More than 1.4 million Canadians have osteoporosis, a chronic condition that causes bones to become fragile and fracture easily. Clinical trials have shown that lifestyle changes and early medical management can reduce osteoporotic fractures in high-risk people. Past studies suggest that many people over 50 years of age who suffer a minor fracture are at risk for osteoporosis. This is an ideal time for osteoporosis investigation. Yet these patients are most often treated for the fracture alone and not investigated for osteoporosis. The aim of Maureen Ashe’s research is to investigate whether educating patients and raising physician awareness about osteoporosis after a low-trauma fracture could improve the investigation rate and if necessary, enable more patients to receive preventative therapy. Preliminary results from the study indicate that after providing education to patients and physicians at hospital fracture clinics, a substantially higher number of patients were assessed for osteoporosis.
Research Pillar: Clinical
Treatment adherence in first episode psychosis with a history of violence: understanding correlates and improving adherence
Research shows that if people who have experienced a first psychotic episode adhere to treatment, they are less prone to relapse and have improved overall well-being. However, studies also indicate that less than 50 percent of these individuals take their medication as prescribed, and less than one-third participate in relapse prevention treatments. It’s known that people with schizophrenia and a history of violence, substance use, or antisocial personality disorder are less likely to adhere to medication regimens and psychosocial treatments. Alicia Spidel is looking at the relationship between treatment adherence and a history of violence in people experiencing a first psychotic episode, and whether first episodes are related to higher rates of personality disorders and substance use. She is also assessing whether motivational interviewing, a client-centred therapeutic approach, motivates participants to manage their symptoms and prevent relapse. The results could be used to refine treatment programs for people with schizophrenia and reduce criminal behaviour.
The effect of surgical technique on morphology and biomechanical behavior of allograft bone-cement in hip reconstruction with impaction allografting
Of the approximately 18,000 hip replacements performed annually in Canada, 10 to 20 percent fail after 10 years. Failure and removal of an implant cause extensive bone loss to the femur (thigh bone). This bone deficiency makes it difficult to fix a new implant in place. Impaction allografting involves impacting and cementing morsels of bone in the femur to set a new implant in place. The appeal of this technique is its documented potential to restore bone. The procedure, however, has had mixed clinical results. Carolyne Albert is exploring ways to improve the surgical tools and techniques for impaction allografting. She is comparing the current technique with alternative surgical techniques. The research could lead to a technique that will provide implant stability while improving the potential for bone restoration.
The effects of inconsistency on everyday activities of Alzheimer’s disease
Studies have shown that people with Alzheimer’s disease are more inconsistent, compared to healthy older adults, on cognitive tasks (e.g., memory, reaction time). Research in this area has measured fluctuations in performance on multiple occasions over short periods of time. What is not clear is how these inconsistencies affect people’s daily lives. Various factors — including cognitive, visual and perceptual abilities, language and speed of processing — influence functional abilities. Catherine Burton is studying the impact of inconsistent cognitive performance on ability to perform everyday activities, such as managing finances and taking medications. Her research could help characterize the neural systems required for particular cognitive processes, which would assist in identifying people most at risk and in need of support.
A randomised controlled trial of a home based strength and balance retraining program in older persons presenting to the emergency department with a fall or related injury
In BC, falls are the most common cause of injury leading to hospitalization of people over 65. Older people with fall-related injuries severe enough to require a visit to an emergency department are at particularly high risk of falling again and incurring further injuries. Current treatment guidelines encourage an extensive and costly course of care for these individuals, including physiotherapy, ophthalmology, family physician support and occupational therapy. Meghan Donaldson’s research has shown that many at-risk patients do not receive this course of care. Meghan is investigating whether a home-based strength and balance retraining program can prevent subsequent falls in people who have already been treated in an emergency department for a fall. The research could provide evidence that a simple and cost-effective exercise program, involving fewer referrals than what current guidelines call for, could successfully reduce falls in older adults at risk of injury due to falls.
