Methadone maintenance treatment (MMT) is the most effective form of treatment for opioid dependence, a chronic, recurrent disease. However, the availability and means by which MMT is delivered varies greatly, both locally and internationally. Understandably, the resulting accessibility, quality and comprehensiveness of care provided through the various treatment practices have important public health implications, and require careful consideration. Notably, there are vast differences between the drug treatment systems in California and British Columbia. Treatment for opioid dependence remains restricted in California due to regulatory constraints on treatment settings, (i.e. registered drug treatment centres), and physician practice, (i.e. limits on the number of patients per physician). Nonetheless, treatment through drug treatment centres may offer some advantages. In comparison, access to MMT in BC has improved following administrative transfer from the federal government to provincial colleges of physicians and subsequent deregulation through the introduction of community-based treatment (i.e. office-based prescription and dispensation in community-based pharmacies). Community-based treatment may maximize access, albeit at a relatively high cost, although the economic merits of maximizing access are well-established. Building on his earlier research in this area, Mr. Nosyk is working to identify differences in patient characteristics, treatment outcomes and costs of opioid dependence treatment systems in both the countries, with a specific focus on the performance of the treatment systems in terms of effectiveness, efficiency and equity. The knowledge gained from his research can be extended to estimate the health and economic impact of introducing treatment services at the population-level, and corresponds with long-term recommendations to expand services to provide more comprehensive treatment for substance users in BC.
Year: 2009
Evaluation of a Proposed Revision of the HCR-20 Violence Risk Assessment Scheme.
Violence is a serious public health concern. It embodies a considerable societal burden and its individual cost, in terms of both physical and mental health, is enormous, whether it pertains to victims, perpetrators or those close to them. Currently, legal, forensic and psychiatric institutions are confronted with the difficult task of determining whether a specific individual may be at risk of harming others. Violence risk assessments are conducted in order to find a way to reduce or manage that risk, either in the community or within institutions. Because the decisions made by mental health professionals during such assessments have serious consequences, it is essential that the decision-making processes be scientifically and clinically sound. The Historical/Clinical/Risk-Management-20 (HCR-20) represents one of the most researched and established instruments used to assess risk for community and institutional violence in offenders, civil psychiatric patients, forensic psychiatric patients, as well as males and females with mental illness, personality disorder or substance abuse problems. Since the development of the HCR-20 in 1997, a large body of data on its efficacy has been collected, and the authors concluded that some revisions were necessary. Diana Strub’s research involves an evaluation of a subscale of the revised HCR-20 assessment scheme in its entirety on a new sample of 150 individuals (i.e. offenders and mentally disordered offenders), about to be released into the community. Her work has implications for violence risk reduction and management for individuals with mental illness, personality disorders, correctional involvement and/or substance abuse problems. Such violence prevention strategies are expected, in turn, to considerably reduce physical and mental health concerns for those at risk, their victims and those close to them, as well as alleviate some of the burden placed on the health care system.
An Innovative Approach to Providing Patient Care: Examining the Role of the Nurse Practitioner in Primary Care Group Medical Visits
As the Canadian population ages, primary health care has increased its focus on the prevention and management of chronic disease in the elderly. However, access to primary care providers such as family doctors has become more difficult in recent years. Consequently, nurse practitioners (NPs) are increasingly delivering primary health services for people with chronic disease through what’s called the group medical visit (GMV). GMVs are a model of care delivery in which primary care is offered in a group format, instead of single patient/provider format. GMVs are being implemented across BC as part of the practice support program aimed at improving the primary health care system in the province. Past work indicates that patients and providers of GMVs are satisfied with GMVs. However, research on their effectiveness is limited. Laura Housden is examining the role of NPs in providing GMVs in BC and whether or not the GMV format is associated with quality patient care, such as patient self management of disease and chronic disease health indicators. To that end, she is conducting in-depth interviews with NPs currently providing GMVs. Direct observation of GMVs will be undertaken to better understand the process of the visit and context of the appointments. Chart audits will also be done to determine quality of care. The results of Ms. Housden’s research will provide a greater understanding of the role of NPs in providing GMVs, as well as the effectiveness of this care model in reaching and caring for people with chronic illnesses. Ultimately, this information could help to inform public health policy in BC.
Older Persons’ Transitions in Care
The purpose of this program of research is to improve care for frail elderly people in nursing homes and secondarily, to reduce the burden of elderly patients on emergency department resources and to give decision makers tools to identify potentially modifiable elements to improve the quality of care of residents who move between nursing homes and emergency departments.
A structure-function analysis of the exo-beta-D-N-acetylglucosaminidase StrH, an important Streptococcus pneumoniae virulence factor.
