Canada is amid an opioid crisis, with six or seven deaths a day due to opioid overdose. Prescription opioid misuse can also transition to illicit opiate and intravenous drug use, substantially increasing the risk for overdose and blood-borne infections. Rates of overdose death due to counterfeit fentanyl have also risen and represent a growing crisis in most regions in Canada, with British Columbia (BC) being particularly hard hit. Half of the 800 anticipated overdose deaths for 2016 in BC are expected to involve fentanyl.
Dr. Fairbairn’s research will:
- Address the effectiveness of a randomized controlled trial to evaluate a designated opioid prescriber intervention using BC’s centralized prescription network to reduce inappropriate opioid dispensation and overdose risk.
- Inform overdose prevention strategies by characterizing the inter-relationships between medication prescribing patterns and patterns of illicit drug use.
- Evaluate the longitudinal impacts of new overdose prevention initiatives and addiction treatment guidelines on overdose outcomes.
This research directly responds to BC’s recent declaration of a public health emergency, Health Canada’s urgent call to develop strategies to tackle the overdose epidemic, and the global challenge of prescription opioid abuse by generating evidence for safer prescribing practices and informing and broadening the evidence base for the treatment of opioid addiction.
Social connections and social support networks are essential for physical and mental health. In fact, recent research suggests that how long people live is better predicted by the quality of their social relationships and how well they are integrated in their community, than it is by how much they smoke and drink, or whether they are obese. Loneliness, on the other hand, is linked to negative health outcomes including depression, poor sleep quality, more hospital and doctor visits, and compromised immune system functioning.
This research will focus on the processes involved in successful social interactions with strangers, friendship formation, and social integration. It will focus on questions including: Why do some people have a harder time making friends than others? How do people develop a sense of belonging when they move to a new community? How do the size of someone's social networks, and the availability of social support, influence specific health outcomes like immune function and cardiovascular disease risk? Given that Canadian culture is characterized by high rates of immigration and residential mobility, developing effective evidence-based strategies for combating loneliness and social isolation can have direct benefits for individuals and communities alike.
Knowledge translation activities for this research will include active engagement with broad audiences of university administrators and advisors, student mental health groups, and community members. Dr. Chen will produce reports for groups directly involved in promoting community social integration efforts, whilst serving as a scientific/faculty advisor for initiatives to disseminate research findings directly to the public. She will use research findings to develop specific interventions to facilitate friendship formation and social integration, targeted to individuals who are experiencing social disruptions or difficulty transitioning into new environments. Enhanced knowledge about these topics is expected to contribute to the public good and welfare of British Columbians.
Cardiovascular disease (CVD) is the leading cause of death of Canadians, and is strongly influenced by genetic factors. Integrating basic biomedical research into how specific gene variants influence the function of cardiac cells, with clinical research of patients and families with early onset CVD, will lead to important advances in translating the results of genetics research to improved care for patients and families with CVD.
Opioid use disorder is one of the most challenging forms of addiction facing the health care system in BC and is a major driver of the recent surge in illicit drug overdose deaths in the province. In the context of the current public health emergency, Provincial Health Services Authority agencies the BC Centre for Disease Control (BCCDC) and BC Mental Health & Substance Use Services (BCMHSUS) have identified an urgent need for a policy framework articulating the full range of therapeutic options for the optimal treatment and harm reduction measures those with opioid use disorder.
Drawing on his expertise on substance use, first responder support and policy development, Adam Vaughan will work with experts and researchers at BCCDC and BCMHSUS, senior decision makers in the BC Ministry of Health and regional health authorities, and various addiction-related departments at UBC and SFU to develop a provincial policy framework that outlines a proposed continuum of care for those who require harm reduction, overdose prevention and opioid treatment services.
Vaughan's work on an opioid use disorder continuum of care will also contribute to the current development of an overarching provincial substance use policy framework and ultimately help advance BC drug policy.
Interior Health (IH) serves more than 215,000 km² of BC’s southern interior. This part of BC falls within the traditional, unceded territories of the Secwepemc, Ktunaxa, Syilx, Nlaka’pamux, Ulkatcho, Tsilhqot’in and St’at’imc peoples. Within these territories are people, both on and off reserve, who live in small urban, rural or remote communities. The First Nations, Metis, and Inuit populations served by IH are disproportionately affected by health inequities.
IH’s Aboriginal Health team is currently exploring ways in which health equity and cultural safety can be more systematically integrated into IH’s operational processes, program planning, and policy arenas. Dr. Shahram will focus on creating a policy proposal for broad integration of health equity impact assessments into the cultural fabric of IH — making culturally safe, equity-centred thinking the norm for leadership and practice.
