Year: 2013

Physical activity, sedentary behaviour and gene-environment interactions in cancer

Dr. Boyle’s research will investigate the role that physical activity and sedentary behaviour play in the development of non-Hodgkin lymphoma, multiple myeloma, and breast cancer.

This project aims to: 1) examine the associations between physical activity and sedentary behaviour and the risks of non-Hodgkin lymphoma and multiple myeloma, and 2) investigate whether the effects of physical activity and sedentary behaviour on the risks of non-Hodgkin lymphoma and breast cancer are modified by particular genes.

These research questions will be investigated using data from four case-control studies (three of which were conducted in British Columbia), as well as pooled data from an international consortium of case-control studies.

This research will provide new and important information about the associations between physical activity, sedentary behaviour, and cancer. Identification of modifiable risk factors is particularly important for the prevention and control of these cancers, as little is known about their etiology.

Examining executive functions as mediators of a mental and social enrichment intervention for older adults with chronic stroke

Significant proportions of stroke survivors suffer long-term physical disability and are predisposed to sedentary lifestyles. This limits their performance of activities necessary for independent living in the community and contributes to increased risk for recurrent stroke and heart disease. Dr. John Best recognizes that intervention strategies are needed to motivate stroke survivors to engage in routine physical activity and to optimize their physical and motor functions.

Best’s research will examine executive functions (EFs) as mediators of a mental and social enrichment intervention for older adults with chronic stroke. Broadly speaking, EFs refer to the cognitive processes that allow for adaptive behavior and self-control.

One promising strategy targets EFs by engaging stroke survivors in complex mental and social activities. Best’s research will evaluate the importance of improving EFs within the context of a mental and social enrichment intervention in order to have a meaningful impact on physical and motor functions, the ability to perform daily activities, and routine engagement in physical activity.

The information garnered from Best’s research will be crucial for improving stroke rehabilitation for older Canadians who suffer chronic disability from stroke.

Structural characterization of the architecture and assembly of the bacterial type III secretion system injectisome

Gram-negative bacteria such as E.coli, salmonella, shigella, pseudomonas aeruginosa, and yersina pestis are responsible for a wide range of diseases. A common trait shared by these bacteria is their capacity to inject toxins directly into the cells of infected individuals using a syringe-shaped “nano-machine” called the Type 3 Secretion System injectisome. Preventing the injectisome from performing its function would effectively prevent these bacteria from causing a disease.  

The injectisome is an important target for the development of novel treatments against bacterial infection. This research project will attempt to obtain a “map” of the injectisome at the level of individual atoms. Such a map will allow us to understand how different components interact to assemble such a “nano-machine” at the surface of the bacteria, and the mechanism by which the injectisome can inject toxins into human cells.

To map the injectisome at the level of individual atoms, Dr. Bergeron will use a range of biophysical methods, such as X-ray crystallography, nuclear magnetic resonance, electron microscopy, and molecular modelling.

A map of the injectisome could be used to design novel antibiotics or vaccines, which would function against a wide range of bacteria. In addition, understanding the mechanism of this nano-machine could allow the development of microscopic targeted injection devices with a wide range of potential applications.

Characterizing the impact of silent lesions on stroke recovery using multimodal neuroimaging

Half of individuals recovering from a stroke have some form of impaired cognition, which hampers their independence. One possible contributor to impaired cognition after stroke is the presence of small “silent” lesions, which are detected in up to 28 percent of individuals with stroke.

Currently, there is little data describing the impact of silent lesions on stroke recovery. This study will determine if impaired cognition after stroke is associated with the presence and quantity of silent lesions.

Multimodal neuroimaging will identify how silent lesions affect brain function after stroke and determine if the number and/or type of silent lesion differently impacts cognition or brain function. The impact of silent lesions on brain function will be assessed by measuring cerebral vascular reactivity and examining neural network activity during a cognitive task.

Together with a battery of cognitive assessments, these measures will help explain how silent lesions alter cognition after a stroke. This knowledge will lead to the development of new interventions that account for silent lesions, resulting in improved quality of life for Canadians with stroke.

Pharmacogenomic prediction of anthracycline-induced cardiotoxicity

Anthracyclines are a class of drugs used world-wide for the treatment of most cancers. However, their clinical utility is limited by a high risk of cardiac toxicity and congestive heart failure.

Dr. Aminkeng aims to identify genetic markers that can predict anthracycline-induced cardiotoxicity and congestive heart failure using a genome-wide association study (GWAS). The goal is to develop a clinical test that will allow for better identification of risk factors and improved treatment and monitoring that will increase the safety of anthracycline therapy.

