Chronic obstructive pulmonary disease (COPD) is a lung condition that affects more than 75,000 British Columbians. People with COPD have a shortness of breath, chronic cough, and can experience difficulties with the activities of daily life, such as showering, walking, and social activities. Many people with COPD have regular flare-ups, or exacerbations, of their lung condition. These exacerbations result in a severe shortness of breath and overall weakness and fatigue and sometimes lead to long hospital stays. These flare-ups and long hospital stays can cause severe problems with activity tolerance, which then further increases the risk of future flare-ups.
The objective of Dr. Pat Camp's research program is to investigate how physical activity can improve the health outcomes of people who are hospitalized with a COPD flare-up. This research program will include a systematic literature review to summarize the current state of knowledge, validating tools to measure activity in hospitalized COPD patients, and determining if exercise programs for hospitalized patients can improve their quality of life and health outcomes. In addition, Dr. Camp's research program will include projects that incorporate patient input about what activities are important to them, which will indicate the level and type of activity that is necessary in order for these patients to be discharged safely from the hospital.
By developing a thorough understanding of how exercise leads to increased health in COPD patients, this research program aims to improve the quality of life and overall health of patients hospitalized with acute COPD flare-ups. Future work will extend these innovations to other chronic lung disease populations, such as patients with lung transplants or interstitial lung disease.
Borderline personality disorder (BPD) is among the most complex, misunderstood, and stigmatized mental health problems. It is a serious psychiatric condition characterized by instability in relationships, emotions, identity, and behaviour that often induces intense emotional suffering and places affected individuals at high risk of suicide and self-injury. Approximately 10% of individuals affected by BPD die by suicide, 75% have attempted suicide, and 70-80% self-injure. BPD is also a significant concern for the public health-care system. Patients affected by BPD represent up to 20% of psychiatric inpatients and heavily utilize outpatient and hospital emergency services. In fact, the estimated costs to the health-care system per year for each BPD patient range from US$12,000–$30,000. Self-injury and other problems in BPD appear to be related to problems in the management of emotions, or emotion regulation problems.
Dr. Alexander Chapman’s research aims to better understand and treat BPD and related problems, such as self-injury and suicidal behaviour, by examining the role of emotions in BPD and self-injury. Research in his lab, the Personality and Emotion Research Laboratory, includes a variety of studies aimed at better understanding what causes and maintains BPD and self-injury, as well as studies designed to help us understand how to effectively treat BPD. He is also conducting studies on the risks and protective factors for self-injury.
Dr. Chapman’s short-term goal is to continue to develop his research on BPD in two key areas: (1) the role of emotion regulation in BPD and self-injury, and (2) effective treatments for BPD and NSSI. He has several grants for studies in these areas and hopes to expand this research over the next five years. In the long-term, Dr. Chapman would like to develop an interdisciplinary research, treatment, and education centre focused on BPD, self-injury, and related health problems. Such a centre would be unique in Canada and would have the potential to significantly improve our understanding and treatment of BPD as well as the education and training of junior researchers and professionals.
The number of individuals suffering from chronic obstructive pulmonary disease, or COPD is on the rise in Canada and around the world. COPD, is an inflammatory disease primarily associated with lung inflammation. Inflammation also extends beyond the lungs, and the presence of inflammatory factors in the blood causes blood vessel and heart disease, increasing a COPD patient’s risk of heart attack and stroke. Exercise training is known to have anti-inflammatory effects that are beneficial in the treatment and prevention of a number of chronic conditions. However, the effects of exercise on inflammation in the airways and blood of COPD patients is not well understood. It is also unknown whether exercise training can reverse some of the detrimental effects of inflammation in the blood vessels and brains of patients with COPD and reduce their risk of having a heart attack or stroke. To answer these important questions, Dr. Neil Eves will be conducting two studies. His first study will investigate how exercise training affects the airway and blood inflammation of patients with COPD. His second study will investigate how exercise training improves blood vessel function in patients with COPD and whether these improvements are related to changes in inflammation. Reducing inflammation with exercise in patients with COPD could greatly improve the health of these patients and reduce secondary morbidities associated with the disease.