Dr. Shahram will bring her health research expertise and engaged scholarship methodologies (e.g. action research, integrated knowledge translation), and work with IH leadership to create a strategic plan for capacity building and policy change that will enable the advancement of a system-wide policy agenda aimed at integrating cultural safety and health equity assessment into IH policy and operations.
Dr. Shahram received a 2016 Research Trainee Award to examine how health equity strategies in the BC public health system could benefit from Indigenous knowledge and worldviews. This award will placed on hold during her health policy fellowship assignment.
Empty Nose Syndrome (ENS) is thought to be an unusual outcome of sinus surgery due to excessive loss of nasal tissues, particularly from a pair of structures called the inferior turbinates. Turbinates usually function to warm and humidify air flowing into the nose. Patients with ENS often have severe nasal symptoms and develop very poor quality of life as well as mental health problems. As a result of these mixed symptoms, ENS patients are often misdiagnosed, mismanaged, and left to their own devices.
Our research has shown that ENS patients can be identified based on specific clinical symptoms and imaging of the sinuses. We have also found that by rebuilding structures within the nasal cavity known as inferior turbinate augmentation (ITA) we can greatly improve nasal function. However, little is known about the specific changes in nasal function with ENS, how mental health problems develop, or how to best treat these patients.
Our objectives are three-fold: 1) to measure the patterns of nasal airflow and sense of smell present in ENS patients by using computer analysis and smell testing; 2) to understand how ITA might improve function in ENS patients by measuring nasal airflow and sense of smell before and after surgery; and 3) to study the impact of ENS on mental health using depression and anxiety survey scores, and then measure the change in these scores after ITA to study the relationship between the nasal and mental health problems in ENS. By studying the relationship between nasal and psychiatric symptoms in ENS we will both improve our understanding of how this syndrome develops and improve our understanding of how surgical interventions might help mend these symptoms.
Patients with human immunodeficiency virus (HIV) are now living to older ages thanks to effective anti-HIV medicines. Despite these gains, many of them suffer from chronic lung disease that greatly impacts their ability to carry out their daily activities and impairs their quality of life. The type of lung disease they face is similar to what longtime smokers develop, a progressive narrowing of the airways and destruction of the lung. However, in HIV, the process appears to be accelerated and more severe. It’s not unusual, for instance, to see patients in their 30s and 40s develop this lung disease (which is approximately 30-40 years earlier than expected). Also, it’s not unusual for HIV patients who have never smoked before to develop this kind of disease. Unfortunately, the traditional medications we use to treat lung disease often interact with anti-HIV medicines, causing severe side effects. Management of breathing symptoms in HIV patients is therefore difficult and it is imperative that we find better agents to combat lung disease in this population. Only by understanding what causes and drives this lung injury process can this goal be achieved, though.
Multiple studies have now shown that smoking alone cannot explain the lung disease phenomenon in HIV. I believe that HIV injures the lung in a two phase process. First, the virus directly breaks down the protective layer of the airway known as the epithelium. Second, over time, as patients develop repeated lung infections due to their weakened immune systems, the bacterial community of the lung or microbiome shifts. I believe that this community disruption results in molecular changes that age the lung faster. My approach is to perform an in-depth investigation into the epithelium of the airway using two innovative methods. To explore the injury that HIV inflicts on the airway, I have created a novel model of the HIV airway using HIV-infected cells co-cultured on a cell culture model of the airway epithelium. We will use this model to see how HIV-infected cells break down the protective barrier of the lung. To explore the shifts in the microbiome, I have collected airway cells from HIV-infected and uninfected patients to not just describe what bacteria exist in the airway but also to determine what effect the community differences between the two groups have on the function of genes in the cells. We will measure how ‘old’ these cells are and compare these findings to uninfected patients.
End of Award Update: December 2022
Most exciting outputs
The work of my laboratory was the first to detect accelerated epigenetic aging and methylation disruptions in the HIV airway epithelium, work that has now been published in the American Journal of Respiratory and Critical Care Medicine, and eBioMedicine.
Impacts so far
These insights into accelerated aging in the HIV airway epithelium provide clues into why people living with HIV may be prone to developing chronic lung diseases such as Chronic Obstructive Pulmonary Disease or COPD.
Potential future influence
Our work highlights the importance of accelerated aging in HIV, even in patients with well controlled infection. Reversing these aging mechanisms may be critical in the prevention or attenuation of airflow obstruction in this population.
Next steps
We are continuing to explore mechanisms of early aging in the HIV airway using novel technologies such as magnetic resonance imaging, optical coherence tomography, and single cell sequencing.
