In Canada, there are large regional disparities in the waiting times for kidney transplantation. Previous studies show that these disparities cannot be explained by differences in the rate of organ donation or the incidence of kidney disease; instead, they may be the result of practice differences in referral or acceptance of patients for transplantation. Unlike waiting lists for most other medical services, increased waiting times for transplantation are clearly associated with loss of life. Currently, there is no formal, national system to ensure that medically eligible patients have equal access to transplantation across Canada. Very little research has been conducted regarding regional disparities in access to transplantation. To gain insight into the cause of these differences, Dr. John Gill is following a group of new dialysis patients in BC and Alberta to determine if there is a difference in referral for kidney transplantation or acceptance for transplantation within one year of starting dialysis. He will investigate the reasons why patients who are medically eligible for transplantation may not be referred for transplant, and document provincial differences in the time required to complete the transplant assessment and to activate a patient onto the transplant waiting list. Ultimately, this research will contribute to enhanced patient and physician education, better implementation of protocols to ensure that patients are appropriately referred, and new strategies to minimize regional disparities between provinces.
Year: 2005
The control of visual attention by the demands of locomotion – implications for movement disorders and their clinical diagnosis
For sighted individuals, normal everyday activities such as walking down a busy street or through a crowded grocery store are based on using vision to identify not just where one is headed, but what obstacles and hazards need to be avoided as well. While this ability to visually guide our actions may appear effortless, the task requires a complex coupling between the visual and motor systems. When disease or brain injury compromises these links between the visual and motor systems it becomes acutely obvious how much the brain is doing behind the scenes to promote normal motor behaviour. Most research on visual attention and its role in normal cognitive function has long centered on describing how it helps to recognize and identify objects in the visual world. Dr. Todd Handy’s research examines the reverse: the effect movements and locomotion have on vision, which is a previously unexplored facet of visual-motor interactions. Using a system that provides video-simulated motion and measurements of brain activity, Dr. Handy is studying how visual attention automatically responds to the many perceptual demands of locomotion – keeping track of the direction one is heading, recognizing stationary obstacles that may be looming in the path, and noticing moving objects in the periphery that may ultimately be on a collision course without conscious attention to these elements. Dr. Handy hopes his research will contribute to a better understanding of these visual-motor interactions and may provide a promising new method of diagnosing clinical motor disorders.
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.
Job tenure of people with severe mental illness registered in supported employment programs
Although many people with severe mental health problems are ready and available to integrate into the competitive workplace, more than 80 per cent of this group are unemployed. For those who obtain employment, job tenure is typically brief, lasting an average of 3 to 7 months. Supported Employment (SE) programs have been developed to help people with mental problems obtain and maintain employment. Though these SE initiatives fare better than other vocational programs, they still encounter difficulties regarding implementation issues and individual differences in job tenure. Dr. Marc Corbière is evaluating the programmatic and individual components of SE initiatives in the Greater Vancouver area. He is interviewing SE program directors and employment specialists, and asking participants (300-400 people) to fill out questionnaires and tests. From these results, Dr. Corbière will create and evaluate a novel and integrated model of job tenure for people with mental illness, including the ‘best’ program services and individual components. Results of his research will bring a new understanding to the vocational rehabilitation field by determining the key factors for maintaining employment for people with severe mental illness.
Trajectories and predictive characteristics of treatment-relevant violence risk factors among persons with psychiatric illnesses
Statistics Canada figures show more than a quarter of a million violent crimes in Canada reported in 2003, with many more violent crimes unreported. Each violent crime leaves a victim potentially traumatized and physically injured, with resulting high costs to the health system. One target group for whom violence often is studied is people with psychiatric illnesses. Study results have shown an overrepresentation of violence among certain groups of people with psychiatric illnesses, and Canadian law requires that violence risk is assessed among people considered for release from psychiatric, forensic, and correctional agencies. Most of the resulting research, however, has focused on predicting violence among persons with mental illness, rather than on ways to reduce or prevent violent behavior. Dr. Kevin Douglas’ research focuses on treatment-relevant violence risk factors. His research objective is to identify those risk factors most likely to be responsive to treatment, with the goal of informing violence-reduction efforts. Dr. Douglas is following a group of people with mental illnesses released from forensic psychiatric and correctional facilities in British Columbia. They will be administered measures of promising treatment-relevant risk factors (such as poor social support, substance use, and anger) on multiple occasions in the community. From the results of this work, Dr. Douglas will discern which risk factors are most likely both to change and to predict violence. Results from his research may reveal promising treatment targets to reduce violence among this group of people.
