Osteoarthritis is one of the leading causes of physical disability in adults worldwide and is associated with a significant personal and economic burden. It is estimated that one in eight Canadian adults currently have osteoarthritis, which results in $10.2 billion in annual health-care costs and an additional $17.3 billion in economic impact due to loss of employment productivity and other indirect health-care costs. Most commonly affecting the knee, osteoarthritis is characterized by the breakdown of articular cartilage, a smooth lining at the ends of bones that allows ease of movement and shock absorption. It is believed that high magnitude and poorly distributed loads that pass through the knee joint play a strong role in the development and progression of knee osteoarthritis. Improvements in pain, physical function, and quality of life can be achieved by developing treatments that effectively reduce and more evenly distribute these loads.
Dr. Michael Hunt’s research will focus on the use of sophisticated motion analysis equipment and techniques as a way to measure the loads experienced by the knee joint during walking. A better understanding of the factors that influence the magnitude and distribution of knee joint load will inform the development of treatment methods that effectively target these factors. He will focus on methods to optimize the load-reducing capacity and methods of clinical delivery of three treatments: lower limb exercises, gait modification, and shoe insoles. These treatments are designed to be non-invasive (non-surgical and non-pharmacological) in order to improve patient safety while minimizing health-care costs.
This research will be the only program in BC (and one of only a few in Canada) using analysis of motion and knee joint loading to inform clinical treatment for knee osteoarthritis. The focus on non-invasive treatments is in stark contrast to the majority of current osteoarthritis research, which is in the areas of surgery or drugs. Hunt’s research will provide effective treatment alternatives that have lower costs of delivery, fewer side-effects, and wider availability to patients. In addition, new treatment strategies that minimize joint loads have great potential in slowing the rate of disease progression, thereby reducing economic costs in the long-term and significantly improving the quality of life of those affected.
Asthma patients are at risk of potentially severe and sometimes lethal exacerbations. These exacerbations can be caused by a variety of triggers, such as infections or exposure to allergens. Diesel exhaust and other traffic-related constituents can also be inhaled along with the allergen. This multi-inhalant mixture results in immune reactions that are more complex than exposure to the allergen alone. Although it is well established that multi-inhalant mixtures of allergens and pollution contribute to asthma exacerbations, research in this area typically focuses on exposures to single agents, either diesel exhaust or allergens alone.
Dr. Francesco Sava is investigating the relationship and the synergies that exist between diesel exhaust and allergen-triggered asthma exacerbations using a live-patient model. His aim is to demonstrate that inhalation of diesel exhaust increases allergen-induced inflammation in the lungs of asthmatic patients. Using state-of-the-art equipment, he will expose patients to controlled diesel exhaust concentrations. A very small amount of allergen will be introduced into a segment of the patients’ lungs, and the resulting inflammation will be measured. This multi-inhalant exposure model reflects the real-life conditions that patients are likely to encounter. The experimental model he uses has been widely studied, is very safe, and allows researchers to test allergens on humans without triggering an overt asthma attack.
The research will help define the synergies between the real-world concentrations of inhaled diesel exhaust and allergen exposure in the asthmatic population. This information will likely lead to recommendations for air quality and strategies to protect vulnerable populations.
Stroke is the leading cause of neurological disability in Canada. Most stroke survivors have a number of other related conditions, including heart disease, diabetes, obesity and high blood pressure, which contribute to their risk of additional strokes. Exercise not only improves fitness, it also has the potential to reduce the risk of heart disease and stroke.
Dr. Ada Tang is working to understand how aerobic exercise can influence stroke risk factors and heart and arterial function in those who have already had a stroke. She will be evaluating the effects of an exercise program on 51 participants between the ages of 50 and 80, all of whom are one-year post stroke and can walk short distances without help. Participants will be randomly assigned to either an aerobic exercise program, or to a balance and flexibility program. Both programs are conducted at Vancouver General Hospital and feature three one-hour sessions per week. Program participants are carefully monitored during their exercise sessions. The participants’ fitness level and blood pressure will be tested at the start and the end of the six-month exercise program and two months after the end of the program to see if the benefits are maintained. Echocardiograms will be performed to look at heart size and function, blood tests will measure cholesterol levels and other signs of inflammation, and other tests will be done to determine how exercise can improve artery flexibility, heart rate and rhythm.
