Analysis of aIPCC Data

The British Columbia Ministry of Health has expressed a goal of integrating primary and community care and providing as many health care services as possible in the community. The objective of this project is to conduct a quantitative evaluation of these programs. The specific focus of this evaluation is on their effects on health care services use, such as visits to emergency departments, admissions to acute care, and admission to long-term residential care.

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Detecting neuroplasticity after spinal cord injury: Implications for neuropathic pain

Current interventions for neuropathic pain after spinal cord injury (SCI) have proven largely ineffective, an unfavorable outcome that can be partly attributed to poor understanding of mechanisms.

Through his research program, Dr. Kramer aims to shed light on this problem, focusing specifically on the hypothesis that changes in supraspinal (above the spine) structures contribute to neuropathic pain symptoms (e.g., burning sensation in the legs). In experiments using functional magnetic resonance imaging (MRI) and electroencephalography, a technique for measuring electrical activity in the brain, the brain activities following afferent stimulation in individuals with SCI will be investigated.

In an initial experiment, Dr. Kramer will explore how descending control of nociception, the neural processes of encoding and processing noxious stimuli, is affected by SCI. This will be done using behavioral manipulations to control awareness to noxious stimuli (e.g. placebo-analgesia, the inability to feel pain).

In the second experiment, Dr. Kramer will build on preliminary results, which indicate that neuropathic pain is associated with prominent changes in cortical functioning in brain areas involved in processing noxious stimuli. Beyond cortical functioning, he will also examine the role of plasticity in the brainstem in the maintenance of neuropathic pain.

In a final experiment, Dr. Kramer will delve further into the role of cortical and brainstem plasticity, determining the time course for when these changes occur. In proposed imaging experiments, the extent by which structural changes in the central nervous system accompany sensory deficits will be examined using quantitative anatomical MRI techniques.

As part of Dr. Kramer’s ongoing research program, quantitative approaches to objectively assess sensory function will continue to be developed. The focus of this work will be on validating novel neurophysiological and neuroimaging techniques to examine discrete elements of sensory impairments. Additionally, Dr. Kramer will continue to investigate the inter-relationship between neuropathic pain, other secondary complications (e.g., cardiovascular disease), and neurological recovery by analyzing large epidemiological SCI databases.

Overall, the research program will provide a clearer picture of the impact of neuropathic pain on neurological function, methods to improve objective measurement, and will enable implementation of novel interventions aimed at improving outcomes and quality of life for people with SCI.

A community-based research program focused on “Adding Life to Later Years”

In 2011, an estimated 5 million Canadians were 65 years of age or older, a number that is expected to double in the next 25 years. The majority of older adults prefer to live in their family home for as long as possible. However, aging in place – the desire to remain living in the community, with some level of independence – is only possible with provision of adequate housing, transportation, recreational opportunities, health and home services and amenities that facilitate physical activity, social interaction and cultural engagement.

For many older people, receipt of home care services is the only option that enables them to remain independent and live safely in their home. At present, more than 1.4 million Canadians receive publicly funded home care services annually. As the Canadian population ages and with earlier discharges from hospital, the need for home care and associated costs continue to escalate. To ‘age in place’ older people also require community and built environments that facilitate their health and mobility. As health and function decline with aging, older adults’ ability to engage with challenging physical environments (e.g. poor street lighting or long distances to amenities) diminishes and, subsequently, health can be further compromised. We know surprisingly little about aspects of the built environment that enhance older adult health and mobility. Advancing knowledge in this emerging field is key to planning and developing effective strategies that allow older adults to grow old at home.

The overarching goal of Dr. Sims-Gould’s program of research is “adding life to later years” so that older adults can live independently in their homes for as long as possible. Her program of research focuses on enhancing the health and mobility of older adults across two settings: 1. delivery and receipt of home care services, and 2. the neighbourhood built environment. Dr. Sims-Gould’s community based health research program is predominantly qualitative and participatory in nature, and adopts an integrated knowledge translation approach.

Molecular detection of known and novel cancer predisposition genes

Diagnosis of inherited cancer susceptibility has implications for both the patient and their family, as certain drugs may be more effective in cancers caused by a patient’s inherited cancer risk. Carrier testing can also determine whether family members are at risk of cancer. Both the patient and at-risk family members may benefit from increased screening, surveillance and/or prophylactic cancer prevention measures. However, current gene-by-gene testing strategies are costly and time consuming.

To try to speed diagnosis, Dr. Schrader will use cutting-edge DNA sequencing technologies to identify the inherited basis of cancers that run in families or occur multiple times in a single individual. Dr. Schrader will also test the patient’s tumor DNA alongside their normal DNA to look for candidate genes altered in both samples that are most likely to be the basis of the patient’s inherited cancer.