Useful links
Radiotherapy (RT) is a common and cost effective treatment for patients with painful bone metastases (BoM). Complex and lengthy RT courses are increasingly used for BoM, despite substantial evidence and Choosing Wisely Canada guidelines recommending the use of single fraction RT (SFRT) over lengthy courses. Reluctance to adopt SFRT is based on lack of evidence of its effectiveness in patients ineligible for trials, such as those with poor performance status and BoM complicated by fracture or neurological compromise. Unfortunately, guidelines recommending SFRT use in Ontario did not lead to a durable change in practice. Therefore, evidence of SFRT’s effectiveness in a broad population is necessary, including patients ineligible for trials. Comparison of SFRT to lengthier and complex techniques, such as intensity modulated RT (IMRT) and Stereotactic Ablative Body RT (SABR), will build a population-level evidence base to support increased prescription of SFRT in BC and across Canada.
My research team has demonstrated it is feasible to collect and use Patient Reported Outcomes (PRO) on a population scale in BC. We used these PRO to demonstrate that pain improvement is similar between SFRT and weeklong RT courses, the results of which have led to increased prescription of SFRT across all six BC cancer centres. This gained international attention and the Canadian Partnership for Quality Radiotherapy (CPQR) has since invited me to lead PRO collection across the Canadian RT community. Under the current proposal, we will apply a similar integrated knowledge translation (iKT) approach used in our BC-based research to demonstrate evidence for SFRT on a population-level.
Our primary KT goal is to use our research results to increase evidence-based prescription of SFRT. As we did in BC, we will integrate nursing, radiation therapy, and oncology into all stages of PRO collection and comparison between treatments, with subsequent educational outreach and centre-specific interactive small group discussions of research results. We will engage with various levels of health government, leverage our existing relationship with CPQR and the Canadian Partnership Against Cancer, and create an advisory committee of key stakeholders including policy makers, oncologists, and allied health professionals from each province. Impact evaluation of end-of-grant KT activities will focus on reach, collaboration, practice change indicators, and behaviour changes to increased use of SFRT.
Each year in Canada, road trauma causes over 2,000 deaths and 10,000 serious injuries. Disability after an injury is a major public health concern, but the long term health outcome after road trauma is poorly investigated and based mostly on older research that does not reflect modern vehicle safety features or modern medical treatment. In addition, there is almost no research that helps health care providers know which patients are most likely to have a bad outcome following a crash, making it difficult to provide them with the care they require. For policy makers, it is important to know the health care costs and lost productivity that results from road trauma, but this information has not been studied. My study will provide this missing information.
My team will interview patients who visit an emergency department after a traffic crash, including pedestrians, cyclists, and motorists. We will ask about their general health before the crash, the injuries they had from the crash, and other details of the crash. Repeat interviews at 2, 4, 6, and 12 months will ask about problems they had since the crash, including pain, ability to go about their usual activities, and return to work. We will also ask about the medical care they required after the crash.
This study will help doctors and nurses know how quickly people recover from their injuries after a crash and which patients are likely to have long term health problems. It will also describe the medical treatment that these patients require and how much work they miss. This information will give a better estimate of the true cost of road trauma, and may help policy makers decide how much funding to devote to crash prevention programs or to treatment programs for crash victims.
Atrial fibrillation (AF) is the most common heart rhythm disorder. With an aging population, the number of people with AF is expected to rise dramatically. People with AF are twice as likely to die, are five times more likely to have a stroke, can develop worsening heart muscle function, and have a lower quality of life. We have learned that a person's genetic makeup, or DNA, has a major impact on their risk of developing AF; but we have a limited understanding of why, or how to use this information to treat people in a safer and more effective way. People with AF first receive drugs to control their irregular heart rhythm. Even people who have procedures to treat AF are also prescribed drugs. This is particularly important in the group of patients who have persistent AF, who require electrical or chemical therapy to change their heart rhythm, as the success of surgical procedures in this population is well below 50%. Unfortunately our current drugs are generally ineffective, and can be unsafe, with little progress in drug development over the last two decades.
With these challenges in mind, the first goal of my research program is to identify and understand the genes that play a role in the development and progression of AF, and determine which are most common and most important in the Canadian population. To do this, I am gathering a biobank of AF patients and performing the largest scale detailed genetic testing in this population to date. I am also focused on understanding the effect that genes can have on the safety and efficacy of rhythm controlling drugs, and have already started a trial, funded by the Canadian Cardiovascular Society, that will link a person's genetic makeup to these important outcomes. I will then be able to take this large clinical and genetic data set to the laboratory where we have developed the unique ability to generate patient-specific stem cell disease models of AF. The ultimate goal of my research program is to directly tailor therapy for AF patients based on their genetic makeup, using information from clinical research and personalized disease modeling.
