Chronic Illness

Family doctors play growing role in Toronto health-care system: U of T report

Christopher.Sorensen — Fri, 17 May 2019 16:25:49 +0000

Family doctors play growing role in Toronto health-care system: U of T report

Christopher.Sorensen Fri, 05/17/2019 - 12:25

Cutline

A new report by U of T's department of family and community medicine paints a comprehensive picture of family doctors in the Toronto area and the role they play in helping to alleviate the strain on Ontario's health-care system (photo by Pixabay)

Allison Mullin

Topic

Breaking Research

Ontario Impact

Chronic Illness

Cities

Faculty of Medicine

Mental Health

Beyond common colds and flu, the number of patients visiting their family doctors for issues related to mental illness and chronic diseases such as diabetes and hypertension is on the rise, according to a new report on the state of family medicine in the Greater Toronto Area.

The recently released ��Ƶ Family Medicine Report shows a wider variety of ailments are being treated by family doctors than in the past. Anxiety, for instance, is one of the top reasons for visits to family doctors in every age group, and the top reason for adult females. Chronic diseases – the greatest health challenge facing Canada and much of the world – are also increasingly managed by family doctors.

Using data from the de-identified electronic medical record data of nearly half-a-million patients, the report is the first evidence-based, comprehensive picture of the role of family doctors in our health-care system and provides new insights into the health and wellbeing of the citizens of Toronto and beyond.

“This report reinforces the findings of international studies which show that having family medicine as the basis of a country’s health-care system keeps people healthier, reduces costs and ensures more equitable access to care,” says Dr. Michael Kidd, chair of U of T’s department of family and community medicine and one of the authors of the report.

“As we start to roll out Ontario Health Teams, this report provides timely evidence and insights into the central role of family doctors, and the members of our teams, in our health-care system.”

Beyond the treatment of common illnesses, many family doctors in Ontario deliver babies, work in emergency departments, provide palliative and end of life care, participate in research and innovation and much more. The diversity of patients and ailments seen by family doctors is quickly changing as well.

“The data in this report confirmed a number of trends we are seeing in health care,” says Dr. Karen Tu, lead author of the report, a co-director of the ��Ƶ Practice-based Research Network and a professor in the department of family and community medicine with a cross appointment at the Institute of Health Policy Management and Evaluation.

“Mental health and chronic diseases are being treated by family doctors far more frequently. We are also continuing to see high rates of smoking and obesity, so it’s key to find new ways to help family doctors treat and support patients with these concerns.”

The report also highlights areas of care where family doctors can play an even larger role. For instance, only 63 per cent of Indigenous people living in Toronto have a regular family doctor or nurse practitioner, compared to 90 per cent of the general population. The report also tackles issues like the lack of access to palliative care by marginalized populations in the Greater Toronto Area, the health concerns of refugees and what family doctors are doing to address the ongoing opioid crisis.

“Not everyone knows or appreciates the breadth of services family doctors provide and the value family medicine brings to our health-care system,” says Kidd.

“Family medicine provides the solution to overcrowded emergency departments, the challenge of hallway medicine in our hospitals, and the inequities we see in access to quality health-care services.

“This report highlights the importance of family medicine as the foundation of a successful health-care system and reinforces the need for further investment in primary care to ensure that quality health care is available to all Canadians.”

More than 300,000 Canadians enrol in multi-decade research initiative to monitor disease trends

noreen.rasbach — Mon, 18 Jun 2018 04:00:00 +0000

More than 300,000 Canadians enrol in multi-decade research initiative to monitor disease trends

noreen.rasbach Mon, 06/18/2018 - 00:00

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From left, Dr. John McLaughlin, executive director of CPTP, Cindy Morton, chief executive officer of the Canadian Partnership Against Cancer, and Dr. Philip Awadalla, national scientific director of CPTP

Topic

Dalla Lana School of Public Health

Faculty of Medicine

Genetics

Global

Research & Innovation

Subheadline

U of T is national co-ordinating site of Canadian Partnership for Tomorrow Project

Over the past 10 years, more than 300,000 Canadians have volunteered to be part of the Canadian Partnership for Tomorrow Project (CPTP), a research platform that tracks the development of cancers and chronic diseases in the population over several decades to better understand risk factors.

Researchers from across Canada and the ��Ƶ published a manuscript in the Canadian Medical Association Journal last week, marking a culmination of effort from hundreds of Canadian researchers to build the project with support from multiple national and provincial funders.

“This project is a living population observatory that enables researchers – in Canada and across the globe – to tap into a rich population health database of genetic and environmental factors associated with chronic disease development,” said John McLaughlin, CPTP’s executive director, co-author of the manuscript, and professor of epidemiology at the Dalla Lana School of Public Health.

The paper describes how 307,017 participants aged 30 to 74 were recruited with informed consent from the general population within eight Canadian provinces. Most participants provided a blood or other type of sample and about a third completed a physical assessment. All the data in the CPTP are de-identified, but it will provide researchers with a platform for assessing the effects of genetics, behaviour, environment and societal factors on health.

“The CMAJ paper points researchers to this national scientific asset, and how CPTP can be used,” said Philip Awadalla, co-author of the paper and national scientific director of CPTP.

“We’re at the beginning of a new phase for the CPTP as we move from building the platform to creating new evidence that is relevant to Canadians,” said Awadalla, who is also a professor of population and medical genetics in the Faculty of Medicine’s department of molecular genetics and director of computational biology and senior investigator at the Ontario Institute for Cancer Research.