This study will help us better understand how exercise after stroke can improve heart function and heart health. Research results will help health professionals understand the best way to promote a healthy lifestyle after stroke to lower the risk of heart disease or another stroke.
Between 2005 and 2009, more than 16,000 infants in British Columbia were born prematurely. Prematurely born infants are at increased risk for developing motor problems that, in many cases, significantly interfere with daily life and school performance. This degree of motor difficulty is often referred to as developmental coordination disorder, or DCD. Children with DCD struggle with many typical tasks, such as tying shoes, riding a bike, handwriting or participating in sports. While it was once believed that children with DCD would outgrow their motor difficulties, studies have shown that these difficulties can persist into adolescence and adulthood. In addition to physical concerns, children with DCD experience other issues, including difficulty with social and peer relationships, lower self-worth and self-esteem, anxiety and depression, and other emotional health concerns. Thus, there is an urgent need to develop rehabilitative therapies to prevent these lifelong complications.
Dr. Jill Zwicker's research program focuses on understanding how the process of early brain development influences motor-skill development. Previous work suggests that DCD may be caused by abnormal brain development, but this has yet to be confirmed. Dr. Zwicker, an occupational therapist with a clinical and research interest in DCD, is using different brain-imaging techniques and is collecting information about health and treatments from a group of 175 premature infants. The babies will have a brain scan in the first few weeks after birth and will have a second scan around the time they would have been born, had they made it to full term. Measurement will be used to compare brain development between these two points in time.
Dr. Zwicker suspects there may be a relationship between brain development and exposure to pain, and that these factors may affect motor development, so she will also gather information about the number of skin-breaking procedures (for example, needle pokes) that the infants receive. In addition, her research team will collect information about other factors that may influence brain and motor development, including medications received, days on oxygen, illness severity, infection, and lung disease.
By having a stronger understanding of the factors that contribute to the development of DCD in children born prematurely, Dr. Zwicker hopes her research will help prevent poor motor outcomes and help develop new therapies to improve motor and functional outcomes for children born prematurely.
An estimated 86,500 people are currently living with spinal cord injury (SCI) in Canada, and approximately 4,300 more will experience SCI each year. In persons with SCI, the bladder can't receive or send the signals required for normal organ function, and 80 percent of persons with SCI are affected by acute or chronic urinary tract complications that negatively influence their health, quality of life and impact their life expectancy. Currently, evaluation of bladder function is limited to periodic urodynamic testing (UDS), an invasive procedure that requires patients to have catheters inserted into the urethra and rectum. Besides being a painful and inconvenient procedure, the invasive nature of this diagnostic method exposes patients to the risk of serious complications such as urinary tract infection, trauma and bleeding that may further complicate urinary tract conditions. Dr. Babak Shadgan is investigating the use of near-infrared spectroscopy (NIRS) as a novel non-invasive diagnostic method to evaluate the physiologic mechanisms underlying bladder dysfunction in people with SCI. Detecting when the bladder has filled to a given volume or size is essential to avoid accidental incontinence and also to prevent damage to the kidneys from backpressure secondary to a full bladder. NIRS is a non-invasive optical technique that uses light to monitor changes in tissue oxygenation and changes in blood supply to the bladder as the organ fills and empties. Using NIRS for bladder monitoring in this population will demonstrate both scientific relevance and commercial potential and will lead to the development of an NIRS device capable of more effective, more comprehensive, and safer evaluation of bladder dysfunction than current methodologies. The health care burden associated with bladder dysfunction secondary to SCI is considerable; hence, the further development of NIRS for monitoring devices and diagnostic techniques for persons with SCI has potential to reduce complications associated with current invasive tests and improve the standards of care in this population.