Streptococcus pneumoniae is a common bacterium that can cause serious infections like acute respiratory disease (pneumonia), infections of the brain and central nervous system (meningitis), blood infections (septicaemia, sometimes leading to sepsis), and ear infections (otitis media). This organism is one of the leading causes of death from infectious disease across the globe. In addition to showing a lethal synergism with the influenza virus, many strains of S. pneumoniae are rapidly becoming resistant to antibiotics and some strains have even been dubbed “”superbugs. From the practical perspective of combating S. pneumonia, there is a clear need to better understand how it makes us sick. Numerous studies have revealed that the ability of this germ to cause disease strongly depends on it attacking the sugars present in its host’s tissues. Dr. Pluvinage’s work focuses on one protein that performs this type of function, a large enzyme called StrH, which is necessary for S. pneumoniae to infect its most commonly targeted human organs, the lungs and the ears. StrH is responsible for removing an abundant sugar (N-acetylglucosamine) from the surface of host cells and the protective sugar layers found in mucus. Though the activity of StrH is known, precisely how it performs its job is not. Consequently, Dr. Pluvinage is working to characterize the protein’s complex, three-dimensional structure in order to better understand the protein’s function. The results of this research will provide a foundation for generating new small molecular inhibitors that might allow for the effective treatment of infections caused by S. pneumoniae “superbugs”.
Reproductive trends among HIV-positive women in British Columbia's HAART era: Examining the interplay between pregnancy, antiretroviral adherence, and HIV disease progression
A growing proportion of new HIV infections, both locally and globally, are among women of childbearing age, and heterosexual contact is an increasingly important risk of HIV transmission. While it is clear that HIV-positive women continue to desire children, become pregnant, and give birth after knowing their HIV-positive status, the reproductive health concerns and rights of people living with and/or affected by HIV have received little attention. Highly active antiretroviral therapy (HAART), the standard of HIV treatment in BC, is reducing the health risks and barriers to reproduction for people living with HIV. With appropriate adherence to treatment, HAART increases life expectancy, decreases morbidity, and dramatically reduces the risks of HIV transmission from mother-to-child and to sero-discordant sexual partners. Angela Kaida’s research seeks to describe the reproductive trends of HIV-positive women in BC’s “”HAART era”” (roughly 1996 and onwards) and to investigate the complex interplay between pregnancy, antiretroviral adherence, and HIV disease progression. Owing to the structure of HIV-related services and population-level data capture methods, BC provides an entirely unique and highly valuable environment in which to investigate critical questions related to HIV, HAART, and pregnancy. Notably, no other jurisdiction in the world has published population level findings on this topic. This research will provide evidence to guide the development of effective and responsive reproductive and sexual health services and policies for HIV-positive women in BC and beyond. These services are intended to support the rights of HIV positive women to be sexually active and achieve their fertility goals, while minimizing associated risks to maternal, fetal, and partner health. The findings will contribute vital information to the development of provincial, national, and international guidelines that support reproductive decision making among HIV-affected couples and inform the use of antiretroviral therapy during pregnancy.
Investigating the effects of social, cultural, demographic, and socio-economic factors on developmental health and education trajectories of children in British Columbia
In BC, child poverty has reached 22 percent (First Call, 2008), the highest provincial rate within Canada. BC is characterized by its ethno-cultural diversity, with 20 percent of all children having recently immigrated, and more than 50 percent of children in some urban school districts having English as their second language. Furthermore, BC has been affected by rapid economic, environmental and demographic changes. An understanding of how personal and contextual factors are associated with developmental patterns of resilience and vulnerability among the different communities and subpopulations of BC is important. More specifically, it is critical to identify to what degree developmental needs and strengths differ from one context and subpopulation to another, and in which ways these differences in needs and strengths are associated with the cultural and socio-economic characteristics of those different communities and subpopulations.
Dr. Guhn's research draws from a unique, population-level linked database that provides an unprecedented opportunity to examine the social determinants of developmental health and education of children in BC. By utilizing population-level data on health and education outcomes for 40,000 children, and data on socio-economic and demographic characteristics for all of the 478 neighbourhoods in BC, Dr. Guhn will provide a detailed analysis of how social, cultural, demographic, and socio-economic factors are jointly related to health and education trajectories of children in BC. His findings have important implications for further developmental health research as well as for practices and policies in health and education. Furthermore, his data will inform practitioners and policy makers in health and education with respect to the process of adapting health and education service delivery according to characteristics that are specific to particular subpopulations and communities.