Cardiovascular disease is a leading cause of death and disability worldwide. Long-term disease management approaches are effective at reducing the risk of death and disability in patients with cardiovascular disease. Canadians of South Asian and Chinese ancestry are more likely to die from heart disease or stroke than other Canadians and there is emerging evidence that these groups may have poor chronic disease management. Optimal chronic heart disease management may be significantly impaired by language barriers, a limited understanding of health determinants, and potentially differing cultural views of heart disease and treatments. The goal of Dr. Nadia Khan’s research program is to improve chronic cardiovascular care for Canadians of South Asian and Chinese ancestry. She is currently undergoing a very large study of 600 South Asian, 600 Chinese, and 600 Caucasian patients discharged with acute heart attack or unstable angina from hospitals in Vancouver, Toronto, and Calgary. The objectives of her research program include: (1) determining differences in chronic cardiovascular disease management between South Asian, Chinese, and Caucasian patients; (2) identifying the underlying patient barriers associated with poor care for each of these groups; and (3) using this information to develop targeted and culturally sensitive interventions in chronic cardiovascular disease management. Working alongside health care workers, ethnic community members, and decision makers, Dr. Khan will be developing and testing the new strategies to ensure that they are acceptable and practical for each ethnic group. This is the first program to systematically evaluate how different ethnic groups manage coronary artery disease and to identify the cultural factors that may be linked with poor care. The evidence obtained from this study will be used to plan culturally sensitive care programs for those with heart disease who are from South Asian or Chinese ancestry. This program of research will partner with community members, health care workers, and decision makers to ensure that the interventions are relevant to policy and practice.
Pre-term babies, those born before week 37 weeks of gestation, are more susceptible to invasive infections than full-term babies. The smallest babies born “extremely” premature (those born before 32 weeks, or approximately 1,500 grams or less of birth weight) suffer the greatest burden of infection among all age patient age groups in BC and other developed countries in general. About one in four “extremely” pre-term babies suffers from an invasive infection, which adds up to more than 8,760 new invasive infections in North America each year. In addition to the immediate health risks, such as a major loss of cardiorespiratory function or death, these infections may lead to long-term physical and intellectual handicaps in these children.
The work of Dr. Pascal Lavoie aims to understand why pre-term babies are so vulnerable to infections caused by common micro-organisms. Dr. Lavoie and his team are examining the way that babies’ immune cells work early in life to determine if this differs from the function of mature immune systems. In order to do this in a way that is completely safe to babies, he takes advantage of scavenged blood samples (he uses, for example, placental blood normally discarded at birth) analyzed using sophisticated technologies to extract detailed information about the human immune system.
Dr. Lavoie also aims to understand why the immune system of pre-term babies appears underdeveloped and what impact therapeutic manipulation of the latter may have on diseases such as bronchopulmonary dysplasia: a chronic form of neonatal inflammatory lung disease which appears to be caused by excessive activation of the immune system during infection. Ultimately, Dr. Lavoie hopes that a better understanding of the immune systems of pre-term infants will help researchers and doctors develop better treatments to boost immune defenses and prevent the dreadful consequences of infections in vulnerable newborns.
Injection-drug users are extremely susceptible to drug-related health risks, including HIV, hepatitis C and overdose. Although treatments for drug addiction are available, they are not always effective for those with the most severe cases of addiction. A key issue is many members of this vulnerable population remain outside the health care system, which exposes injection-drug users and those in their immediate communities to drug-related health risks. Previous research studies in Europe and Canada have shown that medically prescribed heroin can effectively attract and retain injection-drug users into the health care system and can ultimately improve the health of this vulnerable population. Unfortunately, the negative stigma attached to the medical use of heroin is a barrier to its implementation in many settings. However, an alternative strategy was suggested by a Canadian study, which demonstrated that a small group of participants receiving a licensed pain medication experienced similar health improvements as those receiving medically prescribed heroin.
Dr. Eugenia Oviedo-Joekes’ research is studying whether alternative drug addiction treatments can be used to reach vulnerable populations remaining outside the health care system. She is conducting an innovative clinical trial to test whether licensed pain medications can successfully treat the most severe cases of heroin dependency and is studying how this approach compares to medically prescribed heroin. After patients are effectively stabilized with injection treatment, she will determine if pain medication administered as an oral liquid can be used instead of injections.
Dr. Oviedo-Joekes is focusing her work on a subpopulation of women and Aboriginal people that have experienced high rates of victimization, including physical and sexual abuse, or violent or traumatic experiences, which dramatically impact their health. She hopes these treatments will directly benefit those with the most severe cases of heroin addiction and she will also measure the beneficial impacts in their communities.
Repetitive-use tendinopathy, formerly known as tendonitis, is a major cause of repetitive strain injury (RSI). The occupational costs of RSI are enormous: work-related injuries cost Canada $8.6 billion annually and an estimated one-third of workers' compensation costs in industry are due to RSI of soft tissues, particularly tendons. In 2001, 2.3 million Canadians reported an RSI, and the average time lost from work per case of tendon-related injuries was 79 days (Source: StatsCanada 2001). Despite the enormous clinical, societal, and economic significance of RSIs, there is only limited understanding of the mechanisms that cause them.
In order to establish new treatments for RSI, Dr. Alexander Scott has established an innovative tendinopathy research program. He is incorporating a multi-disciplinary approach from basic to clinical science, which integrates a number of different methods, including molecular and cell biology, biomechanics, and rehabilitation science. His work will focus on the role of new blood vessel formation as a feature of chronic tendon injury. This work promises basic insight into the biology of RSI as well as directly applicable knowledge to develop new therapeutic strategies. This will be the first research program in Canada to have a primary focus on the biology of work-related tendon overuse injuries using a multidisciplinary approach. The ultimate vision of this program is to find better treatments for work-related tendon injuries.
