Sudden cardiac arrest (SCA), due to abrupt disruption of cardiac function, is a major health problem globally. SCA can happen to anyone at any age who may or may not have been diagnosed with heart disease. SCA has a poor survival rate of about 10 percent, with an estimated 35,000 deaths in Canada annually. With an increasing rate of cases (16 percent from 2017 to 2020), SCA remains a major public health issue in British Columbia. The most effective strategy to improve survival is to achieve rapid SCA recognition, given that for every minute without cardiopulmonary resuscitation (CPR) survival rates drop by 10 percent. Wearable devices may play a major role in decreasing SCA mortality, providing real-time cardiac information for early SCA detection. My aim is to develop a wearable SCA device with embedded sensors, and use their real-time physiological data combined with artificial intelligence algorithms, to make an accurate SCA detection system. This SCA detection system will be designed to identify SCA and alert Emergency Medical Services with the individual’s location (via GPS), enabling them to provide life-saving interventions in a timely manner.
Award Partner: Centre for Health Evaluation & Outcome Sciences
Determination of the optimal SARS-CoV-2 vaccination strategy to achieve a robust and long-lasting immune response
Global COVID-19 vaccine distribution has been inequitable, with high-income countries afforded widespread access to vaccines and boosters, while among the low-income countries only 2 percent of individuals are vaccinated. Consequently, over 50 percent of the world’s population remains unvaccinated. Fortunately, however, data from vaccinated cohorts can inform the most efficient and effective community-level vaccination strategies for the unvaccinated populations. Currently approved mRNA vaccines were initially tested with dosing intervals of 21-28 days; however, this may lead to suboptimal immunity. Further, data informing the optimal timing and frequency of booster doses is lacking. This project will answer critical questions regarding the optimal vaccination strategies to achieve a robust long-lasting immune response. In this study I will employ data from a prospective national cohort of adult paramedics, providing sociodemographic data and serum blood samples. I will identify the optimal vaccination strategies to achieving a robust immune response at 12, 18 and 24 months, including examining differences between sex, race, and age. These data will inform ongoing global vaccination efforts, to maximize efficiency and long-term protection.
Investigating what matters to youth: A mixed-methods study of youth-centred opioid treatments and their outcomes
Since 2016, approximately 1,200 youth in British Columbia (BC) between the ages of 15 and 24 have died from opioid-related overdoses. This has left families and communities to mourn the loss of their loved ones.
These overdose deaths can be avoided by getting youth the help they need, as early as possible. However, most of the currently available help has focused on adults, under the assumption that what works for adults will also work for youth. Unfortunately, research in BC has recently found that this is not the case. Instead, existing options for help do not meet youths’ opioid treatment needs.
The main goal of this study is to determine how to best help youth who use opioids. To meet this objective, we will engage youth, parents/caregivers and service providers in a research study. This study will explore priorities for opioid use treatment delivery. It will also determine how to best define the benefits of opioid use treatment for youth.
The findings of this study will help service providers and policy makers to deliver opioid treatments in a way that will better meet youths’ unique needs. The findings will also help future researchers to make sure that they are studying what matters most to youth.
Movement and young minds: Co-designing and integrating physical activity programming into health services for young people experiencing mental health and substance use challenges
In Canada, mental health and substance use (MHSU) disorders affect 25 percent of young people aged 12 to 24 years. Foundry is an organization in British Columbia (BC) made up of a number of centres across the province that offer a variety of services to young people with MHSU disorders. A service not yet offered is physical activity, which can be used to manage mental and physical health. An ideal time to help people develop healthy habits, including being physically active, is while they are still teenagers or young adults.
This study will explore how physical activity programming can be included as a service offered through Foundry centres. This will be done by using photographs to understand youth needs; development of a working group to consider how to add a service; and, co-creation of a physical activity program. This work will be done collaboratively with diverse youth, service providers, and researchers. The long-term goal is to improve the quality of care, and the health of young people with MHSU disorders living in BC, Canada and across the world.