Cardiovascular disease, including heart attack and stroke, is a major public health concern. The Public Health Agency of Canada indicates that 37 per cent of all deaths in Canada are cardiovascular in origin and approximately 10 per cent of hospitalizations in Canada are related to heart disease or stroke. Cardiovascular risk is currently estimated by assessing risk factors such as smoking status, height, weight, and the amount of cholesterol in the blood. Alternate methods such as viewing the heart and brain with magnetic resonance imaging (MRI) could be more useful, as they would help physicians detect and treat impairments in vascular function much earlier, thus reducing cardiovascular disease risk. Dr. Glen Foster wants to find out how measurements of vascular function are related to stroke or heart disease risk by assessing blood vessel function in patients at risk for both diseases. He is defining the relationship between brain blood vessel function and stroke, and heart vessel function and heart disease, by comparing patients who have recently suffered strokes or heart attacks with subjects who are in low- or high-risk groups for either of these conditions. He will be working with a number of colleagues at UBC who have designed a unique system capable of manipulating and controlling blood oxygen and carbon dioxide content within the MRI scanner to examine changes in vascular function in response. Using the MRI to measure vascular function throughout the vessels of the heart and brain, while accurately controlling the blood oxygen and carbon dioxide, is an important new idea in the clinical setting. This leading-edge concept could revolutionize sub-clinical detection of cardiovascular disease; it could help track how effective treatment is and provide new information in the specific anatomical area of heart disease and stroke.
Multiple sclerosis (MS) is an autoimmune disease of the brain and spinal cord (together termed the central nervous system), where inflammation of the myelin coating of nerves leads to cell damage and varying degrees of disability. Neuromyelitis optica (NMO) is another inflammatory demyelinating disease of the central nervous system; however, it differs from MS in a few subtle but important aspects. NMO primarily affects the optic nerves and spinal cord, and evidence suggests that the flow of water in cells is very important in NMO. The similar characteristics of MS and NMO make it difficult to differentiate between the two; however, patient prognosis and optimal treatment for these two diseases are very different. Dr. Shannon Kolind is working to develop a non-invasive quantitative imaging tool for assessing both myelin and total water content throughout the entire central nervous system with the aim of differentiating between MS and NMO in terms of disease processes, diagnosis, prognosis, and treatment outcome. She is using a newly-developed magnetic resonance imaging (MRI) technique that is sensitive and specific to myelin and allows for high-resolution imaging of the brain and spinal cord in clinically feasible times. This technique can also be modified to estimate total water content. Dr. Kolind is using this technique to study the regional differences in myelin and inflammation in areas of focal damage (known as lesions) in MS and NMO, as well as areas of the brain and spinal cord that appear normal but might also have important damage. Ultimately, this research will provide new sensitive and specific imaging markers of excess water (inflammation/edema), myelin health (neuroprotection), myelin loss (neurodegeneration) and myelin repair (remyelination). The importance of this project lies in two potential improvements to the lives of people with MS and NMO. Rapidly and accurately making a diagnosis has a major impact on quality of life by determining the most effective treatment; it also reduces the stress of uncertainty, particularly with regard to prognosis. Furthermore, developing imaging markers and relating them to clinical symptoms will allow easier and more reliable monitoring and prediction of disease progression, which will aid in clinical trials of potential therapies, ultimately leading to the earlier availability of successful treatments.
The United Nations Millennium Development Goal number four commits to reducing child mortality by two thirds before 2015. However, worldwide, eight million children under the age of five die annually. The majority of these deaths occur in resource-poor countries and are a result of a condition called sepsis. Sepsis usually occurs following severe infections, when the body’s immune defences begin to cause harm, leading to death if left untreated. Most infectious diseases including pneumonia, diarrheal diseases and malaria, when severe, result in sepsis. Studies from Kenya have shown that among children admitted to hospital with a severe infection, more children die within the two-month period after leaving the hospital than during their hospital stay. While there are a number of studies regarding hospital treatment, no studies have been conducted to investigate predictors of death after leaving the hospital. Knowledge of these predictors can help to identify which children are in the high- and low-risk groups and thus enabling closer monitoring of high-risk children following discharge. These risk predictors can also be used in clinical trial design so that treatments can be developed, tested, and eventually implemented to reduce sepsis-related deaths following hospitalization. The goal of Dr. Matthew Wiens’ research is to identify predictors of child death from sepsis after leaving the hospital. To do this, he will study a group of children under the age of five who were hospitalized for sepsis at two hospitals in the Mbarara district of Uganda (the Mbarara University Hospital and the Holy Innocents Children’s Hospital). During the hospitalization phase he will collect information on a series of characteristics such as the type and severity of infection, nutritional status, maternal education, access to clean water and many other potential predictors. During the six month follow-up phase after hospitalization the health outcomes of these children will be determined. Using these predictors, Dr. Wiens along with his supervisor and team of researchers will create a scoring system that allows doctors to identify children who at high and low risk of death after discharge and intervene accordingly. Understanding the factors that are likely to influence a child’s long-term health outcome after leaving the hospital will help in the development and implementation of effective interventions to reduce childhood mortality in the developing world.
