Previous research comparing how older adults use health services in urban and rural areas of Canada is inconclusive and sometimes contradictory. Some research found no differences between urban and rural residents; other studies found that people living in rural areas tend to use fewer services than those in urban centres. Diane Allan is comparing health care use and the mobility patterns of urban and rural residents. She is tracking health service records for people 55 and older on Vancouver Island to determine health service use before and after a move, including physician and hospital visits, home support and long-term residential care. Diane is assessing whether the current health care system is able to accommodate people in rural areas who require more specialized and intensive services, and if a lack of services forces people to relocate closer to the health care they require. One challenge is developing an appropriate measure of rural and urban residence. Diane is comparing traditional measures developed by Statistics Canada, with measures based on geographic information systems (GIS) technology, such as distance to a hospital. From a policy perspective this research may help to clarify why some findings report few differences in health service utilization among rural and urban older adults. If only healthy older adults remain living in rural areas while those with poorer health are forced to relocate to more resource rich environments, similar health utilization does not necessarily suggest an adequate health care system. Diane hopes her research will contribute to determining if and why rural older adults move in order to place these utilization patterns into context.
Research Location: Vancouver General Hospital
Role of integrin-linked kinase in human melanoma invasion
Cutaneous melanoma is a highly aggressive skin cancer. The highly malignant nature of melanoma is characterized by the capability of the melanoma cells to invade tissue below the epidermis and spread (metastasize) to almost any organ. Melanoma cells acquire distinct characteristics that enable them to break loose from surrounding tissue and migrate to remote sites. Cell migration is a complex process involving a variety of signaling proteins. Many studies have suggested that integrin-linked kinase (ILK), which provides a link across the cell membrane between integrins in extracellular matrix and actin filaments within the cell, is able to regulate the activity of various components of cell movement. Most strikingly, ILK is highly expressed (active) in melanoma compared to normal epidermal cells, and its expression is significantly correlated with melanoma progression. Philip Ng is studying the role of ILK in melanoma invasion. By investigating the molecular mechanisms on melanoma cell migration promoted by ILK, he hopes to assess the feasibility of blocking melanoma cell migration by interfering with the action of ILK.
Women with chest pain: Negotiating experiences of emergency department care
Cardiac disease is the number one killer of Canadian women. Research has shown that women and men have different experiences in the health-care system. Although emergency departments (ED) are often the first point of contact for women with cardiac symptoms, this setting has seldom been studied. Yet what happens during a visit to the ED may set the stage for later events. Treating heart attacks is highly time-dependent. If women get to an ED for treatment within four hours of the onset of symptoms, health professionals have a good chance of salvaging heart muscle that would otherwise be destroyed. Sheila Turris is investigating how experiences of emergency department care shape women’s decisions about seeking care in future situations. Specifically, she is examining how women arrive at the decision to seek treatment, and how they negotiate emergency care. This research may improve the quality of care women receive in emergency departments, helping to ensure women seek and get early, more effective treatment for signs of cardiac illness.
Regulation of Rho GTPases by integrin-linked kinase
Cell surface proteins regulate interaction between cells and the material surrounding them called the extracellular matrix (ECM). The ECM adheres cells together and buffers them from their environment. Interactions between these proteins and the ECM generate signals that regulate cell movement and survival. A key step in the evolution of cancer is the ability of cancer cells to evade attaching to the extracellular matrix, which allows them to detach from the primary tumour site and metastasize (move to other parts of the body). Dr. Nolan Filipenko is studying integrin linked kinase (ILK), a protein that is directly involved in cell survival and movement. The way ILK regulates cell survival is well understood, but less is known about how ILK regulates cell movement. Dr. Filipenko is investigating how ILK controls cell migration and invasion, research that could ultimately lead to new therapies for treating metastatic disease.