Promoting beta-cell function and survival in rodent models of diabetes with an analogue of the incretin hormone, GIP
Diabetes mellitus is a chronic, debilitating disease in which the body is unable to adequately dispose of circulating glucose. As a result, diabetes mellitus causes damage to the eyes, kidneys, peripheral nerves and cardiovascular system. Type 2 diabetes accounts for about 90 percent of diabetes cases and is typically caused by the development of obesity with its associated resistance to the glucose-lowering actions of insulin, compounded by decreased circulating levels of insulin. Insufficient insulin levels in Type 2 diabetes are caused by the diminished function and increased death of the important insulin-secreting beta-cells located in the pancreas. Therefore, therapeutic interventions that improve the function and survival of beta-cells would clearly benefit patients with Type 2 diabetes. Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are insulin secreting (incretin) hormones that do just that. As a result, drugs have been developed that enhance the activity of these hormones and they have demonstrated powerful anti-diabetic actions in patients with Type 2 diabetes. Scott Widenmaier’s current research project is building on his earlier work involving the development of a long-acting GIP analogue that has demonstrated potent effects on cultured beta-cells, and triggered acute increases in insulin levels during single dose treatments of diabetic rodents. More recently it has shown potential to decrease fat levels in obese rodents. Mr. Widenmaier’s current project will evaluate the ability of long-term administration of this same GIP analogue to improve the function and survival of beta cells, and decrease circulating glucose levels and obesity in rodent models of Type 2 diabetes. Ultimately, the information resulting from these studies could contribute to a better understanding of the underlying basis for the beneficial effects of incretin therapy, and potentially lead to the development of next generation therapeutics.
Predictors of Medication Adherence in Renal Transplant Patients: Self-Efficacy, Depressive Symptomology, and Neuropsychological abilities.
Chronic Kidney disease (CKD), is relatively common among middle-aged and older adults and the incidence is increasing. For example, 119 million Canadians had CKD in 1996, while by 2004 that number had reached roughly 154 million. Furthermore, just under 1,000 people received kidney transplants in Canada in 2005, while three times that many remained on wait lists that year alone. Needless to say, the successful clinical management of CKD is dependent on a number of factors. Recently, Ms. Theone Paterson and colleagues have determined that cognitive abilities are impaired in patients with CKD following successful kidney transplant, in a similar way to that seen in patients with CKD prior to kidney failure. Importantly, they also recently found that difficulties completing both traditional and everyday cognitive problems are predictive of decreased medication adherence among renal transplant patients, and that depressive symptoms partially mediate the relationship between traditional cognitive performance and medication adherence. Therefore, the extent to which real world functional issues such as adherence is predicted by traditional and everyday problem solving, depression and self-efficacy is an important issue in renal transplant, for patients, their healthcare providers, and their caregivers. In her current research program, Ms. Paterson is focusing on the relationships among traditional and everyday measures of cognitive performance, general and medication adherence-specific self-efficacy, self-reported depressive symptoms and medication adherence in people who have undergone successful renal transplantation. The results of this work will aid not only in understanding difficulties faced by transplant patients, but also in the development of interventions designed to improve adherence and consequently, real-world functioning for these patients. Additionally, the results of this research will be used to develop sensitive and valid measures to assess real-world function in patients with CKD and ultimately improve their quality of life.
Small molecules with affinity for S100A7, a tumorigenic protein in breast cancer
Biochemical events in humans are influenced and triggered by cell signalling pathways and their associated feedback loops. Changes and mutations to members of these signalling pathways can cause cancer to develop. Trouble can also occur when alternative pathways are triggered or when built-in negative feedback (“”shut off””), loops are not triggered. In the case of cancer, the observed uncontrolled cell growth results in tumours that can eventually metastasize and send diseased cells throughout the body resulting in an aggressive, invasive cancer. Before the aggressive stage of cancer is reached, the disease often goes through stages of progressively worsening cancers. In breast cancer, Ductal Carcinoma In Situ (DCIS), is one such stage prior to invasive disease. With DCIS, the cancer is contained to a duct and has not yet spread to other areas of the breast or body. Research at the BC Cancer Agency’s Deeley Research Centre has revealed two proteins, S100A7 and Jab1, involved in a pathway associated with the transition from DCIS to invasive breast cancer. There is compelling evidence to suggest that if the interaction between S100A7 and Jab1 were prevented or disrupted, the critical signalling pathways would not be triggered and the progress of invasive breast cancer would be stopped. Amanda Whiting is researching the effects of blocking the interactions between S100A7 and Jab1 by using small, drug-like molecules. In particular, Ms. Whiting’s research uses the molecule 2,6-ANS, as the basis for modifications to improve binding to S100A7 and decrease binding to other important body proteins. Her research will provide an expanded understanding of small molecule binding requirements and, in turn, allow for appropriate modifications to the compounds. Moreover, her work explores a potential new target for breast cancer therapy using small molecule inhibitors to disrupt a cancer-associated protein-protein interaction.