A program of social epidemiology and metabolic outcomes research (SEMOR) to support healthy aging
Obesity is one of many chronic conditions that are rising in Canada, with heart disease as the top killer for women. Social inequalities exist in these conditions, but few studies focus on the social causes of obesity in women versus men, or on how social causes reinforce each other.
My research program aims to fill these knowledge gaps so that interventions to prevent and manage chronic conditions can be better designed and more effective. One of my projects is focused on co-developing novel ways to promote heart health among Indigenous women because of the profound burden of CVD in one of Canada’s most marginalised group. A key program goal is to produce strong research evidence to inform public health strategies and interventions for preventive action on obesity, and to build capacity of the next generation of researchers and healthcare providers to further improve health and health equity in Canada, especially BC.
Promoting mental health in immigrant, refugee, and non-immigrant children: A British Columbia intergenerational population cohort study
Mental health problems are estimated to be the most common disabling condition among adolescents worldwide, with children growing up in socially disadvantaged homes having up to three times the risk of mental health problems compared to children without such disadvantage. Studies show a high degree of intergenerational stability in these patterns, with social stressors putting particular subgroups of children at higher risk from the earliest stages of development. Immigrant and refugee children make up a significant proportion of the BC child population, and have a unique set of circumstances that may increase or decrease their risk of mental health problems as they reach adolescence. In BC, an established system of child development monitoring paired with new data linkages to provincial health, immigration, and Statistics Canada records create a globally unique opportunity to investigate continuities from maternal mental health problems to childhood emotional symptoms and adolescent mental health problems, for immigrant, refugee, and non-immigrant children. The purpose is to identify opportunities to break these continuities, informing the timing and design of preventative interventions to promote population mental health.
End of Award Update: December 2022
Most exciting outputs
This project opened a door for me to contribute to two integrated knowledge translation studies monitoring family, child, and youth
mental health during the COVID-19 pandemic. Working together with researchers and stakeholders from public mental health and
government, we brought urgent attention to pandemic-related population mental health trends among BC families and young people
through research reports, a policy brief, an op-ed, media interviews, and eight published articles. I was excited to at the same time
complete my original study on mental health among immigrant, refugee, and non-immigrant children and present these results at the
International Population Data Linkage Network Conference in 2022. Findings from this study suggested that BC children with
immigration backgrounds enter school with lower emotional health than children with non-immigration backgrounds and are likely to
benefit from increased social supports.
Impacts so far
Our research on child and youth mental health during the pandemic was referred to during a Debate of the BC Legislative Assembly
and referenced in a BC Ministry of Education report on Key Principles and Strategies for K-12 Mental Health Promotion in Schools. I
also had the opportunity to present this research to over 100 health professionals through the Centre for Health Evaluation and
Outcome Sciences Work in Progress seminar series, drawing attention and inviting conversation around the pandemic recovery
response for supporting the mental health of families and young people in BC.
Potential future influence
The connections I have made with researchers and stakeholders through this award have initiated a pathway for what I hope will be
many future opportunities to synergize between research, health services, and policy to make collective population health impacts at a
I will continue collaborating with colleagues and bridging connections between research and practice in my new role in a health
services research and evaluation position. Results from the immigration mental health study have been selected for submission to a
journal special issue and will hopefully become available in 2023!
- Changes in social support and the emotional health of immigrant, refugee, and non-immigrant children across middle childhood: A three year follow up study. (International Journal of Population Data Science, August 2022)
- Impacts of the COVID-19 Pandemic on Family Mental Health in Canada: Findings from a Multi-Round Cross-Sectional Study (International Journal of Environmental Research and Public Health, November 2021)
Watch this presentation on the mental health impacts of the COVID-19 pandemic on students, parents, and teachers, produced for the Centre for Health Evaluation and Outcome Sciences (CHÉOS) Work in Progress Seminar Series, featuring Anne Gadermann, Kimberly Thomson, and Monique Gagné Petteni.