Bringing evidence to the patient
Asthma is becoming more common throughout the world. It is a major cause of hospitalization and an avoidable cause of death in a minority of patients. Dr. Mark FitzGerald, who has taken a leading role in developing national and international asthma guidelines, is evaluating new treatment strategies for asthma. These include drug therapies and strategies specifically designed for patients with near fatal asthma (NFA). In collaboration with other researchers, Dr. FitzGerald is also assessing how variations in asthma management affect outcomes. Tuberculosis (TB) is a global health problem that affects high risk groups in Canada, such as injection drug users and Aboriginal persons. Currently there is no way to determine an individual’s risk of developing active TB when the disease is latent, unless there are other risk factors such as HIV or diabetes. In collaboration with the Centers for Disease Control and Prevention in Atlanta, Georgia, Dr. FitzGerald is researching how to better identify those at risk of developing TB and investigating better strategies for the treatment and the prevention of TB. In the area of outcomes-related research, Dr. FitzGerald is the Director of the Centre for Clinical Epidemiology and Evaluation where he coordinates a multi-disciplinary group of investigators interested in the development, implementation and evaluation of evidence based interventions.
Psychoeducation in bipolar disorder: determining the effects of psychoeducation upon recurrence and quality of life in first episode mania patients
More than half a million Canadians suffer from bipolar disorder, a chronic psychiatric condition that causes repeated episodes of depression and/or elation. The condition significantly disrupts social and work lives, with high costs to the health care system. Although medical management of bipolar disorder has improved, many people have repeat episodes requiring frequent hospitalizations, and 15 percent of patients commit suicide. Research on the disorder is beginning to focus on treatments involving psychoeducation as well medication. This approach is designed to provide education about bipolar disorder and its treatment, promote early detection of symptoms, encourage regular sleep-wake cycles and social routines, enhance self-monitoring, and improve stress management skills. Dr. Erin Michalak is studying whether psychoeducation can improve quality of life for patients who have experienced their first episode of elated mood (mania). The research could determine whether psychoeducation helps to prevent relapse, reduce symptoms, improve adherence to medication, and improve ability to function socially and at work. The findings could be used to develop early intervention programs for people newly diagnosed with bipolar disorder.
Respiratory Sleep Disorders Research Unit
Respiratory sleep disorders affect more than 100,000 people in BC, with significant costs to the health care system and to the quality of life for those affected. A patient with a respiratory sleep disorder may stop breathing hundreds of times during the night, waking momentarily each time breathing resumes. As a result, they chronically get very little sleep.
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Genetic Pathology Evaluation Centre
Researchers at the centre are using tissue microarray technology to systematically validate whether certain biomarkers – cellular or molecular substances found in cancers – can be used to improve cancer diagnostics or predict the course of disease. With the ability to test hundreds of tumour samples at a time, researchers can assess the potential value of potential biomarkers with an efficiency that would have been unimaginable just a few years ago.
PC-TRIADD: The Prostate Centre’s Translational Research Initiative for Accelerated Discovery and Development
PC-TRIADD is a new initiative of the Prostate Centre at Vancouver General Hospital, where scientists and clinicians work together to translate discovery research into clinical practice through the development and implementation of clinical trials to assess the safety and effectiveness of new gene therapies. The centre contains the largest prostate tumor bank in Canada, and was the first organization in B.C. to construct and use “high throughput microarrays,” which enables researchers to study thousands of genes simultaneously from tissue samples. Scientists at the centre have already identified five key genes that cause prostate cancer to progress, and have developed targeted drugs that are currently being tested in clinical trials.
Retinoids in synovial sarcoma
Synovial sarcoma is a form of cancer occurring most commonly in the limbs of young adults. Patients are treated with aggressive surgery and radiation, but the disease often spreads and proves fatal. Current chemotherapy provides limited benefit, with serious side effects. Using gene microarrays, a new technology that allows scientists to monitor tens of thousands of genes simultaneously in tumour specimens, Dr. Nielsen helped discover a group of genes playing a central role in synovial sarcoma. These include several potential therapeutic targets, including the signalling pathway involving retinoic acid, a vitamin A derivative. Several existing and experimental drugs interfere with this pathway and have been successfully used to treat other cancers such as leukemia, but have not been tested in synovial sarcoma. Dr. Torsten Nielsen is using the gene expression profile of this cancer type to develop targeted therapies needed for its treatment.