An interdisciplinary research program for evidence-based public health interventions and policy for illicit drugs in BC and Canada
The use of illicit drugs in Canada is associated with substantial, widespread consequences, including high rates of death and health complications among users, and significant social and economic costs to society. Canada has traditionally addressed illicit drug use with law enforcement measures, with prevention and treatment measures playing a secondary role. Recent efforts to reform Canadian drug policy go hand-in-hand with a strong need for expanded research to support the development of effective and evidence-based intervention programs and public health policies. Dr. Benedikt Fischer is examining how to develop more effective public health-oriented prevention, treatment and policy options to reduce the harms of illicit drug use. His research focuses on five main areas: street drug use monitoring; opioid treatment programs; prevention and treatment for hepatitis C among illicit drug users; cannabis control reform; and criminal justice interventions for drug offenders. Dr. Fischer is integrating basic, clinical and social health research and working in collaboration with researchers from across Canada, with an emphasis on issues of national relevance as well as those specific to British Columbia.
Investigating the molecular basis of collagen's finely tuned stability with single-molecule manipulation techniques
Collagen is the fundamental structural protein in our bodies, which means changes in its chemical composition can have profound, widespread effects on health. For example, connective tissue diseases, the leading cause of disability and absence from work in Canada, can be caused by a change affecting only one position out of 1000 in the DNA sequence that codes for collagen. As we age, collagens in our body tissues become chemically modified, leading to structural changes that result in weakening of bone structure and the deterioration of joints, arteries and the retina, a situation that is exacerbated by diabetes. The controlled production and degradation of collagen is important for normal embryo development; a breakdown in this controlled pathway is also associated with the spread of cancerous tumors in the body. All of these health-related problems are related to chemical changes in collagen, which lead to changes in its structural and elastic properties at the tissue level. Dr. Nancy Forde is studying the elastic properties and stability of single collagen molecules, to identify the relationship between chemical changes and changes in the structure and function of collagen. Her team is employing the world’s smallest tweezers, optical and magnetic tweezers, to grab, stretch and twist single collagen proteins. This special equipment is currently applied to protein study at only a handful of labs worldwide. Dr. Forde and her team are directing their efforts to better understand how changes in collagen at the molecular level affect the elastic and structural properties of tissues. This research could help explain how tissues deteriorate with age, as well as the impact of these changes on the development and severity of diseases such as cancer and diabetes.
A molecular picture of the innate immune response to Salmonella: quantitative proteomic and cell biological analysis of Salmonella vacuole development
Salmonella bacteria reside in the intestines of animals and can be transmitted to humans via contaminated food or water. These bacteria cause diseases such as typhoid fever and acute gastroenteritis, posing major health problems throughout the world. The body normally produces an immune response to these invading microorganisms. In a process known as phagocytosis, the blood’s immune cells engulf the bacteria, enclose them in specialized internal compartments, and then release destructive enzymes that kill them. However, Salmonella and several other intracellular parasites have evolved methods to subvert this process. By blocking the delivery of the destructive enzymes, these parasites avoid extermination and are able to survive and multiply inside the immune cells. Ultimately, bacteria escape from the cell and spread throughout the body to cause disease. Dr. Leonard Foster is employing advanced proteomic methods and instrumentation to explore and describe what occurs at the molecular level during phagocytosis. This research will lead to a better understanding of the basic operation of this important aspect of immune function. It will also advance knowledge of the molecular mechanisms employed by Salmonella bacteria to prevent the immune cells from delivering the destructive enzymes, potentially leading to better methods of protecting against Salmonella infection.
The Canadian healthy resident – healthy patient study
Research has shown that physicians with healthy personal habits are more likely to encourage patients to adopt such habits. This suggests that improving the health of physicians may, in turn, contribute to improved health of patients. Dr. Erica Frank is leading the ‘Canadian Healthy Resident–Healthy Patient’ study which is examining the link between physician health and patient health. Using a survey questionnaire, Dr. Frank is collecting personal and clinical information from medical residents nationally. These data will form the basis for development of interventions to improve the personal and clinical health practices of health professionals in training and practice. Dr. Frank’s study will then pilot those interventions in BC, and disseminate the results nationally and globally. Results from this research hold promise for informing policies and programs involving healthcare providers and communities.
Parents of children with cancer: a study of factors related to their psychological wellbeing
A diagnosis of cancer not only affects the patient, it also greatly affects the family caregivers. The physical and emotional effects of caring for a loved one with cancer can be devastating, with fatigue and burn-out a frequent occurrence. Dr. Anne Klassen is studying factors affecting the wellbeing of parent caregivers of children with cancer, with a specific interest in the direct and indirect relationships and supports that may contribute to differences in psychological wellbeing among these parents. Her study is recruiting a population-based sample, from British Columbia, Manitoba and Ontario, of approximately 500 families with children in active treatment for cancer. She is collecting data on a comprehensive set of factors, including background and context variables; child characteristics; caregiver strain; caregiver self-perception; coping factors and psychological wellbeing. Results from Dr. Klassen’s research will further the understanding of why some parents are able to cope with caring for a child with cancer while others cannot. Ultimately this research will help with earlier recognition of families at risk and the development of preventive or other strategies to better meet their needs, for the benefit of children, parents and families.