According to the World Health Organization, obsessive-compulsive disorder (OCD) is one of the top 10 causes of disability. The disorder often begins in childhood and interferes with normal development. This disabling mental illness affects approximately 2 – 3 percent of British Columbians and, although treatable, is often under diagnosed.
The aim of Dr. S. Evelyn Stewart's research program is to improve the lives of BC children and families living with OCD. Her goal is to improve the evaluation and awareness of pediatric OCD in BC by conducting research to guide scientific and clinical understanding of OCD and its management by health professionals, and by establishing national and international linkages, which will lead to future research collaborations. Dr. Stewart's specific objectives for the first five years are to 1) create a unique research program within the new pediatric OCD clinic at BC Children's Hospital that is closely tied with the community, 2) establish a pediatric OCD DNA and research data site for BC, 3) launch a comprehensive patient-assessment method, and 4) investigate the outcomes and effectiveness of the program itself.
This program is unique, as it pulls together expertise from the clinic, the community and the laboratory. One important feature of Dr. Stewart's program is the effective transfer of new information between the clinic and the research lab in order to help the outcomes of practice inform research. Dr. Stewart anticipates this program will help limit the suffering and health-care costs related to OCD. The program is anticipated to develop into the first North American OCD Centre of Excellence.
Lungs are for life. Unfortunately, the most frequent long-term illnesses in children and babies are respiratory system conditions. Children's lungs can be damaged in many ways: bacterial and viral infections, asthma, or faulty genes causing thick mucus to accumulate in the lungs of children with cystic fibrosis. Even the oxygen and artificial ventilation needed to sustain the lives of premature babies can cause lasting lung damage. A feature shared by all these serious childhood lung diseases is that some of the damage is caused by activation of the innate immune system, which is an important part of our immune defense network. The innate immune system is like a “double-edged” sword. While innate immunity is essential for keeping us healthy, it can cause excessive lung-damaging inflammation if the activity is not carefully controlled.
To prevent lung damage, Dr. Stuart Turvey is examining the systems that control the activity of the innate immune system. These control elements are known as negative regulators. His team will study these negative regulators in a variety of childhood lung diseases spanning premature babies and lung infections through to asthma and cystic fibrosis. The unique aspect of this project, and of Dr. Turvey's group in general, is a commitment to translational research focused on people with lung disease. This means research results from the lab bench are applied directly to patient care.
Rather than relying exclusively on laboratory (animal or cell) models of disease, Dr. Turvey’s team plans to examine genetic material donated by people affected by infectious and inflammatory lung diseases. The results of this work will be an exciting starting point for gaining a better understanding of the causes of childhood lung diseases and developing new medicines to safely control the damaging inflammation that occurs in the lungs of so many babies and children.
Provoked vestibulodynia (PVD) is severe pain at the vaginal opening and the most common form of chronic genital pain in women. Although as many as 14 per cent of Canadian women and 20 per cent of adolescents are affected by this condition, it is frequently underdiagnosed and undertreated, and as a result, many women experience sexual difficulties, emotional distress, and multiple medical visits. Although different types of treatment exist, ranging from medication to psychological therapy, the best treatments to reduce PVD pain and distress, and which patients will benefit the most, are not known. Evidence indicates that psychological therapies such as cognitive behavioural therapy (CBT) and mindfulness-based therapy (MBT) are effective at reducing pain and sex-related distress for women with PVD. CBT is designed to challenge thoughts and uses active strategies (e.g. progressive muscle relaxation to decrease muscle tension) to change one’s experience, whereas MBT teaches individuals to be nonjudgmental and accepting of their experience and to learn to live without reacting to pain. Dr. Kelly Smith’s aim is to determine whether CBT or MBT is the most effective approach for reducing PVD pain and improving women’s quality of life, and she will determine which patient characteristics are associated with better responses to these treatments. She will be examining personal and medical characteristics for women with PVD who participated in the Multidisciplinary Vulvodynia Program, a treatment program based at Vancouver General Hospital for women with chronic genital pain. She will then study whether CBT or MBT is related to greater pain reduction and improvements in sexual function/emotional distress in a group of 70 women participating in an 8-session CBT or MBT group program. At the end of the study, women will be interviewed to assess their satisfaction with the program and provide feedback on how to improve the program. Dr. Smith’s studies will be the first to provide information on which of these psychological treatments works best for specific types of women with PVD. This information will provide clinicians with evidence-based guidance regarding potential treatment recommendations and will be essential in helping to reduce the health and economic burdens associated with PVD. Dr. Smith’s final results will be communicated to physicians and other health providers in British Columbia, and her findings will be submitted for publication in professional, wide-reaching health journals.
