthy and at-risk infants. The research involves confirming a comprehensive list of behaviour associated with newborn distress, and comparing the actions of healthy and at-risk newborns during and after routine diaper change and heel lancing, a common procedure for obtaining a blood sample to screen infants for metabolic errors. She is also linking newborn behaviour with changes in facial action and heart rate. The research will further develop measures of newborn pain, improve understanding of how caregivers can help alleviate pain, and lead to protocols for preventing, assessing and treating newborn pain.