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The Evidence Speaks (February 2018)


The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.

In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Kawano T, Grunau B, Scheuermeyer FX, Gibo K, Fordyce CB, Lin S, Stenstrom R, Schlamp R, Jenneson S, Christenson J. Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest. Ann Emerg Med. 2018 Jan 6 epub ahead of print.

Needle insertion into the bone is used to gain access to the bloodstream and administer medications and fluids during out-of-hospital cardiac arrest resuscitation. Though it may provide faster access in many patients, whether this access route results in worse outcomes has been called into question. CHÉOS Scientists Drs. Brian Grunau and Rob Stenstrom and other researchers from B.C. and Japan conducted a secondary analysis of the Resuscitation Using an Impedance Valve and Early Versus Delayed (PRIMED) study. Using this publicly available data set, they tested the effect of intraosseous (bone) compared with intravenous vascular access on neurological outcomes, specifically. Favourable neurologic outcome at hospital discharge was defined as having a modified Rankin Scale score of 0 to 3 (no symptoms to moderate neurologic disability). Of the 15,145 adult patients with non-traumatic out-of-hospital cardiac arrest across B.C., 660, or 5 per cent, received intraosseous vascular access. Only 1.5 per cent of those had favourable neurologic outcomes, compared with 7.6 per cent of those who received intravenous vascular access. Not only was intraosseous access associated with lower favourable neurologic outcomes, it was also associated with lower odds of return of spontaneous circulation and survival. Intraosseous access is thought to be less effective due to blood flow characteristics specific to the bone. Based on these findings, it may be preferable to use intravenous access in out-of-hospital cardiac arrest.

Thomson KC, Guhn M, Richardson CG, Shoveller JA. Associations between household educational attainment and adolescent positive mental health in Canada. SSM Popul Health. 2017 Dec; 3:403-10.

The foundations of mental health are established at a young age with half of all lifetime mental health disorders emerging before age 14. Social factors have been shown to predict child and adolescent mental health problems. Low household level of education and income may predict onset and severity of childhood mental health problems. Less is known about associations with positive mental health—the ability to realize one’s full potential, cope effectively with stress, work productively, and contribute to society—a construct distinct from mental illness. Together with researchers from the Human Early Learning Partnership (HELP) and School of Population and Public Health at UBC, CHÉOS Scientist Dr. Chris Richardson co-authored a study to investigate the association between household educational attainment and adolescent positive mental health. Data from the 2011–12 Canadian Community Health Survey was used to assess the association between the highest level of household educational attainment and positive mental health as measured using the Mental Health Continuum Scale. A total of 10,091 Canadian adolescents between 12 and 19 years of age who were living at home with at least one parent were included in the sample. Most of these adolescents, 83 per cent, reported experiencing “flourishing” mental health. The lowest proportion of flourishing, 74.4 per cent, was reported among adolescents living in households where there was attempted, but not complete, post-secondary educational attainment. The association was most pronounced among younger adolescents (12–14 years of age) and females. These results differ from previous research that found that mental health changes incrementally according to level of household education. This study challenges current conceptions of educational attainment and raises questions about common underlying factors that may affect both incomplete household education and adolescents’ mental health.

Abuyassin B, Badran M, Ayas NT, Laher I. Intermittent hypoxia causes histological kidney damage and increases growth factor expression in a mouse model of obstructive sleep apnea. PLoS ONE. 2018 Feb 1;13(2):e0192084.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Previous epidemiological studies have shown that patients with OSA often experience accelerated decline in kidney function, but it is unclear whether OSA itself or other related disorders like hypertension and diabetes are the cause. CHÉOS Scientist Dr. Najib Ayas and fellow researchers from the UBC Faculty of Medicine used a mouse model of OSA to assess whether intermittent hypoxia (IH), a key pathological feature of OSA, was a factor in kidney function decline. Ten male mice were randomly assigned to receive IH or the control intermittent air (IA) conditions for 60 days. To assess kidney damage and dysfunction, the researchers looked at a number of metrics of kidney health using histopathological and immunohistochemical methods, western blot, fluorometric staining to identify in situ cell death, and serum and urine analyses. They found that the mice exposed to IH had a 1.8-fold expansion of mesangial matrix compared to controls, an indicator of impaired renal function. This was supported by increased expression of several growth factors in the IH mice. Evidence of greater renal cellular death among IH compared to control mice was also seen. Higher excretion of urinary albumin in IH mice suggests mild disruption of glomerular filtration. There was no evidence of severe renal functional damage as seen from comparable levels of serum creatinine observed between both groups of mice. These results led the researchers to conclude that IH causes kidney injury and provide potential pathways to target for mitigating OSA-related kidney damage.

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