Study participants have been recruited via the Canadian Pharmacogenomics Network for Drug Safety. Patients will be genotyped using the GWAS Illumina Infinium assay. In vitro, in vivo, and pharmacokinetic studies and pharmacodynamics modelling will be used to study the functional relevance of identified genes.

A highly predictive test for anthracycline-induced cardiotoxicity and congestive heart failure would significantly benefit patients, families and physicians by improving counselling and treatment options. For example, a patient at high risk could receive more aggressive echocardiogram monitoring for toxicity, receive a cardio-protective drug such as dexrasoxane, or be treated with an alternative chemotherapy protocol.

Transforming community-based primary health care delivery through comprehensive performance measurement and reporting

This award is co-funded by Health Research BC, through CIHR’s Community-Based Primary Health Care (CBPHC) Innovation Teams Grant. 

 

Most Canadians enter the health care system through a visit to a doctor, nurse practitioner or healthcare team based in their communities for the treatment and management of a wide variety of acute and chronic health problems. CBPHC covers a range of services across the continuum of care: primary prevention (including public health) and primary care services; health promotion and disease prevention; chronic disease diagnosis, treatment and management; rehabilitation support; home care and end-of-life care.

 

Although Canada is spending an increasing share of its revenue on healthcare, it is falling behind other industrialized nations in obtaining value for its investment. While Canada has made substantial financial investments in renewing CBPHC over the last decade, no information system exists to routinely capture whether renewal efforts improve CBPHC performance or quality of care in Canada.

 

Dr. Sabrina Wong, a professor in the School of Nursing and Centre for Health Services and Policy Research at the University of British Columbia (UBC) co-led a multi-provincial research program to improve the science and reporting of performance measurement of the primary health care system in Canada.

 

Working with co-PIs, Drs. William Hogg and Sharon Johnston of the Bruyère Institute in Ottawa and Fred Burge at Dalhousie University, the team conducted four studies over the five-year research program using data collected and analyzed from three study regions in British Columbia, Ontario and Nova Scotia with similar socio-demographic characteristics. The aim of their work was to learn how comprehensive performance measurement and reporting could support improvements and innovation in the delivery of primary care services to Canadians, especially populations vulnerable by multiple poor determinants of health.

 

By measuring and reporting on how regions within the health system performs, Wong’s research — the first of its kind in British Columbia and Nova Scotia — provides a foundation to transform the organization and delivery of the Canadian CBPHC system, leading to an enhanced patient experience, improved health outcomes and reduced costs.

End of Award Update – February 2022

Most exciting outputs

The TRANSFORMATION study set out to improve the science of performance measurement in primary health care in Canada. As the project comes to a close, it has demonstrated success in identifying performance measures of significance to patients, clinicians, and policy makers; advancing methods for the collection of patient reported experience and outcome measures; developing health segmentation methods and inter-provincially comparable indicators of primary care performance using health administrative data. Findings have been shared through conference presentations, journal publications, and engagement of policy makers and health region administrators.

 

Impact so far

The study has advanced the use of mixed methods in this area of research. Knowledge translation and the training of graduate and post-graduate students in primary health care research methods has resulted in spin-off projects. The Public Health Agency of Canada has recently funded a project to address vaccine hesitancy through primary care practices using a patient outreach and survey system piloted as part of the Transformation project. In Nova Scotia, the study has informed development of annual surveys of patient health experience required for institutional accreditation.

 

In BC, work completed by TRANSFORMATION on the patient reported experiences and outcomes survey was used to inform the office of Patient Centred Measurement in their work on development of a population-based primary care experiences survey (originally slated to roll out in 2021). This work was also used by Doctors of BC in their development and implementation of a practice-based patient experiences survey. Work completed on using administrative data to formulate population segments informed the work of the BC Ministry of Health in how different segments of the population use primary care services. The work of TRANSFORMATION has also been used by scholars and research students, providing opportunities to publish, present results, and connect with other leading primary health care researchers across Canada.

 

Potential future influence

Learnings from this project are being used to inform development of the patient reported indicator surveys for the Organisation for Economic Co-operation and Development. Knowledge, methods, partnerships and software developed through this project is already increasing the capacity for performance measurement, including by developing supporting infrastructure for a primary care learning health system in Canada.

 

Next steps

Our next stage of work is moving the science, theory, and discoveries from this work, into practice. This work is in progress, including the further development of automated systems to collect data from patients in a timely manner and provide practices with data for near real time QI efforts. In addition, there is interest in integrating data from electronic medical records to support quality improvement and performance measurement in primary health care. Future work will be needed to refine methods for using these measures to influence behaviour – both at the level of primary care patients and practices and at the health policy level.

 

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