Sleep apnea occurs when a person repeatedly stops breathing for a short period of time while they sleep. This common disorder affects about 20 per cent of Canadians. During sleep apnea episodes, blood oxygen levels fall, resulting in persistent low levels of oxygen, called hypoxia. Consequently, people with sleep apnea commonly experience adverse health outcomes, including high blood pressure, heart attacks and strokes. Preliminary findings from Dr. Philip Ainslie’s research lab have shown that reductions in brain blood flow can worsen sleep apnea, while increases in brain blood flow may reduce it. Dr. Shawnda Morrison’s research will expand on these exciting initial findings by exploring the possibility of treating sleep apnea by manipulating brain blood flow. Dr. Morrison will use sophisticated imaging techniques to examine the effect of an oral medication, which alters brain blood flow, in patients at rest and while they sleep. Her first study will examine patients with and without sleep apnea in a controlled laboratory setting. In her second study, Dr. Morrison will induce sleep apnea in otherwise healthy humans at high altitude (5,000 metres, near the base camp of Mt. Everest, Nepal). In this study, she will also conduct the same experiments on a group of high-altitude residents who do not develop sleep apnea, and compare any differences observed between the two groups. The results of these studies will have major implications for understanding what influences brain blood flow and how these different factors can then affect sleep apnea. Those people who do not develop sleep apnea will provide insight into future sleep apnea treatments. Indeed, these studies will provide a “proof of concept” that an oral medication, which alters brain blood flow, can be an effective treatment for sleep apnea. This will, in turn, dramatically reduce the incidence of heart disease and stroke in patients who have sleep apnea.
The development of effective HIV/AIDS treatment has resulted in dramatic improvements in the health of people infected with the virus. Taken regularly, highly active antiretroviral therapy (HAART) interrupts the viral life cycle, suppresses the level of HIV in a patient's bloodstream, and promotes health improvements. The recent finding that individuals undergoing effective treatment are far less likely to transmit the virus to others has spurred the development of a new strategy aimed at preventing new HIV infections. Dubbed "Seek, Test and Treat", the goal of this initiative is to increase the number of people on HIV treatment in Prince George and in Vancouver's Downtown Eastside.
Dr. M-J Milloy is specifically focusing on the expansion of HIV treatment among people of Aboriginal ancestry who use illicit drugs. In Canada, young Aboriginal people are a growing sector of the HIV/AIDS pandemic, and Aboriginal people are highly over-represented among HIV-positive drug users. Dr. Milloy’s research will look at treatment for HIV and health outcomes for Aboriginal drug users and, in light of increasing calls by Aboriginal leaders for research that focuses on health and wellness among Aboriginal people, will try to identify the characteristics of successful treatment.
Dr. Milloy's research will address a number of outstanding concerns:
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Are Aboriginal individuals who are HIV-positive and use illicit drugs being effectively treated with HAART?
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What are some of the broader factors, such as stable housing or employment, that promote effective treatment?
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What is the level of viral resistance to HIV medications among Aboriginal drug users?
Much of the data for this study will come from the AIDS Care Cohort to Evaluate access to Survival Services, an ongoing study of approximately 750 HIV-positive drug users in Vancouver. The research will be supervised by Dr. Evan Adams, Physician Advisor to the First Nations Health Council, who will ensure that the research is respectful and responsible to Aboriginal participants and communities.
The information gained could be used to improve existing systems to provide HAART as well as inform new Aboriginal-led efforts to improve health and wellness. By improving HAART delivery and expanding the number of people receiving effective care for HIV infection, it is hoped that the number of new infections will also drop.