Earlier this spring, U of T was named CPTP’s national co-ordinating site, led by Awadalla and McLaughlin in partnership with the Ontario Institute for Cancer Research. Recognized as Canada’s premier health research initiative, the CPTP research platform is unlocking the answers to why some people develop cancer and chronic diseases while others do not.

“The complexity of cancer is such that massive data sets are required to identify common risk factors on a national scale, which may open the door to new pre-diagnostic techniques and prevention strategies,” said Dr. Stephen Robbins, scientific director of the CIHR Institute of Cancer Research..

On the CPTP research platform, any researcher can submit a proposal to access portions of the data. More than 80 scientific programs have already begun research with CPTP, and received independent funding from national and international funders. A study published earlier this year in Nature Communications showed how environmental exposures interact with our genomes to impact health. The CPTP scientists involved in the study will also use the cohort to answer questions about why cancer rates vary across the country (B.C. has much lower rates of certain types of cancers compared to Atlantic Canada).

Awadalla and colleagues have received funding from the Canadian Institutes of Health Research to examine metabolic syndrome, which includes a range of conditions like high blood pressure, Type 2 diabetes, glucose intolerance and cardiovascular disease. The study seeks to understand how environmental factors, including air pollution and green space, interact with genetics to impact rates of metabolic disease nationally.

Funding for this program is a partnership across many national and provincial organizations including: the Canadian Partnership Against Cancer, Heart and Stroke Canada, Genome Quebec, Ministère de l'Économie, de la Science et de l'Innovation, Ontario Institute for Cancer Research, Cancer Care Ontario, Public Health Ontario, Alberta Health Services and Alberta Innovation.

Read here for more information about the CPTP and its regional partners (CARTaGENE, Ontario Health Study, BC Generations, Atlantic Path, and the Alberta Tomorrow Project) and details about accessing the data.

U of T engineering discovery potential game-changer for chronic illness treatment

katie.fong — Tue, 07 Jun 2016 15:54:14 +0000

U of T engineering discovery potential game-changer for chronic illness treatment katie.fong Tue, 06/07/2016 - 11:54

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Left to right: Elliott Donaghue, Malgosia Pakulska, Jaclyn Obermeyer (Marit Mitchell photo)

Marit Mitchell

Author legacy

Marit Mitchell

Topic

Breaking Research

Molly Shoichet

Faculty of Applied Science & Engineering

Proteins

Chronic Illness

Health

A U of T Engineering team has designed a simpler way to keep therapeutic proteins where they are needed for long periods of time. The discovery is a potential game-changer for the treatment of chronic illnesses or injuries that often require multiple injections or daily pills.

For decades, biomedical engineers have been painstakingly encapsulating proteins in nanoparticles to control their release. Now, a research team, all from the department of Chemical Engineering and the Institute of Biomaterials and Biomedical Engineering, led by University Professor Molly Shoichet has shown that proteins can be released over several weeks, even months, without ever being encapsulated. In this case the team looked specifically at therapeutic proteins relevant to tissue regeneration after stroke and spinal cord injury.

“It was such a surprising and unexpected discovery,” said co-lead author and recent PhD graduate Irja Elliott Donaghue, who first found that the therapeutic protein NT3, a factor that promotes the growth of nerve cells, was slowly released when just mixed into a Jello-like substance that also contained nanoparticles. “Our first thought was, ‘What could be happening to cause this?’”

Proteins hold enormous promise to treat chronic conditions and irreversible injuries — for example, human growth hormone is encapsulated in these tiny polymeric particles, and used to treat children with stunted growth. In order to avoid repeated injections or daily pills, researchers use complicated strategies both to deliver proteins to their site of action, and to ensure they’re released over a long enough period of time to have a beneficial effect.

This has long been a major challenge for protein-based therapies, especially because proteins are large and often fragile molecules. Until now, investigators have been treating proteins the same way as small drug molecules and encapsulating them in polymeric nanoparticles, often made of a material called poly(lactic-co-glycolic acid) or PLGA.

As the nanoparticles break down, the drug molecules escape. The same process is true for proteins; however, the encapsulating process itself often damages or denatures some of the encapsulated proteins, rendering them useless for treatment. Skipping encapsulation altogether means fewer denatured proteins, making for more consistent protein therapeutics that are easier to make and store.

“This is really exciting from a translational perspective,” said PhD student Jaclyn Obermeyer. “Having a simpler, more reliable fabrication process leaves less room for complications with scale-up for clinical use.”

The three lead authors, Elliott Donoghue, Obermeyer and 2016 PhD graduate Malgosia Pakulska, have shown that to get the desired controlled release, proteins only need to be alongside the PLGA nanoparticles, not inside them. Their work was published recently in the journal Science Advances.

“We think that this could speed up the path for protein-based drugs to get to the clinic,” said Elliott Donaghue.

The mechanism for this encapsulation-free controlled release is surprisingly elegant. Shoichet’s group mixes the proteins and nanoparticles in a Jello-like substance called a hydrogel, which keeps them localized when injected at the site of injury. The positively charged proteins and negatively charged nanoparticles naturally stick together. As the nanoparticles break down they make the solution more acidic, weakening the attraction and letting the proteins break free.

“We are particularly excited to show long-term, controlled protein release by simply controlling the electrostatic interactions between proteins and polymeric nanobeads,” said Shoichet. “By manipulating the pH of the solution, the size and number of nanoparticles, we can control release of bioactive proteins. This has already changed and simplified the protein release strategies that we are pursuing in pre-clinical models of disease in the brain and spinal cord.”

“We’ve learned how to control this simple phenomena,” Pakulska said. “Our next question is whether we can do the opposite—design a similar release system for positively charged nanoparticles and negatively charged proteins.”