The Determination of Accessibility to and Utilization of Fair PharmaCare by Various Ethnic Minority Groups

Since the mid-1990s, North American prescription drug expenditures have been escalating at double-digit rates. Canadians spent $18 billion on prescription medicines in 2004. The rising cost of prescription drugs has raised concerns about the affordability of health care for Canadians. Provincial drug coverage programs within Canada employ diverse strategies for reimbursement. In British Columbia, an income-based drug benefit plan is utilized. This program, dubbed Fair PharmaCare, requires residents to register with the government to be eligible for public subsidy. Vivian Leong is evaluating levels of participation in the Fair PharmaCare program in different socioeconomic and socio-cultural communities to determine the factors that influence access among ethnic minorities. Vivian will identify whether some groups have unequal access to pharmacare subsidies, and if so, why the inequity exists. She is also assessing whether provincial government efforts to promote awareness among minority groups have been effective. This research will help policy makers address inequities and target health promotion to reach and better serve various ethnic communities in British Columbia.

Femoroacetabular impingement as a predictor for Osteoarthritis of the hip

Osteoarthritis (OA) is a debilitating disease characterized by the degeneration of cartilage. OA is a common disease among the elderly, affecting more than three-quarters of people over the age of 75. Research has suggested a link between the development of OA and femoracetabular impingement syndrome (FIS), a disease of the hip. In FIS, the femur makes contact with the acetabulum (the cup-like recess in the pelvis that acts as the socket in the joint), causing pain. This is most evident during periods of extreme range of motion and often occurs due a structural abnormality of either the femoral head or the acetabulum. Early detection of FIS has the potential to allow doctors to alleviate or arrest the onset of osteoarthritis. However, radiographs, which are the current standard of diagnosis, have limitations. Joshua Levitzā€™s research seeks to develop a better way to diagnose FIS. His study involves creating computerized, 3-D bony models of hips from MR images, to study hip alignment in both subjects diagnosed with FIS and healthy control subjects, and determine the significant factors characterizing FIS. By developing a more sensitive gold standard for diagnosing FIS, this research may provide a method for early prediction of OA.

Gold Nanoparticle-Conjugated Antibodies as Optical Contrast Agents for In Vivo Molecular Imaging of Cancer

Cancer is the leading cause of premature death in Canada, and the number of new cases continues to rise as the population grows and ages. Based on current rates, 38 per cent of Canadian women and 44 per cent of Canadian men will develop cancer in their lifetimes, many when they are 70 or older. Traditionally, physicians assess the severity of cancer tumours by removing tissue samples from a patient and assigning a severity score based on what they see under the microscope. This process can be time-consuming and yields limited information. Recent discoveries have identified a number of molecules produced by cancer cells. Gerald Li is working on an optical imaging system to detect and evaluate the presence of these molecules. In particular, his focus will be on the use of specially designed probes that will flag these molecules, allowing a physician to immediately identify malignant cells. This system will make it possible to image various parts of the body to detect cancer earlier, predict which pre-cancerous lesions will become tumours, and image tumours in the operating room to help determine the boundary between healthy and malignant cells. It will also assist in the selection of treatments targeting cells that create these molecules.

Mechanistic approaches to androgen-independent prostate cancer

Prostate cancer is the main form of cancer affecting men in the western world. Because cellular mutations within the prostate are regulated in part by androgens (male sex hormones), treatment of prostate cancer usually involves starving the prostate of androgens. While this therapy initially stops cancer progression, over time, the cancer continues to progress. Jennifer Locke is researching why prostate cancer progresses despite the apparent lack of androgens during treatment for the disease. Jennifer is testing the hypothesis that new androgens are produced within the prostate during androgen-deprivation therapy, causing the cancer to reoccur. Using molecular and analytical techniques, she is investigating androgen synthesis pathways. This research could enable identification and evaluation of inhibitors of these pathways, which may lead to new therapeutic options. Her ultimate goal is to improve treatment outcomes and quality of life for prostate cancer patients.

Identification of Genetic Alterations Involved in the Progression of Epithelial Cancers

Cancer causes six million deaths worldwide each year, and is the second leading cause of death in developed countries. Of 227,000 new cases diagnosed in Canada this year, about 80 per cent will be some type of carcinoma, a malignant tumor that begins in the epithelial cells lining the inner and outer surfaces of our organs. Carcinomas comprise a vast array of cancers, including lung, breast, prostate, colorectal, oral, esophageal and cervical. Although current treatments can be effective, survival rates vary for these different types of cancer. Mutations in genes are responsible for the development of all cancers. But the nature of epithelial cancer cells makes it difficult to distinguish which mutations initiate the process. William Lockwood is using new technology to define patterns of DNA change in people with early stage epithelial cancer and to identify the genes responsible for the progression of the disease. Ultimately, these genes may be used to predict which pre-cancerous lesions are prone to develop into tumours to improve early detection and treatment.

