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.
Research Location: St Paul's Hospital
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.
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.
An interventional HIV research program to reduce transmission and enhance antiretroviral treatment outcomes among highly marginalized populations
The prevalence of HIV infection among injection drug users and other highly marginalized groups is a significant health issue in Canada. Vancouver’s Downtown Eastside (DTES) is particularly hard hit, with HIV prevalence rates estimated at 25 per cent. These high rates of HIV infection persist in spite of efforts to reduce HIV transmission through various prevention programs, harm reduction strategies, treatment facilities and community law enforcement. HIV prevention strategies and treatment therapies that are effective among other populations have not had the same success in the most vulnerable and marginalized members of society. As an HIV clinician and researcher in the DTES, Dr. Mark Tyndall’s research takes three streams: Observational Cohort Studies: Identifying trends in risk behaviors, drug use patterns, HlV/Hepatitis C rates, social changes, law enforcement initiatives, and the impact of harm reduction interventions on key health indicators; Antiretroviral Therapy: Developing and evaluating strategies and programs that enhance the uptake, delivery and sustainability of antiretroviral therapy to marginalized groups; and Clinical trials research: Advancing Vancouver as a centre for clinical trials research for the evaluation of candidate HIV vaccines and other novel therapies among marginalized groups. Together, Dr. Tyndall’s studies will allow for evidence-based decision-making and improved health outcomes for marginalized groups living with HIV in the DTES and other urban areas in BC.
Pharmacist-Initiated Intervention Trial in OsteoArthritis
To measure the effectiveness of a multi-disciplinary intervention involving pharmacists, physiotherapists and family physicians in the early diagnosis and treatment of individuals who are developing osteoporosis of the knee.
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Renal function and cardiovascular outcomes in patients with atherosclerotic renal artery stenosis
Renal artery stenosis is the narrowing of the arteries that supply blood to the kidneys. Research on the progression of kidney and cardiovascular disease in patients with this condition is limited. Dr. Nadia Zalunardo is examining whether kidney disease progresses more quickly in people with renal artery stenosis. Nadia is also studying whether people with the condition have higher rates of mortality, cardiovascular events such as stroke, heart attack and heart failure, and vascular procedures such as amputations and bypass surgery. The research could increase understanding about whether treating cardiovascular risk factors, such as diabetes, high blood pressure and elevated cholesterol, slows the progression of kidney disease and improves outcomes in patients with renal artery stenosis. The findings could also enable nephrologists (physicians specializing in treating kidney disease) to better project the need for dialysis and improve care for patients with kidney disease.
Estimating the economic burden of treating HIV/AIDS in the era of highly active antiretroviral therapy (HAART) with simulation modeling
AIDS is a chronic, life-threatening disease caused by the human immunodeficiency virus (HIV). HIV attacks the immune system, making people more susceptible to certain types of cancers and infection. Untreated patients generally survive about 10 years. Highly active antiretroviral therapy (HAART), which became widely available in 1996, has significantly reduced illness and death from HIV infection. However, the treatment regimen is expensive and the cumulative costs of treatment are growing as life expectancy increases. A crude estimate of treatment costs for HIV patients in Canada — drugs, physician and hospital visits and lab tests — exceeds $800 million a year. Because this cost estimate is based on simplistic assumptions, health care managers have asked for more accurate tools to help make policy decisions in HIV/AIDS management. Getting a handle on actual costs is particularly important given emerging evidence of an increase in the HIV incidence rate, in BC and across Canada. Karissa Johnston is developing a more sophisticated computer simulation model to accurately estimate the annual and lifetime medical costs for treating people infected with HIV. This tool will also predict how costs will change for various treatment protocols and population groups. Health planners will be able to use these estimates to assess the costs and benefits of disease prevention, drug compliance and various treatment strategies.
The epidemiologic and economic burden of illness of methanol and ethylene glycol poisoning in British Columbia
Methanol and ethylene glycol are the principle ingredients in automotive antifreeze products. When ingested, the result is organ failure and death unless treatment is initiated within hours of exposure. Survivors are at risk for blindness from methanol, or severe kidney damage from ethylene glycol, which can require weeks of dialysis. Treatment of methanol and ethylene glycol poisoning includes antidote therapy and use of dialysis to remove the poison. There are currently two antidotes available: ethanol and fomepizole. Ethanol is inexpensive but difficult to administer and causes many adverse effects. A new antidote, fomepizole, is relatively free of adverse effects, easy to use, and may prevent the need for dialysis in some patients, but it is very expensive. Katherine Lepik, a pharmacist with the BC Drug and Poison Information Centre, is researching the incidence, severity, mortality, and cost of methanol and ethylene glycol poisoning in BC. She is examining which age groups are at greatest risk for poisoning, why people are poisoned, and how to use health databases to monitor rates and severity of methanol and ethylene glycol poisoning. Her goal is to help prevent poisonings and ensure hospital staff have the resources and training to appropriately treat patients.
Mending and maintaining the quality of lives: Evaluating the treatment programs provided for mentally disordered offenders in British Columbia
The Forensic Psychiatric Hospital in British Columbia is currently evaluating approximately 30 rehabilitation programs offered to psychiatric patients who are found not criminally responsible for offenses because of severe mental illnesses, such as major mood disorders, schizophrenia and other psychotic disorders. While standard outcome indicators are needed to evaluate the effectiveness of these programs, these are difficult to develop because each patient experiences different symptoms and disabilities. Carol Wong is assessing a patient-centered evaluation tool (called Goal Attainment Scaling) for measuring patient improvement. Using this approach, the treatment team identifies and evaluates the most important goals and outcomes for each patient to achieve in a particular timeframe. Carol is also examining whether a patient’s readiness for treatment has an impact on outcomes, as this factor has consistently been overlooked in practice. The results of this research should help improve the effectiveness of rehabilitation programs, therefore reducing the likelihood of repeat offenses and improving mental health and quality of life for forensic psychiatric patients and their families.
The impact of co-payment and deductibles of prescription drugs: Estimating own and cross price elasticity of demand
Most health services in Canada are covered under the Canada Health Act. One major exception to this coverage is outpatient drugs. Most provinces have instituted cost sharing programs with patients, such as co-payments and deductible plans for prescription drugs. Researchers in the US found overall health care expenditures are reduced when patients make co-payments for prescription drugs, physician visits, or hospital admissions. Dr. Xin Li is investigating whether the opposite is true in Canada, since other health services are publicly funded. Xin is analyzing whether a co-payment plan for medications causes patients to use other “free” health services as substitutes for medication, resulting in an overall increase in health care expenditures. She is focusing on patients with rheumatoid arthritis because expensive drugs are increasingly the mainstay for treatment of the disease. This research will clarify the impact of user fees on the use of health care services among patients with rheumatoid arthritis in BC. The findings could be used to identify the most cost-effective approach for treating rheumatoid arthritis, and potentially, many other conditions.