Osteoporotic fractures among the elderly are a growing public health burden worldwide. Osteoporotic fractures are associated with a high incidence of disease and disability, and high risk for long term institutionalization. They also add substantial costs to the healthcare system. The main factors that cause hip fracture include experiencing a fall, loss of protective mechanisms and reduced bone strength. Integrated methods and tools for improving prevention strategies are therefore crucially needed. Dr. Saija Kontulainen is utilizing state-of-the-art imaging tools to better detect individuals at high risk for osteoporotic fracture. She is investigating whether these new tools can more accurately measure bone size and structure than the most common diagnostic procedure, bone density testing. The current procedure measures the amount of mineral in bones and is not potent to predict fracture risk of an individual. Saija is determining if the new imaging tools can identify which bone properties are key factors in hip fracture. The tools could also be used to monitor the effectiveness of bone therapies involving medication, nutritional supplements and exercise.
Research Location: Vancouver Coastal Health Research Institute
Cognitive and psychosocial outcome after renal transplantation
Successful kidney transplants significantly improve physical and psychological health and life expectancy for recipients. However, a kidney transplant’s impact on cognitive abilities (brain functions such as awareness, perception and reasoning) is relatively unknown, even though cognitive impairments have been reported in patients on dialysis treatment for chronic kidney disease. Other factors can also impact cognitive function, including other illnesses and medication regimens. Patients with chronic kidney disease are also at considerably higher risk of emotional distress than their peers. To determine if cognitive capacities improve following a transplant, Shannon Lund is conducting one of the first studies comparing cognitive differences between patients on dialysis and those who have received kidney transplants. Shannon is specifically comparing cognitive function, depression, anxiety and coping styles in groups of patients, before and after transplantation. The research could help clarify the source of cognitive deficits in patients with chronic kidney disease before and after kidney transplantation, and help health care professionals develop more effective treatment strategies to improve care of these patients.
Relevance of the presynaptic protein Complexin II to schizophrenia
Schizophrenia and related forms of psychosis are among the most severe, persistent and debilitating illnesses affecting young people. A key priority in the treatment of this disease is the development of novel antipsychotic drugs to address common cognitive deficits resulting from schizophrenia, which include impairment of attention, memory and executive function. These deficits are identified as being the most serious symptoms of the disease, and the degree of severity is the best predictor of how well or poorly affected individuals will fare over the long term. Dr. Alasdair Barr’s current research is focused primarily on identifying brain cell alterations associated with schizophrenia that may contribute to cognitive deficits. His team’s previous work has shown that levels of two related presynaptic proteins, complexin I (inhibitory terminals) and II (excitatory terminals) are decreased in the frontal cortex and hippocampus. They also demonstrated that lower hippocampal levels of complexin II were associated with cognitive dysfunction, representing the first description of a relationship between abnormal synaptic function and cognitive function in schizophrenia. Dr. Barr’s current work is building on these findings to further understand the role of complexins in cognition and schizophrenia.
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.
Pharmacist identification of new, diagnostically confirmed osteoarthritis (PHIND-OA)
Knee osteoarthritis is the most common cause of disability in older adults. There are three million Canadians currently afflicted with this condition, and it’s predicted that this number will increase by 50 per cent by 2020. The costs of medical care, drugs, and lost wages resulting from this disability is a major economic burden in Canada. Several research studies have demonstrated the benefit of non-drug therapy such as education and exercise for people with knee osteoarthritis. However, many individuals remain undiagnosed for their condition and don’t receive appropriate interventions. Dr. Carlo Marra is researching the potential of pharmacists, who are highly accessible health care practitioners, to help identify people with knee osteoarthritis by using a simple screening questionnaire. Next, he will investigate whether pharmacists can initiate an intervention that brings together patient, physiotherapist, and family practitioner to improve physical function, minimize pain, and reduce the economic burden of this disease. In addition, regular follow-ups will occur to assess and encourage compliance with the intervention, assess outcomes and answer any questions. Dr. Marra anticipates his research will demonstrate the value of this innovative, cost-effective strategy to improve outcomes and quality of life for people with knee osteoarthritis.
Falls risk assessment in elderly, community-dwelling women with age-related macular degeneration
About 30 percent of elderly people fall once or more a year, resulting in injury, disability, loss of independence and enormous cost to the health care system. Age-related macular degeneration (AMD), a degenerative disease of the retina, is the leading cause of legal blindness in Canada and the developed world. The most severe form of AMD affects one in 20 elderly people and is associated with a complete loss of central vision. However, data on fall risk among elderly people with AMD is extremely limited. Shelagh Szabo is conducting the first study to assess whether people with AMD are at higher risk of falling than other elderly individuals because of visual impairment. As people with AMD score poorly on visual measures that predict falls in other individuals, it seems likely that those with AMD may have a higher incidence of falls than those with normal vision. Conversely, as most AMD patients have reduced levels of physical activity due to their poor vision, they may actually fall less than healthy people. If the research confirms that people with AMD are frequent fallers, prevention programs could be targeted for the visually impaired to reduce falls and injury, as well as fall-related costs to the health system.
The structure and function of the Striatum in First Episode Psychosis
Schizophrenia is a complex and devastating mental disorder, marked by a breakdown in the relation between thoughts, feelings, and actions. Symptoms include delusions, hallucinations, disorganized language, and disorganized or catatonic behaviour. About one percent of the population develops schizophrenia, usually in late adolescence or early adulthood. However, the cause of this disabling illness remains unclear. Recent evidence suggests disturbances in early brain development may predispose people to schizophrenia. The striatum, a region of the brain involved in motor, sensory, and cognitive processes, is thought to be involved in the development of the disorder. Babak Khorram is using magnetic resonance imaging (MRI) technology to compare brain scans of schizophrenia patients and healthy volunteers. Babak is investigating whether abnormalities of the striatum are present when the illness begins, or emerge as a result of treatment, and the effect on patients’ cognitive functioning and treatment. The results could enable clinicians to screen people thought to be susceptible to the disorder, due to genetic and environmental factors. The research could ultimately improve diagnosis and treatment of schizophrenia.