An Internet-based self monitoring intervention for patients with chronic heart failure

In 1997, congestive or chronic heart failure (CHF) was the primary cause of death in British Columbia and in 2000, it was the most common cause of hospitalization for Canadians over the age of 65. Multidisciplinary interventions, including education, follow up and self-management strategies have been shown to improve quality of life and decrease subsequent hospital admissions among people with CHF. However, up to 50 per cent of hospital readmissions for CHF occur because patients have not learned to manage and monitor their condition effectively. Biljana Maricā€™s research is investigating the feasibility of Internet-based self-monitoring for CHF patients. Participants will log on to the study website each morning, enter their current body weight and answer five questions about their health status and any symptoms they are experiencing. A nurse will log on to a secure database to monitor responses and follow up with participants when responses trigger an alert. Biljanaā€™s study will examine patient and staff uptake, and assess the impact of the program on patient quality of life and self care. If adopted, Internet monitoring of heart patients could decrease the health care costs associated with heart failure readmissions, alleviating some of the financial burden on the health care system while improving patient health outcomes.

T Cell Therapy of Breast Cancer: Defining and Circumventing Barriers to T Cell Infiltration of the Tumour Microenvironment

T cells are white blood cells involved in a variety of our immune system responses, including detection and destruction of cancer cells. With T cell therapy, ā€œtumour-reactiveā€ T cells are isolated from a patientā€™s blood, and large numbers are grown outside the body. These T cells are then infused back into the patient to help the body recognize and destroy cancer cells, a method called adoptive immunotherapy. Michele Martin is studying the potential for using T cell therapy to treat breast cancer. Early results show about 19 per cent of tumours will regress or shrink with this treatment ā€“ unprecedented with other types of treatment ā€“ while the rest have partial or no regression. Michele is investigating how some of the tumours manage to exclude the T cells and also whether combining T cell therapy with low doses of chemotherapy can facilitate T cell infiltration into these tumours. If successful, this approach could improve breast cancer cure rates and reduce the side effects associated with current treatments.

Prefrontal-cortico-amygdalar circuitries underlying cue-induced reinstatement and the effects of amphetamine sensitization on responding for food reinforcement

With drug addiction, people typically resume seeking drugs if exposed to cues associated with the drug. This phenomenon, called cue-induced reinstatement, is frequently studied, but a number of neurological issues have yet to be addressed. Two parts of the brain may be a common link in the neural circuitry underlying these cue-induced responses. These are the amygdala, the portion of the brain that regulates emotions, and the prefrontal cortex, a part of the frontal lobe involved in executive functioning. The two areas respond differently to cues for food rewards than to drug cues. Ryan McLaughlin is investigating the similarities and differences in how these areas of the brain regulate food and drug rewards to determine if the difference results from long-term alterations in brain function, brought about by repeated drug use. If so, this research will confirm that chronic drug abuse can radically alter how the brain processes information and could eventually lead to new treatments for people trying to recover from drug addiction.

Relations among maternal sensitivity in early infancy and infants' attachment security at 12 months

The quality of the mother-infant relationship early in infancy forms a foundation for infantsā€™ subsequent social and emotional development. In particular, mothersā€™ sensitive responses to behavioural cues helps their infants develop a sense of self and other and helps them regulate their emotions. Attachmentā€”or the bond between infants and their caregiversā€”is a developmental achievement in the first year of life that is essential for healthy physical and psychological growth. Studies have shown that insecurely-attached infants are at risk for a range of negative developmental outcomes. Nancy Mcquaid is working to identify ways in which mothers interact with their infants that facilitate, or inhibit healthy social and emotional development. Nancyā€™s research will contribute to our understanding of healthy infant development and will help develop means of intervention for infants who are at risk for developmental emotional and interactive disturbances, such as infants of mothers with postpartum depression and low birth weight infants.

Evaluating Patientsā€™ Preferences for Asthma Therapy Using a Discrete Choice Experiment

Approximately one in 12 Canadians has asthma, a chronic respiratory disease characterized by airway inflammation and variable airflow obstruction. Previous research into how asthma patients manage their disease has found an over-reliance on short-acting beta-agonists (used as needed to quickly relieve symptoms) and an under-use of inhaled corticosteroids (used regularly to prevent asthma attacks). This treatment pattern has been associated with a higher risk of death related to asthma. The overuse of short-acting beta-agonists appears to be linked to socioeconomic status. Despite receiving all drugs at no cost, asthma patients receiving social assistance are more likely to use greater amounts of short-acting beta-agonists than individuals not needing assistance. Helen McTaggart-Cowan is conducting research aimed at identifying the extent to which patients are willing to trade off the immediate symptom relief of short-acting beta-agonists against the ongoing management achieved with inhaled corticosteroids. She is investigating the relative importance of symptom control, cost, side effect minimization and convenience of treatment in an effort to determine the associations between drug preferences and both socioeconomic status and asthma control status. By identifying the factors that result in inappropriate asthma management, Helenā€™s research will contribute to improved asthma care and provide a foundation for future work aimed at improving treatment efficacy and compliance.