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The Evidence Speaks

The Evidence Speaks (February 2019)

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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.

Thomson KC, Richardson CG, Gadermann AM, Emerson SD, Shoveller J, Guhn M. Association of childhood social-emotional functioning profiles at school entry with early-onset mental health conditions. JAMA Netw Open. 2019 Jan;2(1):e186694.

A new publication co-authored by CHÉOS Scientists Drs. Chris Richardson and Anne Gadermann suggests that social-emotional vulnerabilities measured in kindergarten children may be associated with early-onset mental health conditions later in childhood. Data for the study came from the Developmental Trajectories Cohort, which links data from the Early Development Instrument (EDI)to records kept by the B.C. Ministry of Health and Ministry of Education. The EDI is a questionnaire administered by kindergarten teachers across B.C. that measures five areas of childhood development, including social competence and emotional maturity. The analysis looked at a cohort of 34,552 children who entered kindergarten between 1996 and 1998 and followed them until age 14. This cohort captures 86% of children attending kindergarten in B.C. during that time period. From this population, six social-emotional functioning profiles at school entry were identified and their association with later development of mental health conditions was measured. The prevalence of mental health conditions from ages 6 to 14 years was 4.0% for depression, 7.0% for anxiety, 5.5% for conduct disorder (i.e., difficulty following rules and behaving in a socially acceptable way), 7.1% for attention-deficit/hyperactivity disorder (ADHD), and 5.4% for 2 or more conditions. Based on the 6 functioning profiles, 41.6% (14,262 children) exhibited vulnerabilities in internalizing behaviours (e.g., inhibition, anxiety) and externalizing behaviours (e.g., aggression, hyperactivity), some of which were linked to later mental health challenges. Children with higher hyperactivity and aggression were more likely to see a medical professional about conduct disorder, ADHD, and/or multiple conditions. The study highlights the importance of monitoring social and structural factors early in life to promote mental health and child development.

Janjua NZ, Darvishian M, Wong S, Yu A, Rossi C, et al.; the British Columbia Hepatitis Testers Cohort Team. Effectiveness of ledipasvir/sofosbuvir and sofosbuvir/velpatasvir in people who inject drugs and/or those in opioid agonist therapy. Hepatol Commun. 2019 Jan 10 epub ahead of print.

CHÉOS Scientist Dr. Naveed Janjua’s recently published paper demonstrates that direct acting anti-viral treatments (DAAs) for hepatitis C virus (HCV) are effective in people who inject drugs and/or are engaged in opioid agonist therapy (OAT); however, more services are needed to improve HCV cure rates. The results come from a real-world effectiveness trial of HCV treatments in the B.C. Hepatitis Testers Cohort — a cohort which includes all people tested for HCV or HIV, or reported cases of hepatitis B virus, HCV, HIV, or tuberculosis between 1990 and 2016 in B.C. The trial compared two combinations of DAAs (i.e., sofosbuvir/velpatasvir (SOF/VEL) and ledipasvir/SOF (LDV/SOF)) on curing HCV in people with varying injection drug use and OAT statuses. The 5,283 eligible study participants were categorized based on whether they reached sustained virologic response (SVR), defined as an undetectable HCV RNA, following completion of a 10-week treatment regimen. Both treatments were found to achieve high SVR in people with a history of IDU or OAT, comparable to non-IDU or OAT participants, and results did not vary significantly based on HIV infection, problematic alcohol use, or major mental illness. There was a significant loss to follow-up in people who inject drugs that did not achieve SVR which was partially due to death and overdose while on treatment or before scheduled follow-up visits. In the context of curing HCV, people lost to follow are likely to achieve SVR due to the effectiveness of DAAs but the discontinuation of care limits opportunities to prevent reinfection or death unrelated to HCV. Dr. Janjua’s findings suggest that DAAs are effective but will not be enough to improve overall health in people who inject drugs and that other, comprehensive services will be required to prevent drug-related deaths and poor health.

Nikoo M, Moazen-Zadeh E, Nikoo N, Javidanbardan S, Kazemi A,…Schütz C, Krausz M et al. Comparing opium tincture and methadone for medication-assisted treatment of patients with opioid use disorder: Protocol for a multicenter parallel group noninferiority double-blind randomized controlled trial. Int J Method Psych Res. 2019 Feb 4 epub ahead of print.

Drs. Michael Krausz and Christian Schütz, along with collaborators from Iran and UBC, recently published the protocol for a new, first-of-its-kind study to compare an opium tincture with methadone for the treatment of opioid use disorder. Opium tincture (OT) is a potentially attractive treatment option for opioid dependence in some populations due to its availability, side-effect profile, and cultural acceptance but, to date, lacks evidence regarding its effectiveness. Using a multi-centre, double-blind, randomized design, the study will look at whether OT is as effective as methadone and will also compare secondary measures including safety, withdrawal symptoms, quality of life, and cost effectiveness. Recruitment and data collection for the trial has already been conducted at four treatment clinics located in major cities in Iran. In total, 204 participants were randomized to receive either 1 mL of OT or 0.5 mL methadone using a patient-centered dosing strategy. Results for the study will be available following final analysis and will provide valuable evidence upon which to base further investigation and dosing requirements for OT, should it be found to be effective.

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