Health, work and society: Improving health economic evaluations
Decision makers need to decide how to best allocate limited societal and healthcare resources to fund different healthcare services. Health economic evaluation is a tool commonly used to inform these types of funding decisions; however, which costs to consider in economic evaluation can have a significant impact on the resulting funding decision. A societal perspective considers costs within the formal healthcare sector (e.g., physician, hospital and drug costs) as well as costs outside the healthcare sector (e.g., work productivity costs of patients and their family caregivers). Existing health economic evaluations have largely ignored patient and caregiver work productivity costs mainly due to the limitations in current measurement methods.
My program of research will focus on the development of methods that will provide accurate estimates of patient and caregiver work productivity costs. These methods will then be applied and tested in an economic evaluation of new treatments for recurrent Clostridium difficile infection. Ultimately, my research findings will help improve health economic evaluations for other diseases, leading to better healthcare decision making in BC, Canada and beyond.
Exploring novel approaches to reduce the prevalence of depression
Depression has recently become the leading cause of disability, worldwide. It affects one out of every 20 Canadians, causing significant suffering to patients and their families and costing the economy CAD$32.3 billion each year. Previous efforts to address the burden of disease caused by depression have mostly been focused on expanding access to mental health services.
Recent analyses, however, suggest that the prevalence and burden of depression has remained the same in the last two decades, in spite of the intensified efforts to improve access to mental health services. This is mainly because not enough efforts have been spent on providing treatments that are adequate, appropriate, and equitable, and also because of the lack of investments on prevention.
In my research program, I propose to:
- study treatment patterns that are adequate and that work for specific group of people at specific times
- examine complex combinations of social factors that influence access to mental health services, and
- identify community-based activities that promote mental wellness and resilience. The program of research has the potential to generate recommendations at the individual, health system, and community level that can be implemented to reduce the prevalence and burden of depression over time.
Implementation of Shared Decision Making to Improve Person- and Family-Centred Care
The healthcare system is undergoing a paradigm shift toward person- and family-centred care. While this is a critical priority, it will be challenging to put into practice. One strategy to implement this change is shared decision-making (SDM), a process that supports patients and providers to discuss the risks and benefits of options, clarify preferences, and make choices based on their informed values. Knowledge translation and implementation science (KT/IS) are key approaches for accelerating this system change.
To advance the science of implementing evidence into policy and practice, I will implement and assess evidence-based SDM tools in routine primary care, focusing on maternal health.
Key objectives include to:
- Investigate factors contributing to successful implementation of SDM tools in routine care,
- Adapt, implement, and assess health care professional training to support uptake of SDM,
- Investigate how documentary film can work as a method of knowledge translation to support patients’ informed choices, and
- Evaluate partnerships between researchers and policy makers to catalyze the implementation of SDM.
This research will be used to advance person- and family-centred care in maternal health and in primary care more broadly.
A causal inference framework for analyzing large administrative healthcare databases with a focus on multiple sclerosis
Provincial health authorities routinely collect patient information on a massive scale, but health researchers face the challenge of exploring cause-and-effect relationships using these non-randomized population-based data sources. Machine learning methods are increasingly used to analyze these large datasets, although they do not inherently take causal structures (i.e., how the variables affect each other) into consideration and may lead to less-than-optimal or even erroneous conclusions.
Health researchers urgently need new big-data analytic methods that are geared towards extracting causal explanations rather than merely increasing prediction accuracy. This project will develop innovative biostatistical methodologies that will better equip health researchers to infer causation from big-data sources.
As a motivating problem, with a bias reduction goal in mind, Dr. Karim will investigate potential benefits of disease-modifying drugs in multiple sclerosis patients 50 years of age or older. Ultimately, this methodological development will enable health researchers to convert information into actionable knowledge for other common, chronic conditions, leading to cost-effective medical decision making and improving the health of Canadians.