As part of her five-year research program, Dr. Schrader also proposes using these same sequencing technologies to test whether we can improve upon current cancer detection strategies in individuals with known cancer susceptibilities. By screening body fluids for free DNA released from early tumors with secondary mutations, it may be possible to detect evidence of early tumors. A positive screen may alert physicians to undertake more targeted diagnostic strategies to find and treat cancers at an early stage. Furthermore, if these technologies are successful in detecting early cancer in these high-risk patient groups, similar strategies could also be considered for screening for common types of cancer in the general population. Finally, genome-wide sequencing also has the potential to reveal information regarding non-cancer related genetic disease risks. Arguably, the clinical uptake of genome-wide sequencing has been the fastest in oncology, where tumor sequencing is undertaken to identify drug-targetable mutations. Clinical and research practices regarding the management of potentially clinically significant incidental genomic findings are evolving. As a medical geneticist in the BC Cancer Agency, Dr. Schrader will research both the cancer and non-cancer related incidental findings revealed through the course of clinical and research tumor sequencing.

Understanding of the scope of potential incidental findings will be critical as the policy and practice moves forward with this regard.

Self-regulation of physical activity behaviour: Novel theory-based intervention strategies for bolstering exercise adherence

Engaging in regular physical activity is pivotal for individuals with prediabetes. Self-regulating independent physical activity requires confidence to schedule in exercise and overcome challenges, goal-set, self-monitor, and revise plans accordingly. Social cognitive theory (SCT) encompasses these crucial components of self-regulation, and is one of the most influential theories explaining behaviour. Traditional physical activity interventions grounded in SCT have demonstrated utility for increasing adherence by teaching these self-regulatory skills, but are often lengthy, costly, and require substantial commitment. Innovative strategies are needed to improve upon existing dismal physical activity rates in adults with prediabetes.

Dr. Jung’s program of research aims to develop and test novel, feasible, and translatable self-regulatory training techniques. Her hypothesis is that brief SCT interventions provide a practical and feasible means to bolster self-regulatory skills necessary for long-term adherence to physical activity.

Through randomized control trials, Dr. Jung will test the efficacy of a brief SCT intervention on increasing independent physical activity for one year in 100 inactive adults with prediabetes. Further, as improvements in technology have made self-regulatory skills training accessible for individuals with prediabetes, the utility of a mobile self-monitoring (SM) platform to increase independent physical activity and lead to greater goal achievement will be assessed in a fitness facility and physiotherapy clinic. Building upon pilot research that demonstrated the superiority of an exercise plus SM intervention incorporating continuous glucose monitors (CGM) as compared to standard care exercise program on independent physical activity, Dr. Jung will assess the feasibility and sustainability of a SM intervention utilizing CGM within a pre-existing community exercise program for individuals with prediabetes.

Program evaluation is becoming increasingly valued as a means to improve existing physical activity programs; Dr. Jung will also evaluate the efficacy of a nation-wide physical activity program targeting disadvantaged children and their caregivers. Measures of SCT constructs – potent predictors of physical activity behaviour change, will be assessed in addition to program implementation fidelity, sustainability, and feasibility throughout this multi-year project.

Ion channels: Molecular determinants of health and disease in the head and heart

Though vastly different, both the brain and the heart rely on large complicated proteins called ion channels in order to function properly. These proteins facilitate the controlled flow of ions in and out of cells by forming pores that stud cellular membranes. Specialized brain cells called neurons utilize ion channels and the electrical signals they generate to communicate with one another. A repertoire of different ion channels also shapes the birth, growth and development of neurons. During brain injury, ion channel activity can render populations of neurons vulnerable to damage. However, following injury, ion channels can also sensitize surviving neurons and modify their structure and function in ways that allow them to respond, adapt and promote repair. Similarly, the electrical activity underlying the coordinated beating of heart muscle cells is generated by the concerted actions of a cohort of ion channels. It follows that mutations in the proteins that form ion channels can manifest in a spectrum of clinical neurological and heart conditions.

In a series of coordinated projects, Dr. Swayne is working to shed light on how ion channels impact on brain and heart health. Dr. Swayne has been examining the cell biology of pannexin ion channels and their role in neuronal development and injury-triggered plasticity. In collaboration with a group at the University of Ottawa, Dr. Swayne’s team is also studying how probenecid, a drug that stops the function of pannexins, impacts stroke recovery. In parallel, to identify novel ion channel regulators of developmental and injury-triggered neuronal plasticity, her lab is combining basic biochemistry with cutting edge expertise at the UVIC Genome BC Proteomics Centre. Finally, in partnership with the UBC Community Genetics Research Program, Dr. Swayne is also investigating the cell biological underpinnings of clinically relevant cardiac ion channel mutations affecting certain BC First Nations communities.