Bone-conduction auditory steady-state response thresholds: Effects of maturation and hearing loss
Tests to detect hearing loss measure the ability of sound vibrations at different frequencies to reach the brain. Hearing tests measure the ability to hear either air-conducted sounds (sounds that reach the inner ear through the ear canal) or bone-conducted sounds (sounds transmitted through bones in the ear and skull). Susan Small received a 2001 MSFHR Trainee Award to study an emerging method for testing hearing focused on auditory steady-state responses (ASSRs), which objectively measure response to sound stimuli. Studies show that ASSRs can accurately estimate hearing levels for air-conducted sounds. However, there is no data on the effectiveness of ASSRs in measuring hearing levels in infants for bone-conducted sounds. Susan is building on her earlier research by estimating bone-conduction hearing thresholds for infants when using ASSRs. Results from this research could improve hearing assessments and early diagnosis of hearing loss in infants.
The link between cardiovascular and bone health: a randomized controlled trial of statins and exercise rehabilitation in post-menopausal women
Cardiovascular disease (CVD) and osteoporosis are major health problems in North America. CVD is the leading cause of death of North American women, and one in four Canadian women over the age of 50 has osteoporosis. Once a woman reaches menopause, the risk for both osteoporosis and CVD increases substantially. Both diseases were thought to be independent consequences of aging. However, mounting evidence shows links between these diseases. For example, a widely used class of cholesterol lowering drugs, known as statins, reduces atherosclerosis (hardening of the arteries) and also increases bone health. Exercise may also provide the same health benefits, but more than 60 percent of Canadian women between 50 and 70 are not active enough to reduce their risk of heart disease or osteoporosis. Dr. Darren Warburton is studying the combined effect of statins and exercise on cardiovascular and bone health, physical fitness and quality of life. The research could provide important new information to help develop prevention and treatment programs for these diseases in post-menopausal women.
Neuropsychology of vision and eye movements
Nearly half of the human brain is involved in processing vision and eye movements. These functions can be impaired by strokes or brain tumours, as well as neurological disorders such as schizophrenia and autism. Using imaging technologies, experimental vision tests and eye movement recordings, Dr. Jason Barton is studying how neurological diseases disrupt the brain_s sensory and motor processing systems. Recognizing faces is one of the most demanding tasks for our visual systems, requiring both high-level perception and memory. Faces differ in only subtle ways in structure and shape, and the average person sees hundreds of faces in a day: despite this, humans are able to recognize faces effortlessly. Dr. Barton is studying how face perception is organized in the normal human brain, and how it is disrupted in patients with brain damage from strokes and surgery, and in those with Asperger_s disorder, an autism-like condition. Dr. Barton is also investigating saccades, rapid eye movements that shift our gaze toward a target and antisaccades, an unusual eye movement in which subjects look away from a suddenly appearing target. Performance on novel tasks like antisaccades can tell us something about how we exercise control over our responses to the environment. Abnormalities on such tasks can inform us about the problems with response control in conditions like schizophrenia. These studies will improve our understanding of these neurological disorders, how they disrupt visual processing, and lead to the development of future remedies.
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.
The early external cephalic version 2 trial
Of almost 40,000 babies born in BC in 2002, nearly 2,000 (4.8 percent) were breech (their bottom and legs were born before their heads). Research shows that breech babies are most safely delivered by Caesarean section. However, Caesareans cause more complications than vaginal births, and the resulting scar on the uterus complicates subsequent pregnancies. When a baby is found to be in a breech position using ultrasound, care providers can try to turn a baby to a head down position by feeling the baby through the mother’s abdomen and moving the baby’s head downward and its bottom upward. This procedure is called external cephalic version (ECV), and studies have shown that the chance of both breech birth and Caesarean section is reduced if ECV is performed close to the end of pregnancy (after 37 weeks). Dr. Eileen Hutton and her team of researchers from across Canada are conducting The Early ECV 2 Trial, which is an international randomised controlled trial designed to investigate whether performing ECV earlier in pregnancy, at 34-35 weeks, further decreases the number of Caesarean sections without increasing the risk of preterm birth. Dr. Hutton, founder and editor of the Canadian Midwifery Journal of Research and Practice, is also involved in a large international trial investigating the best way for twins to be born (vaginally or by Caesarean section), and is doing work in BC investigating patient initiated Caesarean section.