Overall, Dr. Swayne’s research will bridge critical knowledge gaps in the understanding of ion channel function and dysfunction in the brain and heart.

Reducing the burden and gaps in care from Systemic Autoimmune Rheumatic Diseases (REGAIN SARDs)

Of all rheumatic diseases, systemic autoimmune rheumatic diseases (SARDs) – which include systemic lupus erythematosus, Sjogren’s syndrome, systemic sclerosis, polymyositis, dermatomyositis and the systemic vasculitides – are associated with the highest morbidity, mortality and cost. Given their rarity and that all SARDs share mechanisms of induction, pathogenesis, treatment and complications, studying SARDs as a group rather than as individual diseases is both logical and feasible.

The overarching aim of Dr. Avina-Zubieta’s research is to improve the life of people living with SARDs. He will do this by assessing the disease burden of SARDs and developing strategies to prevent SARDs and their associated complications, while also developing tools to help both patients and health care providers better manage SARDs.

The availability of population-based health databases in British Columbia offer cost-effective opportunities to longitudinally study health outcomes in SARDs. Dr. Avina-Zubieta will use these databases to: conduct an assessment of the economic and disease burden of SARDs in order to identify their collective importance as a public health problem in BC; examine health risks facing individuals with SARDs compared to individuals without SARDs and the potential role of treatment to decrease these risks; identify potential risk factors for the development of SARDs, such as smoking, hormones and certain medications (e.g., statins); and mentor trainees and other personnel in a high quality research environment.

Overall, the research program will contribute to enhancing the quality of life of those living with SARDS.

Pharmacoepidemiologic and pharmaceutical outcomes research to improve medication use, adherence, and outcomes in patients with arthritis

Arthritis consists of more than 100 types of conditions and is the most common cause of severe chronic pain and disability in Canada, affecting 4.4 million Canadians. People living with arthritis rely on medications to relieve symptoms, prevent their disease from worsening, and allow them to participate in daily activities. However, there are still many unanswered questions regarding these medications. For example: are patients agreeing with doctor recommendations and adhering to treatment;  how can health care providers support and educate arthritis patients about taking arthritis medications; what are the impacts of arthritis medications when taken during pregnancy?

The theme of Dr. De Vera’s research program is “Medication Matters” and her goal is to improve outcomes of medication taking in arthritis patients. In her research, Dr. De Vera will use a variety of methods including clinical trials conducted with pharmacists in the community to evaluate ways in which patients with arthritis, starting with gout, can be supported by so that they better take their medications. She will also use databases in British Columbia on health care visits and drug prescriptions to study how arthritis medications are being used by women with arthritis who are pregnant and how these medications affect the health of the mother and her baby.

By answering these urgent questions, Dr. De Vera’s research will help inform the optimal use of arthritis medications and directly impact people living with these diseases and their health care providers.

Cardiac responses to spinal cord injury and exercise

The prognosis for the 2.5 million North Americans living with spinal cord injury (SCI) is poor. These wheelchair bound individuals are subjected to a number of physical, social, and environmental barriers that compound paralysis and limit daily physical activity. The five-fold increase in risk for heart disease reduces life-expectancy and costs the North American healthcare system $3 billion per annum.

Heart disease is the number one cause of illness and death in the SCI population. On a daily basis, these individuals are tasked with managing abnormal blood pressure control, fatigue, and a host of other bowel and bladder problems. Chronic management of these ‘secondary’ conditions can be poor, owing primarily to a lack of understanding of the underlying mechanisms. In able-bodied individuals, regular physical activity has multiple cardiovascular benefits. Although numerous attempts have been made to engage SCI individuals in regular physical activity, there is limited information available on the cardiovascular benefits of exercise in SCI individuals.

The primary aim of this research project is to investigate the effects of daily physical activity and structured exercise on heart function after SCI.

To improve our understanding of how the heart changes after SCI and the effectiveness of exercise, Dr. West will conduct simultaneous studies in rodents and humans with SCI. The use of a clinically relevant rodent model of SCI will allow Dr. West to answer fundamental questions about cardiac structure and function, and what mechanisms are responsible for the changes that occur after SCI and exercise. The findings will then be translated through conducting assessments of the heart in individuals with SCI.

This project is unique as it will be the first to use ultrasound to make identical measures of heart function in both rodents and humans. Additionally, Dr. West will be able to conduct direct assessments of heart function in the rodent model and follow this up with a detailed examination of the structure of the heart. Finally, he will conduct novel experiments into the effect of lower-limb passive cycling in rodents with SCI and follow this up by assessing how the heart responds to a novel passive leg energetic arm exercise intervention in humans.

Results from this study will yield vital information that can be used to assist in the rehabilitation and management of individuals with SCI.